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Medical Ethics in Clinical Practice
Matjaž Zwitter
Verlag Springer-Verlag, 2019
ISBN 9783030007195 , 216 Seiten
Format PDF, OL
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Preface
5
Contents
7
1: Ethics and Law
14
1.1 Law
15
1.2 Ethics
15
1.3 Law and Ethics: Why Do We Need Two Systems?
16
Suggested Reading
17
2: Ethical Codes and Declarations
19
2.1 Hippocratic Oath and Other Ancient Documents
20
2.2 Medical Ethics in Modern Documents
22
2.3 Advantages and Disadvantages of Normative Ethics
23
References
23
Suggested Reading
23
Selected Codes of Medical Ethics
24
3: Ethical Theories
26
3.1 Utilitarian Ethics
28
3.2 Deontological Ethics
29
3.3 Virtue Ethics
30
3.4 The Four Principles and Common Morality Ethics
31
Reference
33
Suggested Reading
33
4: Moral Status
34
4.1 Who Has Moral Status?
35
4.2 Criteria for Moral Status
36
Reference
38
Suggested Reading
38
5: Ethical Analysis
39
Suggested Reading
44
6: Autonomy and Its Limitations
45
6.1 Right to Information
47
6.2 Right to Confidence
47
6.3 Right to Privacy
49
6.4 Voluntary Surrender of Autonomy
50
6.5 Patients’ Autonomy and Cultural Diversity
50
6.6 Persons with Limited Autonomy
50
6.7 Surrogate Decision-Makers
51
6.8 Advanced Directives
52
6.9 Physician’s Autonomy and Conscientious Objection
53
Suggested Reading
53
7: Communication
55
7.1 Information Flows in Multiple Directions
56
7.2 Communication as a Process
57
7.3 Modern Media and the Internet
57
7.4 The Broad Scope of the Conversation
58
7.5 The Opaqueness of the Medical Jargon
59
7.6 Cultural Diversity
60
7.7 Practical Advice
60
Suggested Reading
61
8: Relations in the Medical Team
63
8.1 Professional Competence
64
8.2 Communication in a Medical Team
64
8.3 Disagreement and Conflicts
65
8.4 Positive Team Spirit
66
Suggested Reading
66
9: Professional Malpractice
67
9.1 Mistake, Error, Neglect, Unfortunate Coincidence?
68
9.1.1 Limited Resources, Compromises in Probability-Based Medicine, and the Right to Compensation
69
9.2 Criminalization of Professional Malpractice
70
9.3 The Media, the Public, and Professional Mistakes
70
9.4 Support for the Accused Physician
71
Reference
71
Suggested Reading
71
10: Limited Resources, Priorities, and Corruption
73
10.1 Consequences of Poorly Organized Healthcare
74
10.2 Probability-Based Medicine
76
10.3 Priorities
77
10.4 Corruption
79
Reference
80
Suggested Reading
80
11: Image of a Physician
82
11.1 The Physician in Exceptional Circumstances
84
11.2 Who Is a Good Physician?
85
11.3 Who Is Draining the Idealism from Our Profession?
86
11.4 Burnout and the Anchor Outside Medicine
86
11.5 Conscientious Objection and the Respect of Personal Values
87
11.6 Digressions
88
Reference
89
Suggested Reading
89
12: Preventive Medicine
90
12.1 Vaccination
91
12.2 Healthy Lifestyle
92
12.3 Protection of Vulnerable Groups of Society
93
12.4 Epidemiology and Epidemiological Studies
93
12.5 Return to the Introductory Parable
93
Suggested Reading
94
13: Ethics at the Beginning of Life
95
13.1 Natural Conception
96
13.1.1 Contraception
96
13.1.2 Morning-After Pill
96
13.1.3 Abortion
96
13.1.4 Prenatal Diagnostics
97
13.1.5 Delivery at Home
98
13.2 Sterilization
98
13.3 Insemination or Egg Cell Donation
98
13.4 Medically Assisted Insemination for Healthy Women
99
13.5 In Vitro Fertilization
100
13.6 Surrogate Motherhood
101
References
102
Suggested Reading
102
14: Pediatrics
104
14.1 The Newborn
105
14.2 Vaccination
106
14.3 Child Neglect and Maltreatment
108
14.4 Chronic Disease and Communication
109
14.5 Genetics
109
14.6 Death of a Child
110
14.7 Research
110
References
111
Suggested Reading
111
15: Genetics
112
15.1 What Information Can Be Gained from Genetic Testing?
113
15.2 Disease Exclusion, Choice of Gender, and Selection of Other Traits of the Future Child
114
15.3 Genetic Testing in Childhood and Adulthood
116
15.4 Accidental Findings
117
Suggested Reading
118
16: Emergency Medicine and Transplantation
120
16.1 Admission to the Intensive Care Unit
122
16.2 Introducing, Withholding, and Withdrawing Intensive Care
122
16.3 Futile Intensive Care
123
16.4 Determining Death
123
16.5 Organ Transplantation
124
Reference
125
Suggested Reading
125
17: The Elderly and the Mentally-Ill
126
17.1 Who Are the Elderly?
128
17.2 Who Are the Mentally Ill?
129
17.3 Impaired Critical Judgement and Loss of Autonomy
130
17.4 Surrogate Decision-Making
130
17.5 Acting Against the Will of the Patient
131
17.6 Hunger Striking and Anorexia Nervosa
131
17.7 Social Status and Stigmatization
132
Suggested Reading
132
18: Dying and Death
134
18.1 The Wish to Die and Suicide
136
18.2 What Is Not Euthanasia?
137
18.3 Euthanasia and Physician-Assisted Suicide
137
18.4 Persistent Vegetative State
139
18.5 On Immortality
140
18.6 Education and Research
141
References
141
Suggested Reading
141
19: Research
143
19.1 The Four Phases of Clinical Trials
145
19.2 Patient Information
147
19.3 Academic Clinical Trials
148
19.4 Clinical Trials with a Commercial Sponsor
149
19.5 Progress, Patient Solidarity, and Honesty
152
References
153
Suggested Reading
154
20: Unproven Methods of Diagnostics and Treatment
156
20.1 Alternative Diagnostics
158
20.2 Supplementary and Alternative Treatment
159
20.3 Right to Try
159
References
161
Suggested Reading
161
21: Physicians Beyond Patient Care
162
21.1 Managerial Responsibilities and Politics
163
21.2 Expert
164
21.3 The Physician, the Pharmaceutical Industry, and Medical Equipment Providers
164
21.4 Teacher
165
21.5 The Physician in Public
166
21.6 Sports Medicine
166
21.7 Physician as Patient
167
References
168
Further Reading
168
22: Student Seminars
170
22.1 Surrogate Motherhood
173
22.2 Physician’s Confidentiality
174
22.3 Eluana Englaro
174
22.4 Love Life
175
22.5 Donor for Bone Marrow Transplantation
175
22.6 Unsolicited Medical Intervention
176
22.7 Elderly Driver
176
22.8 Posthumous Insemination
177
22.9 Physician as Patient
177
22.10 Crime Due to Mental Disease
178
22.11 Conscientious Objection
178
22.12 Ethics and Gladiators in Professional Sports
179
22.13 Medical Malpractice and the Right to Compensation
179
22.14 Anorexia Nervosa
180
22.15 Prevention of Pregnancy in Psychiatric Patient
180
22.16 Placebos in Clinical Trials
181
22.17 Choosing the Gender of the Newborn
181
22.18 Vegan Diet for Children
182
22.19 Accusation of Medical Malpractice: Disclosure of Personal Information
182
22.20 Boxing
183
22.21 Gifts
183
22.22 Drug Addicts, Pregnancy, and Parenthood
184
22.23 Who Is a Good Physician?
184
22.24 Parents Declining Mandatory Vaccination of Their Children
184
22.25 Collaboration Between the Psychiatrist and the Family Physician
185
22.26 Medically Assisted Insemination for Healthy Women
185
22.27 Physicians as Leading Politicians
186
22.28 Shooting as an Olympic Sport
186
22.29 Fine-Needle Biopsy of the Breast for a 12-Year-Old Girl
187
22.30 The Death of Ivan Ilyich
187
22.31 Waiting Periods for Funerals
187
22.32 Cancer Ward
188
22.33 Physician-Alcoholic
188
22.34 Disappearance of Inexpensive Drugs with Long-Lasting Positive Experience
188
22.35 Empathy and Trust
189
22.36 Medical Treatment of Patients Without Health Insurance
189
22.37 Doping in Sports
190
22.38 Intimate Relationships with a Patient
190
22.39 Paulo Coelho: Veronica Decides to Die
191
22.40 Communication with a Troublesome Patient
191
22.41 The Franja Partisan Hospital
192
22.42 Donor of Embryonic Stem Cells and Anonymity
192
22.43 Addiction to Prescription Drugs
193
22.44 Literature as a Medication
194
22.45 Sinclair Lewis: “Arrowsmith”
194
22.46 Female Genital Mutilation
194
22.47 Accusation of Medical Malpractice
195
22.48 Transport of a Dying Chronic Patient to the Emergency Department
196
22.49 Dr. Catherine Hamlin
196
22.50 An Aggressive Patient
197
22.51 Legalization of Marihuana
197
22.52 Lay People’s Attitudes Towards Euthanasia
197
22.53 Discrimination
198
22.54 Is Pedophilia a Disease?
199
22.55 The Nuremberg Trial Against Nazi Physicians
199
22.56 Humor in Communication with Patients
199
22.57 Obamacare—American Healthcare Reform: Successes and Difficulties
200
22.58 Child Abuse
200
22.59 Ethical Questions in Self-Inflicted Diseases
201
22.60 Homeopathy
202
22.61 Treatment of the Demented Patient
202
22.62 The Physician in Commercials
203
22.63 The Ebola Epidemic: Ethical Questions
203
22.64 Gene Testing in Underage Daughters
204
22.65 Revocation of Driver’s License
204
22.66 Airplane Seats for Overweight Persons
205
22.67 Individual Consent for Review of Old Biopsies
205
22.68 Love in a Nursing Home
206
22.69 Professional Sports in Children
206
22.70 Medical Strike
207
22.71 Artificial Womb
207
22.72 Genetic Testing for Prediction of a Disease
207
22.73 Cancerphobia
208
22.74 Communication in the Waiting Room
209
22.75 Traditional Medicine
209
22.76 Late Termination of Pregnancy
209
22.77 Postponement of Prison Sentence Service for Health Reasons
210
22.78 Animals in Biomedical Research
210
22.79 Death of Grandparents
210
22.80 Guerilla Surgeon
211
22.81 Loneliness
211
22.82 Mental Health of Political Leaders
212
22.83 Eugenics
212
22.84 Fatherhood
212
22.85 Mark Langervijk
213
22.86 Molière and the Characters of Physicians
213
22.87 Alternative Diagnostics
213
22.88 Trade with Human Organs for Transplantation
214
22.89 Dr. Thomas Percival: Medical Ethics
215
22.90 Mielke and Mitscherlich: “Doctors of Infamy—The Story of the Nazi Medical Crimes”
215
22.91 Oregon: The Death with Dignity Act
216
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