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Case Studies in Biomedical Ethics


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Table of Contents

INTRODUCTION: FOUR QUESTIONS OF ETHICS ; What Are the Source, Meaning, and Justification of Ethical Claims? ; 1. Distinguish between Evaluative Statements and Statements Presenting Nonevaluative Facts ; 2. Distinguish between Ethical and Nonethical Evaluations ; 3. Determine Who Ought to Decide ; WHAT KINDS OF ACTS ARE RIGHT? ; How Do Rules Apply to Specific Situations? ; What Ought to Be Done in Specific Cases? ; PART I: ETHICS AND VALUES IN MEDICAL CASES ; CHAPTER 1: A MODEL FOR ETHICAL PROBLEM SOLVING ; The Five-Step Model ; Application of the Model ; 1. Respond to the Sense That Something Is Wrong ; 2. Gather Information ; 3. Identify the Ethical Problem/Moral Diagnosis ; 4. Seek a Resolution ; 5. Work with Others to Choose a Course of Action ; CHAPTER 2: VALUES IN HEALTH AND ILLNESS ; Identifying Value Judgments in Medicine ; Separating Ethical and Other Evaluations ; CHAPTER 3: WHAT IS THE SOURCE OF MORAL JUDGMENTS? ; Grounding Ethics in the Professional Code ; Grounding Ethics in the Physician's Orders ; Grounding Ethics in Institutional Policy ; Grounding Ethics in the Patient's Values ; Grounding Ethics in Religious or Philosophical Perspectives ; PART II: ETHICAL PRINCIPLES IN MEDICAL ETHICS ; CHAPTER 4: BENEFITING THE PATIENT AND OTHERS: THE DUTY TO DO GOOD AND AVOID HARM ; Benefiting the Patient ; Benefiting Society and Individuals Who Are Not Patients ; Benefit to the Profession ; Benefit to the Health Professional and the Health Professional's Family ; CHAPTER 5: JUSTICE: THE ALLOCATION OF HEALTH RESOURCES ; Justice among Patients ; Justice between Patients and Others ; Justice in Public Policy ; Justice and Other Ethical Principles ; CHAPTER 6: AUTONOMY ; Determining Whether a Patient Is Autonomous ; External Constraints on Autonomy ; Overriding the Choices of Autonomous Persons ; CHAPTER 7: VERACITY: HONESTY WITH PATIENTS ; The Condition of Doubt ; Lying in order to Benefit ; Special Cases of Truth-Telling ; The Right of Access to Medical Records ; CHAPTER 8: FIDELITY: PROMISE-KEEPING, LOYALTY TO PATIENTS, AND IMPAIRED PROFESSIONALS ; The Ethics of Promises: Explicit and Implicit ; Fidelity and Conflicts of Interest ; Incompetent and Dishonest Colleagues ; CHAPTER 9: AVOIDANCE OF KILLING ; Active Killing versus Letting Die ; Withholding versus Withdrawing Treatment ; Direct versus Indirect Killing ; Justifiable Omissions: The Problem of Nutrition and Hydration ; Voluntary and Involuntary Killing ; Killing as Punishment ; PART III: SPECIAL PROBLEM AREAS ; CHAPTER 10: ABORTION, STERILIZATION, AND CONTRACEPTION ; Abortion ; Sterilization ; Contraception ; CHAPTER 11: GENETICS, BIRTH, AND THE BIOLOGICAL REVOLUTION ; Genetic Counseling ; Genetic Screening ; In Vitro Fertilization and Surrogate Motherhood ; Preimplantation Diagnosis ; Gene Therapy ; CHAPTER 12: MENTAL HEALTH AND BEHAVIOR CONTROL ; The Concept of Mental Health ; Mental Illness and Autonomous Behavior ; Mental Illness and Third-Party Interests ; Other Behavior-Controlling Therapies ; CHAPTER 13: CONFIDENTIALITY: ETHICAL DISCLOSURE OF MEDICAL INFORMATION ; Breaking Confidence to Benefit the Patient ; Breaking Confidence to Benefit Others ; Breaking Confidence as Required by Law ; Conflict between Confidentiality and Other Duties ; CHAPTER 14: ORGAN TRANSPLANTS ; Procuring Organs ; Allocating Organs ; CHAPTER 15: HEALTH INSURANCE, HEALTH SYSTEM PLANNING, AND RATIONING ; The Problem of Small, Incremental Benefits ; Limits on Unproved Therapies ; Marginally Beneficial, Expensive Therapy ; Valued Care that Is Not Costworthy ; Funding Care that Patients Have Refused ; Pharmaceutical Manufacturers versus Insurers ; Insurance and the Uninsured ; CHAPTER 16: EXPERIMENTATION ON HUMAN SUBJECTS ; Calculating Risks and Benefits ; Privacy and Confidentiality ; Equity in Research ; Conflicts of Interest in Research ; Informed Consent in Research ; CHAPTER 17: CONSENT AND THE RIGHT TO REFUSE TREATMENT ; The Elements of a Consent ; The Standards for Consent ; Comprehension and Voluntariness ; CHAPTER 18: DEATH AND DYING ; The Definition of Death ; Competent and Formerly Competent Patients ; Never Competent Patients ; Futile Care and Limits Based on the Interests of Others ; APPENDIX: CODES OF ETHICS ; The Hippocratic Oath ; World Medical Association, Declaration of Geneva ; The American Medical Association, Principles of Medical Ethics ; Universal Declaration on Bioethics and Human Rights

About the Author

Dan C. English: Affiliated Scholar, Center for Clinical Bioethics, Georgetown University


Case Studies in Biomedical Ethics is by far the most comprehensive and engaging text I have yet encountered in the field. It includes a far-ranging array of cases in bioethics for use in the classroom presented in terms of a compelling account of the basic principles and issues of contemporary health care ethics... I believe that it will set the new standard in the field. Daniel E. Palmer, Kent State University The sheer range of cases is better than any other of the score of textbooks I have seen. One of the great virtues of the book is the style, which is consistently clear and engaging without sacrificing attention to the complexities and subtleties of the issues. The coverage of topics is more extensive than any other textbook I am aware of... The integration of commentary on each specific case, as well as a larger framework for putting the cases in the context of basic principles of medical ethics, is exemplary. The book is an excellent choice for any college-level course in medical ethics. Daniel Berthold, Bard College

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