Ethics in health care: role, history, and methods

Abstract

The five chapters in Part I of this volume provide a general introduction to the field of health care ethics, including its purpose, history, methods, and relation to the domains of law and culture. The account of the nature, scope, and limits of health care ethics provided in these chapters is designed to set the stage for examination of the multiple specific topics in ethics and health care in the subsequent chapters of the book. Chapter 1, “The role of ethics in health care,” begins with a description of several concepts of ethics, common sources of moral guidance, and methods for resolving moral disagreements. It then considers the relation of ethics and health care, arguing that ethical issues are especially prominent in health care. This prominence is a result both of the importance of the human interests at stake and of the complexity of many treatment decisions. Ethics can guide difficult choices in health care, but decisions also depend on factual information, and even the most careful moral reasoning may not produce a unique and definitive “correct” solution. Chapter 2, “A brief history of health care ethics and clinical ethics consultation in the United States,” describes the emergence of health care ethics as a new field of inquiry and practice in the latter half of the twentieth century. This review highlights major changes in the US health care system during this period. It also identifies three high-profile events that called public attention to moral issues in medical research and practice: investigative reports condemning the decades-long Tuskegee Study of Untreated Syphilis in poor black men, the US Supreme Court abortion decision in Roe v. Wade , and the New Jersey Supreme Court Quinlan decision on rights to refuse life-sustaining medical treatment. Chapter 2 also outlines the development of the practice of clinical ethics consultation in US health care facilities. From its origins in the 1970s, clinical ethics consultation has become a widely available service designed to help health care professionals, patients, and families make difficult moral choices about medical treatment. Chapter 3, “Methods of health care ethics,” summarizes a variety of different approaches that scholars have proposed for moral reasoning in health care settings. These approaches recommend different theoretical tools and strategies to guide moral deliberation, including basic principles, paradigmatic cases, moral rules, and moral virtues. This chapter also describes a simple, step-by-step procedure for analyzing health care ethics cases.