Health Care Ethics: Principles and Problems

by Garrett, Thomas M.; Baillie, Harold W.; Garrett, Rosellen M.

• ISBN13: 9780130194480
• ISBN10: 0130194484
• Edition: 4th
• Format: Paperback
• Copyright: 2001-01-01
• Publisher: Pearson College Div

Summary

This clear, readable reference explores the full range of contemporary issues in health care ethics from a practical philosophical perspective. Ethical principles are applied directly to cases, and many examples are used to illustrate issues. Avoids medical and philosophical jargon. Offers up-to-date material on today's critical issues like genetic screening and therapy, testing and screening, and biomedical research. Covers institutional ethics and professional standards. Presents alternative views to show readers the diversity of the field. An excellent reference for nurses, doctors, or anyone involved in heath care fields.

Table of Contents

Preface	ix
PRINCIPLES OF HEALTH CARE ETHICS
Ethics, Professional Ethics, and Health Care Ethics	1	(28)
Theories of Ethics	2	(6)
Key Issues	8	(7)
Applied Ethics	15	(1)
The Professions and Professional Ethics	16	(5)
The Health Care Professions	21	(6)
Summary	27	(1)
Notes	27	(2)
Principles of Autonomy and Informed Consent	29	(28)
General Formulation	29	(1)
Patient Autonomy: Informed Consent	30	(9)
Paternalism: Weak and Strong	39	(4)
The Consent of Children, Adolescents, and Incompetent Patients	43	(2)
Exceptions in Emergencies	45	(5)
The Right to Refuse Treatment	50	(1)
Problem Areas	51	(1)
Summary	52	(1)
Cases for Analysis	52	(3)
Notes	55	(2)
Principles of Beneficence and Nonmaleficence	57	(26)
Introduction	57	(2)
Specifications of Beneficence	59	(2)
Specifications of Nonmaleficence	61	(5)
The Patient's Obligation	66	(2)
The Health Care Provider's Obligation	68	(2)
The Surrogate's Obligation	70	(9)
Summary	79	(1)
Cases for Analysis	79	(2)
Notes	81	(2)
The Ethics of Distribution	83	(28)
Introduction	83	(1)
A Definition of Health and Disease	83	(8)
Theories and Their Limits	91	(6)
Microallocation: Individual and Institutional Rationing	97	(9)
Summary	106	(1)
Cases for Analysis	106	(3)
Notes	109	(2)
Principles of Confidentiality and Truthfulness	111	(25)
Introduction	111	(1)
Truthfulness	112	(5)
Confidentiality	117	(14)
Summary	131	(1)
Cases for Analysis	131	(3)
Notes	134	(2)
PROBLEMS OF HEALTH CARE ETHICS
Professional Standards and Institutional Ethics	136	(29)
Introduction	136	(1)
Judging Quality	137	(3)
The Obligation to Police	140	(8)
Institutional Ethics	148	(4)
Ethics Committees	152	(3)
Competition and Institutional Ethics	155	(5)
Summary	160	(1)
Cases for Analysis	160	(3)
Notes	163	(2)
Ethical Problems of Death and Dying	165	(33)
Introduction	165	(1)
Ethics of the Patient	165	(5)
Health Care Providers and the Ethics of Suicide Prevention	170	(2)
Health Care Providers and the Ethics of the Death of a Patient	172	(7)
Physician Initiatives	179	(2)
Cooperation with Active Suicide and Euthanasia	181	(4)
Surrogates and the Termination of Treatment	185	(8)
Summary	193	(1)
Cases for Analysis	194	(3)
Notes	197	(1)
Abortion and Maternal-Fetal Conflict	198	(31)
Introduction	198	(2)
Does the Fetus Have Rights? U.S. Law	200	(1)
The Definition and Types of Abortion	201	(2)
The Moral Status of the Fetus	203	(4)
The Autonomy of the Pregnant Woman	207	(7)
The Ethics of Abortion as a Social Phenomenon	214	(2)
Abortion and the Health Care Provider	216	(4)
Maternal-Fetal Conflict	220	(4)
Summary	224	(1)
Cases for Analysis	224	(3)
Notes	227	(2)
New Methods of Reproduction	229	(22)
Introduction	229	(1)
Artificial Insemination and the General Problem of Assisted Reproduction	230	(3)
In Vitro Fertilization	233	(4)
Surrogate Mothers	237	(3)
The Charge of Artificiality	240	(3)
The Ethics of the Health Care Provider	243	(2)
A Question of Distributive Justice	245	(1)
Summary	246	(1)
Cases for Analysis	247	(3)
Notes	250	(1)
The Ethics of Transplants	251	(27)
Introduction	251	(1)
The Ethics of Organ Donation	252	(8)
The Ethics of the Recipient	260	(1)
The Ethics of the Health Care Team	260	(6)
The Health Care Provider's Ethics of Distribution	266	(4)
The Society's Ethics of Distribution	270	(4)
Summary	274	(1)
Cases for Analysis	274	(3)
Notes	277	(1)
The Ethics of Testing and Screening	278	(21)
Introduction	278	(1)
Testing	279	(9)
Ethical Problems of Mass Screening	288	(7)
Summary	295	(1)
Cases for Analysis	296	(2)
Notes	298	(1)
The Ethics of Biomedical Research	299	(34)
Introduction	299	(1)
The Ethics of the Researcher	300	(12)
The Ethics of the User of Research Results	312	(5)
Fetal Research	317	(4)
Genetic Therapy	321	(5)
Clonning	326	(1)
Summary	327	(1)
Cases for Analysis	328	(5)
References	333	(20)
Index	353

Excerpts

PREFACE Tom Garrett's passing on New Year's Eve 1997 has dramatically altered our expectations and experience in writing this new edition. This book was initially Tom's idea and while his illness progressively removed him from the labor of writing subsequent editions, his intelligence and spirit nevertheless continued to animate our work. This edition has been accomplished without his presence and guidance, and for the two of us there is an incompleteness to this text that no amount of our time or effort could satisfy. We dedicate this text to his memory in the happy acknowledgment of his continuing influence. The fourth edition embodies several improvements over the third, but contains no dramatic structural alterations. Work has been done to clarify and improve the philosophical reflections that provide the context for the discussion of both principles and problems in the field. Further, we have attempted to provide a natural and unified discussion of the problems associated with the still contentious issues surrounding the end of life. To give added perspective we have provided occasional interludes on insights offered from cultural traditions that are not usually understood to be part of the mainstream discussion of American medical ethics. We have also enlarged the discussion of genetics research and, of course, updated information on many issues. As always, there are many people to thank for their contribution to this text. Several colleagues in the field offered their advice and suggestions regarding the revisions in a symposium organized by the University of Scranton. We thank them and the University for this opportunity. Dr. Baillie would also like to thank the University of Scranton for a sabbatical, during which work was completed for this edition. Our work on genetics research has been aided by the support of the Northeast Regional Cancer Institute, which received funding from the Department of Energy's Human Genome Project. We appreciate that support. Our students have provided a continuing opportunity to test the clarity of our thinking and have challenged our presentation with questions and problems that have enlightened and invigorated us. The medical and health care management communities in Scranton and in the Republic of Slovakia have been both teachers and students for us, providing us with anchors in the school of hard knocks. Thank you to Tom Hickey of the University of Michigan, Ann Arbor for his careful review. We would also like to thank Jennifer Ackerman, Emsal Hasan, and Edie Riker at Prentice Hall for their continued confidence in the book and their untiring efforts to bring this edition to completion. Several scholarly presses have provided us with permission to quote from their material, and we appreciate their continued generosity. Finally, and for the fourth time, we would like to thank Eleanore Cooper for her secretarial support so crucial to producing a manuscript, and for her persistent good humor throughout the trials of the last two years. Harold W. Baillie, Ph.D. Rosellen M. Garrett, R.N., Ph.D.