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This casebook consists of hundreds of case vignettes drawn from a variety of areas of clinical practice. It presents over 200 brief, concrete examples along with specific questions and alternatives that highlight the challenging ethical problems involved. This book can be read independently or can serve as a supplement to any core text in clinical/medical ethics.
Interpreting the Hippocratic Oath. Interpreting the ANA Code. Interpreting The AMA''s Code Of Ethics. Conscientious Refusal to Participate in a Procedure. Waiting Room Waits. The Staff Disagrees. Relationships with Patients: Some Boundary Issues. Religious Convictions Expressed In a Public Setting. Physician-Assisted Execution. Accepting Gifts. A Hateful Patient. A Doctor Treats Her Family. The Doctor Who Treats Himself.
2. PROFESSIONALISM, PART 2: PROTECTING PATIENTS AND JUDGING PROFESSIONAL COMPETENCE.
A Dosage Error and an Incident Report. Oops. A Patient in Pain. Good Samaritan After a Beer? Patient Care During a Strike. Unlicensed Assistive Personnel. Turf or Expertise, Part 1: Podiatrists or Orthopedic Surgeons? Turf or Expertise, Part 2: Nurses or Doctors? Turf or Expertise, Part 3: Psychiatrists or Psychologists?
3. ETHICAL ISSUES IN HEALTH CARE EDUCATION.
Education And (In)Experience: Two Vignettes. Education and Risk. Practicing Invasive Procedures on the Newly Dead. How Much Work is Excessive for Residents? Students and Residents Observe Ob/Gyn and Urology Patients. Pressures on Residents to Overlook Possible Wrongdoing: Two Vignettes. Relationships Between Students and Teachers: More Boundary Issues. Videotaping Patients.
4. MANAGED CARE AND HEALTH CARE BUSINESS.
HMO Phobia. A Managed Care Firm Requests a Psychologist''s Reports. Managing Managed Care. Changing Hospital Ownership. Advertisements in Journals and Other Periodicals. Pharmaceutical Research Funding. A Salesperson Treats Residents to Lunch. Drug Samples for Patients. Conflicts of Interest. Pharmaceutical Companies and Developing Nations. Biopatenting Human Genome Sequences.
A Research Subject''s Comprehension Confusion. Parental Research Incentive. Compensating Parents for Research on Their Children. How Much Disclosure is Needed For Consent? Relying On Studies and Experience. Balancing Human''s and Mice''s Interests. Nontherapeutic Research with Alzheimer''s Patients. A Proxy''s "Consent" For Research. Phase 1 Clinical Trials on Children. Experimental Transplantation from Other Species. Is it a Bird? Is it a Plant? Randomized Clinical Trials and Errors. Controversial Fetal Research: Two Vignettes. Conflict of Interest Policies. A Marketplace of Ideas. Bioweapons Research.
6. PEDIATRIC CONTEXTS.
Suspicion of Child Abuse. Vaccination 1. Vaccination 2. Vaccination 3. Reality TV: Covert Surveillance to Protect a Child. Incest and Confidentiality. A Mother Demands Contraception for Her Daughter. An Adolescent Asks for Information. The Moral Equivalent of Advance Directives for Children. A Pregnant Teen with Hodgkin''s Disease. Resuscitation of a Very Premature Infant.
7. MENTAL HEALTH CONTEXTS.
Diagnosing and Treating ADHD. Paternalism and Agoraphobia. Paternalism and a Dangerous Anorexia. Paternalism and Severe Depression. Not Guilty by Reason of Insanity? Expert Testimony. Prevention of a Possible (but Not Probable) Suicide. Refusing Investigation of Possible Cancer. Fine-Tuning the Psyche. Psychoactive Drugs for Young Children. Mental Health Parity.
8. VALID INFORMED CONSENT AND COMPLIANCE PROBLEMS.
Being Asked "What Would You Do?" Irrational Treatment Refusal in an Emergency. A Mildly Mentally Retarded Patient Consents. Suspicions About Substances. A Relative''s Consent for an Unwanted Procedure. Omitting Quantitative Mention of Degree of Uncertainty. A Patient Doesn''t Remember Consent Specifics. Treatment Decision Under Stress. Noncompliance and Pressure. Responses to Noncompliance. Noncompliance of a Tuberculosis Carrier.
9. HEALTH CARE OPTIONS, CULTURE AND DIVERSITY.
Choosing Alternative Health Care Treatments. What is Quackery? Diversity and Limits: Female Circumcision. Religious Grounds for Rejecting Medical Care: Faith Healing. Jehovah''s Witnesses Parents Refuse Transfusion. Sex Selection of a Physician: Four Vignettes. Forbidden Food. Is Intolerance Intolerable? By Faith Alone? Deaf Culture and Cochlear Implants. Wrong About One''s Own Religion. Some Hypotheticals About Pain, Pain Management, and Culture. Paddling. Other Cultures: Other Facts and Other Values. Respecting Cultural Diversity and Health.
10. INFORMATION: COMMUNICATION AND CONFIDENTIALITY.
Withholding Important Genetic Information from a Family. Pressing Someone to Admit Spousal Abuse. Elevator and Cafeteria Conversations. A Patient''s History in Print. Sharing Patient Information with One''s Spouse. Who Should Know What? A Duty to Warn? Truth Telling and Terminal Illness: Lying About Dying. Paternity Information Emerging in Genetic Counseling.
A Patient''s Request Not to Tell Partners. Hope and Power: HIV Patients'' Access to Unapproved Drugs. Funding for AIDS versus for Other Diseases. HIV Risks to Patients? Less-Than-Universal Precautions. Testing Patients for HIV and Hepatitis: Three Vignettes. Refusal to Treat: Choice or Discrimination?
12. REPRODUCTION, GENETICS AND ABORTION.
Postmortem Sperm "Donation." Questioned Requests for Reproductive Assistance: Four Vignettes. Frozen Embryo Brouhaha. In Vitro Fertilization: Helpful or Wasteful? Reproductive Assistance for a Same-Sex Couple? Privatizing Sale of Sperm and Ova. Performing Surrogate Pregnancy as a Living. DNA Banks: Two Vignettes. Eugenics: Positive or Negative? Cloning. Objection to an Abortus-Derived Vaccine. Use of Embryonic Stem Cells to Heal. Stem Cells, Potentiality, and Moral Status. Considering an Abortion. Seeking Prenatal Diagnosis for a Possible Sex-Choice Abortion. Moral or Legal Responsibilities During Pregnancy? Amniocentesis: Risks and Indications. RU-486 and Abortion. Partial Birth Abortion. Building a Better Mouse. A Reproductive Strategy: Pre-Tests and Post-Tests.
13. LIFE AND DEATH DECISIONS, PART 1: ASSISTED SUICIDE AND OTHER PATIENT REQUESTS ABOUT DYING.
The Case of Dr. Nekroviak. Assisting a Dying Patient''s Suicide. Assisting Suicide of a Chronically Ill Patient Who is not Dying. Ignoring a Living Will at a Daughter''s Insistence. Interpreting Advance Directives. Discontinuing Nutrition and Hydration. Voluntary Active Euthanasia: Unthinkable? About Time?
14. LIFE AND DEATH DECISIONS, PART 2: DECIDING LIMITS OF LIFE-PROLONGING TREATMENTS.
Limiting Care by Age. Someone Once Recovered: A Single Instance. Just Venting?
Treatments Judged "Not Clinically Indicated:" Three Vignettes. "We Don''t Have To Begin This Treatment, But Once We Do�" Do-Not-Resuscitate Problems: Two Vignettes. Invasiveness. Mental Retardation and Quality-of-Life Judgements. Deciding Whether to Offer Options: Metastatic Cancer and Pneumonia. Limits of Prematurity. Trisomy Quandary. Conjoined Twins. Persistent Vegetative State. Refusing Treatment for a Patient with Brain Damage. The Search for Medical Futility: Not Necessarily Hopeless. Be Still, My Heart.
15. ALLOCATION AND ACCESS.
Access to Health Care. Poor Access to the System. A Plan to Ration Care. Refusal to Accept Patients: Freedom or Disregard? Second and Third Transplants. An Anencephalic Baby as an Organ Donor. A Family''s Media Campaign. Celebrities and Advocacy. One Last Question: Asking for Organs. Estate Sale of One''s Organs. Selling Organs. Plasma "Donation" and Justice. Sale of Tissues and Organs. Ranking Recipient Candidates: Four Vignettes. Waiting For a Transplant. A Smoker''s Claim to Health Care Resources. Tobacco Litigation and Responsibility. Costing Kids. Negligent Birth? DALYs and QALYs. Creating Fraudulent Diagnoses to Enable Treatment.
16. OTHER ISSUES.
Alcohol Use Issues. Obesity Issues. Tobacco: Risks, Responsibilities, and Public Health. A Reasonable Health Concern, Anxiety or Phobia? Puzzles About Referrals. Lack of Health Screening. Patching Up an Athlete. Enhancement or Therapy? Placebos. A Place for a Placebo? A Whole New Kind of Person. He Doesn''t Think: Therefore What?
Ethical Theory Glossary. Clinical Ethics Glossary. Approaching Ethical Problems: A Guide to Analysis. Codes Of Ethics. The Hippocratic Oath. The Nuremberg Code. World Medical Association Declaration of Helsinki. International Code of Medical Ethics. Declaration Of Geneva. Patient''s Bill of Rights. American Medical Association Principles of Medical Ethics. Code For Nurses. International Code for Nurses.