Introduction to Clinical Ethics: Perspectives from a Physician Bioethicist

Description

This textbook offers an introduction to the field of bioethics, specifically from a practicing physician standpoint. It engages a wide range of recent scholarship and emerging research covering many crucial topics in clinical ethics. While there has been increasing attention to the role of bioethics in medicine, the gap between theory and practice still exists, and it continues to impede the dialogue between health care professionals from one side and bioethicists and philosophers of medicine from the other side. This book builds bridges and open channels of connection between different parties in these conversations. It does so from a physician’s practical perspective, engaging recent scholarship and emerging research, to shed light on pivotal ethical dilemmas in contemporary clinical practice. Preface Acknowledgments Introduction Contents Part I Context of Bioethics in Clinical Practice 1 Physician—Patient Relationship and the Challenges of Modern Practice 1.1 Introduction 1.2 Physicians, Patients and Illnesses 1.2.1 From Shaman to Provider, a Historical Review 1.2.2 Disease and Illness 1.3 Models of Relationship Between Physicians and Patients 1.3.1 Beneficence Based Model 1.3.2 Autonomy Based Model 1.4 Patient Satisfaction 1.4.1 The Rise of the Concept 1.4.2 The Significance of Patient Satisfaction 1.5 Definition and Critique 1.5.1 Theories of Patient Satisfaction 1.5.2 Critique to the Concept 1.6 Achieving the Goals of Medicine 1.6.1 Virtues in Medicine 1.6.2 The Risks of Commodification of Health Care 1.7 Summary Notes Bibliography 2 Models of Medical Clinical Practice: A Comparative Discussion of Secular and Religious Bioethics 2.1 Introduction 2.2 Philosophy of Medicine 2.2.1 General Consideration 2.2.2 Reductionism and Holism 2.3 Scientific Reasoning 2.3.1 Rationality and Empiricism 2.3.2 Clinical Applications 2.4 Subjective Reasoning 2.4.1 The Importance of Stories 2.4.2 Narrative Medicine Movement 2.5 Christian Perspective 2.5.1 From Profession to Vocation 2.5.2 Agape in Medicine 2.6 Summary Notes Bibliography Part II Research and Biotechnology 3 Ethics of Clinical Research, Publications, and Conflict of Interest 3.1 Introduction 3.2 Historical Review 3.2.1 Some Tragedies 3.2.2 Physician or Investigator, Ethical Analysis 3.3 Randomized Controlled Trials 3.3.1 The Concept of Equipoise 3.3.2 The Problem of Placebo 3.4 Informed Consent 3.4.1 Grounding Theories 3.4.2 Essential Elements 3.5 Conflicts 3.5.1 The Vioxx Story 3.5.2 Definition and Analysis 3.6 Summary Notes Bibliography 4 The Debate on Biotechnology and Genetic Therapy 4.1 Introduction 4.2 General Background 4.2.1 The Cell and Genome Editing 4.2.2 CRSPR and Future Dreams 4.3 Grounding the Debate 4.3.1 Human Dignity 4.3.2 Theological Background 4.4 Eugenics and Future Challenges 4.4.1 The New Eugenics 4.4.2 A Sense of Unease 4.5 Memory, Age, Intelligence and More 4.5.1 Enhancement and Therapy 4.5.2 Examining the Unease 4.6 Summary Notes Bibliography Part III Cardiovascular Medicine 5 Clinical Interventions—Anthropological Approach to Advance Heart Failure and Ethical Challenges in Infective Endocarditis 5.1 Introduction 5.2 Heart Failure 5.2.1 Scientific Review 5.2.2 General Facts 5.3 Understanding Chronic Illnesses 5.3.1 Person and Value 5.3.2 Suffering in Chronic Illness 5.4 Heart Failure, Anthropological Analysis 5.4.1 Intrapersonal Relationship 5.4.2 Extra Personal Relationship 5.5 The Dilemma of Valve Replacement Surgery in IVDUs 5.5.1 Surgery Should not Be Offered 5.5.2 Surgery Should Be Offered 5.6 Summary Notes Bibliography 6 Deactivating Cardiovascular Implantable Electronic Device at the End of Life, an Ethical Dilemma in Cardiovascular Medicine 6.1 Historical Review 6.1.1 The Iconography and Symbolism of the Heart 6.1.2 History of Cardiac Pacing 6.2 General Facts 6.3 What is Special About CIEDs? 6.3.1 Ontological Analysis 6.3.2 Phenomenological Analysis 6.4 Practical Consideration Regarding Deactivating CIEDs 6.4.1 Internality Approach to Pacemakers 6.4.2 Externality Approach to Pacemakers 6.5 Between Autonomy and Futility 6.5.1 Autonomy 6.5.2 Futility 6.6 Case Discussion 6.7 Summary Notes Bibliography Part IV End of Life Issues 7 Ethical Dilemmas at the End of Life Brain Death and Palliative Sedation 7.1 Introduction 7.2 Brain Death 7.2.1 Historical Review 7.2.2 From Physics to Metaphysics 7.3 Definitions and Disagreements 7.3.1 Brain Death Equals Death 7.3.2 Brain Death is not Equal to Death 7.4 Palliative Sedation 7.4.1 Definitions and General Facts 7.4.2 The Principle of Double Effect 7.5 Miscellaneous Points 7.5.1 On the Value of Human Life 7.5.2 Ordinary and Extraordinary Treatments 7.6 Summary Notes Bibliography 8 Ethical Dilemmas at the End of Life Addressing Goals of Care 8.1 Introduction 8.2 Facts and Feelings 8.2.1 General Facts Regarding CPR 8.2.2 The Phenomenology of Suffering 8.3 Compassion and Trust 8.3.1 The Role of Compassion 8.3.2 The Role of Trust 8.4 Difficult Scenarios 8.4.1 Hoping for a Miracle 8.4.2 Assessing Capacity 8.5 Summary Notes Bibliography