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Pavadinimas: ETHICAL ANALYSIS OF CLINICAL MEDICINE A GUIDE TO SELF-EVALUATION
Autoriai: GLENN C. GRABER, PH.D. ALFRED D. BEASLEY, M.D. JOHN A. EADDY, M.D.
Metai:
ISBN: 0-8067-0711-9
Brūkšninis kodas: 29035
Ieškoti VUB kataloge
Anotacija:

     The textbook that has been written by this expert team is highly practical to physicians in its approach and content. It is not only a philosophical exercise in critical reasoning and a lexicon of human values, but it is infused with a personal dedication that emanates warmth as well as light from its pages. Such works may help us physicians in our efforts to make caring decisions for our patients and ourselves.



Foreword xi
Preface xiii
Sources and permissions xv
Chapter one:
Physician-patient relationships 1
1 General features 1
1.1 Fantasies: A thought experiment 1
1.2 Expectations 4
1.3 Conclusion 19
2 Information exchange 20
2.1 Relationships 20
2.2 Obligations 23
2.3 Fulfilling these obligations 24
2.4 Placebos and the placebo effect 37
2.5 Conclusions 38
3 Informed consent 40
3.1 The legal and moral requirement of informed consent 40
3.2 Practical applications 45
3.3 The paradox of autonomy 48
3.4 Mental competence 49
3.5 Manipulation 52
4 Confidentiality 53
4.1 The importance of confidentiality 53
4.2 The need for confidentiality in medicine 55
4.3 Confidentiality in medicine 55
4.4 Confidentiality and the law 57
4.5 Cases 58
4.6 President`s Commission recommendations 71
4.7 Review exercises 72
5 Conclusion 72
References 72
Further reading 74
Chapter two:
Professional codes and ethical theories 77
1 Professional codes 77
1.1 The Hippocratic Oath 77
1.2 AMA principles of medical ethics 85
1.3 American college of physicians ethics manual 89
1.4 Limitations of professional codes 96
2 Fundamentals of ethical theory 98
2.1 Ethical judgments 98
2.2 Some points about ethical theory 102
2.3 Key concepts 103
3 Review exercise 109
3.1 Instructions 109
3.2 Case: “To make the parents happy” 109
3.3 Questions 109
3.4 Options for action 110
3.5 Additional questions 110
References 111
Further reading 111
Chapter three:
The scope of professional responsibility 113
1 The scope of medical service 113
1.1 Case: Joyce and Brent Blackspott 114
1.2 Analysis: Physician responsibility for health and disease 115
2 The “Moral center” of medicine 118
2.1 Content of the moral center 118
2.2 Importance of the moral center 119
2.3 The blackspotts and the moral center 120
2.4 Additional cases 120
3 Beyond the moral center 123
3.1 Research 123
3.2 Other potential conflicts of loyalties 126
3.3 Conflicts of loyalties: Toward a policy solution 128
3.4 Family medicine 131
3.5 Team care 131
3.6 Institutional delivery of health care 145
4 Expansions of the scope of responsibility 155
4.1 Beyond treatment 155
4.2 Beyond the clinic 155
4.3 Beyond illness or injury 155
4.4 Palliation, comforting, and strengthening coping skills 156
4.5 Conclusion 156
References 157
Further reading 157
Chapter four:
Life and death 159
1 Determination of death 160
1.1 “Irreversible” 161
1.2 “Vital functions” 162
1.3 Statutory definitions of death 163
1.4 “Pronouncing” death 165
2 Other limits to treatment 165
2.1 AMA policy statements 166
2.2 Limits set by patients 167
2.3 Dealing with families` decisions 178
2.4 Other dimensions of limits to treatment 183
3 Seriously ill newborns 193
3.1 Issues 193
3.2 Conclusions 195
4 Abortion 196
5 Reproductive technologies 198
References 200
Further reading 200
Chapter five:
Who gets what? 207
1 Allocation of resources 207
1.1 Life and death resources 207
1.2 Principles of allocation 208
1.3 Case: Who gets the protection? 211
1.4 Triage 216
1.5 Patient loyalties and demands of justice 217
1.6 Office scheduling as an allocation problem 218
2 Allocation on the social scale 219
2.1 Access to health care services 220
2.2 The monetarization of medicine 230
2.3 Cost control 238
3 Reviewing your expectations 249
Sources of items in exercise, Section 2.2.3 250
References 251
Further reading 252
Appendix I:
More about ethical theories 255
1 Utilitarianism and other goal-based theories 255
1.1 Teleologism, the goal-based theories 255
1.2 The moral reference group 256
1.3 Theories of value 258
1.4 Act vs. Rule approach 267
1.5 Applying goal-based theories 268
1.6 Review exercise: Goal-based theories 270
2 Deontological theories 271
2.1 Duty-based theories 271
2.2 Kant`s deontological theory 275
2.3 Ross` list of Prima Facie duties 276
2.4 Review exercise: Deontological theories 277
2.5 Conclusion 277
References 278
Further reading 278
Appendix II:
Summaries of reports of the President`s Commission for the study of ethical problems
In medicine and biomedical and behavioral research
1 Making health care decisions 279
2 Deciding to forego life-sustaining treatment 283
3 Securing access to health care 290
Appendix III:
American college of physicians ethics manual: Excerpts 293
Table of cases 298
Index 299

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