books on medical ethics

[Chankovsky]

anybody have any recommendations on books pertaining to the medical field. Anything that could give a good understanding of our healthcare system and its problems. It helps to be knowledgeable for interviews.

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[Bones2008]

so are you looking for books on medical ethics or healthcare policy? a great book on medical ethics is <u>First, Do No Harm</u> by Lisa Belkin.

 

[tjc]

A more textbook approach to background and arguments for some salient medical ethics issues can be found in: Classic Cases in Medical Ethics: Accounts of Cases That Have Shaped Medical Ethics by Gregory Pence

Classic Cases in Medical Ethics: Accounts of Cases That Have Shaped Medical Ethics

 

[tygrwds]

The book I used in my bioethics course (and still have) is Contemporary Issues in Bioethics, by Beauchamp and Walters.

 

[IrishOarsman]

Beware Beachamp and Childress. Very influential... and wrong.

Here's a premed site at my Ugrad that has a very extensive booklist.

http://www.nd.edu/~preprof/

 

[Zweihander]

Originally posted by IrishOarsman
Beware Beachamp and Childress. Very influential... and wrong.

Fascinating. I can understand how one might want to define values and state priorities differently than they do, but what makes them wrong?

 

[IrishOarsman]

Oh, it is very easy to be wrong when talking about values.

Basically, if you propose a philosophical system the weight of proof lies on you. They proposed a new system to replace the deontological and utilitarian systems ("common morality")... then proceeded to simply agree with either classic arguments when it suited their purposes, their only argumentative phrase being "because of course everyone would agree with that." Which is, of course, idiotic given that the whole reason why its in a medical ethics book at all is that people don't agree implicitly on the issue.

By the way, their purposes are to put autonomy (of the Pt) as the top moral consideration in medical ethics, leading them to argue for killing in a way that hauntingly resembles a Nordic argument (check out the legal ways a doctor can kill in the Netherlands and tell me then that such a moral guidline is unproblematic.)

 

[Zweihander]

Originally posted by IrishOarsman

By the way, their purposes are to put autonomy (of the Pt) as the top moral consideration in medical ethics, leading them to argue for killing in a way that hauntingly resembles a Nordic argument (check out the legal ways a doctor can kill in the Netherlands and tell me then that such a moral guidline is unproblematic.)

You've got that wrong -- they explicitly don't rank any of there four principles, in favour of a prima facie look at values. It's kind of weird, because they basically set up a system where everyone has to decide every time which values are most important in a given situation, but there is no "this must be sacrificed for that" attitude. I also believe that Beauchamp was expressly opposed to active euthanasia, which I'm pretty sure was quite unthinkable back then.

 

[greggth]

"Marketplace Medicine: The rise of the for-profit hospital chains" by Lindorff, 1992. I just started reading this, it seems good but I think it is probably biased towards a certain political viewpoint.

"Doctors' Dilemmas: Moral conflict and medical care" by Gorovitz, 1982, is kind of cheesy and has way too much philosophy for my taste, but it has several interesting anecdotes sprinkled in between the pontifications.

 

[Dr Chooch]

Last year when the Class of 07 people were interviewing, SMW posted this link, which many of us found helpful:

http://eduserv.hscer.washington.edu/bioethics/topics/index.html

It's a Univ. of Washington site that dissects various ethical issues and has case-based examples of the issues in action. I would definitely check it out, especially if you haven't had any real exposure to bioethics yet. I thought it was a great site...it's doesn't go into toooo much detail, and you can get a good overview of a ton of different ethical issues. Enjoy.

 

[greggth]

Originally posted by Dr Chooch
http://eduserv.hscer.washington.edu/bioethics/topics/index.html

"Do Not Resuscitate Orders:
Case 1
Mr. H is a 24-year-old man who resides in a skilled nursing facility, where he is undergoing rehabilitation from a cervical spine injury. The injury left him quadriplegic. He has normal cognitive function and no problems with respiration. He is admitted to your service for treatment of pneumonia. The resident suggests antibiotics, chest physiotherapy, and hydration. One day while signing out Mr. H to the cross covering intern, the intern says "he should be a DNR, based on medical futility."

Do you agree? Is his case medically futile, and if so, why? "

"Do Not Resuscitate Orders:
Case 1 Discussion
Medical futility means that an intervention, in this case CPR, offers no chance of meaningful benefit to the patient. Interventions can be considered futile if the probability of success (discharged alive from the hospital) is <1%, and/or if the the CPR is successful, then the quality of life is below the minimum acceptable to the patient.

In this case, Mr. H would have a somewhat lower than normal chance of survival from CPR, based on his quadriplegia (homebound lifestyle is a poor prognostic factor) and his mild pneumonia (in cases of severe pneumonia and respiratory failure survival is <1%).

Furthermore, his quality of life, while not enviable, is not without value. Since he is fully awake and alert, you could talk with Mr. H about his view of the quality of his life. You could share with him the likely scenarios should he have an arrest and need CPR. After this discussion, Mr. H can tell you if he would like to have CPR in the event of an arrest or not.

One cannot say on the basis of the current situation that CPR is futile. A decision about resuscitation should occur only after talking with the patient about his situation and reaching a joint decision."

...

I don't know much about medical ethics but here is my opinion.

It sounds as if this patient recently became quadriplegic. In such a case, he would be expected to have bouts of depression. This patient is cognitively normal and should be given full treatment, including treatment for depression, even if he asks to be placed on DNR status. Let him adjust to his condition for a few years, and then when he has adjusted he can make a sober decision about resuscitation.

 

[IrishOarsman]

Originally posted by Zweihander
You've got that wrong -- they explicitly don't rank any of there four principles, in favour of a prima facie look at values. It's kind of weird, because they basically set up a system where everyone has to decide every time which values are most important in a given situation, but there is no "this must be sacrificed for that" attitude. I also believe that Beauchamp was expressly opposed to active euthanasia, which I'm pretty sure was quite unthinkable back then.

I allow only that what you say is what they are claiming to do. In reality, autonomy more often than not beats out the others.

Anyways, if they do not have a prime principle then their system is rather useless. What to do if a situation has conflicting appeals to the four principles? Either they really do lean towards autonomy or they have nothing to say, which is a shame given that a great number of med ethics cases are so divided.

 

[superdevil]

check out "Bioethics: An Anthology," (Helga Kuhse and Peter Singer are the editors). Its an excellent collection of philosophical journal articles (like some other titles people have already mentioned) that show each side of the debate for an insane variety of issues- from abortion to euthanasia, eugenics, cloning, ageism in healthcare, xenotransplants, etc.

caution: whatever you read, do so with an open mind, especially (no flaming, thank you very much) if you are deeply religious or come from such a family. you'll learn more than you expect from most authors- even if they don't end up changing your mind.

 

[Zweihander]

Originally posted by IrishOarsman
I allow only that what you say is what they are claiming to do. In reality, autonomy more often than not beats out the others.

Anyways, if they do not have a prime principle then their system is rather useless. What to do if a situation has conflicting appeals to the four principles? Either they really do lean towards autonomy or they have nothing to say, which is a shame given that a great number of med ethics cases are so divided.

Where are you getting this from that they favour autonomy? Also, what reason would they have for misrepresenting their views?

As far as prima facie vs. rank order, I actually think it makes great sense not to have a preassigned importance to each principle. In the end, their system gives decision makers (providers, relatives, patients, what have you) the independence to make decisions specific to a situation without being bound by blind laws. This allows their principles to serve a guiding rather than a dictatorial role. The moral ambiguity will always be there -- ranking principles isn't going to keep people from questioning them. The added burden of prima facie is that there is legal ambiguity as well.

I do agree with you that autonomy tends to come first, but that does not stem from Beauchamp and Childress, and has nothing to do with euthanasia. Americans had already begun to lean towards the notion that the patient should be in control of their own medical fates, and so there are very few situations in which it is justifiable (under current moral codes) to violate a patient's respect for autonomy.

 

[IrishOarsman]

Originally posted by Zweihander
Where are you getting this from that they favour autonomy? Also, what reason would they have for misrepresenting their views?

As far as prima facie vs. rank order, I actually think it makes great sense not to have a preassigned importance to each principle. In the end, their system gives decision makers (providers, relatives, patients, what have you) the independence to make decisions specific to a situation without being bound by blind laws. This allows their principles to serve a guiding rather than a dictatorial role. The moral ambiguity will always be there -- ranking principles isn't going to keep people from questioning them. The added burden of prima facie is that there is legal ambiguity as well.

I do agree with you that autonomy tends to come first, but that does not stem from Beauchamp and Childress, and has nothing to do with euthanasia. Americans had already begun to lean towards the notion that the patient should be in control of their own medical fates, and so there are very few situations in which it is justifiable (under current moral codes) to violate a patient's respect for autonomy.

They favor autonomy and misrepresent themselves because they are not rigorous philosophers. I do not think that their book lacks all utility, nor am I advocating hard and fast laws to cut up medical ethics. However, the systems that they attempt to replace- deontological and utilitarian- are unified methods of evaluating moral situations. Their principles may offer nice ways of thinking about situations, but they do not offer a valuation system that can move towards a resolution of inherently conflicting senarios. The utilitarian can say, well this is negative, this positive, but the end result is more/less utility so it should/should not be done. The deontologist can say that the imperatives at work relate more or less closely to the situation at hand and make a decision from that. There is no coherent system for deciding between claims of autonomy, beneficence, maleficence, and justice. Nor do I find their conceptions of justice and "other" (the last chapter on principles in the new edition) very clear even in themselves.

B+C have written an honest, accessible, and PC book. Nontheless, they should not be the premiere authority in med ethics decisions in hospitals.

 

[Zweihander]

Originally posted by IrishOarsman
There is no coherent system for deciding between claims of autonomy, beneficence, maleficence, and justice.

This is absolutely true, and it is a problem. On the other hand, I think they did this purposefully, because they felt that drawing up a "coherent system" would limit decision-makers in their ability to gauge individual situations. Seems to me, you either rank or you don't. I'm not sure how you can get an in-between that is objective and not coldly institutional (which would in effect not be an in-between at all).

Now, you seem to be contradicting yourself. On the one hand, you say that Beauchamp and Childress are "misrepresenting" themselves, which makes it sound like you think they are lying about what they really mean. On the other hand, you call their book "honest." Which is it?

And, what about their views or their approach makes them "not rigorous philosophers?"