Intervention and Reflection Basic Issues in Medical Ethics (with InfoTrac)

by Munson, Ronald

• ISBN13: 9780534565077
• ISBN10: 0534565077
• Additional ISBN(s): 9780495095026, 9780534520397
• Edition: 7th
• Format: Hardcover
• Copyright: 2003-07-15
• Publisher: Wadsworth Publishing
• More Book Details
• Purchase Benefits

Summary

The most widely used medical ethics textbook today, Munson's INTERVENTION AND REFLECTION is the standard for this course. A collection of the most up to date and influential positions within the most pressing contemporary debates in medical ethics, this book provides students with the most comprehensive and authoritative introduction to the subject as well as a wide variety of cases to study. The combination of Munson?s astute editing (which gives priority to non-technical readings), a wide variety of cases provided alongside the social contexts in which they arise, and insightful commentaries makes this book accessible and provocative to students with no formal philosophical training as well as to students with more formal experience in philosophy and/or the medical professions.

Table of Contents

PART I: RIGHTS	1	(273)
Research Ethics and Informed Consent	2	(98)
Classic Case Presentation: Jesse Gelsinger: The First Gene-Therapy Death	3	(5)
Briefing Session	8	(1)
Drug Testing	9	(1)
The ``Informed'' Part of Informed Consent	10	(1)
The ``Consent'' Part of Informed Consent	11	(1)
Vulnerable Populations	11	(1)
Medical Research and Medical Therapy	12	(16)
Financial Conflict of Interest	13	(1)
Placebos and Research	14	(1)
Therapeutic and Nontherapeutic Research	15	(1)
Research Involving Children	15	(3)
Research Involving Prisoners	18	(2)
Research Involving the Poor	20	(1)
Research Involving the Terminally Ill	20	(2)
Research Involving Fetuses	22	(1)
Research Involving Animals	23	(3)
Women and Medical Research	26	(1)
Summary	26	(2)
Ethical Theories: Medical Research and Informed Consent	28	(2)
Utilitarianism	28	(1)
Kant	28	(1)
Ross	29	(1)
Natural Law	29	(1)
Rawls	30	(1)
Case Presentation: Baby Fae	30	(2)
Social Context: Clinical Trials, HIV, and Pregnancy: A Third-World Tuskegee?	32	(3)
Social Context: The Cold-War Radiation Experiments	35	(3)
Case Presentation: The Willowbrook Hepatitis Experiments	38	(1)
Case Presentation: Echoes of Willowbrook or Tuskegee? Experimenting with Children	39	(1)
Case Presentation: The Use of Morally Tainted Sources: The Pernkopf Anatomy	40	(1)
Readings	41	(1)
Consent and Experimentation	41	(21)
Phase I Cancer Trials: A Collusion of Misunderstanding	41	(4)
Matthew Miller
Philosophical Reflections on Experimenting with Human Subjects	45	(9)
Hans Jonas
The Willowbrook Letters: Criticism and Defense	54	(3)
Stephen Goldby
Saul Krugman
M. H. Pappworth
Geoffrey Edsall
Judgment on Willowbrook	57	(4)
Paul Ramsey
Principles of the Nuremberg Code	61	(1)
The Ethics of Randomized Clinical Trials	62	(12)
Of Mice but Not Men: Problems of the Randomized Clinical Trial	62	(4)
Samuel Hellman
Deborah H. Hellman
Clinical Trials: Are They Ethical?	66	(4)
Eugene Passamani
The Continuing Unethical Conduct of Underpowered Clinical Trials	70	(4)
Scott D. Halpern
Jason T. Karlawish
Jesse A. Berlin
Relativism and Retrospective Judgments	74	(7)
Judging the Past: The Case of the Human Radiation Experiments	74	(7)
Allen Buchanan
Animal Experimentation	81	(13)
Animal Experimentation	81	(7)
Peter Singer
The Case for the Use of Animals in Biomedical Research	88	(6)
Carl Cohen
Decision Scenarios	94	(6)
Physicians, Patients, and Others: Autonomy, Truth Telling, and Confidentiality	100	(77)
Classic Case Presentation: Donald (Dax) Cowart Rejects Treatment---and Is Ignored	101	(3)
Briefing Session	104	(1)
Autonomy	105	(1)
Paternalism	106	(3)
State Paternalism in Medical and Health Care	107	(1)
Personal Paternalism in Medical and Health Care	108	(1)
Informed Consent and Medical Treatment	109	(2)
Free and Informed Consent	109	(1)
Parents and Children	109	(1)
Pregnancy and Autonomy	110	(1)
Truth Telling in Medicine	111	(2)
Placebos	112	(1)
Dignity and Consent	113	(1)
Confidentiality (Privacy)	114	(2)
Breaching Confidentiality	114	(1)
Duty to Warn?	115	(1)
Managed Care	115	(1)
Federal Privacy Regulations	115	(1)
Ethical Theories: Autonomy, Truth Telling, Confidentiality	116	(3)
Case Presentation: Medical ID Cards and Privacy	119	(1)
Social Context: Autonomy and Pregnancy	120	(4)
Case Presentation: The Death of Robyn Twitchell and Christian Science	124	(2)
Readings	126	(1)
Consent to Medical Treatment	126	(19)
Paternalism	126	(9)
Gerald Dworkin
Confronting Death: Who Chooses, Who Controls? A Dialogue	135	(4)
Dax Cowart
Robert Burt
Transparency: Informed Consent in Primary Care	139	(6)
Howard Brody
Autonomy and Pregnancy	145	(9)
Punishing Mothers	145	(3)
Alexander Morgan Capron
Pregnancy and Prenatal Harm to Offspring	148	(6)
John A. Robertson
Joseph D. Schulman
Truth Telling	154	(9)
On Telling Patients the Truth	154	(2)
Mack Lipkin
Respect for Patients, Physicians, and the Truth	156	(7)
Susan Cullen
Margaret Klein
Confidentiality	163	(8)
Confidentiality in Medicine---A Decrepit Concept	163	(3)
Mark Siegler
Supreme Court of California: Decision in the Tarasoff Case	166	(5)
Decision Scenarios	171	(6)
HIV/AIDS	177	(34)
Classic Case Presentation: The Way It Was: Tod Thompson, Dallas, 1993--1994	178	(1)
Briefing Session	179	(1)
Combination Therapy: AIDS on the Run	179	(2)
Decline in Death Rate	180	(1)
Infection Rates	180	(1)
Protease Inhibitors and Combination Drug Therapy	181	(1)
Limits of the Therapy	181	(3)
Best with New Infections	181	(1)
Drug Resistance	182	(1)
Virus Remains	182	(1)
Costs	183	(1)
Side-Effects	183	(1)
Difficult Regimen	184	(1)
False Security	184	(1)
Origin of the AIDS Virus	185	(1)
Spread of the Disease	186	(1)
Children	186	(1)
Deaths	186	(1)
The Future	186	(1)
Case Presentation: Will Teresa Blair Take Her Medicine?	187	(1)
Social Context: What About a Vaccine?	188	(1)
Social Context: AIDS in Africa: What Should Be Done?	189	(4)
Readings	193	(1)
Responsibility and Confidentiality	193	(5)
The Irresponsibility That Spreads AIDS	193	(1)
Alan J. Mayer
The Great Hijack	194	(1)
Bernard Rabinowitz
Controlling HIV/AIDS Forever: Guidelines for Using Protease Inhibitors	195	(3)
Daniel Saturn
HIV Testing	198	(3)
Insurers Are Right on AIDS Testing	198	(2)
Bob Hunter
Jay Angoff
An Insidious Test for AIDS	200	(1)
William C. Gifford III
AIDS Trials in Africa	201	(6)
Human Rights and Maternal---Fetal HIV Transmission Prevention Trials in Africa	201	(4)
George J. Annas
Michael A. Grodin
We're Trying to Help Our Sickest People, Not Exploit Them	205	(2)
Danstan Bagenda
Philippa Musoke-Mudido
Decision Scenarios	207	(4)
Race, Gender, and Medicine	211	(62)
Classic Case Presentation: Bad Blood, Bad Faith: The Tuskegee Syphilis Study	212	(3)
Briefing Session	215	(1)
African Americans and Health Care	216	(6)
Programs Haven't Eliminated the Difference	216	(1)
Why the Gap?	217	(1)
The Tuskegee Effect	218	(1)
AIDS	219	(1)
Clinical Trials	220	(1)
Children's Health	220	(1)
Organ Transplants	221	(1)
Closing the Gap	222	(1)
American Indians and Alaska Natives and Health Care	222	(2)
Indian Health Service	222	(1)
Causes of Death	223	(1)
Summary	224	(1)
Asian and Pacific Islanders and Health Care	224	(2)
Health Profile	225	(1)
Summary	226	(1)
Hispanic Americans/Latinos and Health Care	226	(1)
Health Profile	226	(1)
Recent Changes	227	(1)
Women and Health Care	227	(5)
Include Women, Study Women	228	(1)
Additional Support	229	(1)
Positive Changes	229	(1)
Backlash or Balance?	230	(2)
Conclusion	232	(1)
Case Presentation: Lee Lor: Caught in a Culture Conflict	233	(2)
Social Context: The Mammography Debate	235	(5)
Social Context: The Prostate Cancer Epidemic	240	(3)
Readings	243	(1)
Perspectives on Gender and Race	243	(11)
Gender, Race, and Class in the Delivery of Health Care	243	(5)
Susan Sherwin
Bioethics: The Need for a Dialogue with African Americans	248	(6)
Annette Dula
Conducting Research	254	(8)
Women and Underserved Populations: Access to Clinical Trials	254	(5)
Sara Goering
The Dangers of Difference: The Legacy of the Tuskegee Syphilis Study	259	(3)
Patricia A. King
Setting Public Policy	262	(7)
The Demise of Affirmative Action and the Future of Health Care	262	(2)
H. Jack Geiger
Parties to the Social Contract? Justice and Health Care for Undocumented Immigrants	264	(5)
Kenneth De Ville
Decision Scenarios	269	(4)
PART II: CONTROLS	273	(178)
Genetic Control	274	(91)
Classic Case Presentation: The Stem-Cell Debate	275	(4)
Briefing Session	279	(1)
Genetic Intervention: Screening, Counseling, and Diagnosis	280	(12)
Genetic Disease	280	(2)
Genetic Screening	282	(3)
Genetic Counseling	285	(1)
Prenatal Genetic Diagnosis	286	(3)
Ethical Difficulties with Genetic Intervention	289	(3)
Eugenics	292	(3)
Negative and Positive Eugenics	292	(2)
Use of Desirable Germ Cells	294	(1)
Ethical Difficulties with Eugenics	294	(1)
Genetic Research, Therapy, and Technology	295	(5)
Recombinant DNA	295	(2)
Gene Therapy	297	(1)
Biohazards	297	(2)
Ethical Difficulties with Genetic Research, Therapy, and Technology	299	(1)
Social Context: The Holy Grail of Biology: The Human Genome Project	300	(3)
Case Presentation: Huntington's Disease: Genetic Testing and Ethical Dilemmas	303	(3)
Social Context: Genetic Testing and Screening	306	(4)
Case Presentation: Gene Therapy	310	(4)
Readings	314	(1)
Stem Cells	314	(7)
President's Council on Bioethics: Cloning and Stem Cells	314	(4)
Pontifical Academy for Life: Declaration on the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells	318	(1)
Regulated Cloning for Biomedical Research	319	(2)
James Q. Wilson
Genetic Testing	321	(7)
Pitfalls of Genetic Testing	321	(3)
Ruth Hubbard
R. C. Lewontin
Disowning Knowledge: Issues in Genetic Testing	324	(4)
Robert Wachbroit
Genetic Counseling	328	(10)
Genetic Dilemmas and the Child's Right to an Open Future	328	(10)
Dena S. Davis
Genetic Testing and Reproductive Decisions	338	(13)
Genetics and Reproductive Risk: Can Having Children Be Immoral?	338	(6)
Laura M. Purdy
Implications of Prenatal Diagnosis for the Human Right to Life	344	(7)
Leon R. Kass
Gene Therapy	351	(10)
Germ-Line Therapy and the Medical Imperative	351	(10)
Ronald Munson
Lawrence H. Davis
Decision Scenarios	361	(4)
Reproductive Control	365	(86)
Classic Case Presentation: Hello, Dolly: The Advent of Reproductive Cloning	366	(4)
Briefing Session	370	(1)
IVF, GIFT, ZIFT, and Other Techniques	371	(2)
IVF	371	(1)
GIFT, ZIFT, IVC, ULER, PZD, ICSI, DNA Transfer, and CD	372	(1)
Need, Success Rates, and Costs of Assisted Reproduction	373	(3)
Multiple Births	373	(1)
Freezing Embryos	374	(1)
Gestational Surrogates and Donor Ova	375	(1)
Criticisms of Assisted Reproduction Practices	376	(1)
Benefits of IVF and Other Forms of Assisted Reproduction	376	(1)
Ethical and Social Difficulties	377	(1)
Cloning and Twinning	378	(1)
Artificial Insemination	379	(4)
The Procedure	380	(1)
Reasons for Seeking Artificial Insemination	380	(1)
Types of Artificial Insemination	381	(1)
Sperm Donors	381	(1)
Issues in Artificial Insemination	382	(1)
Ova Donors	383	(1)
Surrogate Pregnancy	383	(1)
Ethical Theories and Reproductive Control	384	(1)
Case Presentation: Louise Brown: The First ``Test-Tube Baby''	385	(2)
Case Presentation: Septuplets: The Perils of Multiple Pregnancies	387	(1)
Social Context: Postmenopausal Motherhood	388	(2)
Social Context: Father Shopping: Sperm by Mail	390	(1)
Case Presentation: Baby M and Mary Beth Whitehead: Surrogate Pregnancy in Court	390	(2)
Case Presentation: The Calvert Case: A Gestational Surrogate Changes Her Mind	392	(1)
Readings	393	(1)
Assisted Reproduction	393	(25)
Congregation for the Doctrine of the Faith: Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation: Replies to Certain Questions of the Day	393	(8)
The Right to Lesbian Parenthood	401	(3)
Gillian Hanscombe
``Give Me Children or I Shall Die!'' New Reproductive Technologies and Harm to Children	404	(10)
Cynthia B. Cohen
Medical Miracle or Medical Mischief? The Saga of the McCaughey Septuplets	414	(4)
Arlene Judith Klotzko
Surrogate Pregnancy	418	(15)
Surrogate Motherhood as Prenatal Adoption	418	(7)
Bonnie Steinbock
Is Women's Labor a Commodity?	425	(8)
Elizabeth S. Anderson
Human Cloning	433	(14)
The Wisdom of Repugnance	433	(5)
Leon R. Kass
National Bioethics Advisory Commission: Cloning Human Beings: Ethical Considerations	438	(9)
Decision Scenarios	447	(4)
PART III: RESOURCES	451	(108)
Scarce Medical Resources	452	(55)
Classic Case Presentation: Selection Committee for Dialysis	453	(3)
Briefing Session	456	(1)
Transplants, Kidneys, and Machines	457	(3)
Controlling Rejection	457	(1)
Allocation and Scarcity	458	(1)
Seattle and Kidney Machines	458	(1)
Dialysis Costs and Decisions	459	(1)
Microallocation Versus Macroallocation	460	(1)
Ethical Theories and the Allocation of Medical Resources	461	(1)
Social Context: Acquiring and Allocating Transplant Organs	462	(7)
Case Presentation: Sandra Jensen Gets a Transplant	469	(1)
Case Presentation: The Ayalas' Solution: Having a Child to Save a Life	470	(1)
Social Context: Fetal-Cell Implants	471	(3)
Case Presentation: Drug Lottery: The Betaseron Shortage	474	(1)
Readings	475	(1)
Allocation Principles	475	(8)
The Allocation of Exotic Medical Lifesaving Therapy	475	(8)
Nicholas Rescher
Acquiring Transplant Organs	483	(10)
The Donor's Right to Take a Risk	483	(2)
Ronald Munson
Conscription of Cadaveric Organs for Transplantation: Let's at Least Talk About It	485	(4)
Aaron Spital
Charles A. Erin
Take My Kidney, Please	489	(1)
Michael Kinsley
Ethics of Paid Organ Donation	490	(3)
Kishore D. Phadke
Urmila Anandh
Allocating Transplant Organs	493	(9)
The Prostitute, the Playboy, and the Poet: Rationing Schemes for Organ Transplantation	493	(5)
George J. Annas
Carl Cohen, Martin Benjamin, and the Ethics and Social Impact Committee of the Transplant and Health Policy Center, Ann Arbor, Michigan: Alcoholics and Liver Transplantation	498	(4)
Decision Scenarios	502	(5)
Paying for Health Care	507	(52)
Classic Case Presentation: Robert Ingram: Dilemma of the Working Poor	508	(1)
Briefing Session	509	(1)
Claim-Rights, Legal Rights, and Statutory Rights	510	(1)
Moral Rights	510	(1)
Political Rights	511	(1)
Health Care as a Right	511	(2)
Objections	512	(1)
Social Context: Costs of Care	513	(5)
Social Context: Solving the Problem?	518	(5)
Case Presentation: The Canadian System as a Model for the United States?	523	(5)
Case Presentation: Employer-Mandated Health Insurance: The Hawaiian Example	528	(1)
Readings	529	(1)
Justice and Health Care	529	(13)
President's Commission for the Study of Ethical Problems in Medicine: An Ethical Framework for Access to Health Care	529	(8)
Is There a Right to a Decent Minimum of Health Care?	537	(5)
Allen E. Buchanan
Managed Care and Rationing	542	(7)
The Doctor as Double Agent	542	(4)
Marcia Angell
Wanted: A Clearly Articulated Social Ethic for American Health Care	546	(3)
Uwe E. Reinhardt
Alternatives to the Present System	549	(5)
The Forgotten Domestic Crisis	549	(2)
Marcia Angell
The Benefits of Privatization	551	(3)
Victor Dirnfeld
Decision Scenarios	554	(5)
PART IV: TERMINATIONS	559	(182)
Abortion	560	(71)
Classic Case Presentation: When Abortion Was Illegal: Mrs. Sherri Finkbine and the Thalidomide Tragedy	561	(1)
Briefing Session	561	(1)
Human Development and Abortion	562	(1)
The Status of the Fetus	563	(1)
Pregnancy, Abortion, and the Rights of Women	564	(1)
Therapeutic Abortion	565	(1)
Abortion and the Law	566	(1)
Ethical Theories and Abortion	567	(1)
Social Context: How Americans View Abortion: Tolerant Ambivalence	568	(3)
Social Context: The ``Partial-Birth Abortion'' Controversy	571	(4)
Social Context: Crucial Legal and Policy Decisions	575	(4)
Social Context: RU-486---The ``Abortion Pill''	579	(3)
Social Context: The ``Morning-After Pill''	582	(1)
Readings	583	(1)
The Status of the Fetus	583	(29)
An Almost Absolute Value in History	583	(4)
John T. Noonan Jr.
A Defense of Abortion	587	(9)
Judith Jarvis Thomson
On the Moral and Legal Status of Abortion	596	(9)
Mary Anne Warren
Why Abortion Is Immoral	605	(4)
Don Marquis
The Morality of Abortion and the Deprivation of Futures	609	(3)
Mark T. Brown
Feminist Perspectives	612	(10)
Abortion Through a Feminist Ethic Lens	612	(4)
Susan Sherwin
A Case for Pro-life Feminism	616	(6)
Sidney Callahan
Late-Term Abortion	622	(4)
Thomson, the Right to Life, and Partial-Birth Abortion	622	(4)
Peter Alward
Decision Scenarios	626	(5)
Impaired Infants and Medical Futility	631	(56)
Classic Case Presentation: Baby Owens: Down Syndrome and Duodenal Atresia	632	(1)
Briefing Session	633	(1)
Genetic and Congenital Impairments	634	(1)
Specific Impairments	634	(2)
Down Syndrome	634	(1)
Spina Bifida	635	(1)
Hydrocephaly	635	(1)
Anencephaly	635	(1)
Esophageal Atresia	636	(1)
Duodenal Atresia	636	(1)
Problems of Extreme Prematurity	636	(1)
Testing for Impairments	636	(1)
Ethical Theories and the Problem of Birth Impairments	637	(2)
Social Context: The Dilemma of Extreme Prematurity	639	(4)
Social Context: The Baby Doe Cases	643	(2)
Case Presentation: Baby K: An Anencephalic Infant and a Mother's Request	645	(2)
Readings	647	(1)
The Status of Impaired Infants	647	(17)
Examination of Arguments in Favor of Withholding Ordinary Medical Care from Defective Infants	647	(6)
John A. Robertson
Ethical Issues in Aiding the Death of Young Children	653	(5)
H. Tristram Engelhardt Jr.
Life-and-Death Decisions in the Midst of Uncertainty	658	(6)
Robert F. Weir
Other Perspectives	664	(7)
Avoiding Anomalous Newborns	664	(7)
Michael L. Gross
Medical Futility	671	(10)
Medical Futility	671	(5)
Nancy S. Jecker
Roberta A. Pagon
Medical Futility: Commentary	676	(5)
Norman C. Fost
Decision Scenarios	681	(6)
Euthanasia and Physician-Assisted Suicide	687	(54)
Classic Case Presentation: Karen Quinlan: The Debate Begins	688	(2)
Briefing Session	690	(1)
Active and Passive Euthanasia	690	(1)
Voluntary, Involuntary, and Nonvoluntary Euthanasia	691	(1)
Defining ``Death''	692	(1)
Advance Directives	693	(2)
Ethical Theories and Euthanasia	695	(2)
Social Context: The Physician-Assisted Suicide Law in Oregon	697	(4)
Case Presentation: The Cruzan Case: The Supreme Court Upholds the Right to Die in a Landmark Decision	701	(2)
Case Presentation: Dr. Jack Kevorkian: Physician-Assisted Suicide Activist	703	(2)
Case Presentation: A Canadian Tragedy	705	(1)
Social Context: Physician-Assisted Suicide: The Dutch Experience	706	(2)
Readings	708	(1)
The Case Against Euthanasia and Physician-Assisted Suicide	708	(8)
The Wrongfulness of Euthanasia	708	(3)
J. Gay-Williams
When Self-Determination Runs Amok	711	(5)
Daniel Callahan
The Case for Euthanasia and Physician-Assisted Suicide	716	(14)
When Abstract Moralizing Runs Amok	716	(4)
John Lachs
Active and Passive Euthanasia	720	(3)
James Rachels
Voluntary Active Euthanasia	723	(7)
Dan W. Brock
Alternatives	730	(4)
Lonnie R. Bristow for the American Medical Association: Physician-Assisted Suicide	730	(3)
Terminal, but Not Hopeless	733	(1)
Sandol Stoddard
Deciding for the Incompetent	734	(2)
Supreme Court of New Jersey: In the Matter of Karen Quinlan, an Alleged Incompetent	734	(2)
Decision Scenarios	736	(5)
PART V: FOUNDATIONS OF BIOETHICS: ETHICAL THEORIES, MORAL PRINCIPLES, AND MEDICAL DECISIONS	741	(51)
Basic Ethical Theories	744	(1)
Utilitarianism	744	(8)
The Principle of Utility	745	(1)
Act and Rule Utilitarianism	746	(4)
Preference Utilitarianism	750	(1)
Difficulties with Utilitarianism	751	(1)
Kant's Ethics	752	(5)
The Categorical Imperative	752	(1)
Another Formulation	753	(1)
Duty	753	(1)
Kant's Ethics in the Medical Context	754	(2)
Difficulties with Kantian Ethics	756	(1)
Ross's Ethics	757	(4)
Moral Properties and Rules	757	(1)
Actual Duties and Prima Facie Duties	758	(2)
Ross's Ethics in the Medical Context	760	(1)
Difficulties with Ross's Moral Rules	760	(1)
Rawls's Theory of Justice	761	(5)
The Original Position and the Principles of Justice	761	(2)
Rawls's Theory of Justice in the Medical Context	763	(2)
Difficulties with Rawls's Theory	765	(1)
Natural Law Ethics and Moral Theology	766	(5)
Purposes, Reasons, and the Moral Law as Interpreted by Roman Catholicism	766	(2)
Applications of Roman Catholic Moral-Theological Viewpoints in the Medical Context	768	(2)
Difficulties with Natural Law Ethics and Moral Theology	770	(1)
Major Moral Principles	771	(1)
The Principle of Nonmaleficence	771	(2)
The Principle of Beneficence	773	(2)
The Principle of Utility	775	(1)
Principles of Distributive Justice	776	(3)
The Principle of Equality	777	(1)
The Principle of Need	777	(1)
The Principle of Contribution	778	(1)
The Principle of Effort	778	(1)
The Principle of Autonomy	779	(5)
Autonomy and Actions	780	(1)
Autonomy and Options	780	(1)
Autonomy and Decision Making	781	(1)
Restrictions on Autonomy	782	(2)
Theories Without Principles	784	(1)
Virtue Ethics	784	(2)
The Virtues	785	(1)
Virtue Ethics in the Medical Context	785	(1)
Difficulties with Virtue Ethics	786	(1)
Care Ethics	786	(4)
Values, Not Principles	787	(1)
Care Ethics in the Medical Context	788	(1)
Difficulties with Care Ethics	789	(1)
Feminist Ethics	790	(2)
Feminist Ethics in the Medical Context	791	(1)
Difficulties with Feminist Ethics	792	(1)
Retrospect	792	(2)
Notes and References	794