Bioethics: Principles, Issues, and Cases

Preface ixPart I Principles and TheoriesChapter 1 Moral Reasoning in Bioethics 3Ethics and Bioethics 3Ethics and the Moral Life 5In Depth: Morality and the Law 7Moral Principles in Bioethics 8Autonomy 9Beneficence 10Utility 11Justice 12Ethical Relativism 13In Depth: Anthropology and Moral Diversity 14Ethics and Religion 17Moral Arguments 18Argument Fundamentals 19Patterns of Moral Arguments 22Review: Valid and Invalid Argument Forms 23In Depth: Fallacies in Moral Reasoning 24Evaluating Premises 26Key Terms 28Summary 28Further Reading 29Notes 29Chapter 2 Bioethics And Moral Theories 30The Nature of Moral Theories 30Influential Moral Theories 31Utilitarianism 32In Depth: Utilitarianism and the Golden Rule 34Kantian Ethics 34Natural Law Theory 36Rawls' Contract Theory 38Virtue Ethics 39The Ethics of Care 40In Depth: Can Virtue Be Taught? 41Feminist Ethics 42Criteria for Judging Moral Theories 42Review: Evaluating Moral Theories: Criteria of Adequacy 44Applying the Criteria 44Utilitarianism 45Kant's Theory 46Key Terms 46Summary 47Further Reading 47Notes 48Part 2 Physician and PatientChapter 3 Paternalism And Patient Autonomy 51Shades of Autonomy and Paternalism 51Refusing Treatment 52In Depth: The Hippocratic Oath 53Futile Treatment 54Legal Brief: Refusing Treatment for Children on Religious Grounds 55In Depth: CPR and DNR 56Applying Major Theories 56Key Terms 57Summary 57Classic Case File: Elizabeth Bouvia 58Cases for Evaluation 60Further Reading 62Notes 63Readings63"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 88Bouvia 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 103Chapter 4 Truth-Telling And Confidentiality 105Paternalism and Deception 105In Depth: Do Patients Want the Truth? Do Physicians Tell It? 106Confidential Truths 108Legal Brief: Confidentiality and a Duty to Warn 109Applying Major Theories 110Classic Case File: Carols R. 111Key Terms 112Summary 112Cases for Evaluation 112Further Reading 114Notes 114Readings 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 135Tarasoff v. Regents of the University of California, Supreme Court of California 138Chapter 5 Informed Consent 144Autonomy and Consent 144Conditions of Informed Consent 145In Depth: Two Views of Informed Consent 147Legal Brief: Important Informed Consent Cases 148Applying Major Theories 149Key Terms 149Summary 149Classic Case File: Jerry Canterbury 150Cases for Evaluation 151Further Reading 153Notes 154Readings 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 183Canterbury v. Spence, United States Court of Appeals 189Chapter 6 Human Research 193The Science of Clinical Trials 194In Depth: The Tuskegee Tragedy 195Beneficence, Science, and Placebos 196Science and Informed Consent 199In Depth: Women in Clinical Trials 200Research on the Vulnerable 201In Depth: Why Enter a Clinical Trial? 202Applying Major Theories 205Key Terms 206Summary 206Classic Case File: The UCLA Schizophrenia Study 207Cases for Evaluation 208Further Reading 212Notes 212Readings 213The Nuremberg Code 213Declaration 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 246Part 3 Life and DeathChapter 7 Abortion 253Starting Point: The Basics 253Fact File: U.S. Abortions 254In Depth: Abortion and Public Opinion 256The Legal Struggle 257Persons and Rights 257In Depth: Late-Term Abortion 258Applying Major Theories 262Key Terms 263Summary 263Classic Case File: Nancy Klein 264Cases for Evaluation 265Further Reading 268Notes 268Readings 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 333United States Supreme Court Roe v. Wade 342Planned Parenthood of Southeastern Pennsylvania v. Casey, United States Supreme Court 347Chapter 8 Reproductive Technology 354In Vitro Fertilization 354Fact File: Assisted Reproduction 355Surrogacy 360In Depth: IVF and Children's Future Children 361Cloning 362Legal Brief: Surrogacy Contracts and the Law 363In Depth: Cloning Time Line 365Applying Major Theories 366Key Terms 367Summary 367Classic Case File: Baby M 368Cases for Evaluation 369Further Reading 371Notes 372Readings 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 441Opinion in the Matter of Baby M, New Jersey Supreme Court 452Chapter 9 Genetic Choices 460Genes and Genomes 460Genetic Testing 461In Depth: Direct-to-Consumer Genetic Tests 464Gene Therapy 468Fact File: Genetic Tests 469Stem Cells 471In Depth: Recent Research in Gene Therapy 472Applying Major Theories 474Classic Case File: The Kingsburys 475Key Terms 476Summary 476Cases for Evaluation 477Further Reading 479Notes 479Readings 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 524Chapter 10 Euthanasia And Physician-Assisted Suicide 526Deciding Life and Death 527Legal Brief: Euthanasia and Assisted Suicide: Major Developments 529In Depth: Euthanasia and Assisted Suicide: What Doctors Think and Do 530Autonomy, Mercy, and Harm 530In Depth: Oregon's Death With Dignity Act 533Applying Major Theories 534In Depth: Physician-Assisted Suicide and Public Opinion 535Key Terms 536Summary 536Classic Case File: Nancy Cruzan 537Cases for Evaluation 538Further Reading 541Notes 541Readings 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 592Vacco v. Quill, United States Supreme Court 601Washington v. Glucksberg, United States Supreme Court 604Part 4 Justice and Health CareChapter 11 Dividing Up Health Care Resources 613Health Care in Trouble 613In Depth: Unequal Health Care for Minorities 615Fact File: U.S. Health Care 616Theories of Justice 616A Right to Health Care 617In Depth: Public Opinion: Obtaining Adequate Health Care 618The Ethics of Rationing 620Key Terms 622Summary 622Classic Case File: Christine deMeurers 623Cases for Evaluation 624Further Reading 626Notes 627Readings 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 675Glossary 683Index 685