Chapter 1 Professionalism, Part I: Professional Codes, Roles, and Boundaries 1 --
Special Responsibilities 2 --
1.1 Interpreting the Hippocratic Oath 2 --
1.2 Interpreting a Nursing Code of Ethics 3 --
1.3 Interpreting the AMA's Code of Ethics 4 --
1.4 Conscientious Refusal to Participate in a Procedure 5 --
1.5 Waiting Room Waits 5 --
1.6 The Staff Disagrees 6 --
1.7 Relationships with Patients: Some Boundary Issues 6 --
1.8 Religious Convictions Expressed in a Public Setting 7 --
1.9 Physician-Assisted Execution 8 --
1.10 Accepting Gifts 8 --
1.11 A Hateful Patient 9 --
1.12 A Doctor Treats Her Family 9 --
1.13 The Doctor Who Treats Himself 10 --
Chapter 2 Professionalism, Part II: Protecting Patients and Judging Professional Competence 11 --
2.1 A Dosage Error and an Incident Report 12 --
2.3 A Patient in Pain 13 --
2.4 Good Samaritan After a Beer? 13 --
2.5 Patient Care During a Strike 14 --
2.6 Unlicensed Assistive Personnel 14 --
2.7 Turf or Expertise, Part I: Podiatrists or Orthopedic Surgeons? 15 --
2.8 Turf or Expertise, Part II: Nurses or Doctors? 15 --
2.9 Turf or Expertise, Part III: Psychiatrists or Psychologists? 16 --
Chapter 3 Ethical Issues in Health Care Education 17 --
3.1 Education and (In)experience: Two Vignettes 18 --
3.2 Education and Risk 18 --
3.3 Practicing Invasive Procedures on the Newly Dead 19 --
3.4 How Much Work is Excessive for Residents? 19 --
3.5 Students and Residents Observe Ob/Gyn and Urology Patients 20 --
3.6 Pressures on Residents to Overlook Possible Wrongdoing: Two Vignettes 20 --
3.7 Relationships Between Students and Teachers: More Boundary Issues 21 --
3.8 Videotaping Patients 22 --
Chapter 4 Managed Care and Health Care Business 23 --
Managed Care and HMOs 23 --
Marketing and Sales Techniques; Research and Development 24 --
4.2 A Managed Care Firm Requests a Psychologist's Reports 25 --
4.3 Managing Managed Care 25 --
4.4 Changing Hospital Ownership 26 --
4.5 Advertisements in Journals and Other Periodicals 27 --
4.6 Pharmaceutical Research Funding 27 --
4.7 A Salesperson Treats Residents to Lunch 28 --
4.8 Drug Samples for Patients 28 --
4.9 Conflicts of Interest 29 --
4.10 Pharmaceutical Companies and Developing Nations 30 --
4.11 Biopatenting Human Genome Sequences 30 --
Minimizing Risk and Minimizing Bias 33 --
5.1 A Research Subject's Comprehension Confusion 34 --
5.2 Parental Research Incentive 35 --
5.3 Compensating Parents for Research on Their Children 35 --
5.4 How Much Disclosure Is Needed for Consent? 36 --
5.5 Relying on Studies and Experience 36 --
5.6 Balancing Humans' and Mice's Interests 37 --
5.7 Nontherapeutic Research with Alzheimer's Patients 37 --
5.8 A Proxy's "Consent" for Research 38 --
5.9 Phase I Clinical Trials on Children 38 --
5.10 Experimental Transplantation from Other Species 39 --
5.11 Is It a Bird? Is It a Plant? 39 --
5.12 Randomized Clinical Trials and Errors 40 --
5.13 Controversial Fetal Research: Two Vignettes 40 --
5.14 Conflict of Interest Policies 41 --
5.15 A Marketplace of Ideas? 42 --
5.16 Bioweapon Research 42 --
Chapter 6 Pediatric Contexts 44 --
Critically Ill Neonates 45 --
6.1 Suspicion of Child Abuse 45 --
6.5 Reality TV: Covert Surveillance to Protect a Child 47 --
6.6 Incest and Confidentiality 48 --
6.7 A Mother Demands Contraception for Her Daughter 48 --
6.8 An Adolescent Asks for Information 49 --
6.9 The Moral Equivalent of Advance Directives for Children 49 --
6.10 A Pregnant Teen with Hodgkin's Disease 50 --
6.11 Resuscitation of a Very Premature Infant 51 --
Chapter 7 Mental Health Contexts 52 --
Which Self? What Responsibility? 52 --
The Mental and the Physical 53 --
7.1 Diagnosing and Treating ADHD 53 --
7.2 Paternalism and Agoraphobia 54 --
7.3 Paternalism and a Dangerous Anorexia 54 --
7.4 Paternalism and Severe Depression 54 --
7.5 Not Guilty by Reason of Insanity? Expert Testimony 55 --
7.6 Prevention of a Possible (but Not Probable) Suicide 56 --
7.7 Refusing Investigation of Possible Cancer 56 --
7.8 Fine-Tuning the Psyche 56 --
7.9 Psychoative Drugs for Young Children 57 --
7.10 Mental Health Parity 58 --
Chapter 8 Valid Informed Consent and Compliance Problems 60 --
Valid Informed Consent 60 --
8.1 Being Asked "What Would You Do?" 61 --
8.2 Irrational Treatment Refusal in an Emergency 61 --
8.3 A Mildly Mentally Retarded Patient Consents 62 --
8.4 Suspicions About Substances 63 --
8.5 A Relative's Consent for an Unwanted Procedure 63 --
8.6 Omitting Quantitative Mention of Degree of Uncertainty 64 --
8.7 A Patient Doesn't Remember Consent Specifics 64 --
8.8 Treatment Decision Under Stress 65 --
8.9 Noncompliance and Pressure 66 --
8.10 Responses to Noncompliance 66 --
8.11 Noncompliance of a Tuberculosis Carrier 67 --
Chapter 9 Health Care Options, Culture, and Diversity 68 --
9.1 Choosing Alternative Health Care Treatments 69 --
9.2 What Is Quackery? 69 --
9.3 Diversity and Limits: Female Circumcision 70 --
9.4 Religious Grounds for Rejecting Medical Care: Faith Healing 72 --
9.5 Jehovah's Witness Parents Refuse Transfusion 72 --
9.6 Sex Selection of a Physician: Four Vignettes 73 --
9.8 Is Intolerance Intolerable? 74 --
9.9 By Faith Alone? 75 --
9.10 Deaf Culture and Cochlear Implants 76 --
9.11 Wrong About One's Own Religion? 77 --
9.12 Some Hypotheticals About Pain, Pain Management, and Culture 77 --
9.14 Other Cultures: Other Facts and Other Values? 79 --
9.15 Respecting Cultural Diversity and Health 80 --
Chapter 10 Information: Communication and Confidentiality 81 --
Limits to Confidentiality 81 --
Withholding of Information 82 --
10.1 Withholding Important Genetic Information from a Family 83 --
10.2 Pressing Someone to Admit Spousal Abuse 83 --
10.3 Elevator and Cafeteria Conversations 84 --
10.4 A Patient's History in Print 84 --
10.5 Sharing Patient Information with One's Spouse 85 --
10.6 Who Should Know What? 85 --
10.7 A Duty to Warn? 86 --
10.8 Truth-Telling and Terminal Illness: Lying about Dying 87 --
10.9 Paternity Information Emerging in Genetic Counseling 87 --
Chapter 11 HIV/AIDS 89 --
11.1 A Patient's Request Not to Tell Partners 91 --
11.2 Hope and Power: HIV Patients' Access to Unapproved Drugs 91 --
11.3 Funding for AIDS versus for Other Diseases 92 --
11.4 HIV Risks to Patients? 92 --
11.5 Less-Than-Universal Precautions 93 --
11.6 Testing for HIV and Hepatitis: Three Vignettes 93 --
11.7 Refusal to Treat: Choice or Discrimination? 94 --
Chapter 12 Reproduction, Genetics, and Abortion 95 --
Reproductive Technology and Genetics 95 --
12.1 Postmortem Sperm "Donation" 97 --
12.2 Questioned Requests for Assisted Reproduction: Four Vignettes 97 --
12.3 Frozen Embryo Brouhaha 98 --
12.4 In Vitro Fertilization: Helpful or Wasteful? 99 --
12.5 Reproductive Assistance for a Same-Sex Couple 99 --
12.6 Privatizing the Sale of Sperm and Ova 100 --
12.7 Performing Surrogate Pregnancy as a Living 100 --
12.8 DNA Banks: Two Vignettes 101 --
12.9 Eugenics: Positive or Negative? 102 --
12.11 Objection to an Abortus-Derived Vaccine 104 --
12.12 Use of Embryonic Stem Cells to Heal 104 --
12.13 Stem Cells, Potentiality, and Moral Status 105 --
12.14 Considering an Abortion 106 --
12.15 Seeking Prenatal Diagnosis for a Possible Sex-Choice Abortion 106 --
12.16 Moral or Legal Responsibilities During Pregnancy? 107 --
12.17 Amniocentesis: Risks and Indications 108 --
12.18 RU-486 and Abortion 108 --
12.19 Partial Birth Abortions (Or Whatever They Should Be Called) 109 --
12.20 Building a Better Mouse 110
12.21 A Reproductive Strategy: Pre-Tests and Post-Tests 110 --
Chapter 13 Life and Death Decisions, Part I: Assisted Suicide and Other Patient Requests About Dying 112 --
Drawing Distinctions 112 --
13.1 The Case of Dr. Nekroviak 113 --
13.2 Assisting a Dying Patient's Suicide 114 --
13.3 Assisting the Suicide of a Chronically Ill Patient Who Is Not Dying 114 --
13.4 Ignoring a Living Will at a Daughter's Insistence 115
13.5 Interpreting Advance Directives 115 --
13.6 Discontinuing Nutrition and Hydration 116 --
13.7 Voluntary Active Euthanasia: Unthinkable? About Time? 117 --
Chapter 14 Life and Death Decisions, Part II: Deciding Limits of Life-Prolonging Treatments 119 --
14.1 Limiting Care by Age 120 --
14.2 Someone Once Recovered: A Single Instance 120 --
14.3 Just Venting? 121 --
14.4 Treatments Judged "Not Clinically Indicated:" Three Vignettes 121 --
14.5 "We Don't Have to Begin This Treatment, but Once We Do ..." 122 --
14.6 Do-Not-Resuscitate Problems: Two Vignettes 122 --
14.8 Mental Retardation and Quality-of-Life Judgments 124 --
14.9 Deciding Whether to Offer Options: Metastatic Cancer and Pneumonia 124 --
14.10 Limits of Prematurity 125 --
14.11 Trisomy Quandary 125 --
14.12 Conjoined Twins 126 --
14.13 Persistent Vegetative State 127 --
14.14 Refusing Treatment for a Patient with Brain Damage 128 --
14.15 The Search for Medical Futility: Not Necessarily Hopeless 128 --
14.16 Be Still, My Heart 129 --
Chapter 15 Allocation and Access 131 --
Criteria for Allocating Scarce Resources 131 --
Transplantation Issues 132 --
Pricing, Valuing, and Rationing 132 --
15.1 Access to Health Care 133 --
15.2 Poor Access to the System 133 --
15.3 A Plan to Ration Care 134 --
15.4 Refusal to Accept Patients: Freedom or Disregard? 134 --
15.5 Second and Third Transplants 135 --
15.6 An Anencephalic Baby as an Organ Donor 136 --
15.7 A Family's Media Campaign 137 --
15.8 Celebrities and Advocacy 137 --
15.9 One Last Question: Asking for Organs 138 --
15.10 Estate Sale of One's Organs 138 --
15.11 Selling Organs 139 --
15.12 Plasma "Donation" and Justice 139 --
15.13 Sale of Tissues and Organs 140 --
15.14 Ranking Recipient Candidates: Four Vignettes 140 --
15.15 Waiting for a Transplant 141 --
15.16 A Smoker's Claim to Health Care Resources 142 --
15.17 Tobacco Litigation and Responsibility 142 --
15.18 Costing Kids 143 --
15.19 Negligent Birth? 144 --
15.20 DALYs and QALYs 145 --
15.21 Creating Fraudulent Diagnoses to Enable Treatment 146 --
Chapter 16 Other Issues 148 --
Health Risks and Responsibility 148 --
Short-Term Goals; Aesthetic Goals 148 --
Puzzles about Identity 149 --
16.1 Alcohol Use Issues 149 --
16.2 Obesity Issues 150 --
16.3 Tobacco: Risks, Responsibilities, and Public Health 150 --
16.4 A Reasonable Health Concern, Anxiety, or Phobia? 151 --
16.5 Puzzles about Referrals 152 --
16.6 Lack of Health Screening 153 --
16.7 Patching up an Athlete 153 --
16.8 Enhancement or Therapy? 154 --
16.10 A Place for a Placebo? 155 --
16.11 A Whole New Kind of Person 156 --
16.12 He Doesn't Think; Therefore, What? 156 --
Ethical Theory Glossary 158 --
Clinical Ethics Glossary 163 --
Approaching Ethical Problems: A Guide to Analysis 168 --
Don'ts: Some Unproductive Theories and Approaches 168 --
Possible Do's: Some More Promising Approaches 172 --
The Hippocratic Oath 177 --
The Nuremberg Code 178 --
World Medical Association Declaration of Helsinki 179 --
International Code of Medical Ethics 183 --
Declaration of Geneva 184 --
A Patient's Bill of Rights 185 --
American Medical Association Principles of Medical Ethics 187 --
Code of Ethics for Nurses
The ICN Code of Ethics for Nurses 189.
