Ethics In Clinical Practice

Preface xi Acknowledgments xiii 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) 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) 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) 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) 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) 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) 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