Case Studies in Biomedical Ethics Decision-Making, Principles, and Cases

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  • Edition: 1st
  • Format: Paperback
  • Copyright: 2009-02-23
  • Publisher: Oxford University Press
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We are living in an unprecedented era of biomedical revolution. Medicine is remaking humans, and controversy surrounds such topics as abortion, artificial organs, brain circuitry, eugenics, euthanasia, and gene therapy. At the same time, medical advances are posing complex ethical problems for both patients and professionals. The most comprehensive and up-to-date collection of its kind, Case Studies in Biomedical Ethics: Decision-Making, Principles, and Cases explores fundamental ethical questions arising from real situations faced by health professionals, patients, and others. Featuring a wide range of more than 100 case studies drawn from current events, court cases, and physicians' experiences, the book is divided into three parts. Part I presents a basic framework for ethical decision-making in healthcare, covering such issues as separating evaluative questions from questions of fact; distinguishing between ethical and nonethical evaluations; and identifying the source of ethical judgments. Expanding upon this framework, Part II explains the ethical principles: beneficence and nonmaleficence, justice, respect for autonomy, veracity, fidelity, and avoidance of killing. Parts I and II provide students with the background to analyze the ethical dilemmas presented in Part III, which features cases on a broad spectrum of issues including abortion, genetics, mental health, confidentiality, health insurance, experimentation on humans, the right to refuse treatment, and death and dying. Each case is accompanied by the authors' commentary, which guides students in considering the issues. Ideal for undergraduate and graduate courses in biomedical ethics, bioethics, and medical ethics, Case Studies in Biomedical Ethics incorporates opening text boxes in each chapter that cross-reference relevant cases in other chapters. It also includes an appendix of important ethical codes and a glossary of key terms.

Author Biography

Robert M. Veatch, Ph.D., is Professor of Medical Ethics and the former Director of the Kennedy Institute of Ethics at Georgetown University. He is also Professor of Philosophy. Amy M. Haddad, Ph.D., R.N., is Professor of Pharmacy Sciences, Director for the Center for Health Policy Ethics, and the Dr. C.C. and Mabel L. Criss Endowed Chair in the Health Sciences at Creighton University. Dan C. English, M.D., M.A., is an Affiliated Scholar at the Center for Clinical Bioethics at Georgetown University and former Chairman of the Dept. of Surgery, Michigan State University, College of Human Medicine.

Table of Contents

List of Casesp. xiii
List of Tablesp. xix
Prefacep. xxi
Introduction: Four Questions of Ethicsp. 3
What Are the Source, Meaning, and Justification of Ethical Claims?p. 4
Distinguish between Evaluative Statements and Statements Presenting Nonevaluative Factsp. 4
Distinguish between Ethical and Nonethical Evaluationsp. 6
Determine Who Ought to Decidep. 8
What Kinds of Acts Are Right?p. 10
Consequentialismp. 10
Deontological or "Duty-Based" Ethicsp. 11
Other Issues of Normative Ethicsp. 14
How Do Rules Apply to Specific Situations?p. 15
What Ought to Be Done in Specific Cases?p. 17
Notesp. 18
Ethics and Values in Medical Casesp. 21
A Model for Ethical Problem Solvingp. 23
The Five-Step Modelp. 23
Application of the Modelp. 24
Respond to the Sense that Something Is Wrongp. 25
Gather Informationp. 26
Identify the Ethical Problem/Moral Diagnosisp. 27
Seek a Resolutionp. 29
Work with Others to Choose a Course of Actionp. 31
Notesp. 31
Values in Health and Illnessp. 33
Identifying Value Judgments in Medicinep. 33
Separating Ethical and Other Evaluationsp. 41
Notesp. 47
What Is the Source of Moral Judgments?p. 49
Grounding Ethics in the Professional Codep. 50
Grounding Ethics in the Physician's Ordersp. 57
Grounding Ethics in Institutional Policyp. 59
Grounding Ethics in the Patient's Valuesp. 61
Grounding Ethics in Religious or Philosophical Perspectivesp. 64
Notesp. 67
Ethical Principles in Medical Ethicsp. 69
Benefiting the Patient and Others: The Duty to Do Good and Avoid Harmp. 71
Benefiting the Patientp. 72
Health in Conflict with Other Goodsp. 72
Conflicts among Health-Related Benefitsp. 76
Relating Benefits and Harmsp. 78
Benefits of Rules and Benefits in Specific Casesp. 82
Benefiting Society and Individuals Who Are Not Patientsp. 85
Benefits to Societyp. 85
Benefits to Specific Nonpatientsp. 89
Benefits to the Professionp. 91
Benefit to the Health Professional and the Health Professional's Familyp. 93
Notesp. 95
Justice: The Allocation of Health Resourcesp. 97
Justice among Patientsp. 98
Justice between Patients and Othersp. 103
Justice in Public Policyp. 105
Justice and Other Ethical Principlesp. 109
Notesp. 112
Autonomyp. 113
Determining Whether a Patient Is Autonomousp. 116
External Constraints on Autonomyp. 122
Overriding the Choices of Autonomous Personsp. 125
Notesp. 131
Veracity: Honesty with Patientsp. 132
The Condition of Doubtp. 134
Lying in Order to Benefitp. 136
Protecting the Patient by Lyingp. 137
Protecting the Welfare of Othersp. 139
Special Cases of Truth-Tellingp. 143
Patients Who Do Not Want to Be Toldp. 143
Family Members Who Insist the Patient Not Be Toldp. 145
The Right of Access to Medical Recordsp. 148
Notesp. 151
Fidelity: Promise-Keeping, Loyalty to Patients, and Impaired Professionalsp. 154
The Ethics of Promises: Explicit and Implicitp. 155
Fidelity and Conflicts of Interestp. 162
Incompetent and Dishonest Colleaguesp. 166
Notesp. 170
Avoidance of Killingp. 172
Active Killing versus Letting Diep. 175
Withholding versus Withdrawing Treatmentp. 179
Direct Versus Indirect Killingp. 184
Justifiable Omissions: The Problem of Nutrition and Hydrationp. 188
Voluntary and Involuntary Killingp. 194
Killing as Punishmentp. 198
Notesp. 201
Special Problem Areasp. 205
Abortion, Sterilization, and Contraceptionp. 207
Abortionp. 208
Abortion for Medical Problems of the Fetusp. 209
Abortion Following Sexual Assaultp. 212
Abortion to Save the Life of the Pregnant Womanp. 216
Abortion and the Mentally Incapacitated Womanp. 218
Abortion for Socioeconomic Reasonsp. 220
Sterilizationp. 222
Contraceptionp. 224
Notesp. 227
Genetics, Birth, and the Biological Revolutionp. 229
Genetic Counselingp. 231
Genetic Screeningp. 235
In Vitro Fertilization and Surrogate Motherhoodp. 238
Preimplantation Diagnosisp. 241
Gene Therapyp. 243
Notesp. 246
Mental Health and Behavior Controlp. 250
The Concept of Mental Healthp. 251
Mental Illness and Autonomous Behaviorp. 256
Mental Illness and Third-Party Interestsp. 262
Other Behavior-Controlling Therapiesp. 270
Notesp. 273
Confidentiality: Ethical Disclosure of Medical Informationp. 276
Breaking Confidence to Benefit the Patientp. 279
Breaking Confidence to Benefit Othersp. 282
Breaking Confidence as Required by Lawp. 285
Conflict between Confidentiality and Other Dutiesp. 290
Notesp. 292
Organ Transplantsp. 294
Procuring Organsp. 295
Donation versus Salvagingp. 295
Diseased and Poor-Quality Organsp. 298
Donation after Cardiac Deathp. 300
Preserving the Organs of the Dyingp. 303
Socially Directed Organ Donationp. 306
Living Donor/Deceased Donor Organ Swapsp. 308
Children as Living Organ Sourcesp. 310
Allocating Organsp. 313
Maximizing Benefits and Distributing Organs Fairlyp. 313
When Voluntary Risks Cause a Need for Organsp. 314
Multiple Organs and Special Priority for Special Peoplep. 317
Notesp. 321
Health Insurance, Health System Planning, and Rationingp. 323
The Problem of Small, Incremental Benefitsp. 324
Limits on Unproved Therapiesp. 326
Marginally Beneficial, Expensive Therapyp. 328
Valued Care that Is Not Cost-worthyp. 331
Funding Care that Patients Have Refusedp. 333
Pharmaceutical Manufacturers versus Insurersp. 335
Insurance and the Uninsuredp. 337
Notesp. 339
Experimentation on Human Subjectsp. 340
Calculating Risks and Benefitsp. 342
Privacy and Confidentialityp. 349
Equity in Researchp. 354
Conflicts of Interest in Researchp. 358
Informed Consent in Researchp. 361
Notesp. 364
Consent and the Right to Refuse Treatmentp. 366
The Elements of a Consentp. 367
The Standards for Consentp. 372
Comprehension and Voluntarinessp. 376
Notesp. 387
Death and Dyingp. 389
The Definition of Deathp. 390
Competent and Formerly Competent Patientsp. 395
Never Competent Patientsp. 400
Never Competent Persons without Available Familyp. 400
Never Competent Persons with Available Familyp. 404
Futile Care and Limits Based on the Interests of Othersp. 409
Notesp. 416
Appendix: Codes of Ethicsp. 419
The Hippocratic Oathp. 420
World Medical Association, Declaration of Genevap. 420
The American Medical Association, Principles of Medical Ethicsp. 421
Universal Declaration on Bioethics and Human Rightsp. 422
Notesp. 430
Glossaryp. 431
List of Cases from Public Sourcesp. 435
Indexp. 439
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