Intervention and Reflection: Basic Issues in Bioethics / Edition 9 available in Hardcover
INTERVENTION AND REFLECTION: BASIC ISSUES IN BIOETHICS, 10th Edition offers students a compelling introduction to biomedical ethics by combining riveting human stories with clear explanations of cutting edge scientific research. A collaboration between a nationally-acclaimed bioethicist and a seasoned journalist, this textbook continues to be the most widely used bioethics textbook on the market. Each chapter includes crisp summaries of the relevant ethical theories as well as classic and contemporary articles on the most pressing topics in the field. This edition features new chapters on "Medicine in a Pluralistic Society" and the "Challenge of Global Bioethics. The accessible presentation of the conceptual debate and human dimension of today's biomedical ethics captivates and engages students, whether they are philosophy, nursing or medical majors or have no philosophical or scientific training.
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About the Author
Ronald Munson is Professor of Philosophy of Science and Medicine at the University of Missouri-St. Louis and a nationally acclaimed bioethicist. After receiving his Ph.D. from Columbia University, he was a Postdoctoral Fellow in Biology at Harvard University and a Visiting Fellow at the Harvard Medical School. Munson has served as a bioethicist for the National Eye Institute and the National Cancer Institute, as an editor for the AMERICAN JOURANAL OF SURGERY, and as a member of the Washington University Human Studies Committee. Munson's other books include RAISING THE DEAD: ORGAN TRANSPLANTS, ETHICS, AND SOCIETY, THE WOMAN WHO DECIDED TO DIE: CHALLENGES AND CHOICES AT THE EDGES OF MEDICINE, REASONING IN MEDICINE, and ELEMENTS OF REASONING, 7e (with Andrew Black). He is also the author of the novels NOTHING HUMAN, FAN MAIL, NIGHT VISION, and THE HARVARD GAME.
Ian Lague is a journalist and editor based in Portland, Oregon. He received his M.A. from Columbia University's Graduate School of Journalism, with a special focus on health reporting, and holds a philosophy degree from Swarthmore College. A former Managing Editor of BOSTON REVIEW, he has edited and written articles on such topics as the prescription drug wholesale industry, distributive justice in caregiving, and the role of public funding in private healthcare enterprises. He is a co-editor, with Joshua Cohen, of THE PLACE OF TOLERANCE IN ISLAM (Beacon Press, 2002), and has served as a developmental editor for college textbooks in Applied Ethics, Bioethics, and Critical Thinking.
Table of Contents
1. PHYSICIANS, PATIENTS, AND OTHERS: ROLES AND RESPONSIBILITIES Case Presentation: Donald (Dax) Cowart Rejects Treatmentand Is Ignored. Social Context: Autism and Vaccination. Case Presentation: Faith and Medicine. Social Context: For Their Own GoodPlacebos and Paternalism. Social Context: The Obesity EpidemicAutonomy versus Public Health? Case Presentation: The Psychology of Torture. Case Presentation: Healing the Hmong. BRIEFING SESSION: Autonomy. Paternalism. Informed Consent and Medical Interests. Informed Consent and "Do No Harm." Whose Consent? Whose Interests? Parents and Children. Pregnancy and Autonomy. Truth-Telling in Medicine. Placebos. Dignity and Consent. Confidentiality. Duty to Warn? Heath Insurance and Confidentiality. HIPAA Regulations. Ethical Theories: Autonomy, Truth-Telling, Confidentiality. READINGS: Onora O'Neill: Paternalism and Partial Autonomy. Gerald Dworkin: Paternalism. Dax Cowart and Robert Burt: Confronting DeathWho Chooses, Who Controls? A Dialogue. Gerald Dworkin: Patients and Prisoners. Anita Catlin: The Dilemma of Jehovah's Witness Children Who Need Blood to Survive. Eugene Rosam: Reply to Anita Catlin. Michelle Gold: Is Honesty Always the Best Policy? Susan Cullen and Margaret Klein: Respect for Patients, Physicians, and the Truth. Mark Siegler: Confidentiality in MedicineA Decrepit Concept. Supreme Court of California: Decision in the Tarasoff Case. DECISION SCENARIOS: 1. When Prayer is Not Enough. 2. Protecting Against Disease. 3. Weight Cops. 4. Maternal-Fetal Conflict. 5. Pregnancy vs. Autonomy? 6. Should Doctors Take "No" for an Answer? 7. Vampire Confession. 8. Nurse or Executioner? 2. RESEARCH ETHICS AND INFORMED CONSENT Case Presentation: The Afterlife of Henrietta LacksConsent, Research, and Race. Case Presentation: Abigail Alliance v. FDADo Terminally III People Have a Right to Take Experimental Drugs? Case Presentation: Jesse GelsingerThe First Gene-Therapy Death. Case Presentation: From Vioxx to the ASR ImplantDo Research Sponsors Suppress Bad News? Social Context: Prisoners as Test Subjects? Social Context: The Cold-War Radiation Experiments. Case Presentation: The Willowbrook Hepatitis Experiments. Case Presentation: Baby Fae. BRIEFING SESSION: Clinical Trials. The "Informed" Part of Informed Consent. The "Consent" Part of Informed Consent. Vulnerable Populations. Medical Research and Medical Therapy. Investigators and Financial Conflict. Placebos and Research. Therapeutic and Nontherapeutic Research. Medical Research in a Pluralistic Society. Research Involving Children. Research Involving Prisoners. Research Involving the Poor. Offshore Research. Research Involving the Terminally Ill. Research Involving Fetuses. Research Involving Animals. Ethical Theories: Medical Research, and Informed Consent. READINGS: Stephen Goldby, Saul Krugman, et al.: The Willowbrook Letters: Criticism and Defense. Paul Ramsey: Judgment on Willowbrook. Principles of the Nuremberg Code. World Medical Association: Declaration of Helsinki. National Commission for the Protection of Human Subjects: Belmont Report. Hans Jonas: Philosophical Reflections on Experimenting with Human Subjects. Deborah and Samuel Hellman: Of Mice But Not MenProblems of the Randomized Clinical Trial. Eugene Passamani: Clinical Trials: Are They Ethical? Marcia Angell: Drug Companies and MedicineWhat Money Can Buy. Emma D'Arcy: A Partnership Worth Promoting. Judith Rogers: Majority Opinion in Abigail Alliance v. FDA. Thomas B. Griffith: Dissenting Opinion in Abigail Alliance v. FDA. Peter Singer: Animal Experimentation. Carl Cohen: The Case for the Use of Animals in Biomedical Research. DECISION SCENARIOS: 1. A Right to Try? 2. Genuine Consent? 3. Guinea-Pigging. 4. Facebook Lab Rats? 5. Phase I and Consent. 6. Using Nazi Data. 7. Tissue Theft? 8. Boyd Rush: The First Animal-Human Transplant. 9. When the Numbers are Small, Can a Trial Be Ethical? 10. Primate Head Trauma. 3. GENETIC CONTROL. Case Presentation: Genae Girard and Gene Patents. Social Context: The Promise of Precision Medicine. Case Presentation: The CRISPR Revolution. Case Presentation: Testing for Genetic RiskThe Angelina Jolie Effect. Social Context: Prenatal Genetic Testing. Case Presentation: Huntington's Disease. Case Presentation: The Threat of Genetic Discrimination. Case Presentation: Gene Therapy: Progress and Peril. Social Context: The Human Genome Project. Social Context: Stem CellsThe End of the Battle? BRIEFING SESSION: Genetic Intervention: Screening Counseling and Diagnosis. Prenatal Genetic Diagnosis. Ethical Difficulties with Genetic Intervention. Negative and Positive Eugenics. Germ Cell Selection and Engineering. Ethical Difficulties with Eugenics. Genetic Research, Therapy, and Technology. Recombinant DNA. Gene Therapy and Gene Editing. Biohazards and GMOs. Ethical Difficulties with Genetic Research, Therapy, and Technology. READINGS: Jeff McMahan: The Morality of Screening for Disability. Dena Davis: Genetic Dilemmas and the Child's Right to an Open Future. Julian Savulescu: Why We Should Select the Best Children. Michael Sandel: The Case Against Perfection. Bonnie Steinbock: Disability, Prenatal Testing, and Selective Abortion. Leon Kass: Implications of Prenatal Diagnosis for the Human Right to Life. Gerard Magill and William Neaves: Ontological and Ethical Implications of Direct Nuclear Reprogramming. Pontifical Academy for Life: Declaration on the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells. DECISION SCENARIOS: 1. Improving Society One Embryo at a Time. 2. A Child Like Us. 3. Screening for Marriage. 4. DNA Dragnet? 5. A Duty Not to Reproduce? 6. A Duty to Tell or To Remain Silent? 7. Choosing Sexual Orientation? 4. REPRODUCTIVE CONTROL Case Presentation: Brave New Families. Case Presentation: Louise BrownThe First "Test-Tube Baby." Case Presentation: Egg and Sperm Donors. Social Context: Advances in Reproductive Cloning. Case Presentation: Savior Sibling. Case Presentation: Baby M and Mary Beth WhiteheadSurrogate Pregnancy in Court. Case Presentation: The Calvert CaseA Gestational Surrogate Changes Her Mind. BRIEFING SESSION: Techniques of Assisted Reproduction. Donors, Recipients, and Surrogates. Sperm and Egg Donors. Embryos. Cloning and Twinning. General Criticisms of ART. Impact on Children. Impact on the Family. Eugenics. Dysgenics. Cloning. Ethical Theories and Reproductive Control. READINGS: Cynthia B. Cohen: New Reproductive Technologies and Harm to Children. Gillian Hanscombe: The Right to Lesbian Parenthood. Congregation for the Doctrine of the Faith: Instruction on Respect for Human Life in its Origin. Leon Kass: The Wisdom of Repugnance. Carson Strong: The Ethics of Human Reproductive Cloning. Bonnie Steinbock: Surrogate Motherhood as Prenatal Adoption. Elizabeth S. Anderson: Is Women's Labor a Commodity? DECISION SCENARIOS: 1. The Perils of Multiple Pregnancy. 2. Looking for the Family Tree. 3. Embryo = Person? 4. Surrogacy and Morality. 5. A Matter of Autonomy? 6. A Replacement Child? 7. An Interest in Existing? 8. Family Balance? 5. ABORTION Case Presentation: When Abortion was IllegalThe Odyssey of Sherri Finkbine. Case Presentation: Roe v. Wade. Social Context: A Statistical Profile of Abortion in the United States. Social Context: Plan B and Emergency Contraception. Case Presentation: The Rise of Medication Abortion. Social Context: The "Partial-Birth Abortion" Controversy. Social Context: Supreme Court Abortion Decisions After Roe v. Wade. Social Context: State Abortion LawsRolling Back Roe? BRIEFING SESSION: Gestational Development. Abortion and Pregnancy. The Status of the Fetus. Pregnancy, Abortion, and the Rights of Women. Therapeutic Abortion. Abortion and the Law. Ethical Theories and Abortion. READINGS: Judith Jarvis Thomson: A Defense of Abortion. Don Marquis: Why Abortion Is Immoral. Mary Anne Warren: On the Moral and Legal Status of Abortion. Patrick Lee and Robert George: The Wrong of Abortion. DECISION SCENARIOS: 1. Emergency Contraception. 2. After the Concert. 3. A Procedure by Another Name. 4. Mail Order Miscarriage. 5. Disabled and Pregnant. 6. Whose Life? 7. Fetal Reduction. 8. A Family Tragedy. 9. Unexpected News. 6. THE DILEMMA OF SEVERELY IMPAIRED INFANTS Case Presentation: The Agony of Bente Hindriks. Social Context: The Dilemma of Extreme Prematurity. Case Presentation: Baby OwensDown Syndrome and Duodenal Atresia. Social Context: The Baby Doe Cases. Case Presentation: Baby KAn Anencephalic Infant and a Mother's Request. BRIEFING SESSION: Genetic and Congenital Impairments. Specific Impairments. Down Syndrome. Spina Bifida. Hydrocephaly. Anencephaly. Esophageal Atresia. Duodenal Atresia. Problems of Extreme Prematurity. Amniocentesis and CVS. Triple Test. Cell-Free DNA Analysis. Ethical Theories and the Problem of Birth Impairments. READINGS: James Lemuel Smith: The Groningen Protocol. Ashley's Mom and Dad: The "Ashley Treatment." S. Matthew Liao, Julian Savulescu, and Mark Sheehan: The Ashley TreatmentBest Interests, Convenience, and Parental Decision Making. John A. Robertson: Examination of Arguments in Favor of Withholding Ordinary Medical Care from Defective Infants. H. Tristram Engelhardt, Jr.: Ethical Issues in Aiding the Death of Young Children. DECISION SCENARIOS: 1. Wrongful Life? 2. Another Ashley? 3. No Food, No Water? 4. The Messenger Case. 6. Pointless Suffering? 7. EUTHANASIA AND PHYSICIAN-ASSISTED DEATH Case Presentation: Brittany Maynard and Physician-Assisted Death. Social Context: When the Diagnosis is Death. Case Presentation: Karen Quinlan. Social Context: The Cruzan CaseThe Supreme Court Upholds the Right to Die. Case Presentation: Jack KevorkianMoral Leader or Dr. Death? Case Presentation: Terri Schiavo. BRIEFING SESSION: Active and Passive Euthanasia. Voluntary, Involuntary, and Nonvoluntary Euthanasia. Defining Death. Advance Directives and Refusal of Treatment. Death and Meaning. Ethical Theories and Euthanasia. READINGS: James Rachels: Active and Passive Euthanasia. Winston Nesbitt: Is Killing No Worse Than Letting Die? J. Gay-Williams: The Wrongfulness of Euthanasia. Peter Singer: Voluntary Euthanasia: A Utilitarian Perspective. Supreme Court of New Jersey: In the Matter of Karen Quinlan. David DeGrazia: Advance Directives, Dementia, and 'The Someone Else Problem.' DECISION SCENARIOS: 1. Not the Same Person 2. The Timothy Quill Case. 3. What Would He Want? 4. The Bartling Case. 4. Angel of Mercy? 8. ORGAN TRANSPLANTS AND SCARCE MEDICAL RESOURCES Case Presentation: Lungs for Sarah Murnaghan. Case Presentation: Did Steve Jobs Buy A Liver? Social Context: Acquiring and Allocating Transplant Organs. Case Presentation: The Prisoner Who Needed a Heart. Case Presentation: The "God Committee"Distributing Dialysis in Seattle. Case Presentation: Transplants and Disability. BRIEFING SESSION: Transplants, Kidneys, and Machines. Controlling Rejection. Allocation and Scarcity. Seattle and Kidney Machines. Dialysis Costs and Decisions. Microallocation vs. Macroallocation. Ethical Theories and the Allocation of Medical Resources. READINGS: Jacob M. Appel: Kidney Transplantation in Inmates Awaiting Execution. Carl Cohen et. al.: Alcoholics and Liver Transplantation. Ronald Munson: The Donors' Right to Take a Risk. Janet Radcliffe-Richards, et al.: The Case for Allowing Organ Sales. Kishore D. Phadke and Urmila Anandh: Refuse to Support the Illegal Organ Trade. George J. Annas: Rationing Schemes for Organ Transplantation. Ezekial J. Emaneuel and Alan Wertheimer: Who Should Get Influenza Vaccine When Not All Can? DECISION SCENARIOS: 1. First-Come, First-Served? 2. Robbing the Dead? 3. Taking a Chance for Love. 4. Buying a Liver. 5. Selling a Kidney. 6. Lifestyle Factors. 7. How Many Livers Are Fair? 8. Who Gets the Ventilators? 9. DISTRIBUTING HEALTH CARE Case Presentation: The Way It WasRobert Ingram Can't Afford to be Sick. Social Context: The Affordable Care Act. Social Context: The Health Care CrisisThe Road to Reform. BRIEFING SESSION: Needs and Rights. Claim Rights, Legal Rights, and Statutory Rights. Moral Rights. Political Rights. Health Care as a Right. Objections. READINGS: Kai Nielsen: Autonomy, Equality, and a Just Health Care System. Norman Daniels: Equal Opportunity and Health Care. Mark Hall and Richard Lord: ObamacareWhat the Affordable Care Act Means for Patients and Physicians. Avik Roy: How to Transcend Obamacare. John Geyman: Some Lessons from the Affordable Care Act's First Five Years. DECISION SCENARIOS: 1. Free Rider. 2. Custodial Care. 3. Rationing or Realism? 4. Not the Best Option. 5. Should Women Pay Higher Premiums? 10. MEDICINE IN A PLURALISTIC SOCIETY Social Context: Women, Men, and Biomedical Research. Case Presentation: Policing Pregnancy. Case Presentation: The Tuskegee Syphilis StudyBad Blood, Bad Faith. Social Context: Race, Poverty, and DisparityA Crisis in Public Health. Case Presentation: BiDil and BeyondThe Controversy Over Race-Based Medicine. Case Presentation: The Bouvia PrecedentPatient Autonomy or Disability Discrimination? Case Presentation: Lee Larson and Cochlear Implants. Case Presentation: Intersex CareBeyond Shame and Surgery. Social Context: The DSM and Sexual Minorities. BRIEFING SESSION: Concepts of Race and Ethnicity. Traditional Concepts of Race. Race as Proxy. Race as Construct. Concepts of Sex, Gender, and Sexuality. Concepts of Sex. Concepts of Gender. Concepts of Sexual Orientation. Concepts of Disability. Medical Concepts of Disability. Social Concepts of Disability. Disability as Difference. Nature and Norms. READINGS: Hilde Lindemann, The Woman Question in MedicineAn Update. Howard Minkoff and Lynn M. Paltrow: The Rights of "Unborn Children" and the Value of Pregnant Women. Patricia King: The Dangers of Difference: Legacy of the Tuskegee Syphilis Study. Dorothy Roberts: What's Wrong with Race-Based Medicine? Annette Dula: Toward an African-American Perspective on Bioethics. Tia Powell and Edward Stein: Legal and Ethical Concerns about Sexual Orientation Change Efforts. Alice Dreger: Sex Beyond the Karyotype. Susan Wendell: Who Is Disabled? Defining Disability. Thomas Szasz, The Myth of Mental Illness. DECISION SCENARIOS: 1. Gender and Clinical Trials. 2. Racism and Patient Autonomy. 3. Pregnancy and Cocaine. 4. Gender Dysphoria? 5. Neurodiversity 6. Race-Based Medicine? 11. THE CHALLENGE OF GLOBAL BIOETHICS Case Presentation: "The Devil's Experiment"STD Research in Guatemala. Social Context: Clinical Trials in the Developing World. Social Context: PandemicAIDS Worldwide. Case Presentation: Cutting and Culture BRIEFING SESSION. Duty and Disparity. Globalized Clinical Trials? Relativism and Pluralism. READINGS. David Resnik: The Distribution of Biomedical Research Resources and International Justice. A.J. McMichael et al: Global environmental change healthimpacts, inequalities, and health sector. George Annas and Michael A Grodin: Human Rights and Maternal-Fetal HIV Transmission Prevention Trials in Africa. Danstan Bagenda and Philla Musoke-Mudido: We're Trying to Help Our Sickest People, Not Exploit Them. Angela Wasunna: Redirecting the Female Circumcision Debate. Sirkku Hellsten: Global Bioethics: Utopia or Reality? DECISION SCENARIOS: 1. Global Crises, Individual Responsibilities? 2. The Trovan Trial. 3. Circumcision or Mutilation? 4. Debts and Disparities. 5. ABCs. 6. Tuskegee in the Congo? 12. ETHICAL THEORIES, MORAL PRINCIPLES, AND MEDICAL DECISIONS. MORAL THEORIES Utilitarianism. The Principle of Utility. Act and Rule Utilitarianism. Preference Utilitarianism. Difficulties with Utilitarianism. Kant's Ethics. The Categorical Imperative. Duty. Kant's Ethics in the Medical Context. Difficulties with Kantian Ethics. Ross's Ethics. Moral Properties and Rules. Actual Duties and Prima Facie Duties. Ross's Ethics in the Medical Context. Difficulties with Ross's Moral Rules. Rawls's Theory of Justice. The Original Position and the Principles of Justice. Rawls's Theory of Justice in the Medical. Context. Difficulties with Rawls's Theory. Natural Law Ethics and Moral Theology. Purposes, Reasons, and the Moral Law as Interpreted by Roman Catholicism. Applications of Roman Catholic Moral-Theological Viewpoints in the Medical Context. Difficulties with Natural Law Ethics and Moral Theology. MAJOR MORAL PRINCIPLES The Principle of Nonmaleficence. The Principle of Beneficence. The Principle of Utility. Principles of Distributive Justice. The Principle of Equality. The Principle of Need. The Principle of Contribution. The Principle of Effort. The Principle of Autonomy. Autonomy and Actions. Autonomy and Options. Autonomy and Decision Making. Restrictions on Autonomy. BEYOND PRINCIPALISM. The Capabilities Approach. Central Capabilities. The Capabilities Approach in the Medical Context. Difficulties with the Capabilities Approach. Virtue Ethics. The Virtues. Virtue Ethics in the Medical Context. Difficulties with Virtue Ethics. Care Ethics. Values, Not Principles. Care Ethics in the Medical Context. Difficulties with Care Ethics. Feminist Ethics and Critical Theories of Identity. Critical Theories of Identity in a Medical Context. Difficulties with Identity-Based Ethical Theories. RETROSPECT