Medical Ethics in Clinical Practice (eBook)

Matjaž Zwitter is a Professor and Chair of the Department of Ethics and Law at the University of Maribor, Slovenia, a Professor of Oncology and Radiotherapy at the Faculty of Medicine in Ljubljana, Slovenia, and a Senior Consultant Physician at the Institute of Oncology in Ljubljana, Slovenia. He has authored more than 45 papers included in the PubMed database and has co-edited two books: Communication with the cancer patient: information and truth (The New York Academy of Sciences, 1997) and New challenges in communication with the cancer patient (Springer, 2013). In addition to his formal achievements and positions, his main qualification is 40 years of personal experience devoted to treating patients with cancer.

Preface 5
Contents 7
1: Ethics and Law 14
1.1 Law 15
1.2 Ethics 15
1.3 Law and Ethics: Why Do We Need Two Systems? 16
Suggested Reading 17
2: Ethical Codes and Declarations 19
2.1 Hippocratic Oath and Other Ancient Documents 20
2.2 Medical Ethics in Modern Documents 22
2.3 Advantages and Disadvantages of Normative Ethics 23
References 23
Suggested Reading 23
Selected Codes of Medical Ethics 24
3: Ethical Theories 26
3.1 Utilitarian Ethics 28
3.2 Deontological Ethics 29
3.3 Virtue Ethics 30
3.4 The Four Principles and Common Morality Ethics 31
Reference 33
Suggested Reading 33
4: Moral Status 34
4.1 Who Has Moral Status? 35
4.2 Criteria for Moral Status 36
Reference 38
Suggested Reading 38
5: Ethical Analysis 39
Suggested Reading 44
6: Autonomy and Its Limitations 45
6.1 Right to Information 47
6.2 Right to Confidence 47
6.3 Right to Privacy 49
6.4 Voluntary Surrender of Autonomy 50
6.5 Patients’ Autonomy and Cultural Diversity 50
6.6 Persons with Limited Autonomy 50
6.7 Surrogate Decision-Makers 51
6.8 Advanced Directives 52
6.9 Physician’s Autonomy and Conscientious Objection 53
Suggested Reading 53
7: Communication 55
7.1 Information Flows in Multiple Directions 56
7.2 Communication as a Process 57
7.3 Modern Media and the Internet 57
7.4 The Broad Scope of the Conversation 58
7.5 The Opaqueness of the Medical Jargon 59
7.6 Cultural Diversity 60
7.7 Practical Advice 60
Suggested Reading 61
8: Relations in the Medical Team 63
8.1 Professional Competence 64
8.2 Communication in a Medical Team 64
8.3 Disagreement and Conflicts 65
8.4 Positive Team Spirit 66
Suggested Reading 66
9: Professional Malpractice 67
9.1 Mistake, Error, Neglect, Unfortunate Coincidence? 68
9.1.1 Limited Resources, Compromises in Probability-Based Medicine, and the Right to Compensation 69
9.2 Criminalization of Professional Malpractice 70
9.3 The Media, the Public, and Professional Mistakes 70
9.4 Support for the Accused Physician 71
Reference 71
Suggested Reading 71
10: Limited Resources, Priorities, and Corruption 73
10.1 Consequences of Poorly Organized Healthcare 74
10.2 Probability-Based Medicine 76
10.3 Priorities 77
10.4 Corruption 79
Reference 80
Suggested Reading 80
11: Image of a Physician 82
11.1 The Physician in Exceptional Circumstances 84
11.2 Who Is a Good Physician? 85
11.3 Who Is Draining the Idealism from Our Profession? 86
11.4 Burnout and the Anchor Outside Medicine 86
11.5 Conscientious Objection and the Respect of Personal Values 87
11.6 Digressions 88
Reference 89
Suggested Reading 89
12: Preventive Medicine 90
12.1 Vaccination 91
12.2 Healthy Lifestyle 92
12.3 Protection of Vulnerable Groups of Society 93
12.4 Epidemiology and Epidemiological Studies 93
12.5 Return to the Introductory Parable 93
Suggested Reading 94
13: Ethics at the Beginning of Life 95
13.1 Natural Conception 96
13.1.1 Contraception 96
13.1.2 Morning-After Pill 96
13.1.3 Abortion 96
13.1.4 Prenatal Diagnostics 97
13.1.5 Delivery at Home 98
13.2 Sterilization 98
13.3 Insemination or Egg Cell Donation 98
13.4 Medically Assisted Insemination for Healthy Women 99
13.5 In Vitro Fertilization 100
13.6 Surrogate Motherhood 101
References 102
Suggested Reading 102
14: Pediatrics 104
14.1 The Newborn 105
14.2 Vaccination 106
14.3 Child Neglect and Maltreatment 108
14.4 Chronic Disease and Communication 109
14.5 Genetics 109
14.6 Death of a Child 110
14.7 Research 110
References 111
Suggested Reading 111
15: Genetics 112
15.1 What Information Can Be Gained from Genetic Testing? 113
15.2 Disease Exclusion, Choice of Gender, and Selection of Other Traits of the Future Child 114
15.3 Genetic Testing in Childhood and Adulthood 116
15.4 Accidental Findings 117
Suggested Reading 118
16: Emergency Medicine and Transplantation 120
16.1 Admission to the Intensive Care Unit 122
16.2 Introducing, Withholding, and Withdrawing Intensive Care 122
16.3 Futile Intensive Care 123
16.4 Determining Death 123
16.5 Organ Transplantation 124
Reference 125
Suggested Reading 125
17: The Elderly and the Mentally-Ill 126
17.1 Who Are the Elderly? 128
17.2 Who Are the Mentally Ill? 129
17.3 Impaired Critical Judgement and Loss of Autonomy 130
17.4 Surrogate Decision-Making 130
17.5 Acting Against the Will of the Patient 131
17.6 Hunger Striking and Anorexia Nervosa 131
17.7 Social Status and Stigmatization 132
Suggested Reading 132
18: Dying and Death 134
18.1 The Wish to Die and Suicide 136
18.2 What Is Not Euthanasia? 137
18.3 Euthanasia and Physician-Assisted Suicide 137
18.4 Persistent Vegetative State 139
18.5 On Immortality 140
18.6 Education and Research 141
References 141
Suggested Reading 141
19: Research 143
19.1 The Four Phases of Clinical Trials 145
19.2 Patient Information 147
19.3 Academic Clinical Trials 148
19.4 Clinical Trials with a Commercial Sponsor 149
19.5 Progress, Patient Solidarity, and Honesty 152
References 153
Suggested Reading 154
20: Unproven Methods of Diagnostics and Treatment 156
20.1 Alternative Diagnostics 158
20.2 Supplementary and Alternative Treatment 159
20.3 Right to Try 159
References 161
Suggested Reading 161
21: Physicians Beyond Patient Care 162
21.1 Managerial Responsibilities and Politics 163
21.2 Expert 164
21.3 The Physician, the Pharmaceutical Industry, and Medical Equipment Providers 164
21.4 Teacher 165
21.5 The Physician in Public 166
21.6 Sports Medicine 166
21.7 Physician as Patient 167
References 168
Further Reading 168
22: Student Seminars 170
22.1 Surrogate Motherhood 173
22.2 Physician’s Confidentiality 174
22.3 Eluana Englaro 174
22.4 Love Life 175
22.5 Donor for Bone Marrow Transplantation 175
22.6 Unsolicited Medical Intervention 176
22.7 Elderly Driver 176
22.8 Posthumous Insemination 177
22.9 Physician as Patient 177
22.10 Crime Due to Mental Disease 178
22.11 Conscientious Objection 178
22.12 Ethics and Gladiators in Professional Sports 179
22.13 Medical Malpractice and the Right to Compensation 179
22.14 Anorexia Nervosa 180
22.15 Prevention of Pregnancy in Psychiatric Patient 180
22.16 Placebos in Clinical Trials 181
22.17 Choosing the Gender of the Newborn 181
22.18 Vegan Diet for Children 182
22.19 Accusation of Medical Malpractice: Disclosure of Personal Information 182
22.20 Boxing 183
22.21 Gifts 183
22.22 Drug Addicts, Pregnancy, and Parenthood 184
22.23 Who Is a Good Physician? 184
22.24 Parents Declining Mandatory Vaccination of Their Children 184
22.25 Collaboration Between the Psychiatrist and the Family Physician 185
22.26 Medically Assisted Insemination for Healthy Women 185
22.27 Physicians as Leading Politicians 186
22.28 Shooting as an Olympic Sport 186
22.29 Fine-Needle Biopsy of the Breast for a 12-Year-Old Girl 187
22.30 The Death of Ivan Ilyich 187
22.31 Waiting Periods for Funerals 187
22.32 Cancer Ward 188
22.33 Physician-Alcoholic 188
22.34 Disappearance of Inexpensive Drugs with Long-Lasting Positive Experience 188
22.35 Empathy and Trust 189
22.36 Medical Treatment of Patients Without Health Insurance 189
22.37 Doping in Sports 190
22.38 Intimate Relationships with a Patient 190
22.39 Paulo Coelho: Veronica Decides to Die 191
22.40 Communication with a Troublesome Patient 191
22.41 The Franja Partisan Hospital 192
22.42 Donor of Embryonic Stem Cells and Anonymity 192
22.43 Addiction to Prescription Drugs 193
22.44 Literature as a Medication 194
22.45 Sinclair Lewis: “Arrowsmith” 194
22.46 Female Genital Mutilation 194
22.47 Accusation of Medical Malpractice 195
22.48 Transport of a Dying Chronic Patient to the Emergency Department 196
22.49 Dr. Catherine Hamlin 196
22.50 An Aggressive Patient 197
22.51 Legalization of Marihuana 197
22.52 Lay People’s Attitudes Towards Euthanasia 197
22.53 Discrimination 198
22.54 Is Pedophilia a Disease? 199
22.55 The Nuremberg Trial Against Nazi Physicians 199
22.56 Humor in Communication with Patients 199
22.57 Obamacare—American Healthcare Reform: Successes and Difficulties 200
22.58 Child Abuse 200
22.59 Ethical Questions in Self-Inflicted Diseases 201
22.60 Homeopathy 202
22.61 Treatment of the Demented Patient 202
22.62 The Physician in Commercials 203
22.63 The Ebola Epidemic: Ethical Questions 203
22.64 Gene Testing in Underage Daughters 204
22.65 Revocation of Driver’s License 204
22.66 Airplane Seats for Overweight Persons 205
22.67 Individual Consent for Review of Old Biopsies 205
22.68 Love in a Nursing Home 206
22.69 Professional Sports in Children 206
22.70 Medical Strike 207
22.71 Artificial Womb 207
22.72 Genetic Testing for Prediction of a Disease 207
22.73 Cancerphobia 208
22.74 Communication in the Waiting Room 209
22.75 Traditional Medicine 209
22.76 Late Termination of Pregnancy 209
22.77 Postponement of Prison Sentence Service for Health Reasons 210
22.78 Animals in Biomedical Research 210
22.79 Death of Grandparents 210
22.80 Guerilla Surgeon 211
22.81 Loneliness 211
22.82 Mental Health of Political Leaders 212
22.83 Eugenics 212
22.84 Fatherhood 212
22.85 Mark Langervijk 213
22.86 Molière and the Characters of Physicians 213
22.87 Alternative Diagnostics 213
22.88 Trade with Human Organs for Transplantation 214
22.89 Dr. Thomas Percival: Medical Ethics 215
22.90 Mielke and Mitscherlich: “Doctors of Infamy—The Story of the Nazi Medical Crimes” 215
22.91 Oregon: The Death with Dignity Act 216