We are living in an unprecedented era of biomedical revolution. Medicine is remaking humans, and controversy surrounds such topics as abortion, artificial organs, brain circuitry, eugenics, euthanasia, and gene therapy. At the same time, medical advances are posing complex ethical problems for both patients and professionals.

The most comprehensive and up-to-date collection of its kind, Case Studies in Biomedical Ethics: Decision-Making, Principles, and Cases explores fundamental ethical questions arising from real situations faced by health professionals, patients, and others.

Featuring a wide range of more than 100 case studies drawn from current events, court cases, and physicians' experiences, the book is divided into three parts. Part I presents a basic framework for ethical decision-making in healthcare, covering such issues as separating evaluative questions from questions of fact; distinguishing between ethical and nonethical evaluations; and identifying the source of ethical judgments. Expanding upon this framework, Part II explains the ethical principles: beneficence and nonmaleficence, justice, respect for autonomy, veracity, fidelity, and avoidance of killing. Parts I and II provide students with the background to analyze the ethical dilemmas presented in Part III, which features cases on a broad spectrum of issues including abortion, genetics, mental health, confidentiality, health insurance, experimentation on humans, the right to refuse treatment, and death and dying. Each case is accompanied by the authors' commentary, which guides students in considering the issues.

Ideal for undergraduate and graduate courses in biomedical ethics, bioethics, and medical ethics, Case Studies in Biomedical Ethics incorporates opening text boxes in each chapter that cross-reference relevant cases in other chapters. It also includes an appendix of important ethical codes and a glossary of key terms.

List of Cases

List of Tables

Preface

 

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?

Consequentialism

Deontological or "Duty-Based" Ethics

Other Issues of Normative Ethics

How Do Rules Apply to Specific Situations?

What Ought to Be Done in Specific Cases?

 

PART 1: 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 2: ETHICAL PRINCIPLES IN MEDICAL ETHICS

Chapter 4: Benefiting the Patient and Others: The Duty to Do Good and Avoid Harm

Benefiting the Patient

Health in Conflict with Other Goods

Conflicts among Health-Related Benefits

Relating Benefits and Harms

Benefits of Rules and Benefits in Specific Cases

Benefiting Society and Individuals Who Are Not Patients

Benefits to Society

Benefits to Specific Nonpatients

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

Protecting the Patient by Lying

Protecting the Welfare of Others

Special Cases of Truth-Telling

Patients Who Do Not Want to Be Told

Family Members Who Insist the Patient Not Be Told

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 3: SPECIAL PROBLEM AREAS

Chapter 10: Abortion, Sterilization, and Contraception

Abortion

Abortion for Medical Problems of the Fetus

Abortion Following Sexual Assault

Abortion to Save the Life of the Pregnant Woman

Abortion and the Mentally Incapacitated Woman

Abortion for Socioeconomic Reasons

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

Donation versus Salvaging

Diseased and Poor-Quality Organs

Donation after Cardiac Death

Preserving the Organs of the Dying

Socially Directed Organ Donation

Living Donor/Deceased Donor Organ Swaps

Children as Living Organ Sources

Allocating Organs

Maximizing Benefits and Distributing Organs Fairly

When Voluntary Risks Cause a Need for Organs

Multiple Organs and Special Priority for Special People

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 Cost-worthy

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

Never Competent Persons without Available Family

Never Competent Persons with Available Family

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

Glossary

List of Cases from Public Sources

Index

"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 |k No