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Case Studies in Biomedical Ethics

Decision-Making, Principles, and Cases

Robert M. Veatch, Ph.D., Amy M. Haddad, Ph.D., R.N., and Dan C. English, M.D.

Publication Date - February 2009

ISBN: 9780195309720

480 pages
6-1/2 x 9-1/4 inches

Retail Price to Students: $64.95

Featuring a wide range of more than 100 case studies drawn from current events, court cases, and physicians' experiences, this timely volume explores fundamental ethical questions arising from real situations faced by health professionals, patients, and others.


We are living in an unprecedented era of biomedical revolution. Medicine is remaking humans, and controversy surrounds such topics as abortion, artificial organs, brain circuitry, eugenics, euthanasia, and gene therapy. At the same time, medical advances are posing complex ethical problems for both patients and professionals.
The most comprehensive and up-to-date collection of its kind, Case Studies in Biomedical Ethics: Decision-Making, Principles, and Cases explores fundamental ethical questions arising from real situations faced by health professionals, patients, and others. Featuring a wide range of more than 100 case studies drawn from current events, court cases, and physicians' experiences, the book is divided into three parts. Part I presents a basic framework for ethical decision-making in healthcare, covering such issues as separating evaluative questions from questions of fact; distinguishing between ethical and nonethical evaluations; and identifying the source of ethical judgments. Expanding upon this framework, Part II explains the ethical principles: beneficence and nonmaleficence, justice, respect for autonomy, veracity, fidelity, and avoidance of killing. Parts I and II provide students with the background to analyze the ethical dilemmas presented in Part III, which features cases on a broad spectrum of issues including abortion, genetics, mental health, confidentiality, health insurance, experimentation on humans, the right to refuse treatment, and death and dying. Each case is accompanied by the authors' commentary, which guides students in considering the issues.
Ideal for undergraduate and graduate courses in biomedical ethics, bioethics, and medical ethics, Case Studies in Biomedical Ethics incorporates opening text boxes in each chapter that cross-reference relevant cases in other chapters. It also includes an appendix of important ethical codes and a glossary of key terms.


"Case Studies in Biomedical Ethics is by far the most comprehensive and engaging text I have yet encountered in the field. It includes a far-ranging array of cases in bioethics for use in the classroom presented in terms of a compelling account of the basic principles and issues of contemporary health care ethics. . . . I believe that it will set the new standard in the field."--Daniel E. Palmer, Kent State University

"The sheer range of cases is better than any other of the score of textbooks I have seen. One of the great virtues of the book is the style, which is consistently clear and engaging without sacrificing attention to the complexities and subtleties of the issues. The coverage of topics is more extensive than any other textbook I am aware of. . . . The integration of commentary on each specific case, as well as a larger framework for putting the cases in the context of basic principles of medical ethics, is exemplary. The book is an excellent choice for any college-level course in medical ethics."--Daniel Berthold, Bard College

Table of Contents

    List of Cases
    List of Tables
    Introduction: Four Questions of Ethics
    What Are the Source, Meaning, and Justification of Ethical Claims?
    Distinguish between Evaluative Statements and Statements Presenting Nonevaluative Facts
    Distinguish between Ethical and Nonethical Evaluations
    3. Determine Who Ought to Decide
    What Kinds of Acts Are Right?
    Deontological or "Duty-Based" Ethics
    Other Issues of Normative Ethics
    How Do Rules Apply to Specific Situations?
    What Ought to Be Done in Specific Cases?
    Chapter 1: A Model for Ethical Problem Solving
    The Five-Step Model
    Application of the Model
    1. Respond to the Sense that Something Is Wrong
    2. Gather Information
    3. Identify the Ethical Problem/Moral Diagnosis
    4. Seek a Resolution
    5. Work with Others to Choose a Course of Action
    Chapter 2: Values in Health and Illness
    Identifying Value Judgments in Medicine
    Separating Ethical and Other Evaluations
    Chapter 3: What Is the Source of Moral Judgments?
    Grounding Ethics in the Professional Code
    Grounding Ethics in the Physician's Orders
    Grounding Ethics in Institutional Policy
    Grounding Ethics in the Patient's Values
    Grounding Ethics in Religious or Philosophical Perspectives
    Chapter 4: Benefiting the Patient and Others: The Duty to Do Good and Avoid Harm
    Benefiting the Patient
    Health in Conflict with Other Goods
    Conflicts among Health-Related Benefits
    Relating Benefits and Harms
    Benefits of Rules and Benefits in Specific Cases
    Benefiting Society and Individuals Who Are Not Patients
    Benefits to Society
    Benefits to Specific Nonpatients
    Benefit to the Profession
    Benefit to the Health Professional and the Health Professional's Family
    Chapter 5: Justice: The Allocation of Health Resources
    Justice among Patients
    Justice between Patients and Others
    Justice in Public Policy
    Justice and Other Ethical Principles
    Chapter 6: Autonomy
    Determining Whether a Patient Is Autonomous
    External Constraints on Autonomy
    Overriding the Choices of Autonomous Persons
    Chapter 7: Veracity: Honesty with Patients
    The Condition of Doubt
    Lying in Order to Benefit
    Protecting the Patient by Lying
    Protecting the Welfare of Others
    Special Cases of Truth-Telling
    Patients Who Do Not Want to Be Told
    Family Members Who Insist the Patient Not Be Told
    The Right of Access to Medical Records
    Chapter 8: Fidelity: Promise-Keeping, Loyalty to Patients, and Impaired Professionals
    The Ethics of Promises: Explicit and Implicit
    Fidelity and Conflicts of Interest
    Incompetent and Dishonest Colleagues
    Chapter 9: Avoidance of Killing
    Active Killing versus Letting Die
    Withholding versus Withdrawing Treatment
    Direct versus Indirect Killing
    Justifiable Omissions: The Problem of Nutrition and Hydration
    Voluntary and Involuntary Killing
    Killing as Punishment
    Chapter 10: Abortion, Sterilization, and Contraception
    Abortion for Medical Problems of the Fetus
    Abortion Following Sexual Assault
    Abortion to Save the Life of the Pregnant Woman
    Abortion and the Mentally Incapacitated Woman
    Abortion for Socioeconomic Reasons
    Chapter 11: Genetics, Birth, and the Biological Revolution
    Genetic Counseling
    Genetic Screening
    In Vitro Fertilization and Surrogate Motherhood
    Preimplantation Diagnosis
    Gene Therapy
    Chapter 12: Mental Health and Behavior Control
    The Concept of Mental Health
    Mental Illness and Autonomous Behavior
    Mental Illness and Third-Party Interests
    Other Behavior-Controlling Therapies
    Chapter 13: Confidentiality: Ethical Disclosure of Medical Information
    Breaking Confidence to Benefit the Patient
    Breaking Confidence to Benefit Others
    Breaking Confidence as Required by Law
    Conflict between Confidentiality and Other Duties
    Chapter 14: Organ Transplants
    Procuring Organs
    Donation versus Salvaging
    Diseased and Poor-Quality Organs
    Donation after Cardiac Death
    Preserving the Organs of the Dying
    Socially Directed Organ Donation
    Living Donor/Deceased Donor Organ Swaps
    Children as Living Organ Sources
    Allocating Organs
    Maximizing Benefits and Distributing Organs Fairly
    When Voluntary Risks Cause a Need for Organs
    Multiple Organs and Special Priority for Special People
    Chapter 15: Health Insurance, Health System Planning, and Rationing
    The Problem of Small, Incremental Benefits
    Limits on Unproved Therapies
    Marginally Beneficial, Expensive Therapy
    Valued Care that Is Not Cost-worthy
    Funding Care that Patients Have Refused
    Pharmaceutical Manufacturers versus Insurers
    Insurance and the Uninsured
    Chapter 16: Experimentation on Human Subjects
    Calculating Risks and Benefits
    Privacy and Confidentiality
    Equity in Research
    Conflicts of Interest in Research
    Informed Consent in Research
    Chapter 17: Consent and the Right to Refuse Treatment
    The Elements of a Consent
    The Standards for Consent
    Comprehension and Voluntariness
    Chapter 18: Death and Dying
    The Definition of Death
    Competent and Formerly Competent Patients
    Never Competent Patients
    Never Competent Persons without Available Family
    Never Competent Persons with Available Family
    Futile Care and Limits Based on the Interests of Others
    Appendix: Codes of Ethics
    The Hippocratic Oath
    World Medical Association, Declaration of Geneva
    The American Medical Association, Principles of Medical Ethics
    Universal Declaration on Bioethics and Human Rights
    List of Cases from Public Sources