Bioethics in Context

Gary E. Jones is Professor of Philosophy at the University of San Diego, USA and a member of the California Bar Association. Joseph P. DeMarco is Professor Emeritus of Philosophy at Cleveland State University, USA.

Acknowledgments
Introduction

Chapter 1: Moral Theory in Bioethics

Consequentialism and Deontology

Consequentialism

Rule Consequentialism
Hare’s Utilitarianism


Kantian Deontology
Rule Theory
Case Study: Dr. Mando


Alternative Approaches

Principlism
Particularism
Virtue Ethics
Feminist Ethics and the Ethics of Care
Casuistry


Conclusion
Exercises and Discussion Questions

Chapter 2: Basic Law

The American Legal System

Common Law
Statutory Law
Executive Orders and Agencies
Constitutional Law
State Court Systems
The Federal Court System


Legal Processes and Lawsuits

Legal Processes
Lawsuits


Ethics and the Law
Conclusion
Exercises and Discussion Questions

Chapter 3: Justice and the Right to Care

The Meaning of Justice
Justice and Equality

Equality of Resources: Ronald Dworkin
Group Equality: R.H. Tawney
Complex Equality: Michael Walzer
Criteria of Just Distribution


Theories of Justice

Utilitarian Theory
Social Contract Theory
Libertarian Theory
Feminist Ethics and Just Health Care
Norman Daniels’s Approach to Health-Care Justice
Just Health Care: Beauchamp and Childress


Allocation of Health Care

Models for the Allocation of Health Care to Individuals

The Proprietary Model
The Merit Model
The Social Worth Model
The Need Model


Policy Options for the Allocation of Health Care

Fee-for-Service Model
The Universal and Comprehensive Provision of Benefits Model
Fee-for-Service with a Safety Net Model
Universal Basic Health-Care Model
Professional Considerations
Containment of Health-Care Costs
Rationing of Health Care




Patient Protection and Affordable Care Act

The PPACA and the Iron Triangle

Accessibility
Quality
Cost


Concerns about the Viability of the PPACA
The PPACA and the US Constitution

Expansion of Medicaid
Individual Mandate


Ethical Aspects of the Individual Mandate and Medicaid Expansion


Conclusion
Exercises and Discussion Questions

Chapter 4: The Duty to Treat

Physicians and Other Health-Care Providers

In General, No Duty to Treat
Duty Not to Abandon
Is There a Moral Duty to Treat?
Standards of Care
Malpractice
Good Samaritan Laws


Hospitals

Medicare
Medicaid
Emergency Treatment
Staff Physicians
Nurses


Rights and Duties of Third-Party Payers

ERISA: Employment Retirement Income Security Act


Conclusion
Exercises and Discussion Questions

Chapter 5: Informed Consent

The Basics of Informed Consent

Three Concepts of Informed Consent
Elements of Informed Consent
Disclosure
Waiving and Delegating Informed Consent
Proxy Decision Making
Advance Directives


Assessing Capacity

The Meaning of Decisional Capacity
Mental Illness and Capacity to Consent
Enhancing Capacity
Capacity: Young and Old
Religion and Capacity
Does Rejection of Treatment Indicate Incapacity?
Erring on the Side of Autonomy
Assessing Capacity


Informed Consent: Ethical Issues

Constraints on Informed Consent

Coercion
Manipulation
Offers and Rewards
Influence


Medical Paternalism
Autonomy vs. Beneficence
Ethical Evaluation of Informed Consent
Informed Consent and Ethics Committees


Informed Consent: Legal Issues

The Scope of Informed Consent

Community of Physicians Standard
Reasonable Physician Standard
Objective Patient Standard
Subjective Patient Standard


Three Exceptions to Informed Consent

Incompetency
Emergency Care
The Therapeutic Privilege


Legal Consequences of the Failure to Obtain Informed Consent
Revising Informed Consent
False Imprisonment
Special Problem Areas


Conclusion
Exercises and Discussion Questions

Chapter 6: Informed Refusal and the Discontinuation of Treatment

The Criteria for and Meaning of Death

Persistent Vegetative States
Religious Objections to the Brain-Death Criterion


Medical Futility

What Is Medical Futility?

Physiological or Strict Futility
Quantitative Futility
Qualitative Futility


Case Studies of Medical Futility

Are Wanglie and Baby K Cases of Medical Futility?


Who Decides?
What Is the Chance of Success?
Policies on Futility

The AMA Policy
The Texas Statute




Discontinuing Medical Treatment

Determining Whether to Discontinue Treatment

Family Consent
Substituted Judgment
Best Interest Standard
Mixed Standard: Limited Objective Test


Withdrawing versus Withholding Treatment
Passive Euthanasia
Active Euthanasia and Physician-Assisted Suicide

The Ethics and Laws of Assisted Suicide




Ethical and Legal Foundations of Informed Refusal

The Ethics of Informed Refusal
Legal Foundations of Informed Refusal

Karen Quinlan: Privacy and Treatment
Nancy Cruzan: Clear and Convincing Evidence
Elizabeth Bouvia: Do Motives Matter?
Removing Respirators versus Removing Feeding Tubes
Other Cases: Schiavo and Borenstein




Treatment Decisions Involving Children

Birth Defects and Treatments
Parental Autonomy and Mandated Treatment
Refusal of Treatment for Religious Reasons


Conclusion
Exercises and Discussion Questions

Chapter 7: Nursing: Legal and Moral Issues

What is Nursing?

Licensure and Credentialing
Nurse Practice Acts and Nursing Boards
Standard of Care
Nurses and Conscience Clauses


The Limits of Nurses’ Responsibilities

Nurses and Diagnoses
Whose Obligation: Nurse’s or Physician’s?
Nurses Practicing Medicine?
Advocating for a Patient
Boundary Violations
Nurses in Emergencies


Some Particular Duties and Obligations

Nursing Assessment
Acquiring Informed Consent
Duty to Protect against Patient Self-Harm v
Duty to Warn Third Parties
Reporting Suspected Child Abuse


Conclusion
Exercises and discussion questions

Chapter 8: Privacy and Confidentiality

Privacy

Privacy as a Moral Rule
Utilitarian Justifications for Privacy
Covert Surveillance
The Legal Right to Privacy

The Right to Privacy of Conduct
The Right to Privacy of Information




Confidentiality

The Physician–Patient Relationship
The Physician’s Obligation of Confidentiality
HIPAA Regulations
Maintaining Confidentiality
Other Legal Exceptions to Confidentiality

Evaluating the Tarasoff Case


HIV and the Law
Duty to Warn of Genetic Risk


Conclusion
Exercises and Discussion Questions

Chapter 9: Cultural Competency

The Importance of Cultural Competency

Reasons in Support of Cultural Competency


Medical Diagnoses and Cultural Difference

Reacting to Patients: Responding to Differences
Respecting Differences and Negotiating Biases
Responding to Patient Biases
Not All People in Any Culture Are the Same
Whose Culture Dominates?
The Initial Encounter with Patients


Cultural Competency and Informed Consent

Cultural Competency and Informed Refusal


Cultural Competency and Translation

Translation and the Law
When Culture Conflicts with the Law

Deciding to Report
Balancing Moral and Legal Obligations




The Affordable Care Act
Conclusion
Exercises and Discussion Questions

Chapter 10: Issues in Human Reproduction

Abortion

Fetuses and Personhood
Philosophical Perspectives on Abortion
Legal Aspects of Abortion

The Legal Status of the Fetus




In Vitro Fertilization
Surrogate Motherhood
Involuntary Sterilization
Genetic Testing and Treatments

Genetics and Disease
Genetic Testing
Preimplantation Genetic Diagnosis


Genetic Enhancements

Senescence
Happiness


The Stem-Cell Debate
Human Cloning

Cloning to Produce Children
Cloning for Research Purposes


Conclusion
Exercises and Discussion Questions

Chapter 11: Mental Illness

What is Mental Illness?
Commitment, Consent, and Decision Making

Institutional Commitment and Consent
Treatment Decisions


Incompetence

The Use of Restraints


Legal Responsibilities and Liabilities

Malpractice
Duties to Third Parties


Conclusion
Exercises and Discussion Questions

Chapter 12: Medical Research: Clinical Trials

What are Clinical Trials?
Protecting Research Subjects

Historical Abuse
The Belmont Report
The Declaration of Helsinki


Placebos
Types of Clinical Trials

Phase I Trials
Phase II Trials
Phase III Trials


Protocols
Clinical Equipoise
Participation in a Clinical Trial
Federal Regulations
Legal Issues in Clinical Trials

Abney, et al. v. Amgen Inc.
Grimes v. Kennedy Krieger Institute, Inc.; Myron Higgins, A Minor, Etc., et al. v. Kennedy Krieger Institute, Inc.
Kristina Ann Dahl, MD, et al. v. HEM Pharmaceuticals, Inc., et al.
Estate of Kevin Baker v. University of Vermont
Greenberg, et al. v. Miami Children’s Hospital Research Institute, Inc., et al.


Conclusion
Exercises and Discussion Questions

Chapter 13: Transplantation Ethics

Organ Donation
Evaluating Prospective Organ Recipients
Selling Organs
Live Donors

Donors Lacking Competence
Donations against One’s Will


Prisoners as Organ Donors
Conclusion
Exercises and Discussion Questions

Index
Index of Court Cases
Index of Statutes
Index of Model Acts