Originally published in 1999, this classic textbook includes twenty-six cases with commentary and bibliographic resources designed especially for medical students and the training of ethics consultants. The majority of the cases reflect the day-to-day moral struggles within the walls of hospitals. As a result, the cases do not focus on esoteric, high-tech dilemmas like genetic engineering or experimental protocols, but rather on fundamental problems that are pervasive in basic healthcare delivery in the United States: where to send a frail, elderly patient who refuses to go to a nursing home, what role the family should play in making a treatment decision, what a hospital should do when it is getting stuck with too many unpaid bills.
This thoroughly revised and updated second edition includes thirteen new cases, five of which are designated as "skill builder" cases aimed specifically at persons who wish to conduct clinical ethics case consultations. The new cases highlight current ethical challenges that arise in caring for populations such as undocumented immigrant patients, persons with substance use disorders involving opioids, and ethical issues that arise beyond the bedside at the organizational level. The reader is invited to use the supplemental videos and assessment tools available on the website of the Loyola University Chicago ACES project (www.LUC.edu/ethicsconsult).
Table of Contents
Preface
Acknowledgments
Section 1: Consent and Capacity
Case 1: Truth Telling and Cultur—-Using an Interpreter in a Consultation (Skill Builder Case)
Case 2: What Does She Really Want? Coercion, Persuasion, and the Family
Case 3: "He Doesn't Know What He's Saying" Advance Directives in Emergency Setting
Case 4: "Please Don't Cut Off My Leg" Going from a Wish to a Plan of Care
Case 5: Consent and the Elderly—Is the Patient Her Own Best Spokesperson?
Case 6: "I Don't Want Any Tubes" Capacity and the Care of a Patient with a Kidney Transplant
Case 7: Caring for a Patient Who Uses Heroin—Fairness and Professional Responsibility
Practical Commentary and Cheat Sheet
Conceptual Framework
Further Reading
Section 2: End-Of-Life Decision Making
Case 8: The Stroke Case—"I Can't Be Responsible for Killing Your Mother" (Skill Builder Case)
Case 9: Futility—"But She Said She Wanted Everything" (Skill Builder Case)
Case 10: Withdrawing Treatment—Easier Said Than Done
Case 11: The Letter and Spirit of a Directive—Making Decisions with a Patient of Variable Capacity
Case 12: How Competent Does a Surrogate Need to Be? A Decison Maker Who Might Not Appreciate the Choice to Be Made
Case 13: How Does a POLST Form Help? When a Surrogate Contradicts a Valid DNR Order
Case 14: Withdrawing Treatment and the Family's "Returning Hero"—When One Family Member Says "Go" but the Surrogate Says "No"
Case 15: "They're Crazy!" The Micromanaging Family
Practical Commentary and Cheat Sheet
Conceptual Framework
Further Reading
Section 3: Decision Making for Minors
Case 16: "God Can Do Miracles, and He Will Heal Jessica" A Pediatric Patient Wants to Forgo Treatment but Her Parent Disagrees (Skill Builder Case)
Case 17: Transfusions as a Preventive Measure for a Witness Child—Do the Child's Medical Interests Outweigh Family Integrity?
Case 18: IV Drug Addiction and the Perfect Son—Difficult Decisions in Treating a Chronic Opiod User
Case 19: "She'll Never be Able to Take Care of That Child!" Family Integrity and the Newborn's Best Interest
Case 20: Families and Hope—Fostering the Patient's Self-Determination
Case 21: Who's the Patient? Dealing with a Formidable Advocate
Practical Commentary and Cheat Sheet
Conceptual Framework
Further Reading
Section 4: Organizational Ethics
Case 22: "If We Do This, They'll All Come Here" A Kidney Transplant for an Undocumented Immigrant? (Skill Builder Case)
Case 23: "But She's Our Patient" Margin and Medical Mission
Case 24: Charity Care—What Are The Criteria?
Case 25: "What's the Use?" Capacity, Addiction, and Fairness
Case 26: A Teaching's Hospital Transfer Policy—Who is Responsibile for This Patient?
Practical Commentary and Cheat Sheet
Conceptual Framework
Further Reading
Index
About the Authors
Reviews
"A challenging and practical resource for all academic collections."—CHOICE connect
"This is far more than a book. In combining a casebook with web-based consultation videos, Mark Kuczewski, Rosa Lynn Pinkus, and Katherine Wasson have created a cutting-edge way to learn to practice ethics consultation. Personally, I highly recommend it."—Marion Danis, MD, Department of Bioethics, National Institutes of Health Clinical Center
"This updated Ethics Casebook for Hospitals has practical features for training hospital ethics committee members, including resources for conducting role plays or simulation to elucidate different stakeholder perspectives in case consultations, and ways to develop and evaluate ethics consultants' knowledge and skills competencies. The innovative pairing with clinical ethics consultation resources housed on Loyola's Neiswanger Institute for Bioethics' website enhances the functionality of this casebook for individuals providing ethics consultation services. Also, broadening the scope of topics covered from the commonly encountered end-of-life issues to organizational ethics and substance use disorders makes this edition of the casebook particularly relevant as an introduction to hospital-based clinical ethics consultation."—Anita Tarzian, PhD, RN, Program Coordinator and Associate Professor, University of Maryland School of Nursing
About the Author
Mark Kuczewski, PhD, is the Fr. Michael I. English, S.J., Professor of Medical Ethics, Director of the Neiswanger Institute for Bioethics and Health Policy, and Chair of the Department of Medical Education at the Loyola University Chicago Stritch School of Medicine. A former President of the American Society for Bioethics and Humanities, Mark has been a leader in the effort to promote quality in clinical ethics case consultation.
Rosa Lynn B. Pinkus, PhD, served as Professor of Medicine/Neurosurgery, Associate director for the Center of Bioethics and Health Law and director of the Consortium Ethics Program, University of Pittsburgh. She retired in December 2013 and currently teaches a graduate bioethics course for the Department of Bioengineering, University of Pittsburgh.
Katherine Wasson, PhD, MPH, is an associate professor and bioethicist at the Neiswanger Institute for Bioethics and Health Policy at Loyola University Chicago Stritch School of Medicine. She is an educator, researcher and clinical ethics consultant and the Principal Investigator for the Assessing Clinical Ethics Skills project.
