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

by Veatch, Robert M.; Haddad, Amy M.; English, Dan C.

• ISBN13: 9780195309720
• ISBN10: 0195309723
• Edition: 1st
• Format: Paperback
• Copyright: 2009-02-23
• Publisher: Oxford University Press

Summary

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 Cases	p. xiii
List of Tables	p. xix
Preface	p. xxi
Introduction: Four Questions of Ethics	p. 3
What Are the Source, Meaning, and Justification of Ethical Claims?	p. 4
Distinguish between Evaluative Statements and Statements Presenting Nonevaluative Facts	p. 4
Distinguish between Ethical and Nonethical Evaluations	p. 6
Determine Who Ought to Decide	p. 8
What Kinds of Acts Are Right?	p. 10
Consequentialism	p. 10
Deontological or "Duty-Based" Ethics	p. 11
Other Issues of Normative Ethics	p. 14
How Do Rules Apply to Specific Situations?	p. 15
What Ought to Be Done in Specific Cases?	p. 17
Notes	p. 18
Ethics and Values in Medical Cases	p. 21
A Model for Ethical Problem Solving	p. 23
The Five-Step Model	p. 23
Application of the Model	p. 24
Respond to the Sense that Something Is Wrong	p. 25
Gather Information	p. 26
Identify the Ethical Problem/Moral Diagnosis	p. 27
Seek a Resolution	p. 29
Work with Others to Choose a Course of Action	p. 31
Notes	p. 31
Values in Health and Illness	p. 33
Identifying Value Judgments in Medicine	p. 33
Separating Ethical and Other Evaluations	p. 41
Notes	p. 47
What Is the Source of Moral Judgments?	p. 49
Grounding Ethics in the Professional Code	p. 50
Grounding Ethics in the Physician's Orders	p. 57
Grounding Ethics in Institutional Policy	p. 59
Grounding Ethics in the Patient's Values	p. 61
Grounding Ethics in Religious or Philosophical Perspectives	p. 64
Notes	p. 67
Ethical Principles in Medical Ethics	p. 69
Benefiting the Patient and Others: The Duty to Do Good and Avoid Harm	p. 71
Benefiting the Patient	p. 72
Health in Conflict with Other Goods	p. 72
Conflicts among Health-Related Benefits	p. 76
Relating Benefits and Harms	p. 78
Benefits of Rules and Benefits in Specific Cases	p. 82
Benefiting Society and Individuals Who Are Not Patients	p. 85
Benefits to Society	p. 85
Benefits to Specific Nonpatients	p. 89
Benefits to the Profession	p. 91
Benefit to the Health Professional and the Health Professional's Family	p. 93
Notes	p. 95
Justice: The Allocation of Health Resources	p. 97
Justice among Patients	p. 98
Justice between Patients and Others	p. 103
Justice in Public Policy	p. 105
Justice and Other Ethical Principles	p. 109
Notes	p. 112
Autonomy	p. 113
Determining Whether a Patient Is Autonomous	p. 116
External Constraints on Autonomy	p. 122
Overriding the Choices of Autonomous Persons	p. 125
Notes	p. 131
Veracity: Honesty with Patients	p. 132
The Condition of Doubt	p. 134
Lying in Order to Benefit	p. 136
Protecting the Patient by Lying	p. 137
Protecting the Welfare of Others	p. 139
Special Cases of Truth-Telling	p. 143
Patients Who Do Not Want to Be Told	p. 143
Family Members Who Insist the Patient Not Be Told	p. 145
The Right of Access to Medical Records	p. 148
Notes	p. 151
Fidelity: Promise-Keeping, Loyalty to Patients, and Impaired Professionals	p. 154
The Ethics of Promises: Explicit and Implicit	p. 155
Fidelity and Conflicts of Interest	p. 162
Incompetent and Dishonest Colleagues	p. 166
Notes	p. 170
Avoidance of Killing	p. 172
Active Killing versus Letting Die	p. 175
Withholding versus Withdrawing Treatment	p. 179
Direct Versus Indirect Killing	p. 184
Justifiable Omissions: The Problem of Nutrition and Hydration	p. 188
Voluntary and Involuntary Killing	p. 194
Killing as Punishment	p. 198
Notes	p. 201
Special Problem Areas	p. 205
Abortion, Sterilization, and Contraception	p. 207
Abortion	p. 208
Abortion for Medical Problems of the Fetus	p. 209
Abortion Following Sexual Assault	p. 212
Abortion to Save the Life of the Pregnant Woman	p. 216
Abortion and the Mentally Incapacitated Woman	p. 218
Abortion for Socioeconomic Reasons	p. 220
Sterilization	p. 222
Contraception	p. 224
Notes	p. 227
Genetics, Birth, and the Biological Revolution	p. 229
Genetic Counseling	p. 231
Genetic Screening	p. 235
In Vitro Fertilization and Surrogate Motherhood	p. 238
Preimplantation Diagnosis	p. 241
Gene Therapy	p. 243
Notes	p. 246
Mental Health and Behavior Control	p. 250
The Concept of Mental Health	p. 251
Mental Illness and Autonomous Behavior	p. 256
Mental Illness and Third-Party Interests	p. 262
Other Behavior-Controlling Therapies	p. 270
Notes	p. 273
Confidentiality: Ethical Disclosure of Medical Information	p. 276
Breaking Confidence to Benefit the Patient	p. 279
Breaking Confidence to Benefit Others	p. 282
Breaking Confidence as Required by Law	p. 285
Conflict between Confidentiality and Other Duties	p. 290
Notes	p. 292
Organ Transplants	p. 294
Procuring Organs	p. 295
Donation versus Salvaging	p. 295
Diseased and Poor-Quality Organs	p. 298
Donation after Cardiac Death	p. 300
Preserving the Organs of the Dying	p. 303
Socially Directed Organ Donation	p. 306
Living Donor/Deceased Donor Organ Swaps	p. 308
Children as Living Organ Sources	p. 310
Allocating Organs	p. 313
Maximizing Benefits and Distributing Organs Fairly	p. 313
When Voluntary Risks Cause a Need for Organs	p. 314
Multiple Organs and Special Priority for Special People	p. 317
Notes	p. 321
Health Insurance, Health System Planning, and Rationing	p. 323
The Problem of Small, Incremental Benefits	p. 324
Limits on Unproved Therapies	p. 326
Marginally Beneficial, Expensive Therapy	p. 328
Valued Care that Is Not Cost-worthy	p. 331
Funding Care that Patients Have Refused	p. 333
Pharmaceutical Manufacturers versus Insurers	p. 335
Insurance and the Uninsured	p. 337
Notes	p. 339
Experimentation on Human Subjects	p. 340
Calculating Risks and Benefits	p. 342
Privacy and Confidentiality	p. 349
Equity in Research	p. 354
Conflicts of Interest in Research	p. 358
Informed Consent in Research	p. 361
Notes	p. 364
Consent and the Right to Refuse Treatment	p. 366
The Elements of a Consent	p. 367
The Standards for Consent	p. 372
Comprehension and Voluntariness	p. 376
Notes	p. 387
Death and Dying	p. 389
The Definition of Death	p. 390
Competent and Formerly Competent Patients	p. 395
Never Competent Patients	p. 400
Never Competent Persons without Available Family	p. 400
Never Competent Persons with Available Family	p. 404
Futile Care and Limits Based on the Interests of Others	p. 409
Notes	p. 416
Appendix: Codes of Ethics	p. 419
The Hippocratic Oath	p. 420
World Medical Association, Declaration of Geneva	p. 420
The American Medical Association, Principles of Medical Ethics	p. 421
Universal Declaration on Bioethics and Human Rights	p. 422
Notes	p. 430
Glossary	p. 431
List of Cases from Public Sources	p. 435
Index	p. 439
Table of Contents provided by Ingram. All Rights Reserved.