Tough Decisions: Cases in Medical Ethics / Edition 2

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Overview


Life is full of tough decisions that must be made ethically and under the pressures of time. This book places readers in realistic situation where they experience the difficulties of making tough medical decisions. The cases are composites of actual cases the authors have seen or managed. In the role of decision-maker, the reader helps to determine what happens in the case as his or her decision often shapes the course of events and the patient's outcome. This gives a compelling sense of the pressures that bear on clinical decision-making. The authors assume that the reader wants to do the right thing, but faces the problem of determining what the right thing will be when information is necessarily incomplete and the future unknown. Ethical theory emerges as others involved in the case offer different views of what is right in a particular medical situation. Two concluding chapters discuss the major theories of medical ethics, but there are no answers in the back of the book. Instead, the book will familiarize readers with some of the ethical principles and issues critical to the practice of medicine to patients and their families.

"...presents realistic composites of cases the authors have actually seen or managed where they must make tough medical decisions...provides a good sense of the pressures that bear on clinical decision making.

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Product Details

  • ISBN-13: 9780195090420
  • Publisher: Oxford University Press, USA
  • Publication date: 10/28/2000
  • Edition description: REV
  • Edition number: 2
  • Pages: 248
  • Sales rank: 482,185
  • Product dimensions: 8.90 (w) x 5.90 (h) x 0.80 (d)

Meet the Author

Johns Hopkins University School of Medicine, Baltimore, MD

Saint Mary's College, Notre Dame, ID

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Table of Contents

A Note to the Reader
Ch. 1 Maggie 3
Summary: A retirement home resident suffers cardiac arrest. Should she be resuscitated?
Issues: Do-not-resuscitate orders - should they always be followed? Legal liability and medical decisions, patient control, advance directives
Ch. 2 Jill 11
Summary: A patient with disseminated breast cancer approaches a physician for help in her dying
Issues: Physician-assisted suicide, autonomy, the social role of physicians
Ch. 3 Ed Martinez 17
Summary: A patient suffers cardiac arrest during routine surgery. How aggressively should his care be managed, especially as the prognosis worsens?
Issues: Killing vs letting die: when, how, and why may support be withdrawn? May a respirator be removed? May feeding be discontinued? Organ transplantation, Euthanasia
Ch. 4 Leon 33
Summary: Worsening headaches and confused speech lead Leon's doctor to recommend a brain biopsy. Should Leon and his wife consent?
Issues: Informed consent and rational decision making
Ch. 5 Ms. Williams 43
Summary: A patient chooses the characteristics she wants in her physician
Issues: Paternalism, honesty, and the art of medicine
Ch. 6 Wanda 49
Summary: A woman with HIV infection is unable and unwilling to control her sexual behavior, posing a threat to the health of many in the community
Issues: Confidentiality, rights of the handicapped, and the politics of disease
Ch. 7 The Maxistop Study 59
Summary: An Institutional Review Board examines a proposal and consent form for human subjects research
Issues: Risks and benefits of research. Incentives for subjects and investigators. Informed consent. Ethics of placebo trials
Ch. 8 Joey, Jessica, Roger, Tom, and Marti 69
Summary: A group of children in a crowded intensive care unit. Space is needed for new patients
Issues: Rights, responsibilities, obligations, and social utility. Conflicts and their interaction with varying medical disorders and prognoses
Ch. 9 Marti Revisited 87
Summary: Staff on rounds discuss long-term plans for Marti, a quadriplegic 12-year-old, and consider her request to discontinue the respirator
Issues: Autonomy and the depressed adolescent. Rational suicide
Ch. 10 Tom Revisited 93
Summary: Staff discuss long-range plans for Tom, a child with multiple chronic medical and developmental problems
Issues: Informed consent and fair vs. manipulative presentation of facts. Parental rights and reasonable decision making
Ch. 11 Billy 101
Summary: An elderly physician schedules a tonsillectomy for a young patient. The treatment may not be needed and the physician has not done the procedure in several years
Issues: Adequate information for patients and families. Physician competence
Ch. 12 The Castelli Baby 107
Summary: A baby is born with a number of serious problems. As her condition deteriorates, is there a point at which aggressive therapy should be stopped?
Issues: Informed consent for parents, "Baby Doe" regulations, and the character of the good doctor
Ch. 13 Christie 123
Summary: A newborn with spina bifida. Given her handicaps, should an operation be performed that would prevent infection and probable death? Outcome at three months and three years
Issues: Informed consent and the presentation of information. Quality of life, parental conflict of interest, medical outcomes, and moral decisions
Ch. 14 The Harrisons' Plans 149
Summary: A couple chooses a surrogate mother for their child, but finds she is unwilling to undergo a cesarean section when the baby's life is at risk
Issues: Surrogacy - obligations of parties in surrogacy arrangements. Coerced surgery
Ch. 15 The Smyth Saga 155
Summary: A couple, one of whom has a family history of Huntington's disease, contemplates a pregnancy
Issues: Confidentiality - family, employers, insurers; genetic testing, honesty
Ch. 16 The Perfect Rexford 163
Summary: A couple debates what they want for their child and the genetic devices available for producing offspring
Issues: Genetic manipulation, choosing for others, parental control
Ch. 17 Affordable Health Care 173
Summary: Advisors review a presidential candidate's speech on health care reform
Issues: Social justice, social welfare, and individual responsibility. Fairness int he social structure of American health care
Ch. 18 Ethical Theory and Medical Ethics 185
A brief presentation of the major theories of medical ethics
Ch. 19 Making Moral Decisions: A Process Approach 213
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