Practical Decision Making in Health Care Ethics

Cases, Concepts, and the Virtue of Prudence

Fourth Edition

Raymond J. Devettere

"Essential reading. . . . A useful reference source for medical students, nurses, physicians, and members of hospital ethics committees."
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For more than twenty 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. Raymond J. 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.

New sections added in this revised fourth edition include sequencing whole genomes, even those of newborns; the new developments in genetic testing now provided by online commercial companies such as 23andMe; the genetic testing of fetuses by capturing their DNA circulating in the pregnant woman's blood; the Stanford Prison experiment and its relevance to the abuses at the Abu Graib prison; recent breakthroughs in the diagnosis of consciousness disorders such as PVS; the ongoing controversy generated by the NIH study of premature babies at many NICUs throughout the county, a study known as SUPPORT that the OHRP (Office of Human Research Protections, an office within the department of HHS) deemed unethical.

Devettere updates most chapters. New cases include Marlise Munoz (dead pregnant woman's body kept on life support by a Texas hospital), Jahi McMath (teenager pronounced dead in California but treated as alive in New Jersey), Margot Bentley (nursing home feeding a woman dying of end stage Alzheimer’s despite her advance directive that said no nourishment or liquids if she was dying with dementia), Brittany Maynard (dying 29-year-old California woman who moved to Oregon to commit suicide with a physician's help), and Samantha Burton (woman with two children who suffered rupture of membranes at 25 weeks and whose physician obtained a court order to keep her at the hospital to make sure she stayed on bed rest).

Thoughtfully updated and renewed for a new generation of readers, this classic textbook will be required reading for students and scholars of philosophy and medical ethics.

Table of Contents

Preface to the Fourth 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 Desire; Happiness; Virtue; Moral Virtues; Prudence:
The Master Virtue; Suggested Readings

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

4. Making 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; 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?; Controversies over Determining Death; Ethical Reflections;
Suggested Readings

7. Life-Sustaining Treatments
Ventilators: The Case of Karen Quinlan, The Case of William Bartling,
The Case of Helga Wanglie, The Case of Barbara Howe; Dialysis: The
Case of Earle Spring; Surgery: The Case of Rosaria Candura; Other
Life-Sustaining Treatments; Suggested Readings

8. Cardiopulmonary Resuscitation
Terminology; 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; Resolving Questions about CPR: The Case of
Maria 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; Early Cases about Feeding Tubes: The Case of Clarence
Herbert, The Case of Claire Conroy, The Case of Elizabeth Bouvia;
Cases of Persistent Vegetative State: The Case of Nancy Cruzan,
The Case of Terri Schiavo; Recent Breakthroughs in the Diagnosis of
Consciousness Disorders; An Unresolved Controversy: The Vatican and
Feeding Tubes; An Emerging Controversy: VSED; Suggested Readings

10. Reproductive Issues
Contraception and Sterilization; Medically Assisted Pregnancy;
Posthumous Motherhood: A Request for Posthumous Motherhood;
Cloning; Surrogate Motherhood: The Case of Baby M; Ethical Reflections;
Suggested Readings

11. Prenatal Life
Abortion: Abortion in History, Abortion and the Supreme Court;
Moral Issues of Abortion: Abortion and Excommunication at a Catholic Hospital;
RU-486; Maternal–Fetal Conflicts: The Case of Angie, The Case of
Samantha Burton; Ethical reflections; 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
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; Relevant Distinctions;
Moral Reasoning and Euthanasia; Legalization of Euthanasia
and Physician-Assisted Suicide: A Slippery Slope; The
Story of a Landmark Suicide: The Case of Diane; Concluding
Reflections; Suggested Readings

14. Medical and Behavioral Research
Notorious Examples of Questionable Ethics in Research; Reactions
to the Questionable Medical Research; Research on Embryos;
Research on Fetuses; Research on Minors; Controversial Research
on Babies: The SUPPORT Study; 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 Jesse 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 and Genomics
Part 1: Ethics and the Genomic Revolution; Part 2: Ethical Issues in
Genetic Testing; Part 3: Screening Newborns and Fetuses; Part 4:
Research to Develop Genetic Therapy: The Case of Jesse Gelsinger;
Suggested Readings

Index of Cases


"Essential reading. . . . A useful reference source for medical students, nurses, physicians, and members of hospital ethics committees."—Canadian Medical Association Journal, reviewing a previous edition or volume

"Both a thorough resource and an ideal course book on medical ethics . . . deeply philosophical and eminently pragmatic."—Choice, reviewing a previous edition or volume


Supplemental Materials


About the Author

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 taught health care ethics at Boston College for twenty-five years and is a member of the institutional review board at Newton-Wellesley Hospital.

680 pp., 7 x 10

ISBN: 978-1-62616-277-8
May 2016

680 pp., 7 x 10

ISBN: 978-1-62616-276-1
May 2016

680 pp.

ISBN: 978-1-62616-278-5
May 2016

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