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     Should a brain-dead woman be artificially maintained for the sake of her fetus? Does a physician have the right to administer a life-saving transfusion despite the patient's religious beliefs? Can a family request a hysterectomy for their retarded daughter? Physicians are facing moral dilemmas with increasing frequency. But how should these delicate questions be resolved and by whom?...

    

A CASEBOOK OF MEDICAL ETHICS offers a real-life view of the central issues involved in clinical medical ethics. Since the analysis of cases plays a critical role in this study, the authors have assembled a broad collection of histories
encountered in their work as medical ethics educators and consultants. The cases are developed in substantial detail to reflect the rich medical and psychosocial complexity involved, and each is brought to a decision point at which a course of
action must be chosen. Among the issues examined are:

- Conflicts between patients' wishes and respect for their well-being
- Tensions concerning duties to patients unable to care for them selves and obligations to family members
- Clashes between patient care obligations and the interests of other persons, including physicians, third parties, and the general public.

     The book also includes commentaries that combine general discussion of ethical principles with specific analysis of the cases exam�ined in the text, as well as various options for resolving conflicts. Readers are invited to assess the
comparative merits and liabilities of these approaches. An ideal text for undergraduate and medical school courses, A CASEBOOK OF  EDICAL ETHICS brings readers to the forefront of medicine, where they share in the determination of crucial ethical decisions.

1 Paternalism in the Therapeutic Relationship
1.1 3 Ambivalence Toward Electroconvulsive Therapy
1.2 6 Treatment Refusal in the Medical Intensive Care Unit
1.3 9 An Uncooperative Leukemia Patient
1.4 12 Rehabilitation of a Dependent Patient
1.5 14 Alternative Approaches to Informed Consent
1.6 17 Previous Refusal of Treatment by a Presently Comatose Patient
1.7 19 A Family's Refusal of Blood Transfusions for a Mother and Her Son
1.8 22 Deciding Whether to Discharge a Suicidal Patient
1.9 25 A Request for Sex-Reassignment Surgery
1.10 28 Divulging Information Concerning an Infant's Condition
31 Commentary
42 Notes
2 Duties to Patient and Family
2.1 45 A Daughter's Insistence on Aggressive Treatment
2.2 48 Parental Refusal of Cancer Treatment on Religious Grounds
2.3 50 Informed Consent and the Dying Adolescent
2.4 53 Treatment Refusal for an Infant with Possible Brain Damage
2.5 56 Venereal Disease and Adolescent Confidentiality
2.6 58 Contraceptives for an Adolescent
2.7 61 Request for Abortion for a Retarded Daughter
2.8 64 Request for Hysterectomy for a Retarded Eleven-Year-Old
2.9 68 Conflict about Maintaining a Brain-Dead Woman for the
Sake of Her Fetus
2.10 71Choosing the Method of Delivery for a Fetus with Hydrocephalus
75 Commentary
83 Notes
3 Deciding for Others
3.1 89 A Bedridden and Cognitively Impaired Elderly Patient
3.2 91 Who Should Decide for a Patient in Persistent Vegetative
State?
3.3 95 Nasogastric Tube Feedings for an Elderly Stroke Patient
3.4 97 A Prolonged Stay in the Neonatal ICU
3.5 100 Deciding Treatment When the Preliminary Diagnosis Is Trisomy 18
3.6 103 Risk/Benefit Assessment of Surgery for a Child Suffering from Strokes
3.7 106 Responding to a Family's Decision for Laetrile
3.8 109 Selecting Therapy for a Mentally Retarded Teenager
3.9 111 Birth Control for a Retarded Woman
3.10 114 A Family's Lack of Commitment
117 Commentary
130 Notes
4 Medical Research Involving Human Subjects
4.1 135 Limited Consent in Alcoholism Research
4.2 138 Disclosure of Preliminary Results in a Randomized Clinical Trial
4.3 140 Constraints on Consent in a Phase I Clinical Trial
4.4 143 Proxy Consent for Incompetent Trauma Patients
4.5 146 Undue Inducement in the Recruitment of Research Subjects
4.6 149 Nontherapeutic Research Procedures Involving Children
4.7 153 Discomfort from Repeated Nontherapeutic Research
Procedures Involving Competent Adults
4.8 155 Physicians' Treatment Preferences and Recruitment of Subjects
for a Randomized Clinical Trial
4.9 159 Parental Preferences and a Child's Involvement in a
Randomized Clinical Trial
4.10 163 Compensating Research Injuries
166 Commentary
179 Notes

5 Physicians, Third Parties, and Society
5.1 187 Request for Surgery the Physician Considers Unnecessary
5.2 190 Providing Free Care
5.3 194 Risk of Litigation as a Factor in Decision Making
5.4 197 Pressures to Provide Customary Care
5.5 200 Confidentiality and Child Abuse
5.6 202 Rejection of a Consultant's Advice
5.7 205 Abortion Resulting in a Live Birth
5.8 208 Costly Nutrition for a Terminal Patient
5.9 211 Cost Factors in the Choice of Treatment for Kidney Stone Disease
5.10 214 Artificial Insemination for a Single Woman
217 Commentary
233 Notes
239 Topical Index to Cases