Practical Decision Making in Health Care Ethics

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528 pp., 7 x 10
ISBN: 9781589012516 (1589012518)

ISBN: 9781589017627

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December 2009
LC: 2009009046


Table of Contents

Practical Decision Making in Health Care Ethics
Cases and Concepts
Third Edition
Raymond J. Devettere

For nearly fifteen years Practical Decision Making in Health Care Ethics has offered scholars and students a highly accessible and teachable alternative to the dominant principle-based theories in the field. Devettere's approach is not based on an ethics of abstract obligations and duties, but, following Aristotle, on how to live a fulfilled and happy life—in short, an ethics of personal well-being grounded in prudence, the virtue of ethical decision making.

This third edition is revised and updated and includes discussions of several landmark cases, including the tragic stories of Terri Schiavo and Jesse Gelsinger (the first death caused by genetic research). Devettere addresses new topics such as partial-birth abortion law, embryonic stem cell research, infant euthanasia in The Netherlands, recent Vatican statements on feeding tubes, organ donation after cardiac death, new developments in artificial hearts, clinical trials developed by pharmaceutical companies to market new drugs, ghostwritten scientific articles published in major medical journals, and controversial HIV/AIDS research in Africa. This edition also includes a new chapter on the latest social and political issues in American health care.

Devettere's engaging text relies on commonsense moral concepts and avoids academic jargon. It includes a glossary of legal, medical, and ethical terms; an index of cases; and thoroughly updated bibliographic essays at the end of each chapter that offer resources for further reading. It is a true classic, brilliantly conceived and executed, and is now even more valuable to undergraduates and graduate students, medical students, health care professionals, hospital ethics committees and institutional review boards, and general readers interested in philosophy, medicine, and the rapidly changing field of health care ethics.

Raymond J. Devettere is a professor of philosophy at Emmanuel College where he directs the values-based education program and serves on the institutional review board. He also teaches health care ethics at Boston College and is a member of both the ethics committee and institutional review board at Newton-Wellesley Hospital.
"Practical Decision Making in Health Care Ethics is a refreshingly different kind of medical ethics textbook. Based on situational prudence and practical wisdom, Devettere's approach provides students and their instructors the opportunity to examine difficult bioethical issues through thoughtful discussion and careful reflection. It works wonderfully with undergraduate students who are forming their own vision of the good life."—Dominic Sisti, The University of Pennsylvania

Table of Contents
Preface to the Third Edition


1. What Is Ethics?
Defining Ethics
Two Kinds of Ethics
Historical Versions of the Ethics of Obligation
Moral Reasoning and the Theories of Obligation
Contrasting the Ethics of Obligation with an Ethics of the Good
Retrieving the Ethics of the Good
Bioethics Today
Suggested Readings

2. Prudence and Living a Good Life
The Good We Seek
Moral Virtue
Suggested Readings

3. The Language of Health Care Ethics
Distinctions That Can Mislead
Helpful Distinctions
Suggested Readings

4. Making Health Care Decisions
Complexity of Health Care Decisions
Decision-Making Capacity
Informed Consent
Advance Directives
The Patient Self-Determination Act
The Case of Hazel Welch
Final Reflections
Suggested Readings

5. Deciding for Others
Becoming a Proxy
Standards for Making Proxy Decisions
Deciding for Older Children
Deciding for the Mentally Ill
Deciding for Patients of Another Culture
Final Reflections on Deciding for Others
Suggested Readings

6. Determining Life and Death
The Classical Conceptual Framework
A New Conceptual Framework
When Does One of Us Begin?
When Does One of Us Die?
Recent Controversies over Determining Death
Ethical Reflections
Suggested Readings

7. Life-Sustaining Treatments
The Case of Karen Quinlan
The Case of Brother Fox
The Case of william Bartling
The Case of Helga Wanglie
The Case of Barbara Howe
The Case of Earle Spring
The Case of Rosaria Candura
Other Life-Sustaining Treatments
Suggested Readings

8. Cardiopulmonary Resuscitation
A Brief History of Resuscitation Attempts
The Effectiveness of Attempting CPR
Learning to Withhold CPR
Important Ethical Elements for a DNR Policy
Lingering Questions about DNR Orders
The Case of Marie M
The Case of shirley Dinnerstein
The Case of Catherine Gilgunn
Suggested Readings

9. Medical Nutrition and Hydration
The Techniques and Technologies
Conceptualizing Medical Nutrition and Hydration
The Case of Clarence Herbert
The Case of Claire Conroy
The Case of Elizabeth bouvia
the Case of Nancy Cruzan
The Case of Terri Schiavo
An Emerging Controversy: the Vatican and Feeding Tubes
Ethical Reflections
Suggested Readings

10. Reproductive Issues
Contraception and Sterilization
Artificial Reproduction Techniques
Surrogate Motherhood
Ethical Reflections
Suggested Readings

11. Prenatal Life
Moral Issues of Abortion
Maternal-Fetal Treatment Conflicts
The Case of Angie
Ethical Reflection
Suggested Readings

12. Infants and Children
Historical Background
A Sampling of Neonatal Abnormalities
Special Difficulties in Deciding for Neonates and Small Children
The Baby Doe Regulations
The Case of Baby Doe
The Case of Baby Jane Doe
The Case of Danielle
The Case of Baby K
The Case of Ashley
Infant Euthanasia in The Netherlands
Suggested Readings

13. Euthanasia and Physician-Assisted Suicide
Historical Overview
Recent Developments
Physician-Assisted Suicide and State Laws
Physician-Assisted Suicide and the Constitution
Relevant Distinctions
Moral Reasoning and Euthanasia
Reasons for Euthanasia and Physician-Assisted Suicide
Reasons against Euthanasia and Physician-Assisted Suicide
The Story of a Landmark Physician-Assisted suicide
The Case of Diane
Concluding Reflections
Suggested Readings

14. Medical Research
Notorious Examples of Questionable Ethics in Research
Reactions to the Questionable Medical Research
Research on Embryos
Research on Fetuses
Research on Minors
Research in Developing Countries
Other Special Populations in Research
Animals and Medical Research
Suggested Readings

15. Transplantation
Transplantation of Organs from Dead Human Donors
The Case of Jamie Fiske
The Case of Jess Sepulveda
Transplantation of Organs from Living Human Donors
Transplantation of Organs from Animals
The Case of Baby Fae
Implantation of Artificial Hearts
Suggested Readings

16. Medical Genetics
Genetic Testing
A Case of Concern About Cancer
Genetic Screening
Genetic Research on Humans
The Case of Jesse Gelsinger
Genetic Enhancement
Human Genome Project
Suggested Readings

17. Social and Political Issues
Paying for Health Care
Legislation and the "Futility" Debate
The Case of Sun Hudson
The Case of Emilio Gonzales
Experimental Drugs for Dying Patients
The Case of Abigail Burroughs and the Abigail Alliance
Seeding Trials and Ghost Writers
Suggested Readings


Index of Cases