Bioethics: Principles, Issues, and Cases Book

Preface ix

Part I Principles and Theories

Chapter 1 Moral Reasoning in Bioethics 3

Ethics and Bioethics 3

Ethics and the Moral Life 5

In Depth: Morality and the Law 7

Moral Principles in Bioethics 8

Autonomy 9

Beneficence 10

Utility 11

Justice 12

Ethical Relativism 13

In Depth: Anthropology and Moral Diversity 14

Ethics and Religion 17

Moral Arguments 18

Argument Fundamentals 19

Patterns of Moral Arguments 22

Review: Valid and Invalid Argument Forms 23

In Depth: Fallacies in Moral Reasoning 24

Evaluating Premises 26

Key Terms 28

Summary 28

Further Reading 29

Notes 29

Chapter 2 Bioethics And Moral Theories 30

The Nature of Moral Theories 30

Influential Moral Theories 31

Utilitarianism 32

In Depth: Utilitarianism and the Golden Rule 34

Kantian Ethics 34

Natural Law Theory 36

Rawls' Contract Theory 38

Virtue Ethics 39

The Ethics of Care 40

In Depth: Can Virtue Be Taught? 41

Feminist Ethics 42

Criteria for Judging Moral Theories 42

Review: Evaluating Moral Theories: Criteria of Adequacy 44

Applying the Criteria 44

Utilitarianism 45

Kant's Theory 46

Key Terms 46

Summary 47

Further Reading 47

Notes 48

Part 2 Physician and Patient

Chapter 3 Paternalism And Patient Autonomy 51

Shades of Autonomy and Paternalism 51

Refusing Treatment 52

In Depth: The Hippocratic Oath 53

Futile Treatment 54

Legal Brief: Refusing Treatment for Children on Religious Grounds 55

In Depth: CPR and DNR 56

Applying Major Theories 56

Key Terms 57

Summary 57

Classic Case File: Elizabeth Bouvia 58

Cases for Evaluation 60

Further Reading 62

Notes 63

Readings63

"Paternalism," Gerald Dworkin 63

"The Refutation of Medical Paternalism," Alan Goldman 73

"Why Doctors Should Intervene," Terrence F. Ackerman 79

"Autonomy, Futility, and the Limits of Medicine," Robert L. Schwartz 84

"Whose Body Is It Anyway?" Atul Gawande 88

Bouvia v. Superior Court, California Court of Appeal 98

"Fundamental Elements of the Patient-Physician Relationship," AMA Council on Ethical and Judicial Affairs 102

"Code of Ethics for Nurses," American Nurses Association 103

Chapter 4 Truth-Telling And Confidentiality 105

Paternalism and Deception 105

In Depth: Do Patients Want the Truth? Do Physicians Tell It? 106

Confidential Truths 108

Legal Brief: Confidentiality and a Duty to Warn 109

Applying Major Theories 110

Classic Case File: Carols R. 111

Key Terms 112

Summary 112

Cases for Evaluation 112

Further Reading 114

Notes 114

Readings 115

"Telling the Truth to Patients: A Clinical Ethics Exploration," David C. Thomasma 115

"On Telling Patients the Truth," Mack Lipkin 119

"On a Supposed Right to Lie from Altruistic Motives," Immanuel Kant 121

"Respect for Patients, Physicians, and the Truth," Susan Cullen Margaret Klein 122

"Why Privacy Is Important," James Rachels 130

"Confidentiality in Medicine-A Decrepit Concept," Mark Siegler 135

Tarasoff v. Regents of the University of California, Supreme Court of California 138

Chapter 5 Informed Consent 144

Autonomy and Consent 144

Conditions of Informed Consent 145

In Depth: Two Views of Informed Consent 147

Legal Brief: Important Informed Consent Cases 148

Applying Major Theories 149

Key Terms 149

Summary 149

Classic Case File: Jerry Canterbury 150

Cases for Evaluation 151

Further Reading 153

Notes 154

Readings 154

"The Concept of Informed Consent," Ruth R. Faden Tom L. Beauchamp 154

"Informed Consent-Must It Remain a Fairy Tale?" Jay Katz 159

"Transparency: Informed Consent in Primary Care," Howard Brody 169

"Should Informed Consent Be Based on Rational Beliefs?" Julian Savulescu Richard W. Momeyer 175

"Informed Consent: Some Challenges to the Universal Validity of the Western Model," Robert J. Levine 183

Canterbury v. Spence, United States Court of Appeals 189

Chapter 6 Human Research 193

The Science of Clinical Trials 194

In Depth: The Tuskegee Tragedy 195

Beneficence, Science, and Placebos 196

Science and Informed Consent 199

In Depth: Women in Clinical Trials 200

Research on the Vulnerable 201

In Depth: Why Enter a Clinical Trial? 202

Applying Major Theories 205

Key Terms 206

Summary 206

Classic Case File: The UCLA Schizophrenia Study 207

Cases for Evaluation 208

Further Reading 212

Notes 212

Readings 213

The Nuremberg Code 213

Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects, World Medical Association 214

"The Belmont Report," National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research 217

"Final Report: Human Radiation Experiments," Advisory Committee on Human Radiation Experiments 220

"Of Mice but Not Men: Problems of the Randomized Clinical Trial," Samuel Hellman Deborah S. Hellman 226

"A Response to a Purported Ethical Difficulty with Randomized Clinical Trials Involving Cancer Patients," Benjamin Freedman 231

"How to Resolve an Ethical Dilemma Concerning Randomized Clinical Trials," Don Marquis 235

"Clinical Trials: Are They Ethical?" Eugene Passamani 238

"The Ethics of Clinical Research in the Third World," Marcia Angell 242

"Ethical Issues in Clinical Trials in Developing Countries," Baruch Brody 246

Part 3 Life and Death

Chapter 7 Abortion 253

Starting Point: The Basics 253

Fact File: U.S. Abortions 254

In Depth: Abortion and Public Opinion 256

The Legal Struggle 257

Persons and Rights 257

In Depth: Late-Term Abortion 258

Applying Major Theories 262

Key Terms 263

Summary 263

Classic Case File: Nancy Klein 264

Cases for Evaluation 265

Further Reading 268

Notes 268

Readings 269

"A Defense of Abortion," Judith Jarvis Thomson 269

"Why Abortion Is Immoral," Don Marquis 279

"On the Moral and Legal Status of Abortion," Mary Anne Warren 291

"An Almost Absolute Value in History," John T. Noonan 301

"Abortion Decisions: Personal Morality," Daniel Callahan 305

"Abortion and the Concept of a Person," Jane English 310

"In Defense of Abortion and Infanticide," Michael Tooley 316

"Abortion Through a Feminist Ethic Lens," Susan Sherwin 333

United States Supreme Court Roe v. Wade 342

Planned Parenthood of Southeastern Pennsylvania v. Casey, United States Supreme Court 347

Chapter 8 Reproductive Technology 354

In Vitro Fertilization 354

Fact File: Assisted Reproduction 355

Surrogacy 360

In Depth: IVF and Children's Future Children 361

Cloning 362

Legal Brief: Surrogacy Contracts and the Law 363

In Depth: Cloning Time Line 365

Applying Major Theories 366

Key Terms 367

Summary 367

Classic Case File: Baby M 368

Cases for Evaluation 369

Further Reading 371

Notes 372

Readings 373

"IVF: The Simple Case," Peter Singer 373

"IVF and Women's Interests: An Analysis of Feminist Concerns," Mary Anne Warren 377

"Give Me Children or I Shall Die!" New Reproductive Technologies and Harm to Children," Cynthia Cohen 389

"Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation," Congregation for the Doctrine of the Faith 400

"Surrogate Mothering: Exploitation or Empowerment?" Laura M. Purdy 409

"On 'Surrogacy," Barbara Katz Rothman 418

"The Wisdom of Repugnance," Leon R. Kass 426

"Cloning Human Beings: An Assessment of the Ethical Issues Pro and Con," Dan W. Brock 441

Opinion in the Matter of Baby M, New Jersey Supreme Court 452

Chapter 9 Genetic Choices 460

Genes and Genomes 460

Genetic Testing 461

In Depth: Direct-to-Consumer Genetic Tests 464

Gene Therapy 468

Fact File: Genetic Tests 469

Stem Cells 471

In Depth: Recent Research in Gene Therapy 472

Applying Major Theories 474

Classic Case File: The Kingsburys 475

Key Terms 476

Summary 476

Cases for Evaluation 477

Further Reading 479

Notes 479

Readings 480

"Implications of Prenatal Diagnosis for the Human Right to Life," Leon R. Kass 480

"Genetics and Reproductive Risk: Can Having Children Be Immoral?" Laura M. Purdy 484

"The Morality of Screening for Disability," Jeff McMahan 491

"Disowning Knowledge: Issues in Genetic Testing," Robert Wachbroit 495

"The Non-Identity Problem and Genetic Harms-the Case of Wrongful Handicaps," Dan W. Brock 499

"Is Gene Therapy a Form of Eugenics?," John Harris 503

"Genetic Enhancement," Walter Glannon 509

"Germ-Line Gene Therapy," LeRoy Walters Julie Gage Palmer 514

"What Does 'Respect for Embryos' Mean in the Context of Stem Cell Research?" Bonnie Steinbock 521

"Declaration on the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells," Pontifical Academy for Life 524

Chapter 10 Euthanasia And Physician-Assisted Suicide 526

Deciding Life and Death 527

Legal Brief: Euthanasia and Assisted Suicide: Major Developments 529

In Depth: Euthanasia and Assisted Suicide: What Doctors Think and Do 530

Autonomy, Mercy, and Harm 530

In Depth: Oregon's Death With Dignity Act 533

Applying Major Theories 534

In Depth: Physician-Assisted Suicide and Public Opinion 535

Key Terms 536

Summary 536

Classic Case File: Nancy Cruzan 537

Cases for Evaluation 538

Further Reading 541

Notes 541

Readings 542

"The Wrongfulness of Euthanasia," J. Gay-Williams 542

"Voluntary Active Euthanasia," Dan W. Brock 545

"When Self-Determination Runs Amok," Daniel Callahan 556

"When Abstract Moralizing Runs Amok," John Lachs 561

"Physician-Assisted Suicide: A Tragic View," John D. Arras 565

"Active and Passive Euthanasia," James Rachels 580

"The Distinction Between Refusing Medical Treatment and Suicide," New York State Task Force on Life and the Law 584

"The Philosophers' Brief," Ronald Dworkin Thomas Nagel Robert Nozick John Rawls Thomas Scanlon Judith Jarvis Thomson 592

Vacco v. Quill, United States Supreme Court 601

Washington v. Glucksberg, United States Supreme Court 604

Part 4 Justice and Health Care

Chapter 11 Dividing Up Health Care Resources 613

Health Care in Trouble 613

In Depth: Unequal Health Care for Minorities 615

Fact File: U.S. Health Care 616

Theories of Justice 616

A Right to Health Care 617

In Depth: Public Opinion: Obtaining Adequate Health Care 618

The Ethics of Rationing 620

Key Terms 622

Summary 622

Classic Case File: Christine deMeurers 623

Cases for Evaluation 624

Further Reading 626

Notes 627

Readings 627

"Is There a Right to Health Care and, if So, What Does It Encompass?" Norman Daniels 627

"The Right to a Decent Minimum of Health Care," Allen E. Buchanan 634

"Multiculturalism and Just Health Care: Taking Pluralism Seriously," Jeffrey Blustein 640

"Rights to Health Care, Social Justice, and Fairness in Health Care Allocations: Frustrations in the Face of Finitude," H. Tristram Engelhardt, Jr. 652

"Rationing Fairly: Programmatic Considerations," Norman Daniels 661

"The Allocation of Exotic Medical Lifesaving Therapy," Nicholas Rescher 666

"QALYfying the Value of Life," John Harris 675

Glossary 683

Index 685