Bioethics : principles, issues, and cases

833 Pages·2020·7.793 MB·English

by  Lewis Vaughn

Bioethics
Principles, Issues, and Cases
Fourth Edition
Lewis Vaughn
New York Oxford
OXFORD UNIVERSITY PRESS
vau03268_fm_i-xii.indd i 05/15/19 12:27 PM
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Library of Congress Cataloging-in-Publication Data
Names: Vaughn, Lewis, author.
Title: Bioethics: principles, issues, and cases / Lewis Vaughn.
Description: Fourth edition. | New York: Oxford University Press, [2020] |
Includes bibliographical references and index.
Identifiers: LCCN 2019017497 (print) | LCCN 2019015775 (ebook) |
ISBN 9780190903268 (paperback: alk. paper) | ISBN 9780190903282 (epub)
Subjects: LCSH: Medical ethics. | Bioethics.
Classification: LCC R724 .V38 2020 (ebook) | LCC R724 (print) |
DDC 174.2—dc23
LC record available at https://lccn.loc.gov/2019017497
9 8 7 6 5 4 3 2 1
Printed by LSC Communications, United States of America
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BRIEF CONTENTS
Preface x
Part 1. P rinciples and Theories
Chapter 1 moral reasoning in bioethics 3
Chapter 2 bioethics and moral theories 34
Part 2. Medical Professional and Patient
Chapter 3 paternalism and patient autonomy 97
Chapter 4 truth-telling and confidentiality 176
Chapter 5 informed consent 228
Chapter 6 human research 271
Part 3. L ife and Death
Chapter 7 a bortion 339
Chapter 8 reproductive technology 440
Chapter 9 g enetic choices 562
Chapter 10 euthanasia and physician-assisted suicide 648
Part 4. Justice and Health Care
Chapter 11 dividing up health care resources 743
Appendix 811
Glossary 813
Index 815
iii
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CONTENTS
Preface x Chapter 2
bioethics and moral theories 34
Part 1. P rinciples and Theories
The Nature of Moral Theories 34
Chapter 1 Influential Moral Theories 35
moral reasoning in bioethics 3 Utilitarianism 36
In Depth: Utilitarianism and the Golden Rule 38
Ethics and Bioethics 3
Kantian Ethics 38
Ethics and the Moral Life 5
Principlism 40
In Depth: Morality and the Law 7
Natural Law Theory 41
Moral Principles in Bioethics 8
Rawls’ Contract Theory 43
Autonomy 9
Virtue Ethics 44
Nonmaleficence 10
In Depth: Can Virtue Be Taught? 46
Beneficence 10
The Ethics of Care 46
Utility 11
Feminist Ethics 47
Justice 12
Casuistry 48
Ethical Relativism 13
Criteria for Judging Moral Theories 49
In Depth: Anthropology and Moral
Review: E valuating Moral Theories: Criteria
Diversity 14
of Adequacy 50
Ethics and Religion 17
Applying the Criteria 50
Moral Arguments 19
Utilitarianism 51
Argument Fundamentals 19
Kant’s Theory 52
Patterns of Moral Arguments 22
Key Terms 53
Review: V alid and Invalid Argument
Summary 53
Forms 23
Further Reading 54
In Depth: Fallacies
Notes 54
in Moral Reasoning 24
Evaluating Premises 26 readings 55
Assessing Whole Arguments 28 “Utilitarianism,” John Stuart Mill 55
Key Terms 29 “The Moral Law,” Immanuel Kant 58
Summary 29 Nicomachean Ethics, Aristotle 63
Argument Exercises 30 “Caring,” Nel Noddings 74
Further Reading 32
“The Need for More Than Justice,” Annette C. Baier 78
Notes 33
“Moral Saints,” Susan Wolf 86
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Contents v
Part 2. Medical Professional and Patient “Fundamental Elements of the Patient-Physician
Relationship,” AMA Council on Ethical and
Chapter 3
Judicial Affairs 165
paternalism and patient
“Advocacy or Subservience for the Sake of
autonomy 97
Patients?” Helga Kuhse 166
Shades of Autonomy and Paternalism 97 “Paternalism Revisited,” Harriet Hall 174
Refusing Treatment 98
In Depth: The Hippocratic Oath 99
Chapter 4
In Depth: Physician Autonomy 100
Legal Brief: Advance Directives 101 truth-telling and
Futile Treatment 102 confidentiality 176
Legal Brief: Refusing Treatment for Children Paternalism and Deception 176
on Religious Grounds 103
In Depth: Do Patients Want the Truth? Do
In Depth: CPR and DNR 104 Physicians Tell It? 177
In Depth: Moral Conflicts in Nursing 104 Confidential Truths 179
Classic Case File: Elizabeth Bouvia 105 Legal Brief: Confidentiality and a Duty
Applying Major Theories 106 to Warn 180
Key Terms 107 In Depth: Truth-Telling and Cultural
Summary 107 Diversity 181
Cases for Evaluation 108 Classic Case File: Carlos R. 182
Further Reading 110 Applying Major Theories 183
Notes 110 Key Terms 183
Summary 183
readings 111 Cases for Evaluation 184
“Paternalism,” Gerald Dworkin 111 Further Reading 186
“The Refutation of Medical Paternalism,” Notes 186
Alan Goldman 121
“Why Doctors Should Intervene,” readings 187
Terrence F. Ackerman 127 “Telling the Truth to Patients: A Clinical Ethics
“Autonomy, Futility, and the Limits of Medicine,” Exploration,” David C. Thomasma 187
Robert L. Schwartz 132 “On Telling Patients the Truth,”
“Four Models of the Physician-Patient Relationship,” Mack Lipkin 191
Ezekiel J. Emanuel and Linda L. Emanuel 137 “Is It Ever OK to Lie to Patients?,”
“Patient Autonomy and Physician Responsibility,” Shelly K. Schwartz 193
Commentaries by Patrick C. Beeman and “Respect for Patients, Physicians, and the Truth,”
Ryan C. VanWoerkom 147 Susan Cullen and Margaret Klein 196
“Confronting Death: Who Chooses, Who Controls? “Why Privacy Is Important,” James Rachels 204
A Dialogue Between Dax Cowart and Robert Burt,” “Confidentiality in Medicine—A Decrepit
Dax Cowart and Robert Burt 150 Concept,” Mark Siegler 209
Bouvia v. Superior Court, California Court “Ethical Relativism in a Multicultural Society,”
of Appeal 160 Ruth Macklin 212
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vi Contents
Tarasoff v. Regents of the University of California, In Depth: Women in Clinical
Supreme Court of California 223 Trials 278
Research on the Vulnerable 279
In Depth: Why Enter
Chapter 5 a Clinical Trial? 280
informed consent 228 Applying Major Theories 283
Key Terms 284
Autonomy and Consent 228
Summary 284
Conditions of Informed Consent 229
Classic Case File: The UCLA Schizophrenia
In Depth: Decision-Making
Capacity 231 Study 285
In Depth: Two Views of Informed Consent 233 Cases for Evaluation 286
Legal Brief: Important Informed Consent Further Reading 290
Cases 234 Notes 290
Applying Major Theories 235
Classic Case File: Jerry Canterbury 236 readings 291
Key Terms 237 The Nuremberg Code 291
Summary 237 Declaration of Helsinki: Ethical Principles for
Cases for Evaluation 238 Medical Research Involving Human Subjects,
Further Reading 240 World Medical Association 292
Notes 240 “The Belmont Report,” The National
Commission for the Protection of
readings 240 Human Subjects of Biomedical and
“The Concept of Informed Consent,” Behavioral Research 295
Ruth R. Faden and Tom L. Beauchamp 240 “Final Report: Human Radiation Experiments,”
“Informed Consent—Must It Remain a Fairy Advisory Committee on Human Radiation
Tale?” Jay Katz 245 Experiments 298
“Transparency: Informed Consent in Primary “Of Mice but Not Men: Problems of the
Care,” Howard Brody 255 Randomized Clinical Trial,” Samuel Hellman
“Informed Consent: Some Challenges to the and Deborah S. Hellman 304
Universal Validity of the Western Model,” “A Response to a Purported Ethical
Robert J. Levine 261 Difficulty with Randomized Clinical
Canterbury v. Spence, United States Court of Trials Involving Cancer Patients,”
Appeals 267 Benjamin Freedman 310
“Racism and Research: The Case of the Tuskegee
Syphilis Study,” Allan M. Brandt 314
Chapter 6
“Is It Time to Stop Using Race in Medical
human research 271
Research?” Angus Chen 326
The Science of Clinical Trials 272 “The Ethics of Clinical Research in the Third
In Depth: The Tuskegee Tragedy 273 World,” Marcia Angell 328
Beneficence, Science, and Placebos 274 “Ethical Issues in Clinical Trials in Developing
Science and Informed Consent 277 Countries,” Baruch Brody 332
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Contents vii
Part 3. L ife and Death Chapter 8
reproductive technology 440
Chapter 7
abortion 339 In Vitro Fertilization 440
Fact File: Assisted Reproduction 441
Starting Point: The Basics 339
Surrogacy 446
Fact File: U.S. Abortions 340
In Depth: IVF and Children’s Future
In Depth: Abortion and Public
Children 447
Opinion 2017 343
Cloning 448
The Legal Struggle 344
In Depth: Cloning Time Line 451
In Depth: Late-Term Abortion 345
Applying Major Theories 452
Persons and Rights 345
In Depth: Sherri Shepherd: How Surrogacy
In Depth: Does a Fetus Feel Pain? 348
Can Go Wrong 453
Applying Major Theories 350
Key Terms 454
Key Terms 351
Summary 454
Summary 351
Classic Case File: Baby M 455
Classic Case File: Nancy Klein 352
Cases for Evaluation 456
Cases for Evaluation 353
Further Reading 458
Further Reading 355
Notes 459
Notes 356
readings 357 readings 460
“A Defense of Abortion,” Judith Jarvis “IVF: The Simple Case,” Peter Singer 460
Thomson 357 “IVF and Women’s Interests: An Analysis
“Why Abortion Is Immoral,” of Feminist Concerns,” Mary Anne
Don Marquis 367 Warren 464
“An Almost Absolute Value in History,” “‘Give Me Children or I Shall Die!’ New
John T. Noonan, Jr. 379 Reproductive Technologies and Harm to
“On the Moral and Legal Status of Abortion,” Children,” Cynthia B. Cohen 476
Mary Anne Warren 383 “Instruction on Respect for Human Life in Its
“Virtue Theory and Abortion,” Rosalind Origin and on the Dignity of Procreation,”
Hursthouse 394 Congregation for the Doctrine of the
“Abortion and the Concept of a Person,” Faith 487
Jane English 408 “The Presumptive Primacy of Procreative
“Abortion,” Margaret Olivia Little 414 Liberty,” John A. Robertson 497
“Abortion Through a Feminist Ethics Lens,” “Surrogate Mothering: Exploitation or
Susan Sherwin 419 Empowerment?” Laura M. Purdy 504
Roe v. Wade, United States “Is Women’s Labor a Commodity?” Elizabeth S.
Supreme Court 428 Anderson 514
Planned Parenthood of Southeastern “Egg Donation and Commodification,” Bonnie
Pennsylvania v. Casey, United States Supreme Steinbock 526
Court 433 “The Wisdom of Repugnance,” Leon R. Kass 535
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viii Contents
“Cloning Human Beings: An Assessment “Genetic Interventions and the Ethics of
of the Ethical Issues Pro and Con,” Enhancement of Human Beings,” Julian
Dan W. Brock 551 Savulescu 627
“Germ-Line Gene Therapy,” LeRoy Walters and
Julie Gage Palmer 636
Chapter 9
“What Does ‘Respect for Embryos’ Mean
genetic choices 562
in the Context of Stem Cell Research?”
Genes and Genomes 562 Bonnie Steinbock 643
Genetic Testing 563 Declaration on the Production and the Scientific
In Depth: Direct-to-Consumer Genetic Tests 566 and Therapeutic Use of Human Embryonic
Gene Therapy 570 Stem Cells, Pontifical Academy for Life 646
Fact File: Available Genetic Tests for
Cancer Risk 571 Chapter 10
Fact File: Recent Research Breakthroughs
euthanasia and physician-assisted
in Gene Therapy 574
suicide 648
Stem Cells 575
Applying Major Theories 577 Deciding Life and Death 649
Classic Case File: The Kingsburys 578 Legal Brief: Euthanasia and Assisted Suicide:
Major Developments 651
Key Terms 579
In Depth: Assisted Suicide: What Do Doctors
Summary 579
Think? 652
Cases for Evaluation 579
Autonomy, Mercy, and Harm 653
Further Reading 582
In Depth: Oregon’s Death With Dignity Act 655
Notes 582
In Depth: End-of-Life Decisions in the
Netherlands 657
readings 583
Applying Major Theories 657
“Implications of Prenatal Diagnosis for the
In Depth: Physician-Assisted Suicide and Public
Human Right to Life,” Leon R. Kass 583
Opinion 658
“Genetics and Reproductive Risk: Can Having
Classic Case File: Nancy Cruzan 659
Children Be Immoral?” Laura M. Purdy 587
Key Terms 660
“The Morality of Screening for Disability,”
Summary 660
Jeff McMahan 594
Cases for Evaluation 661
“Genetic Dilemmas and the Child’s Right to an
Further Reading 664
Open Future,” Dena S. Davis 598
Notes 665
“Disowning Knowledge: Issues in Genetic
Testing,” Robert Wachbroit 608 readings 666
“The Non-Identity Problem and Genetic “Death and Dignity: A Case of Individualized
Harms—The Case of Wrongful Handicaps,” Decision Making,”
Dan W. Brock 612 Timothy E. Quill 666
“Is Gene Therapy a Form of Eugenics?” “Voluntary Active Euthanasia,” Dan W. Brock 670
John Harris 616 “When Self-Determination Runs Amok,”
“Genetic Enhancement,” Walter Glannon 622 Daniel Callahan 682
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Contents ix
“Physician-Assisted Suicide: A Tragic View,” The Ethics of Rationing 754
John D. Arras 687 Classic Case File: Christine deMeurers 756
“Active and Passive Euthanasia,” James Key Terms 758
Rachels 702 Summary 758
“Dying at the Right Time: Reflections on Cases for Evaluation 759
(Un)Assisted Suicide,” John Hardwig 706 Further Reading 761
“The Philosophers’ Brief,” Ronald Dworkin, Thomas Notes 762
Nagel, Robert Nozick, John Rawls, Thomas
Scanlon, and Judith Jarvis Thomson 717 readings 763
“Legalizing Assisted Dying Is Dangerous “Is There a Right to Health Care and, if So, What
for Disabled People,” Liz Carr 725 Does It Encompass?,” Norman Daniels 763
“ ‘For Now Have I My Death’: The ‘Duty to Die’ “The Right to a Decent Minimum of Health
Versus the Duty to Help the Ill Stay Alive,” Care,” Allen E. Buchanan 770
Felicia Ackerman 727 “Rights to Health Care, Social Justice, and Fairness
Vacco v. Quill, United States Supreme Court 738 in Health Care Allocations: Frustrations in the
Face of Finitude,” H. Tristram Engelhardt, Jr. 776
Part 4. Justice and Health Care “Mirror, Mirror 2017: International Comparison
Reflects Flaws and Opportunities for Better
Chapter 11
U.S. Health Care,” Eric C. Schneider, Dana O.
dividing up health care Sarnak, David Squires, et al. 784
resources 743 “Public Health Ethics: Mapping the Terrain,”
Health Care in Trouble 743 James F. Childress et al. 788
In Depth: Unequal Health Care for “Human Rights Approach to Public Health
Minorities 746 Policy,” D. Tarantola and S. Gruskin 799
Fact File: U.S. Health Care 747
Appendix 811
Theories of Justice 748
Glossary 813
In Depth: Comparing Health Care Systems:
Index 815
United States, Canada, and
Germany 749
Fact File: Poll: The Public’s Views on the ACA
(“Obamacare”) 751
A Right to Health Care 752
In Depth: Public Health and Bioethics 753
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