Ethics in Health Care: A Canadian Focus, First Edition

Description

Cover Title Page Copyright Page Contents Preface 1 Ethics as a Discipline Questions to Keep in Mind While Reading this Chapter Introduction Meta-Ethics and Cultural Plurality The Meaning of Ethical Statements Ethical Relativism and Cultural Plurality Critique of Ethical Relativism Ethical Realism (Objectivism) The Nature of Ethics Ethical Theories and their Relevance to Health Care Some Preliminary Remarks Utilitarianism Principle of Utility Deontological Theories Ethical Principles in Health Care Autonomy and Respect for Persons Equality and Justice Fidelity (or Integrity or Best Action) Beneficence Non-Malfeasance or Nonmaleficence Conflict among Deontological Principles and Their Derivative Rights and Duties The Return of Prima Facie The Ranking of Rights Impossibility and Futility Other Ethical Theories Feminist Ethics Virtue Ethics The Structure of Ethical Justification Conclusion Further Readings Endnotes 2 Codes of Ethics and the Medical Profession Questions to Keep in Mind While Reading this Chapter Introduction The Current CMA Code Fundamental Responsibilities Responsibilities to Patients Responsibilities to Society Responsibilities to the Profession Responsibilities to Oneself Discussion The Ethical Status of Codes of Ethics Codes as Statements of Ethos Codes as Quasi-Legal Documents Codes as Statements of the Unique Ethics that Governs a Profession Codes as Statements of Role-Specific Rules Derived from General Ethical Principles Three Fallacies A Model Code of Ethics for Physicians Some Preliminary Considerations Duties or Obligations Rights Withdrawal of Service: Physicians, the Medical Profession and Society Conclusion Further Readings Endnotes Sample Cases 3 The Health Care Professional–Patient Relationship Questions to Keep in Mind While Reading this Chapter Introduction Models of Physician–Patient Relationships The Paternalistic Mode The Agency Model The Contractual Model The Friendship Model The Fiduciary Model Discussion The Paternalistic Model The Agency Model The Contractual Model The Friendship Model The Fiduciary Model Emerging Issues Conclusion Further Readings Endnotes Sample Cases 4 Informed Consent Questions to Keep in Mind While Reading this Chapter Introduction Patients and their Medical Records Patient Ignorance and Failure to Understand Patient Records and Litigation Ownership of Patient Records Patient Records and Third Parties Informed Consent Standards of Disclosure Full Disclosure Professional Disclosure Subjective Disclosure Objective Reasonable Person Standard Standards of Comprehension Age and Consent Patient Delegation of Consent Informed Consent: Some Considerations of Practice Obtaining Consent Forms and Other Matters Types of Consent Factors Affecting Freedom of Consent Cultural Parameters and Freedom to Decide Non-Cultural Parameters Exceptions to Informed Consent The Doctrine of Emergency The Doctrine of Therapeutic Privilege Reasons for Withholding Information Placebos Conclusion Further Readings Endnotes 5 Substitute Decision-Making Questions to Keep in Mind While Reading this Chapter Introduction What Constitutes Competence? Conceptual Competence Emotional Competence Valuational Competence Volitional Competence Who Should Function as Substitute Decision-maker? The Physician The Doctrine of Emergency Physicians and Advance Directives Duly Empowered Substitute Decision-Makers The Parens Patriae Powers of the Court What Values Should a Substitute Decision-Maker Use? Previously Competent Patients Patients Who Have Never Been Competent Assent and Involving Children in Decision-Making Substituted Judgment: Permanently Incompetent Patients Conclusion Further Readings Endnotes 6 Research Using Human Subjects Questions to Keep in Mind While Reading this Chapter Introduction Experimentation: Some Preliminary Issues What is Distinctive about Medical Experimentation? Why Experiment? The Design of Clinical Trials Scientific Validity Numbers Subject Selection Minimal Risk Balance of Risk and Benefit Health Researchers and Research Ethics Boards (REBs) or Committees Therapeutic and Non-Therapeutic Experimentation Consent in Experimentation Consent in Research versus Consent in Therapy Different Ethical Perspectives The “Forbidden Fruit” Controversy: Using Unethically Derived Data Innovative Procedures The Tri-Council Guidelines and Consent in the Research Setting Deception and the Possibility of Harm Consent and Autonomy: The Problem of Incompetent Persons The Duty to Participate in Medical Research Infants, Incompetent Adults and Phase I Trials Assent Reward and Enticement Consent and Collectivities The Role of Pharmaceutical Companies Control of Data and Results Orphan Drugs Conclusion Further Readings Endnotes Sample Cases 7 The Ethics of Deliberate Death Questions to Keep in Mind While Reading this Chapter Introduction The Concept of Death Definitions versus Criteria Materialism versus Dualism Cardiopulmonary Criterion versus Brain-Death Criterion Whole-Brain versus Cerebral Death Deliberate Death Some Terminology Killing versus Letting Die Causality Ethical Responsibility The Ethics of “Letting Nature Take Its Course” Palliation versus Euthanasia Right to Life versus Duty to Life Ordinary versus Extraordinary Means Direct versus Indirect Euthanasia The Morality of Euthanasia: Arguments Contra Life-Centred Arguments Person-Centred Arguments Professional-Centred Arguments Pragmatic Arguments The Morality of Euthanasia: Arguments Pro Autonomy-Based Arguments Equality and Justice–Based Arguments Beneficence and Non-Malfeasance–Based Arguments Assisted Suicide Euthanasia and Brain Death Voluntary versus Non-Voluntary Euthanasia Conclusion Further Readings Endnotes Sample Cases Appendix A: Legislative Proposal 8 Abortion Questions to Keep in Mind While Reading this Chapter Introduction Some Historical Background Framing the Abortion Issue: Some Introductory Considerations Is the Fetus Ever a Person? Potentiality The Fetus as a Dependent Being Fetal Rights Maternal–Fetal Conflict The Ethical Relevance of Methods of Abortion Arguments For and Against Abortion Arguments Pro Arguments Contra Conclusion Further Readings Endnotes Sample Cases 9 Health, Health Care and Social Justice Questions to Keep in Mind While Reading this Chapter Introduction The Definition of “Health” Health and Values Concepts and Values Right to Health Care Right to Health versus Right to Health Care Nature and Origin of the Right to Health Care Limits on the Right to Health Care Allopathic Health Care versus Alternative Health Care Health Care as a Right versus Health Care as a Commodity The Commodity Approach The Rights Approach Discussion The Canada Health Act (CHA) Introduction The CHA The CHA and the Romanow Report Conclusion Further Readings Endnotes Sample Cases 10 Resource Allocation Questions to Keep in Mind While Reading this Chapter Introduction Overall Health Care Budgets within a Socialized Context Macro-Allocation Possible versus Impossible Threshold Effectiveness Vertical Ethical Conflict: Deontological versus Utilitarian Ethics Non-Average Needs Primary and Secondary Macro-Allocation Special Non-Medically Defined Groups First Nations Poverty Age Micro-Allocation Is It Possible to Avoid Micro-Allocation? Ethically Questionable Micro-Allocation Criteria Ethically Possible Criteria Two Final Notes on Allocation Health Care Professionals and Pandemics Sidestepping Allocation Protocols: The Phenomenon of the Identified Victim Conclusion Further Readings Endnotes Sample Cases 11 Reproductive Ethics and the Right to Have Children Questions to Keep in Mind While Reading this Chapter Introduction Some Legal and Historical Considerations Some Preliminary Ethical Considerations The Ambiguity of the “Right to Have Children” Some Arguments and Their Analysis Argument from Biology Argument from Desire Argument from the Realization of Personal Potential Argument from Social Expectation Argument from the Right to Personal Integrity Is There a Right to Have Children? Introduction The Control of Reproduction The Mentally Disabled and the Right to Have Children Commercial Surrogate Motherhood and Related Issues Arguments Contra Arguments Pro Sex Selection Medically-Grounded Sex Selection Arguments Pro Arguments Contra Non-Medical Sex Selection Cultural Grounds Post-menopausal Motherhood “Naturalness” of the Intervention Welfare of Children Welfare of Mothers Access to Ova Conclusion Further Readings Endnotes Sample Cases 12 Biotechnology Questions to Keep in Mind While Reading this Chapter Introduction Ectogenesis Arguments Pro Arguments Contra Discussion Human Cloning Arguments Pro Arguments Contra Discussion Genetic Testing and Genetic Information Arguments Pro and Contra Discussion Genetic Information and Biological Parentage The Implications of Genetic Knowledge: A Paradigm Shift Genetic Engineering Some Historical Considerations Genetic Engineering with Modern Tools Germ Line Gene Therapy Genetic Therapy versus Genetic Enhancement Conclusion Further Readings Endnotes Sample Cases Index A B C D E F G H I J K L M N O P Q R S T U V W Z