Bioethics Principles, Issues, and Cases

Bioethics: Principles, Issues, and Cases explores the philosophical, medical, social, and legal aspects of key bioethical issues. Opening with a thorough introduction to ethics, bioethics, and moral reasoning, it then covers influential moral theories and the criteria for evaluating them. Integrating eighty-nine readings, numerous classic bioethical cases, and abundant pedagogical tools, this text addresses the most provocative and controversial topics in bioethics.

Lewis Vaughn is the author or coauthor of numerous books, including Philosophy: Here and Now, Fourth Edition (2022), The Power of Critical Thinking, Seventh Edition (2021), and Living Philosophy, Third Edition (2021), all published by Oxford University Press.

Preface

PART 1. PRINCIPLES AND THEORIES

Chapter 1: Moral Reasoning in Bioethics
Ethics and Bioethics
Ethics and the Moral Life
In Depth: Morality and the Law
Moral Principles in Bioethics
Autonomy
Nonmaleficence
Beneficence
Utility
Justice
Ethical Relativism
In Depth: Anthropology and Moral Diversity
Ethics and Religion
Moral Arguments
Argument Fundamentals
Patterns of Moral Arguments
Review: Valid and Invalid Argument Forms
In Depth: Fallacies in Moral Reasoning
Evaluating Premises
Assessing Whole Arguments
Obstacles to Critical Reasoning
Key Terms
Summary
Argument Exercises
Further Reading
Notes

Chapter 2: Bioethics and Moral Theories
The Nature of Moral Theories
Influential Moral Theories
Utilitarianism
In Depth: Utilitarianism and the Golden Rule
Kantian Ethics
Principlism
Natural Law Theory
Rawls' Contract Theory
Virtue Ethics
In Depth: Can Virtue Be Taught?
The Ethics of Care
Feminist Ethics
Casuistry
Criteria for Judging Moral Theories
Review: Evaluating Moral Theories: Criteria of Adequacy
Applying the Criteria
Utilitarianism
Kant's Theory
Key Terms
Summary
Further Reading
Notes
Readings:
“Utilitarianism,” John Stuart Mill
“The Moral Law,” Immanuel Kant
Nicomachean Ethics, Aristotle
“The Need for More Than Justice,” Annette C. Baier
“Moral Saints,” Susan Wolf

PART 2. MEDICAL PROFESSIONAL AND PATIENT

Chapter 3: Paternalism and Patient Autonomy
Shades of Autonomy and Paternalism
Refusing Treatment
In Depth: Physician Autonomy
Legal Brief: Advance Directives
Futile Treatment
Legal Brief: Refusing Treatment for Children on Religious Grounds
In Depth: CPR and DNR
In Depth: Moral Conflicts in Nursing
Classic Case File: Elizabeth Bouvia
Applying Major Theories
Key Terms
Summary
Cases for Evaluation
Further Reading
Notes
Readings:
“Paternalism,” Gerald Dworkin
“The Refutation of Medical Paternalism,” Alan Goldman
“Why Doctors Should Intervene,” Terrence F. Ackerman
“Autonomy, Futility, and the Limits of Medicine,” Robert L. Schwartz
“Four Models of the Physician-Patient Relationship,” Ezekiel J. Emanuel
and Linda L. Emanuel
“Confronting Death: Who Chooses, Who Controls? A Dialogue Between Dax
Cowart and Robert Burt,” Dax Cowart and Robert Burt
Bouvia v. Superior Court, California Court of Appeal
“Fundamental Elements of the Patient-Physician Relationship,” AMA
Council on Ethical and Judicial Affairs
“Advocacy or Subservience for the Sake of Patients?” Helga Kuhse

Chapter 4: Truth-Telling and Confidentiality
Paternalism and Deception?
In Depth: Do Patients Want the Truth? Do Physicians Tell It?
Confidential Truths
Legal Brief: Confidentiality and a Duty to Warn
In Depth: Truth-Telling and Cultural Diversity
Classic Case File: Carlos R.
Applying Major Theories
Key Terms
Summary
Cases for Evaluation
Further Reading
Notes
Readings:
“On Telling Patients the Truth,” Mack Lipkin
“Is It Ever OK to Lie to Patients?,” Shelly K. Schwartz
“Why Privacy Is Important,” James Rachels
“Confidentiality in Medicine-A Decrepit Concept,” Mark Siegler
Tarasoff v. Regents of the University of California, Supreme
Court of California

Chapter 5: Informed Consent
Autonomy and Consent
Conditions of Informed Consent
In Depth: Decision-Making Capacity
In Depth: Two Views of Informed Consent
Legal Brief: Important Informed Consent Cases?
Applying Major Theories
Classic Case File: Jerry Canterbury
Key Terms
Summary
Cases for Evaluation
Further Reading
Notes
Readings:
“The Concept of Informed Consent,” Ruth R. Faden and Tom L. Beauchamp
“Informed Consent-Must It Remain a Fairy Tale?” Jay Katz
“Transparency: Informed Consent in Primary Care,” Howard Brody
Canterbury v. Spence, United States Court of Appeals

Chapter 6: Human Research
The Science of Clinical Trials
In Depth: The Tuskegee Tragedy
Beneficence, Science, and Placebos
Science and Informed Consent
In Depth: Women in Clinical Trials
Research on the Vulnerable
In Depth: Why Enter a Clinical Trial?
Applying Major Theories
Key Terms
Summary
Classic Case File: The UCLA Schizophrenia Study
Cases for Evaluation
Further Reading
Notes
Readings:
The Nuremberg Code
Declaration of Helsinki: Ethical Principles for Medical Research
Involving Human Subjects, World Medical Association
“The Belmont Report,” The National Commission for the Protection
of Human Subjects of Biomedical and Behavioral Research
“Final Report: Human Radiation Experiments,” Advisory Committee
on Human Radiation Experiments
“Of Mice but Not Men: Problems of the Randomized Clinical Trial,”
Samuel Hellman and Deborah S. Hellman
“A Response to a Purported Ethical Difficulty with Randomized Clinical
Trials Involving Cancer Patients,” Benjamin Freedman
“Racism and Research: The Case of the Tuskegee Syphilis Study,”
Allan M. Brandt
“The Ethics of Clinical Research in the Third World,” Marcia Angell
“Ethical Issues in Clinical Trials in Developing Countries,” Baruch Brody

PART 3. LIFE AND DEATH

Chapter 7: Abortion
Starting Point: The Basics
Fact File: U.S. Abortions
In Depth: Abortion and Public Opinion
The Legal Struggle
In Depth: Abortions Performed Later in Pregnancy
Persons and Rights
In Depth: Does a Fetus Feel Pain?
Applying Major Theories
Key Terms
Summary
Classic Case File: Nancy Klein
Cases for Evaluation
Further Reading
Notes
Readings:
“A Defense of Abortion,” Judith Jarvis Thomson
“Why Abortion Is Immoral,” Don Marquis
“On the Moral and Legal Status of Abortion,” Mary Anne Warren
“Abortion and the Concept of a Person,” Jane English
“Abortion,” Margaret Olivia Little
“Abortion Through a Feminist Ethics Lens,” Susan Sherwin
Roe v. Wade, United States Supreme Court
Planned Parenthood of Southeastern Pennsylvania v. Casey, United
States Supreme Court

Chapter 8: Reproductive Technology
In Vitro Fertilization
Fact File: Assisted Reproduction
In Depth: “Savior Siblings”
Surrogacy
In Depth: IVF and Children's Future Children
Cloning
In Depth: Cloning Time Line
Applying Major Theories
In Depth: Sherri Shepherd: How Surrogacy Can Go Wrong
Key Terms
Summary
Classic Case File: Baby M
Cases for Evaluation
Further Reading
Notes
Readings:
“IVF: The Simple Case,” Peter Singer
“The Presumptive Primacy of Procreative Liberty,” John A. Robertson
“Surrogate Mothering: Exploitation or Empowerment?” Laura M. Purdy
“Egg Donation and Commodification,” Bonnie Steinbock
“Cloning Human Beings: An Assessment of the Ethical Issues Pro
and Con,” Dan W. Brock

Chapter 9: Genetic Choices
Genes and Genomes
Genetic Testing
Gene Therapy
Fact File: Genetic Testing for Cancer Risk
Fact File: New Developments in Gene Therapy
Stem Cells
Applying Major Theories
Classic Case File: The Kingsburys
Key Terms
Summary
Cases for Evaluation
Further Reading
Notes
Readings:
“Genetics and Reproductive Risk: Can Having Children Be Immoral?” Laura M. Purdy
“The Morality of Screening for Disability,” Jeff McMahan
“Genetic Dilemmas and the Child's Right to an Open Future,”
Dena S. Davis
“Disowning Knowledge: Issues in Genetic Testing,”
Robert Wachbroit
“The Non-Identity Problem and Genetic Harms-The Case of Wrongful
Handicaps,” Dan W. Brock
“Is Gene Therapy a Form of Eugenics?” John Harris
“Genetic Enhancement,” Walter Glannon
“Genetic Interventions and the Ethics of Enhancement of Human Beings,”
Julian Savulescu
“Germ-Line Gene Therapy,” LeRoy Walters and Julie Gage Palmer
“What Does 'Respect for Embryos' Mean in the Context of Stem Cell
Research?” Bonnie Steinbock
Declaration on the Production and the Scientific and Therapeutic
Use of Human Embryonic Stem Cells, Pontifical Academy for Life

Chapter 10: Euthanasia and Physician-Assisted Suicide
Deciding Life and Death
Legal Brief: Euthanasia and Assisted Suicide: Major Developments
In Depth: Assisted Suicide: What Do Doctors Think?
Autonomy, Mercy, and Harm
In Depth: Oregon's Death With Dignity Act
In Depth: End-of-Life Decisions in the Netherlands
Applying Major Theories
In Depth: Physician-Assisted Suicide and Public Opinion
Classic Case File: Nancy Cruzan
Key Terms
Summary
Cases for Evaluation
Further Reading
Notes
Readings:
“Death and Dignity: A Case of Individualized Decision Making,”
Timothy E. Quill
“Voluntary Active Euthanasia,” Dan W. Brock
“When Self-Determination Runs Amok,” Daniel Callahan
“Active and Passive Euthanasia,” James Rachels
“Dying at the Right Time: Reflections on (Un)Assisted Suicide,”
John Hardwig
“The Philosophers' Brief,” Ronald Dworkin, Thomas Nagel, Robert Nozick,
John Rawls, Thomas Scanlon, and Judith Jarvis Thomson
“Legalizing Assisted Dying Is Dangerous for Disabled People,” Liz Carr
“'For Now Have I My Death': The 'Duty to Die' Versus the Duty to Help
the Ill Stay Alive,” Felicia Ackerman
Vacco v. Quill, United States Supreme Court

PART 4. JUSTICE AND HEALTH CARE

Chapter 11: Dividing Up Health Care Resources
Health Care in Trouble
Fact File: U.S. Health Care
Theories of Justice
In Depth: Comparing Health Care Systems: United States,
Canada, and Germany
A Right to Health Care
In Depth: Public Health and Bioethics
The Ethics of Rationing
Classic Case File: Christine deMeurers
Key Terms
Summary
Cases for Evaluation
Further Reading
Notes
Readings:
“Is There a Right to Health Care and, if So, What Does It Encompass?,”
Norman Daniels
“The Right to a Decent Minimum of Health Care,” Allen E. Buchanan
“Rights to Health Care, Social Justice, and Fairness in Health Care
Allocations: Frustrations in the Face of Finitude,”
H. Tristram Engelhardt, Jr.
“Mirror, Mirror?2017: International Comparison Reflects Flaws and
Opportunities for Better U.S. Health Care,” Eric C. Schneider,
Dana O. Sarnak, David Squires, et al.
“Public Health Ethics: Mapping the Terrain,” James F. Childress et al.
“Human Rights Approach to Public Health Policy,” D. Tarantola and S. Gruskin

Chapter 12: Pandemic Ethics
Pandemic Facts
When Resources Are Scarce
Personal Choices
In Depth: The Privilege of Social Distancing
Covid Falsehoods
In Depth: Against Pandemic Falsehoods
Key Terms
Summary
Cases for Evaluation
Further Reading
Notes
Readings:
“Why Some Americans Refuse to Social Distance and Wear Masks,” Michael Sandel and Colleen Walsh
“Fair Allocation of Scarce Medical Resources in the Time of Covid-19,” Ezekiel J. Emanuel, Govind Persad, Ross Upshur, et al
“ICU Triage: How Many Lives or Whose Lives?” Angela Ballantyne

Chapter 13: Race, Racial Bias, and Health Care
Race and Racism
Health Disparities and Race
Implicit Bias in Health Care
In Depth: Can Implicit Biases Be Changed?
Racial Profiling in Medicine
Key Terms
Summary
Cases for Evaluation
Further Reading
Notes
Readings:
“Racial Profiling in Medicine,” Michael Root

Appendix
Glossary
Index