Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine Book

Clinical Ethics was required reading for my Clinical Issues in Bioethics class. I had read an earlier edition of this book five years ago, and was appreciative of the changes that were made in the 6th and 7th editions. For one, there is no longer a numerical grid by which patients receive a "score" that determines whether a doctor should treat him or consider him futile. Furthermore, the later editions seem to be more cognizant of current bioethical debates and more amenable to palliative care, although I will need to look back at the old edition to check that it is actually devoting more space to these topics.

Clinical Issues (6th edition) reads like a sterile medical school text where discussions of withholding and withdrawing treatment, futility and quality of life are cold and detached. Clinical Issues does well in considering context as one of its four main factors in making clinical decisions (medical indications, patient preferences, and quality of life are the other three). This adds a "human" factor to the considerations, and ensures that the ethicist is not looking at this as merely a case, but person or a family.

My strongest objection to this book is its claim to be objective, which seems to be a mis-placed modernistic perspective on an increasingly post-modern field (bioethics). Ethics is not done in a vacuum; it is grounded in a moral foundation. People's moral foundations are tightly and personally held. The authors do well to employ Beauchamp and Childress' autonomy, beneficience, nonmaleficience, and justice perspective, but even in interpreting these (i.e. What is justice?), one does so through the grid of one's moral foundations. While I would concur that there are real and actual truths applicable to all and there are right and wrong decisions in the medical context, that does not mean that decisions as grave as these can be made in a truly objective manner. Quite frankly, I do not think such weighty decisions should be made in a truly objective manner.