Ethics in Clinical Practice

by Ahronheim, Judith C.; Moreno, Jonathan D., Ph.D.; Zuckerman, Connie

• ISBN13: 9780834210752
• ISBN10: 0834210754
• Edition: 2nd
• Format: Hardcover
• Copyright: 1999-10-01
• Publisher: Jones & Bartlett Pub

Summary

New York Medical College, Valhalla. Case studies in clinical medical ethics, for practitioners and students. Uses a format of questions with extended discussions following each case presentation. Previous edition: c1994. DNLM: Ethics, Medical--Legal Cases.

Author Biography

Judith C. Ahronheim, MD: Chief, Eileen E. Anderson Section of Geriatric Medicine Saint Vincent's Hospital and Medical Center New York. Professor of Medicine New York Medical College Valhalla Jonathan D. Moreno, PhD: Kornfeld Professor and Director Center for Biomedical Ethics University of Virginia, Charlottesville Connie Zuckerman, JD: Former Associate Director Center for Ethics in Medicine Beth Israel Medical Center New York

Table of Contents

Preface	xi	(2)
Acknowledgments	xiii
Chapter 1 About Clinical Ethics	1	(16)
Defining Clinical Ethics	1	(2)
The New Clinical Ethics	3	(1)
The Emergence of Modern Clinical Ethics	4	(2)
Who Practices Clinical Ethics?	6	(1)
Religion in Clinical Ethics	7	(2)
Cultural Competence and Clinical Ethics	9	(1)
Law in Clinical Ethics	9	(3)
Public Policy and Clinical Ethics	12	(1)
Organization Ethics and Clinical Ethics	13	(4)
Chapter 2 A Theory of Clinical Ethics	17	(34)
The Dominant Moral Philosophies in Clinical Ethics: Deontology and Utilitarianism	17	(1)
The Principles: Self-Determination, Beneficence, and Justice	18	(33)
Chapter 3 Evaluating Common Distinctions	51	(6)
Active and Passive	51	(1)
Ordinary and Extraordinary Means	52	(1)
Killing and Letting Die	53	(1)
Withholding and Withdrawing	54	(3)
Chapter 4 Clinical Ethics throughout the Life Span	57	(22)
Before Pregnancy	57	(3)
During Pregnancy	60	(3)
Infants	63	(3)
Children and Adolescents	66	(2)
The Elderly	68	(2)
Treating the Family	70	(2)
Futility	72	(2)
Brain Death and Organ Procurement	74	(5)
Chapter 5 Assessing the Standard Theory	79	(12)
A Critique of the Standard Theory	79	(3)
Casuistry	82	(2)
The Care Perspective	84	(2)
Feminist Ethics	86	(5)
Chapter 6 Strategy for a Clinical Ethics Assessment	91	(8)
The Organizational Climate	91	(1)
Identifying the Ethical Issues	92	(1)
Common Pitfalls in Assessing Decisional Capacity	93	(1)
Common Types of Ethical Conflict	94	(3)
A Protocol for a Clinical Ethics Intervention	97	(2)
Chapter 7 Cases	99	(384)
Case 1: A Religious Objection to a Blood Transfusion	99	(10)
Issues To Consider	100	(1)
Medical Considerations	100	(3)
Ethical and Legal Considerations	103	(6)
Case 2: Determining If a Patient Has Decisional Capacity	109	(12)
Issues To Consider	110	(1)
Medical Considerations	110	(3)
Ethical and Legal Considerations	113	(8)
Case 3: Urgent Surgery in a Stuporous Patient: The Use and Limitations of Advance Directives	121	(10)
Issues To Consider	121	(1)
Medical Considerations	121	(2)
Ethical and Legal Considerations	123	(8)
Case 4: Management of Life-Threatening Illness: An Intensive Care Unit Patient with Uncertain Decisional Capacity	131	(13)
Issues To Consider	133	(1)
Medical Considerations	133	(1)
Ethical and Legal Considerations	134	(10)
Case 5: "Don't Tell Mother": Withholding Information from a Patient	144	(8)
Issues To Consider	145	(1)
Medical Considerations	145	(1)
Ethical and Legal Considerations	146	(6)
Case 6: Alternative Medicine for a Patient with Advanced Cancer	152	(16)
Issues To Consider	153	(1)
Medical Considerations	153	(5)
Ethical and Legal Considerations	158	(10)
Case 7: Painful Treatment for a Severely Retarded Man	168	(12)
Issues To Consider	168	(1)
Medical Considerations	168	(3)
Ethical and Legal Considerations	171	(9)
Case 8: Withdrawing Mechanical Ventilation at the Request of a Patient with Decisional Capacity	180	(8)
Issues To Consider	180	(1)
Medical Considerations	180	(2)
Ethical and Legal Considerations	182	(6)
Case 9: Withholding Tube Feeding in a Woman with Advanced Dementia	188	(15)
Issues To Consider	188	(1)
Medical Considerations	189	(5)
Ethical and Legal Considerations	194	(9)
Case 10: A Religious Objection to the Determination of Brain Death	203	(12)
Issues To Consider	203	(1)
Medical Considerations	203	(4)
Ethical and Legal Considerations	207	(8)
Case 11: A Teenager with Prolonged Unconsciousness	215	(13)
Issues To Consider	215	(1)
Medical Considerations	216	(5)
Ethical and Legal Considerations	221	(7)
Case 12: Resuscitation Decision in a Patient with Lung Cancer	228	(13)
Issues To Consider	229	(1)
Medical Considerations	229	(1)
Ethical and Legal Considerations	230	(11)
Case 13: Dispute over DNR Status in a Patient Who Wants Palliative Surgery	241	(11)
Issues To Consider	242	(1)
Medical Considerations	242	(3)
Ethical and Legal Considerations	245	(7)
Case 14: Suicide Risk in a Managed Care Patient	252	(15)
Issues To Consider	253	(1)
Medical Considerations	253	(3)
Ethical and Legal Considerations	256	(11)
Case 15: Assisted Suicide in a Man with Amyotrophic Lateral Sclerosis	267	(20)
Issues To Consider	268	(1)
Medical Considerations	268	(9)
Ethical and Legal Considerations	277	(10)
Case 16: A Married Man Contracts Syphilis	287	(10)
Issues To Consider	287	(1)
Medical Considerations	287	(3)
Ethical and Legal Considerations	290	(7)
Case 17: A House-Bound Woman with Tuberculosis	297	(14)
Issues To Consider	297	(1)
Medical Considerations	297	(4)
Ethical and Legal Considerations	301	(10)
Case 18: Surgical Delay in a Patient Infected with HIV	311	(12)
Issues To Consider	311	(1)
Medical Considerations	311	(4)
Ethical and Legal Considerations	315	(8)
Case 19: An Elderly Driver	323	(11)
Issues To Consider	323	(1)
Medical Considerations	323	(3)
Ethical and Legal Considerations	326	(8)
Case 20: A Difficult Patient and the Limits of Provider Obligations	334	(12)
Issues To Consider	335	(1)
Medical Considerations	335	(2)
Ethical and Legal Considerations	337	(9)
Case 21: "Do Everything": Physician Obligations in the Face of Family Demands	346	(12)
Issues To Consider	347	(1)
Medical Considerations	347	(3)
Ethical and Legal Considerations	350	(8)
Case 22: A Man with Alcoholic Cirrhosis Wants a Liver Transplant	358	(10)
Issues To Consider	358	(1)
Medical Considerations	359	(2)
Ethical and Legal Considerations	361	(7)
Case 23: Genetic Testing in a Woman with a Family History of Breast Cancer	368	(14)
Issues To Consider	368	(1)
Medical Considerations	368	(4)
Ethical and Legal Considerations	372	(10)
Case 24: Assisted Reproduction in a Woman with Strong Religious Beliefs	382	(17)
Issues To Consider	384	(1)
Medical Considerations	384	(6)
Ethical and Legal Considerations	390	(9)
Case 25: Prenatal Counseling of a Pregnant Woman at Risk for HIV Infection	399	(14)
Issues To Consider	399	(1)
Medical Considerations	399	(5)
Ethical and Legal Considerations	404	(9)
Case 26: A Pregnant Woman Using Cocaine	413	(12)
Issues To Consider	413	(1)
Medical Considerations	413	(3)
Ethical and Legal Considerations	416	(9)
Case 27: Tracheoesophageal Fistula in a Newborn with Down Syndrome	425	(16)
Issues To Consider	425	(1)
Medical Considerations	425	(5)
Ethical and Legal Considerations	430	(11)
Case 28: Determination of Death in a Newborn	441	(12)
Issues To Consider	441	(1)
Medical Considerations	442	(3)
Ethical and Legal Considerations	445	(8)
Case 29: A Religious Objection to a Child's Medical Treatment	453	(10)
Issues To Consider	453	(1)
Medical Considerations	453	(2)
Ethical and Legal Considerations	455	(8)
Case 30: A Teenager Who Wants Cosmetic Surgery	463	(11)
Issues To Consider	463	(1)
Medical Considerations	464	(2)
Ethical and Legal Considerations	466	(8)
Case 31: An Adolescent with Cancer Who Wants to Discontinue Medical Treatment	474	(9)
Issues To Consider	475	(1)
Medical Considerations	475	(1)
Ethical and Legal Considerations	476	(7)
Appendix A: Internet References, Suggested Readings, and Other Sources	483	(10)
Index	493