Clinical Ethics Casebook

by Horn, Peter

• ISBN13: 9780534551513
• ISBN10: 0534551513
• Format: Paperback
• Copyright: 1998-09-01
• Publisher: Wadsworth Publishing

Summary

This casebook consists of hundreds of case vignettes drawn from a variety of areas of clinical practice. It presents over 200 brief, concrete examples along with specific questions and alternatives that highlight the challenging ethical problems involved. This book can be read independently or can serve as a supplement to any core text in clinical/medical ethics.

Table of Contents

Preface	xiii
Acknowledgments	xvii
Professionalism, Part I: Professional Codes, Roles, and Boundaries	1	(12)
Roles	1	(1)
Rules	1	(1)
Codes	2	(1)
Traditions	2	(1)
Special Responsibilities	2	(1)
Boundaries	2	(1)
Interpreting the Hippocratic Oath	3	(1)
Interpreting the ANA Code	3	(1)
Interpreting the AMA's Code of Ethics	4	(1)
Conscientious Refusal to Participate in a Procedure	5	(1)
Waiting Room Waits	6	(1)
The Staff Disagrees	7	(1)
Relationships with Patients: Some Boundary Issues	7	(1)
Religious Convictions Expressed in a Public Setting	8	(1)
Physician-Assisted Execution	9	(1)
Accepting Gifts	10	(1)
A Hateful Patient	10	(1)
A Doctor Treats Her Family	11	(1)
The Doctor Who Treats Himself	11	(2)
Professionalism, Part II: Protecting Patients and Judging Professional Competence	13	(7)
A Dosage Error and an Incident Report	14	(1)
Another Dosage Error, Another Report	14	(1)
A Patient in Pain	15	(1)
A Painful Prescribing Problem	16	(1)
Good Samaritan After a Beer?	16	(1)
Patient Care During a Strike	17	(1)
Unlicensed Assistive Personnel	17	(1)
Turf or Expertise, Part I: Podiatrists or Orthopedic Surgeons?	18	(1)
Turf or Expertise, Part II: Nurses or Doctors?	18	(1)
Turf or Expertise, Part III: Psychiatrists or Psychologists?	19	(1)
Ethical Issues in Health Care Education	20	(7)
Education and (In)experience: Two Vignettes	21	(1)
Education and Risk	22	(1)
Practicing Invasive Procedures on the Newly Dead	22	(1)
How Much Work Is Excessive for Residents?	23	(1)
Students and Residents Observe Ob/Gyn and Urology Patients	24	(1)
Pressures on Residents to Overlook Possible Wrongdoing: Two Vignettes	24	(1)
Relationships Between Students and Teachers: More Boundary Issues	25	(1)
Calling Medical Students ``Doctors''	26	(1)
Videotaping Patients	26	(1)
Managed Care and Health Care Business	27	(8)
Managed Care and HMOs	27	(1)
Marketing and Sales Techniques; Research and Development	28	(1)
Managed Care and Generic Drugs	28	(1)
HMO-Phobia	29	(1)
Managed Care Firm Requests Psychologist's Reports	29	(1)
Managing Managed Care	30	(1)
Changing Hospital Ownership	31	(1)
Advertisements in Journals and Other Periodicals	32	(1)
Pharmaceutical Research Funding	32	(1)
Salesperson Treats Residents to Lunch	33	(1)
Drug Samples for Patients	34	(1)
Research	35	(11)
Other Species	35	(1)
Informed Consent	35	(2)
Research Subject's Comprehension Confusion	37	(1)
Parental Research Incentive	37	(1)
Compensating Parents for Research on Their Children	38	(1)
How Much Disclosure Is Needed for Consent?	38	(1)
Relying on Studies and Experience	39	(1)
Balancing Humans' and Mice's Interests	40	(1)
Nontherapeutic Research with Alzheimer's Patients	40	(1)
Patenting Sequences of the Genome	41	(1)
A Proxy's ``Consent'' for Research	42	(1)
Phase I Clinical Trials on Children	42	(1)
Experimental Transplantation from Other Species	43	(1)
Randomized Clinical Trials and Errors	43	(1)
Controversial Fetal Research: Two Vignettes	44	(2)
Pediatric Contexts	46	(9)
Abuse and Neglect	46	(1)
Minors' Status	46	(1)
Critically Ill Neonates	47	(1)
Opinion Conflicts	47	(1)
Suspicion of Child Abuse	48	(1)
Is Immunization Avoidance Neglect?	48	(1)
Covert Surveillance to Protect a Child	48	(1)
Incest and Confidentiality	49	(1)
A Mother Demands Contraception for Her Daughter	50	(1)
An Adolescent Asks for Information	50	(1)
The Moral Equivalent of Advance Directives for Children	51	(1)
Parents in the Emergency Room	51	(1)
Parents Who Can't Let Go: Possibly Futile Treatment	52	(1)
Pregnant Teen with Hodgkin's Disease	53	(1)
Resuscitation of a Very Premature Infant	53	(2)
Mental Health Contexts	55	(8)
Paternalism	55	(1)
Which Self? What Responsibility?	55	(1)
The Mental and the Physical	56	(1)
Diagnosing and Treating ADHD	56	(1)
Paternalism and Agoraphobia	57	(1)
Paternalism and a Dangerous Anorexia	57	(1)
Paternalism and Severe Depression	58	(1)
A Physician in Apparent Denial	59	(1)
Not Guilty by Reason of Insanity? Expert Testimony	59	(1)
Prevention of a Possible (but Not Probable) Suicide	60	(1)
Refusing Investigation of Possible Cancer	61	(1)
Fine-Tuning the Psyche	61	(2)
Valid Informed Consent and Compliance Problems	63	(10)
Valid Informed Consent	63	(1)
Noncompliance	64	(1)
Being Asked ``What Would You Do?''	64	(1)
Irrational Treatment Refusal in an Emergency	65	(1)
Use of Physical Restraints	66	(1)
A Mildly Retarded Patient Consents	66	(1)
Suspicions About Substances	67	(1)
A Relative's Consent for an Unwanted Procedure	68	(1)
Omitting Quantitative Mention of Degree of Uncertainty	68	(1)
A Patient Doesn't Remember Consent Specifics	69	(1)
Treatment Decision Under Stress	70	(1)
Noncompliance and Pressure	70	(1)
Responses to Noncompliance	71	(1)
Noncompliance of a Tuberculosis Carrier	72	(1)
Health Care Options and Diversity	73	(8)
Choosing Alternative Health Care Treatments	74	(1)
What Is Quackery?	74	(1)
Diversity and Limits: Female Circumcision	75	(1)
Other Cultures: Other Facts and Other Values?	76	(1)
Religious Grounds for Rejecting Medical Care: Faith Healing	77	(1)
Jehovah's Witness Parents Refuse Transfusion	78	(1)
Respecting Cultural Diversity and Health	79	(1)
Sex Selection of a Physician: Four Vignettes	79	(2)
Information: Communication and Confidentiality	81	(9)
Limits to Confidentiality	81	(1)
Withholding of Information	82	(1)
Breaking Very Bad News to Fragile People	83	(1)
A Parental Request: Don't Tell an Adolescent Her Prognosis	83	(1)
Giving a Placebo Injection to a Whiner	84	(1)
Withholding Important Genetic Information from a Family	84	(1)
Pressing Someone to Admit Spousal Abuse	85	(1)
Disclosing Dangerous Drivers: Two Vignettes	86	(1)
Elevator and Cafeteria Conversations	87	(1)
Surreptitious Diagnostic Methods	87	(1)
A Patient's History in Print	88	(1)
Sharing Patient Information with a Spouse	88	(2)
AIDS/HIV	90	(7)
Confidentiality	90	(1)
Testing	91	(1)
Refusal to Treat	91	(1)
Funding	91	(1)
A Patient's Request Not to Tell Partners	92	(1)
Hope and Power: HIV Patients' Access to Unapproved Drugs	92	(1)
Funding for AIDS Versus for Other Diseases	93	(1)
HIV Risks to Patients?	94	(1)
Less-Than-Universal Precautions	94	(1)
HIV Status Inquiry	95	(1)
Testing Patients for HIV and Hepatitis: Three Vignettes	95	(1)
Refusal to Treat: Choice or Discrimination?	96	(1)
Reproduction, Genetics, and Abortion	97	(17)
Reproductive Technology and Genetics	97	(1)
Abortion	98	(1)
Amniocentesis: Risks and Indications	99	(1)
Postmortem Sperm ``Donation''	100	(1)
Questioned Requests for Assisted Reproduction: Four Vignettes	101	(1)
Paternity Information Emerging in Genetic Counseling	102	(1)
Frozen Embryo Brouhaha	102	(1)
In Vitro Fertilization: Helpful or Wasteful?	103	(1)
Objection to an Abortus-Derived Vaccine	104	(1)
Considering an Abortion	104	(1)
A Teen Requests a Late Abortion	105	(1)
Reproductive Assistance for a Same-Sex Couple	105	(1)
Privatizing the Sale of Sperm and Ova	106	(1)
Moral or Legal Responsibilities During Pregnancy?	107	(1)
Seeking Prenatal Diagnosis for a Possible Sex-Choice Abortion	107	(1)
RU-486 and Abortion	108	(1)
Performing Surrogate Pregnancy as a Living	109	(1)
DNA Banks: Two Vignettes	109	(1)
Eugenics: Positive or Negative?	110	(1)
Use of Fetal Tissues to Heal Adults	111	(1)
Cloning	112	(2)
Life and Death Decisions, Part I: Assisted Suicide and Other Patient Requests about Dying	114	(8)
Assisted Suicide	114	(1)
Drawing Distinctions	114	(1)
The Case of Dr. Nekroviak	115	(1)
Assisting a Dying Patient's Suicide	116	(1)
Assisting the Suicide of a Chronically Ill Patient Who Is Not Dying	117	(1)
Ignoring a Living Will at a Daughter's Insistence	118	(1)
Interpreting Advance Directives	118	(1)
Discontinuing Nutrition and Hydration	119	(1)
Voluntary Active Euthanasia: Unthinkable? About Time?	120	(2)
Life and Death Decisions, Part II: Deciding Limits of Life-Prolonging Treatments	122	(10)
Life Stages	122	(1)
DNR Statuses	122	(1)
Technical Terms	122	(1)
Limiting Care by Age	123	(1)
Someone Once Recovered: A Single Instance	123	(1)
An Anesthesiologist Wants a DNR Suspended	124	(1)
Brain-Dead and Still on ``Life'' Support	124	(1)
Treatments Judged ``Not Clinically Indicated'': Three Vignettes	125	(1)
``We Don't Have to Begin This Treatment, but Once We Do...''	126	(1)
Do-Not-Resuscitate Problems: Two Vignettes	126	(1)
Invasiveness	127	(1)
Mental Retardation and Quality-of-Life Judgments	128	(1)
Deciding Whether to Offer Options: Metastatic Cancer and Pneumonia	128	(1)
Limits of Prematurity	129	(1)
Trisomy Quandary	130	(1)
Persistent Vegetative State	130	(2)
Allocation and Access	132	(14)
Criteria for Allocating Scarce Resources	132	(1)
Advocacy and Activism	133	(1)
Transplantation Issues	133	(1)
Second and Third Transplants	134	(1)
An Anencephalic Baby as an Organ Donor	135	(1)
A Family's Media Campaign	135	(1)
Creating Fraudulent Diagnoses to Enable Treatment	136	(1)
One Last Question: Asking for Organs	137	(1)
Plasma ``Donation'' and Justice	137	(1)
Access to Health Care	138	(1)
Poor Access to the System	139	(1)
Estate Sale of One's Organs	139	(1)
Ranking Recipient Candidates: Four Vignettes	140	(1)
A Plan to Ration Care	140	(1)
Refusal to Accept Patients: Freedom or Disregard?	141	(1)
Sale of Tissues and Organs	142	(1)
A Smoker's Claim to Health Care Resources	143	(1)
Waiting for a Transplant	144	(1)
Whistle-Blowing on the System	144	(2)
Other Issues	146	(8)
Health Risks and Responsibilities	146	(1)
Short-Term Goals; Aesthetic Goals	146	(1)
Ethics Committees	147	(1)
Alcohol Use Issues	147	(1)
An Ethics Committee Deliberates	147	(1)
Obesity Issues	148	(1)
Reasonable Health Concern, Anxiety, or Phobia?	149	(1)
Puzzles About Referrals	150	(1)
Lack of Health Screening	150	(1)
Patching up an Athlete	151	(1)
Tobacco: Risks, Responsibilities, and Public Health	152	(2)
ETHICAL THEORY GLOSSARY	154	(6)
CLINICAL ETHICS GLOSSARY	160	(6)
APPROACHING ETHICAL PROBLEMS: A GUIDE TO ANALYSIS	166	(10)
CODES OF ETHICS	176	(1)
The Hippocratic Oath	176	(1)
The Nuremburg Code	177	(1)
World Medical Association Declaration of Helsinki	178	(3)
International Code of Medical Ethics	181	(2)
Declaration of Geneva	183	(1)
Patient's Bill of Rights	183	(2)
American Medical Association Principles of Medical Ethics	185	(2)
American Medical Association Ethical Guidelines for Clinical Investigation	187	(3)
Code for Nurses	190