Resolving Ethical Dilemmas / Edition 6

by Bernard Lo MD

Overview

What are the ethical issues raised by the increasing use of big data and artificial intelligence in health care?
How should physicians respond when they have a conscientious objection to an intervention requested by a patient? How should health care organizations respond to physician requests?
How can physicians best help patients make informed decisions about end-of-life and life-sustaining care?
How should interns and residents respond to ethical dilemmas created by duty hours restrictions?

Resolving Ethical Dilemmas: A Guide for Clinicians helps residents, students, and practitioners work through these and many more common and challenging ethical questions that affect patient care. The 6th Edition reflects important changes in medicine and healthcare policy and provides additional clarity to complex concepts. Offering practical, real-world advice, it helps you think through and resolve difficult cases, prompting thoughtful, well-reasoned answers to the question of “What do I do in this situation?”


• Begins with a concise discussion of clinical ethics that provides background information essential to understanding key ethical issues.
• Explores a wide range of real-world ethical dilemmas, each accompanied by expert guidance on salient issues and how to approach them.
• Provides new insights on cases related to oncology, palliative care, family medicine, clinical practice guidelines, genetic testing, the electronic health record, opioid prescriptions, evidence-based medicine, ambulatory care, quality improvement, and advance care planning.
• Helps you work thorough challenges such as how to handle changes arising from the Affordable Care Act, how to manage treatment when it no longer works for the patient, and much more.
• Uses a highly visual, two-color design to facilitate retention of material.

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Product Details

ISBN-13:	9781975103545
Publisher:	LWW
Publication date:	03/20/2019
Edition description:	Sixth
Pages:	384
Sales rank:	523,791
Product dimensions:	6.90(w) x 9.90(h) x 0.60(d)

Table of Contents

Preface to the First Edition vii

Preface to the Sixth Edition ix

Section I Fundamentals of Clinical Ethics

1 An Approach to Ethical Dilemmas in Patient Care 3

2 Overview of Ethical Guidelines 13

3 Informed Consent 20

4 Promoting the Patient's Best Interests 33

5 Confidentiality 42

6 Avoiding Deception and Nondisclosure 51

7 Keeping Promises 61

Section II Shared Decision-Making

8 An Approach to Decisions About Clinical Interventions 67

9 Decision-Making Capacity 69

10 Refusal of Treatment by Competent, Informed Patients 77

11 Who Serves as Surrogate When a Patient Lacks Decision-Making Capacity? 81

12 Standards for Decisions When Patients Lack Decision-Making Capacity 87

13 Persistent Disagreements Over Care 100

14 Potentially Inappropriate Interventions 109

Section III Decisions About Life-Sustaining Interventions

15 Confusing Ethical Distinctions 117

16 Ethics Consultations and Ethics Committees 126

17 Do Not Attempt Resuscitation Orders 131

18 Tube and Intravenous Feedings 140

19 Physician-Assisted Suicide and Active Euthanasia 146

20 Unresponsive Wakefulness and the Minimally Conscious State 157

21 Determination of Death 162

22 Legal Rulings on Life-Sustaining Interventions 167

Section IV The Doctor-Patient Relationship

23 Overview of the Doctor-Patient Relationship 175

24 Refusal to Care for Patients 179

25 Gifts from Patients to Physicians 188

26 Sexual Contact Between Physicians and Patients 193

27 Secret Information About Patients 200

28 Clinical Research 203

Section V Conflicts of Interest

29 Overview of Conflicts of Interest 211

30 Health Outcomes, Access, and Cost in the United States 217

31 Payments to Health Care Providers 220

32 Bedside Rationing of Health Care 227

33 Gifts from Drug Companies 234

34 Disclosing Errors 240

35 Impaired Colleagues 248

36 Ethical Dilemmas Students and House Staff Face 254

Section VI Ethical Issues in Clinical Specialties

37 Ethical Issues in Pediatrics 267

38 Ethical Issues in Surgery 276

39 Ethical Issues in Obstetrics and Gynecology 284

40 Ethical Issues in Psychiatry 292

41 Ethical Issues in Organ Transplantation 299

42 Ethical Issues at the Intersection of Public Health and Clinical Medicine 310

43 Ethical Issues in Caring for Diverse Populations 320

44 Ethical Issues with Digital Health Information 330

45 Ethical Issues in Genomic Medicine 338

46 Ethical Issues with Big Data and Artificial Intelligence 348

Cases for Discussion 357

Index 370

Editorial Reviews

Reviewer: Jaime Konerman-Sease, PhD (c)(Saint Louis University)
Description: The sixth edition of this familiar book on ethical issues in the clinic addresses common dilemmas in medicine as well as strategies to resolve them through shared decision making. This slightly updated version incorporates new scholarship and cultural shifts. The fifth edition was published in 2013.
Purpose: The author addresses common ethical concerns in the medical community primarily from the perspective of physicians. He uses cases to address ethical dilemmas physicians might encounter in everyday practice. He balances descriptions of philosophical underpinnings of ethical dilemmas with everyday physician experience. In this way, he succeeds in providing an introduction to medical ethics for young physicians.
Audience: The book is intended for physicians. It presents too narrow an understanding of the team involved in resolving ethical dilemmas in healthcare and does not adequately address the roles of other clinicians, which limits its appropriateness as a classroom textbook.
Features: The book addresses the most common ethical dilemmas in medicine, and this edition updates many of these typical debates to reflect recent scholarship and public opinion. Significantly, the section on shared decision-making has changed substantially in organization. There is a new chapter on potentially inappropriate intervention instead of futility. This change reflects the shift away from unilateral physician decisions and determines that "futility" disagreements are about conflicting value judgments rather than disputed medical facts. However, the beginning of the chapter is still the same, discussing a strict and loose definition of futility. The author has greatly improved the chapter on genomic marketing, and the added discussions of direct-to-consumer genetic testing and ancestry testing are timely inclusions. The author also questions the culture of "nondirectiveness" in genetic counseling, which is a much-needed position in introductory education on genomic medical ethics. There was a great opportunity in this edition to include updated information about caring for disabled patients, disability stigma, and the social model of disability in medicine, but it does not include any relevant or helpful information regarding disability in clinical ethics. The one inclusion of disability certification is done so in a harmful and stereotypical way. It accepts the unfortunate belief that disability is manufactured by patients for ulterior motives. There needs to be a substantial reflection on the treatment of people with disabilities in the medical community.
Assessment: This book is incredibly useful for introductory courses in medical and clinical ethics. No other book in the field offers such a comprehensive guide to common ethical dilemmas and generally agreed upon definitions. Continual updates are justified as clinical ethics continues to shift with changing technology, laws, and public opinion. However, this book is often used to educate various health sciences disciplines in healthcare ethics, so the focus on physicians is too narrow. Rather, it should incorporate a generalized clinician perspective into the dilemmas and cases. This edition includes many necessary changes, but it also neglected important areas. Despite these shortcomings, it remains one of the best resources for clinical ethics educators.

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