Chapter 1: An Approach to Ethical Dilemmas in Patient Care

Introduction This case is really bothering me. I haven’t been able to stop worrying about it. I’m just not sure what the right thing to do is.” Cases with ethical dilemmas can perplex physicians. Strong reasons for an action might be balanced by cogent countervailing arguments. Common sense, clinical experience, being a good person, and […]

Chapter 2: Overview of Ethical Guidelines

Introduction Ethical dilemmas arise in clinical medicine because there are often sound reasons for conflicting courses of action. In resolving dilemmas, physicians need to refer to general ethical guidelines to inform their choices and justify their decisions. This chapter provides an overview of guidelines in clinical ethics. Subsequent chapters discuss them in detail and apply […]

Chapter 3: Informed Consent

Introduction Although informed consent is legally required, many physicians are skeptical because patients can never understand medical situations as well as doctors and because they can usually persuade patients to follow their recommendations. In some situations, however, therapeutic options differ dramatically in terms of their side effects and impact on the patient, and no option […]

Chapter 4: Promoting the Patient’s Best Interests

Introduction Patients may reject the recommendations of their physicians, refusing beneficial interventions or insisting on interventions that are not indicated. In such cases, physicians are torn between respecting patient autonomy and acting in the patients’ best interests. If physicians simply accept unwise patient decisions in the name of respecting patient autonomy, their role seems morally […]

Chapter 5: Confidentiality

Introduction Patients reveal to physicians sensitive personal information about their medical and emotional problems, alcohol and drug use, and sexual activities. The presumption is that physicians should keep patient information confidential unless the patient gives permission to disclose it; however, exceptions to confidentiality might be warranted to prevent serious harm to third parties or to […]

Chapter 6: Avoiding Deception and Nondisclosure

Introduction Children are taught to tell the truth and avoid lies. In clinical medicine, however, the distinction between telling the truth and lying can seem simplistic. Even doctors who condemn outright lying might consider withholding a grave diagnosis from a patient, covertly administering needed medications to a psychotic patient, or exaggerating a patient’s condition to […]

Chapter 7: Keeping Promises

Introduction Keeping promises reduces uncertainty and promotes trust. Physicians, like all people, make promises and are sometimes tempted to break them. Although promises are regarded as binding, in retrospect, some promises might seem imprudent or mistaken. The following cases demonstrate that some promises can be kept only if important ethical guidelines are violated. Case 7.1. […]

Chapter 8: An Approach to Decisions About Clinical Interventions

Introduction Medical interventions might allow accurate diagnosis and effective treatment, but they might also be applied when their benefit is questionable or when patients would not want them. Physicians, therefore, must try to avoid two types of errors: withholding potentially beneficial tests and therapies that the patient would want and imposing interventions that are not […]

Chapter 9: Futile Interventions

Introduction Patients or surrogates sometimes request medical interventions that physicians consider irrational or pointless. The concept of futility seems an appealing way to resolve such disagreements. The term futility comes from a Latin word meaning “leaky” [1]. In classical mythology, the gods condemned the daughters of Danaus to carry water in leaky buckets. No matter […]

Chapter 10: Decision-Making Capacity

Introduction Physicians must respect the autonomous choices of patients; however, illness or medications can impair the capacity of patients to make decisions about their health care. Such patients might be unable to make decisions, or their decisions contradict their best interests and cause them serious harm. Decision-making ability falls along a continuum, with no natural […]