Doing Right: A Practical Guide to Ethics for Medical Trainees and Physicians Book

Preface ix

Acknowledgments xi

Introduction: A Revolution in Learning 1

Chapter 1 Ethics Matters: Principles and Ethically Sound Medicine

I Ethical Reasoning and Principles in Medicine 8

II Three Ethical Principles and Questions 13

III 'Resolving' Ethical Dilemmas 17

IV 'Doing Right': A Decision-Making Procedure for Clinical Ethics 19

V Applying the Ethics Decision-Making Procedure 24

Chapter 2 The Almost Revolution: Autonomy and Patient-Based Care

I The Autonomy Principle 30

II The Case of Mrs Malette and Dr Shulman 36

III Choices: The Good, the Bad, and the Ugly 38

IV Reduced Autonomy 45

Chapter 3 No Man An Island: Confidentiality and Trust

I Confidentiality 50

II Control of Health Information 52

III Trade Secrets 55

IV Limits to Confidentiality 63

Chapter 4 The Power To Heal: Truth, Lies, and Deception in Clinical Practice

I Truthtelling and Deception 72

II Some Reasons Not to Tell the Truth 73

III Some Reasons to Tell the Truth 76

IV Modern Law and the Profession 81

V The Changing Practice of Medicine 82

VI Some Exceptions to Truthtelling 83

Chapter 5 The Power to Choose: Due Care and Informed Consent

I The Essence of Informed Consent 95

II Ethical Consent 96

III The Doctor Who Didn't: The Case of Mr Reibl versus Dr Hughes 98

IV The Essential Elements of Consent: When, Who, What, How? 100

V Exceptions to Consent 111

Chapter 6 The Waning and Waxing Self: Capacity and Incapacity in Medical Care

I Assessing Capacity 115

II Treatment of the Vulnerable 127

III When Not to Rescue: Messrs Gallagher and Reid versus Dr Fleming 129

IV Failure to Care for Self 132

V CasesInvolving Minors 135

Chapter 7 Helping and Not Harming: Beneficence and Non-Maleficence

I The Principles of Beneficence and Non-maleficence 139

II The 'Duty to Rescue' the Patient 146

III The Duty to Protect the Public 149

IV Minors and Necessary Medical Care 153

V Parental Requests for Treatment 157

Chapter 8 Conduct Becoming: Medical Professionalism and Managing Error

I Professionalism in Healthcare 163

II Professionals and the Drug Industry 169

III Boundaries and Crossings 172

IV The Error of Our Ways 177

Chapter 9 Beyond The Patient: Doing Justice in Medical Care

I Justice in Everyday Medicine 187

II Minimal and Optimal Justice 191

III Medically Necessary Treatment 194

IV Practice Guidelines: A Solution for Just Medicine in Hard Times? 200

IV The Health Professional's Master 203

Chapter 10 Labour Pains: Ethics and New Life

I Birthing and Reproductive Choice 207

II In the Interest of the Child: Being Born and Living Life 214

III The New Age of Reproduction 216

IV Desperately Seeking Stem Cells 221

Chapter 11 A Dark Wood: End-of-Life Decisions

I Allowing Death: The Right to Say No 225

II When No Means No 231

III Advance Directives 233

IV The Dying, the Dead, and the Almost Dead 234

V Physician-Assisted Death 241

Conclusion: Where to Go from Here? 249

Notes 253

Index 285