Cases In Bioethics Research Articles

Case notes and charting of bioethical case consultations.

In summary, the usual elements of a typical health care ethics consultation note might reasonably accommodate the needs and expectations of relevant parties, and would therefore include: 1. identification of the relevant ethical issues, questions, or dilemmas; 2. reference to any relevant facts--medical, nursing, social, psychological, spiritual, legal, political, etc.; 3. a prioritized list of recommendations to improve coordinated care; 4. a clear and concise articulation of relevant arguments, wtih specific reference to the list of recommendations as well as to the institution's overall ethos; 5. a contextual statement, identifying the perceived degree of consensus or support for the recommendations and conclusions, as well as any inherent agendas.

Splitting the Difference: Compromise and Integrity in Ethics and Politics. By Martin Benjamin. Lawrence: University of Kansas Press, 1990. 195p. $22.50 cloth, $12.95 paper.

Politics is often characterized as the art of the implication being that compromise is desirable and that insight, imagination, discipline, and skill are all necessary for a satisfactory and successful compromise. Compromise in ethics, however, is quite another matter: there, it is usually regarded as a sign of weakness or lack of integrity. From Socrates and Sir Thomas More to Gandhi, Elizabeth Cady Stanton, and Martin Luther King, Jr., we revere these men and women not only for the nature of their convictions but also for their unwavering refusal to compromise. Does this point to an important difference between politics and ethics? Martin Benjamin here explores, in the first book-length treatment, the surprisingly rich and complex notion of compromise and integrity in ethics and politics. With wide-ranging examples drawn from Tolstoy to Ralph Nader and from a variety of medical and bioethical cases Benjamin presents in a clear, straightforward fashion an examination of the interplay between compromise and integrity. In the process, Benjamin tackles tough questions the relationship between practical and theoretical ethics, what compromise means for ethical theory, how moral judgments affect compromise, and whether it is possible to compromise without being compromised. In the final chapter Benjamin explores the possibility of political compromise in a matter of great ethical significance abortion.

The Burden of Decision

The good reasons for judicial intervention in some bioethics cases do not mean that physicians, administrators, and families should routinely seek shift the burden of decision the courts. Over the past three decades the courts have been a major forum not merely for resolving bioethical disputes but for acquainting the public with the hard choices that modern medicine so often poses. The courtroom has become such a familiar setting in this context that we seldom ask: what are we doing here? And yet a hard look at that issue is essential if we are going preserve and enhance the very values articulated in such landmark opinions as Cobbs v. Grant, (1) In re Quinlan, (2) and Barber v. Superior Court. (3) Ironically, the groundwork laid in those cases now requires that judges be more reluctant become involved in the disputes about medical interventions brought before them, lest in the process they subtly erode the high view of human dignity and liberty established in these cases on informed consent, patient autonomy, and the limits of medicine. Of course, no one can deny the importance of the landmarks themselves. The full force of judicial authority and eloquence was needed shake physicians from their predisposition hold onto knowledge, conceal uncertainty, and reserve decision-making power themselves. In opinion after opinion,judges made clear that before treating a patient, a physician must not merely obtain consent but must disclose the information the patient needs make a decision about whether and how proceed. Some commentators have been skeptical that the judges ever meant what they said, so many have been the impediments they placed in the way of patients actually enforcing their rights by collecting damages for violations of their right choose. (4) Yet the medical profession-along with patients and their advocacy groups-has apparently believed the ringing phrases in the judicial opinions, as have the rising corps of bioethicists who take the legal doctrine of informed consent as bedrock. Indeed, only now, after twenty years of debate, are bioethicists seriously struggling with integrating concepts like community into an analysis that has focused almost entirely on autonomy and self determination. Thus, informed consent has had an effect on physicians' attitudes, probably on their behavior, and certainly on how prominent physicians and ethicists describe the ideal physician-patient relationship that is far out of proportion the doctrine's actual significance as a basis for recovery. It has been an influence for good of which the law can be proud, even if judges-like the rest of us-need some time getting used the full implications of what they have written. As manifested by the leading cases on informed consent, good reasons certainly exist for courts become involved in some bioethics cases. When circumstances change in important ways--as in medicine over the past several decades-and existing doctrines seem inadequate or of unclear import, the courts perform a vital law-making function through their opinions in landmark cases. What I find be troubling, however, is both our increasing proclivity turn the courts routinely, especially in treatment-termination cases, and judges' greater willingness to yield spasmodic sentiment, vague and unregulated benevolence, in the trenchant phrase of Judge Cardozo. (5) In this article, I will initially take the typical bioethics case involve a disagreement about the recommended medical intervention (though later I will attempt generalize some conclusions a more diverse group of cases). The clear implication of the informed consent cases is that when disagreements occur, a patient's refusal of recommended treatment will be respected. Formally, courts have supported the notion of informed refusal. Yet the courts have been less robust in support of patient choice when the issue is not liability for inadequate disclosure but disagreement over the refusal itself. …

Cases in Bioethics From the Hastings Center Report

Your patient's first trimester exposure to a drug associated with a fourfold increase in the incidence of cleft palate leads her to request an abortion, although the actual risk is very small and the condition can be corrected. Another patient has just announced her engagement to a man you have certified as homosexual for draft exemption purposes, and you are quite sure she isn't aware of his sexual preference. A premed student preparing for the MCAT approaches you with some persuasive arguments that the small doses of amphetamines he is asking for, to enhance his examination performance, won't hurt him or you. There is the patient whose motor vehicle accident, you are almost certain, was self-inflicted. Now he needs lifesaving surgery but calmly and apparently rationally refuses to consent. Or, as a resident you may be torn by your awareness that your program's unusually tough work schedule is hurting both