9780130991614

This briefsummary of the issues of biomedical ethics provides a balanced, systematic, unbiased framework designed to help health professionals an lay people understand and analyze a wide rangeof topics that are currently controversial in medicine ;or that are likely to arise in the future. Broad in scope, it considers ethical systems from variousreligious and secular traditions, including those of non-western cultures such as Asian religious and secular traditions. Topics include the history of codes of ethics; the definition of death, abortion, animal rights and welfare; problems in deciding what will benefit patients; confidentiality, truth-telling, informed consent; the care of the terminally ill; genetics, birth technologies; and problems of social ethics, including resource allocation, organ transplant, and human subjects research. For use in allied health fields.

Robert M. Veatch is Professor of Medical Ethics and former director of the Kennedy Institute of Ethics, Georgetown University.

List of Cases

xi

List of Figures

xii

Preface

xiii

A Map of the Terrain of Ethics

1

(12)

The Levels of Moral Discourse

2

(8)

The Level of the Case

2

(1)

Rules and Rights (Codes of Ethics)

3

(2)

Normative Ethics

5

(2)

Metaethics

7

(3)

A Full Theory of Bioethics

10

(1)

Key Concepts

11

(1)

Bibliography

12

(1)

Works on Basic Ethics

12

(1)

Works on Biomedical Ethics

12

(1)

The Hippocratic Oath and Its Challengers: A Brief History

13

(15)

The Hippocratic Tradition

13

(5)

The Hippocratic Oath

13

(3)

Modern Codes in the Hippocratic Tradition

16

(2)

The Collapse of the Hippocratic Tradition

18

(5)

Codes and Oaths Breaking with the Hippocratic Tradition

19

(2)

Sources from Outside Professional Medicine

21

(2)

Key Concepts

23

(2)

Endnotes for chapter 2

25

(1)

Bibliography

26

(2)

Defining Death, Abortion, And Animal Welfare: The Basis of Moral Standing

28

(19)

Persons, Humans, and Individuals: The Language of Moral Standing

29

(5)

The Concept of Moral Standing

29

(2)

Moral and Nonmoral Uses of the Term Person

31

(3)

Moral and Nonmoral Uses of the Word Human

34

(1)

Defining Death

34

(6)

A Cardiac Definition of Death

35

(2)

A Whole-Brain-Oriented Definition of Death

37

(1)

The Higher-Brain Definition of Death

38

(1)

Definitions and Moral Standing

39

(1)

Abortion

40

(2)

Symmetry between Definition of Death and Abortion

40

(1)

Possible Basis for a Breakdown in the Symmetry

41

(1)

The Moral Status of Non-Human Animals

42

(2)

Key Concepts

44

(1)

Endnotes for chapter 3

44

(1)

Bibliography

45

(2)

The Definition of Death

45

(1)

Abortion

45

(1)

Moral Standing of Non-human Animals

45

(2)

Problems in Benefitting and Avoiding Harm to the Patient

47

(17)

What Counts as a Benefit?

47

(7)

Subjective vs. Objective Estimates of Benefit and Harm

47

(4)

Medical vs. Other Personal Benefits

51

(2)

Conflicting Goals within the Medical Sphere

53

(1)

Ways to Balance Benefits and Harms

54

(4)

Bentham and Arithmetic Summing

54

(1)

Comparing the Ratio of Benefits to Harms

55

(2)

First of All, Do No Harm

57

(1)

The Problem of Medical Paternalism

58

(3)

Key Concepts

61

(1)

Endnotes for chapter 4

62

(1)

Bibliography

62

(2)

The Ethics of Respect for Persons: Lying, Cheating, and Breaking Promises and Why

64

(24)

Physicians Have Considered Them Ethical

64

(2)

The Principle of Fidelity

66

(5)

The Ethics of Confidentiality

67

(4)

The Principle of Autonomy and the Doctrine of Informed Consent

71

(9)

The Concept of Autonomy

72

(1)

Positive and Negative Rights

73

(1)

Informed Consent, Autonomy, and Therapeutic Privilege

74

(3)

Standards of Disclosure for Consent to Be Adequately Informed

77

(3)

The Principle of Veracity: Lying and the Duty to Tell the Truth

80

(4)

The Change in Physician Attitudes

80

(1)

Accounting for the Change in Attitudes

80

(4)

Key Concepts

84

(1)

Endnotes for chapter 5

85

(1)

Bibliography

86

(2)

The Principle of Avoiding Killing

88

(17)

Active Killing vs. Allowing to Die

89

(7)

Distinguishing Active Killing from Allowing to Die

90

(4)

New Legal Initiatives for Physician-Assisted Suicide

94

(2)

Stopping vs. Not Starting

96

(1)

The Distinction Between Direct and Indirect Killing

97

(1)

The Distinction Between Ordinary and Extraordinary Means

98

(4)

The Meaning of the Terms

98

(1)

The Criteria for Classifying Treatments Morally Expendable

99

(1)

The Subjectivity of All Benefit and Harm Assessments

100

(1)

Withholding Food, Fluids, CPR, and Medications

101

(1)

Key Concepts

102

(1)

Endnotes for chapter 6

103

(1)

Bibliography

103

(2)

Death and Dying: the Incompetent Patient

105

(16)

Formerly Competent Patients

106

(7)

The Principle of Autonomy Extended

106

(1)

Substituted Judgment

107

(1)

Going Beyond Advance Directives

107

(2)

Mechanisms for Expressing Wishes

109

(2)

Issues to Be Addressed in an Advance Directive

111

(2)

Never-Competent Patients without Family or Other Pre-existing Surrogates

113

(2)

The Principles

113

(1)

The Legal Standard

113

(1)

Who Should Be the Surrogate?

114

(1)

Never-Competent Patients with Family Surrogates

115

(4)

What Is the Standard Underlying This Family Discretion?

116

(3)

Key Concepts

119

(1)

Endnotes

119

(1)

Bibliography

119

(2)

Social Ethics of Medicine: Allocation of Resources, Transplantation, and Human Subjects Research

121

(27)

The Need for a Social Ethic for Medicine

121

(5)

The Limits of the Ethics of Individual Relations

121

(1)

The Social Ethical Principles for Medical Ethics

122

(4)

Allocation of Health Care Resources

126

(8)

The Demand for Health Care Services

126

(1)

The Inevitability of Rationing

127

(1)

Ethical Responses to the Pressures for Cost Containment

128

(6)

The Role of the Clinician in Allocation Decisions

134

(2)

Organ Transplantation

136

(4)

Is Performing Transplants ``Playing God''?

136

(1)

Procurement of Organs

137

(1)

Organ Allocation

137

(3)

Research Involving Human Subjects

140

(3)

Distinguishing Research and Innovative Therapy

140

(1)

Social Ethics for Research Involving Human Subjects

141

(2)

Key Concepts

143

(1)

Endnotes for chapter 8

144

(1)

Bibliography

145

(3)

Social Ethical Theory

145

(1)

Allocation of Scarce Medical Resources

145

(1)

Organ Transplantation

146

(1)

Research Involving Human Subjects

147

(1)

Human Control of Life: Genetics, Birth Technologies and Modifying Human Nature

148

(19)

The Human as Created and as Creator

149

(1)

Medical Manipulation as Playing God

149

(1)

Having Dominion over the Earth

150

(1)

Genetics and the Control of Human Reproduction

150

(14)

Genetics

150

(8)

New Reproductive Technologies

158

(6)

Key Concepts

164

(1)

Endnotes for chapter 9

164

(1)

Bibliography

165

(2)

Resolving Conflicts among Principles

167

(17)

Different Concepts of Duty

168

(2)

Absolute, Exceptionless Duties

168

(1)

Prima Facie Duties

169

(1)

Duty Proper

170

(1)

Theories of Conflict Resolution

170

(9)

Single Principle Theories

170

(1)

Ranking (Lexically Ordering) Principles

171

(1)

Balancing

172

(1)

Combining Ranking and Balancing

172

(3)

Ways of Reconciling Social Utility and Justice

175

(4)

Translating Principles to Rules

179

(2)

Conclusion

181

(1)

Key Concepts

182

(1)

Endnotes

182

(1)

Bibliography

183

(1)

The Virtues in Bioethics

184

(9)

Virtue Lists

185

(3)

Professional Virtues

186

(1)

Secular Virtues

187

(1)

Religious Virtues

187

(1)

Care as a Virtue

188

(1)

Problems with the Virtues

188

(2)

The Wrong Virtue Problem

189

(1)

The Naked Virtue Problem

189

(1)

Conclusion

190

(1)

Key Concepts

191

(1)

Bibliography

191

(2)

Appendix

193

(2)

Hippocratic Oath

193

(1)

Principles of Medical Ethics (2001) of the American Medical Association

194

(1)

Index

195

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When the first edition ofThe Basics of Bioethicsappeared in the final weeks of the twentieth century, no current, brief survey existed that was a suitable introduction to the field. Textbooks, anthologies, casebooks, and single-authored works were available to provide perspective on the issues of bioethics, but there was no introduction to the field of bioethics under several hundred pages in length. The first edition served that purpose. It was intended for health professionals and lay people who wanted an introduction to the issues in a relatively small edition suitable for use in short courses in schools of medicine, nursing, and the other health professions; continuing professional education; undergraduate courses in philosophy, religion, and the social sciences; and in adult education.Since the publication of the first edition a great deal has happened in the fast-moving field of bioethics. We have cloned the first human being, isolated stem cells with the potential for generating new genetically matched organs for transplant, formulated new patients' bills of rights, and issued a major revision of the international code for human subjects research. We have also seen the first case of killing a patient with genetic experimentation, seen rationing of health care become common, and (in the Netherlands) formally authorized physician killing of patients for mercy without fear of prosecution.We have also seen some progress in the slower-paced discipline of formal ethical analysis. More agreement exists on the need to move back and forth at different levels of ethical analysis--moving from bedside case discussion up to statements of rules and codes and on up to the more abstract levels of normative ethics dealing with ethical principles and virtues. There is more agreement now that it matters less where one starts roaming through the different levels of ethical discourse and more agreement that all levels should be encountered before an ethical conclusion is firm. There is more interest in alternative approaches--in an ethic of virtue to supplement an ethic focusing on actions; more interest in something called "care theory" and in feminist approaches to bioethics.In short, there is a need for a new edition, still at the introductory level but updated both with new developments in clinical medicine and in ethical analysis. This second edition adds two completely new chapters. The first chapter is designed for the reader who has not been exposed to formal ethical theory. It provides a "map" of the ethical terrain, a schema outlining four levels of moral discourse or ethical analysis. This scheme is summarized in the new diagram that appears on the inside of the front and back covers of the book. On this diagram virtually every dispute in bioethics can be mapped.Some disagreements exist at one of the levels. For example, much of bioethics in the late decades of the twentieth century involved controversies over which ethical principles prevailed. This can be seen in the central shaded boxes at the level of "Normative Ethics" in the diagram. Other disputes involve questions of whether to resolve moral controversies by working at this normative level or at some other level (by applying a code of ethics or by focusing on an individual case, for instance). Portions of this central diagram of the "Four Levels of Moral Discourse" is reproduced in various chapters when the ethical controversies of bioethics are presented in greater detail. I hope this diagram will help to clarify, especially to the reader not trained in ethical analysis, exactly what the basis is for moral disagreements in the field of biomedical ethics.The second completely new chapter is the last one, "The Virtues in Bioethics." Discussion of the virtues of the physician are as old as the profession of medicine itself. The Hippocratic Oath touted the virtues of "purity" and "holiness"; the ancient Confucian m

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The Basics of Bioethics

The Basics of Bioethics

0130991619

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