CONTENTS

Preface, X

Part 1. Principles and theories

Chapter 1.

MORAL REASONING IN BIOETHICS, 3

Ethics and Bioethics, 3

Ethics and the Moral Life, 5

In Depth: Morality and the Law, 7

Moral Principles in Bioethics, 8

Autonomy, 9

Nonmaleficence, 10

Beneficence, 10

Utility, 11

Justice, 12

Ethical Relativism, 13

In Depth: Anthropology and Moral Diversity, 14

Ethics and Religion, 17

Moral Arguments, 19

Argument Fundamentals, 19

Patterns of Moral Arguments, 22

Review: Valid and Invalid Argument Forms, 23

In Depth: Fallacies in Moral Reasoning, 24

Evaluating Premises, 26

Assessing Whole Arguments, 28

Key Terms, 29

Summary, 29

Argument Exercises, 30

Further Reading, 32

Notes, 33

Chapter 2.

BIOETHICS AND MORAL THEORIES, 34

The Nature of Moral Theories, 34

Influential Moral Theories, 35

Utilitarianism, 26

In Depth: Utilitarianism and the Golden Rule, 38

Kantian Ethics, 38

Principlism, 40

Natural Law Theory, 41

Rawls' Contract Theory, 43

Virtue Ethics, 44

In Depth: Can Virtue Be Taught?, 46

The Ethics of Care, 46

Feminist Ethics, 47

Casuistry, 48

Criteria for Judging Moral Theories, 49

Review: Evaluating Moral Theories: Criteria of Adequacy, 50

Applying the Criteria, 50

Utilitarianism, 51

Kant's Theory, 52

Key Terms, 53

Summary, 53

Further Reading, 54

Notes, 54

READINGS, 55

"Utilitarianism," John Stuart Mill, 55

"The Moral Law," Immanuel Kant, 58

Nicomachean Ethics, Aristotle, 63

"Caring," Nel Noddings, 74

"The Need for More Than Justice," Annette C. Baier, 78

"Moral Saints," Susan Wolf, 86

Part 2. Medical professional and patient

Chapter 3.

PATERNALISM AND PATIENT AUTONOMY, 97

Shades of Autonomy and Paternalism, 97

Refusing Treatment, 98

In Depth: The Hippocratic Oath, 99

In Depth: Physician Autonomy, 100

Legal Brief: Advance Directives, 101

Futile Treatment, 102

Legal Brief: Refusing Treatment for Children on Religious Grounds, 103

In Depth: CPR and DNR, 104

In Depth: Moral Conflicts in Nursing, 104

Classic Case File: Elizabeth Bouvia, 105

Applying Major Theories, 106

Key Terms, 107

Summary, 107

Cases for Evaluation, 108

Further Reading, 110

Notes, 110

READINGS, 111

"Paternalism," Gerald Dworkin, 111

"The Refutation of Medical Paternaclism," Alan Goldman, 121

"Why Doctors Should Intervene," Terrence F. Ackerman, 127

"Autonomy, Futility, and the Limits of Medicine," Robert L. Schwartz, 132

"Four Models of the Physician-Patient Relationship," Ezekiel J. Emanuel and Linda L. Emanuel, 137

"Patient Autonomy and Physician Responsibility," Commentaries by Patrick C. Beeman and Ryan C. VanWoerkom, 147

"Confronting Death: Who Chooses, Who Controls? "A Dialogue Between Dax Cowart And Robert Burt, 150

Bouvia v. Superior Court, California Court of Appeal, 160

"Fundamental Elements of the Patient-Physician Relationship," AMA Council on Ethical and Judicial Affairs, 165

"Advocacy or Subservience for the Sake of Patients?" Helga Kuhse, 166

* "Paternalism Revisited," Harriet Hall, 174

Chapter 4.

TRUTH-TELLING AND CONFIDENTIALITY, 176

Paternalism and Deception, 176

In Depth: Do Patients Want the Truth? Do Physicians Tell It?, 177

Confidential Truths, 179

Legal Brief: Confidentiality and a Duty to Warn, 180

In Depth: Truth-Telling and Cultural Diversity, 181

Classic Case File: Carlos R., 182

Applying Major Theories, 183

Key Terms, 183

Summary, 183

Cases for Evaluation, 184

Further Reading, 186

Notes, 186

READINGS, 187

"Telling the Truth to Patients: A Clinical Ethics Exploration," David C. Thomasma, 187

"On Telling Patients the Truth," Mack Lipkin, 191

"Is It Ever OK to Lie to Patients?," Shelly K. Schwartz, 193

"Respect for Patients, Physicians, and the Truth," Susan Cullen and Margaret Klein, 196

"Why Privacy Is Important," James Rachels, 204

"Confidentiality in Medicine--A Decrepit Concept," Mark Siegler, 209

"Ethical Relativism in a Multicultural Society," Ruth Macklin, 212

Tarasoff v. Regents of the University of California, Supreme Court of California, 223

Chapter 5.

INFORMED CONSENT, 228

Autonomy and Consent, 228

Conditions of Informed Consent, 229

In Depth: Decision-Making Capacity, 231

In Depth: Two Views of Informed Consent, 233

Legal Brief: Important Informed Consent Cases, 234

Applying Major Theories, 235

Classic Case File: Jerry Canterbury, 236

Key Terms, 237

Summary, 237

Cases for Evaluation, 238

Further Reading, 240

Notes, 240

READINGS, 240

"The Concept of Informed Consent," Ruth R. Faden and Tom L. Beauchamp, 240

"Informed Consent--Must It Remain a Fairy Tale?" Jay Katz, 245

"Transparency: Informed Consent in Primary Care," Howard Brody, 255

"Informed Consent: Some Challenges to the Universal Validity of the Western Model," Robert J. Levine, 261

Canterbury v. Spence, United States Court of Appeals, 267

CHAPTER 6.

HUMAN RESEARCH, 271

The Science of Clinical Trials, 272

In Depth: The Tuskegee Tragedy, 273

Beneficence, Science, and Placebos, 274

Science and Informed Consent, 277

In Depth: Women in Clinical Trials, 278

Research on the Vulnerable, 279

In Depth: Why Enter a Clinical Trial?, 280

Applying Major Theories, 283

Key Terms, 284

Summary, 284

Classic Case File: The UCLA Schizophrenia Study, 285

Cases for Evaluation, 286

Further Reading, 290

Notes, 290

READINGS, 291

The Nuremberg Code, 291

Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects, World Medical Association, 292

"The Belmont Report," The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 295

"Final Report: Human Radiation Experiments," Advisory Committee on Human Radiation Experiments, 298

"Of Mice but Not Men: Problems of the Randomized Clinical Trial," Samuel Hellman and Deborah S. Hellman, 304

"A Response to a Purported Ethical Difficulty with Randomized Clinical Trials Involving Cancer Patients," Benjamin Freedman, 310

"Racism and Research: The Case of the Tuskegee Syphilis Study," Allan M. Brandt, 314

* "Is It Time to Stop Using Race in Medical Research?" Angus Chen, 326

"The Ethics of Clinical Research in the Third World," Marcia Angell, 328

"Ethical Issues in Clinical Trials in Developing Countries," Baruch Brody, 332

Part 3. Life and Death

Chapter 7.

ABORTION, 339

Starting Point: The Basics, 339

Fact File: U.S. Abortions, 340

In Depth: Abortion and Public Opinion 2017, 343

The Legal Struggle, 344

In Depth: Late-Term Abortion, 345

Persons and Rights, 345

In Depth: Does a Fetus Feel Pain?, 348

Applying Major Theories, 350

Key Terms, 351

Summary, 351

Classic Case File: Nancy Klein, 352

Cases for Evaluation, 353

Further Reading, 355

Notes, 356

READINGS, 357

"A Defense of Abortion," Judith Jarvis Thomson, 357

"Why Abortion Is Immoral," Don Marquis, 367

"An Almost Absolute Value in History," John T. Noonan, Jr., 379

"On the Moral and Legal Status of Abortion," Mary Anne Warren, 383

"Virtue Theory and Abortion," Rosalind Hursthouse, 394

"Abortion and the Concept of a Person," Jane English, 408

"Abortion," Margaret Olivia Little, 414

"Abortion Through a Feminist Ethics Lens," Susan Sherwin, 419

Roe v. Wade, United States Supreme Court, 428

Planned Parenthood of Southeastern Pennsylvania v. Casey, United States Supreme Court, 433

Chapter 8.

REPRODUCTIVE TECHNOLOGY, 440

In Vitro Fertilization, 440

Fact File: Assisted Reproduction, 441

Surrogacy, 446

In Depth: IVF and Children's Future Children, 447

Cloning, 448

In Depth: Cloning Time Line, 451

Applying Major Theories, 452

In Depth: Sherri Shepherd: How Surrogacy Can Go Wrong, 453

Key Terms, 454

Summary, 454

Classic Case File: Baby M, 455

Cases for Evaluation, 456

Further Reading, 458

Notes, 459

READINGS, 460

"IVF: The Simple Case," Peter Singer, 460

"IVF and Women's Interests: An Analysis of Feminist Concerns," Mary Anne Warren, 464

"'Give Me Children or I Shall Die!' New Reproductive Technologies and Harm to Children," Cynthia B. Cohen, 476

"Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation," Congregation for the Doctrine of the Faith, 487

"The Presumptive Primacy of Procreative Liberty," John A. Robertson, 497

"Surrogate Mothering: Exploitation or Empowerment?" Laura M. Purdy, 504

"Is Women's Labor a Commodity?" Elizabeth S. Anderson, 514

"Egg Donation and Commodification," Bonnie Steinbock, 526

"The Wisdom of Repugnance," Leon R. Kass, 535

"Cloning Human Beings: An Assessment of the Ethical Issues Pro and Con," Dan W. Brock, 551

Chapter 9.

GENETIC CHOICES, 562

Genes and Genomes, 562

Genetic Testing, 563

In Depth: Direct-to-Consumer Genetic Tests, 566

Gene Therapy, 570

Fact File: Available Genetic Tests for Cancer Risk, 571

Fact File: Recent Research in Gene Therapy, 574

Stem Cells, 575

Applying Major Theories, 577

Classic Case File: The Kingsburys, 578

Key Terms, 579

Summary, 579

Cases for Evaluation, 579

Further Reading, 582

Notes, 582

READINGS, 583

"Implications of Prenatal Diagnosis for the Human Right to Life," Leon R. Kass, 583

"Genetics and Reproductive Risk: Can Having Children Be Immoral?" Laura M. Purdy, 587

"The Morality of Screening for Disability," Jeff McMahan, 594

"Genetic Dilemmas and the Child's Right to an Open Future," Dena S. Davis, 598

"Disowning Knowledge: Issues in Genetic Testing," Robert Wachbroit, 608

"The Non-Identity Problem and Genetic Harms--The Case of Wrongful Handicaps," Dan W. Brock, 616

"Is Gene Therapy a Form of Eugenics?" John Harris, 616

"Genetic Enhancement," Walter Glannon, 622

"Genetic Interventions and the Ethics of Enhancement of Human Beings," Julian Savulescu, 627

"Germ-Line Gene Therapy," LeRoy Walters and Julie Gage Palmer, 636

"What Does 'Respect for Embryos' Mean in the Context of Stem Cell Research?" Bonnie Steinbock, 643

Declaration on the Production and the Scientific and Therapeutic Use of Human Embryonic Stem Cells, Pontifical Academy for Life, 646

Chapter 10.

EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE, 648

Deciding Life and Death, 649

Legal Brief: Euthanasia and Assisted Suicide: Major Developments, 651

In Depth: Assisted Suicide: What Do Doctors Think?, 652

Autonomy, Mercy, and Harm, 653

In Depth: Oregon's Death With Dignity Act, 655

In Depth: End-Of-Life Decisions in the Netherlands, 657

Applying Major Theories, 657

In Depth: Physician-Assisted Suicide and Public Opinion, 658

Classic Case File: Nancy Cruzan, 659

Key Terms, 660

Summary, 660

Cases for Evaluation, 661

Further Reading, 664

Notes, 665

READINGS, 666

"Death and Dignity: A Case of Individualized Decision Making," Timothy E. Quill, 666

"Voluntary Active Euthanasia," Dan W. Brock, 670

"When Self-Determination Runs Amok," Daniel Callahan, 682

"Physician-Assisted Suicide: A Tragic View," John D. Arras, 687

"Active and Passive Euthanasia," James Rachels, 702

"Dying at the Right Time: Reflections on (Un)Assisted Suicide," John Hardwig, 706

"The Philosophers' Brief," Ronald Dworkin, Thomas Nagel, Robert Nozick, John Rawls, Thomas Scanlon, and Judith Jarvis Thomson, 717

"Legalizing Assisted Dying Is Dangerous for Disabled People," Liz Carr, 725

"For Now Have I My Death'': The 'Duty to Die' Versus the Duty to Help the Issue Stay Alive," Felicia Ackerman, 727

Vacco v. Quill, United States Supreme Court, 738

Part 4. Justice and Health Care

Chapter 11.

Dividing up Health Care Resources, 743

Health Care in Trouble, 743

In Depth: Unequal Health Care for Minorities, 746

Fact File: U.S. Health Care, 747

Theories of Justice, 748

In Depth: Comparing Health Care Systems: 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

The Ethics of Rationing, 754

Classic Case File: Christine de Meurers, 756

Key Terms, 758

Summary, 758

Cases for Evaluation, 759

Further Reading, 761

Notes, 762

READINGS, 763

"Is There a Right to Health Care and, if So, What Does It Encompass?" Norman Daniels, 763

"The Right to a Decent Minimum of Health Care," Allen E. Buchanan, 770

"Rights to Health Care, Social Justice, and Fairness in Health Care Allocations: Frustrations in the Face of Finitude," H. Tristram Engelhardt, Jr., 776

"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., 784

"Public Health Ethics: Mapping the Terrain," James F. Childress et al., 788

"Human Rights Approach to Public Health Policy," D. Tarantola and S. Gruskin, 799

Appendix, 811

Glossary, 813

Index, 815