Taking Sides Clashing Views on Controversial Bioethical Issues

PART 1. Medical Decision Making ISSUE 1. Is Informed Consent Still Central to Medical Ethics? YES: Robert M. Arnold and Charles W. Lidz, from Informed Consent: Clinical Aspects of Consent in Health Care , in Warren T. Reich, ed., Encyclopedia of Bioethics, vol. 3, rev. ed. NO: Robert M. Veatch, from Abandoning Informed Consent , Hastings Center Report Physician Robert M. Arnold and professor of psychiatry and sociology Charles W. Lidz assert that informed consent in clinical care is an essential process that promotes good communication and patient autonomy despite the obstacles of implementation. Professor of medical ethics Robert M. Veatch argues that informed consent is a transitional concept that is useful only for moving toward a more radical framework in which physicians and patients are paired on the basis of shared deep social, moral, and institutional values. ISSUE 2. Can Family Interests Ethically Outweigh Patient Autonomy? YES: John Hardwig, from What About the Family?" Hastings Center Report NO: Jeffrey Blustein, from The Family in Medical Decisionmaking , Hastings Center Report John Hardwig, an associate professor of medical ethics, argues that the prevalent ethic of patient autonomy ignores family interests in medical treatment decisions. He maintains that physicians should recognize these interests as legitimate. Bioethicist Jeffrey Blustein contends that although families can be an important resource in helping patients make better decisions about their care, the ultimate decision-making authority should remain with the patient. PART 2. Death and Dying ISSUE 3. Are Some Advance Directives Too Risky for Patients? YES: Christopher James Ryan, from Betting Your Life: An Argument Against Certain Advance Directives , Journal of Medical Ethics NO: Steven Luttrell and Ann Sommerville, from Limiting Risks by Curtailing Rights: A Response to Dr. Ryan , Journal of Medical Ethics Psychiatrist Christopher James Ryan argues that advance directives that refuse active treatment in situations when a patient''s incompetence is potentially reversible should be abolished because healthy people are likely to underestimate their desire for treatment should they become ill. Geriatricians Steven Luttrell and Ann Sommerville assert that respect for the principle of autonomy requires that individuals be permitted to make risky choices about their own lives and that ignoring autonomous choices made by competent adults reinstates the outmoded notion of medical paternalism. ISSUE 4. Should Physicians Be Allowed to Assist in Patient Suicide? YES: Marcia Angell, from The Supreme Court and Physician-Assisted Suicide--The Ultimate Right , The New England Journal of Medicine NO: Kathleen M. Foley, from Competent Care for the Dying Instead of Physician-Assisted Suicide , The New England Journal of Medicine Physician Marcia Angell asserts that a physician''s main duties are to respect patient autonomy and to relieve suffering, even if that sometimes means assisting in a patient''s death. Physician Kathleen M. Foley counters that if physician-assisted suicide becomes legal, it will begin to substitute for interventions that otherwise might enhance the quality of life for dying patients. ISSUE 5. Is It Ethical to Withhold the Truth From Dying Patients? YES: Bernard C. Meyer, from Truth and the Physician , in E. Fuller Torrey, ed., Ethical Issues in Medicine NO: Sissela Bok, from Lying: Moral Choice in Public and Private Life Physician Bernard C. Meyer argues that physicians who adhere to a rigid formula of truth telling fail to appreciate the differences in patients'' readiness to hear and understand the information. Philosopher Sissela Bok argues that the harm resulting from disclosure is less than physicians may think and is outweighed by the benefits. ISSUE 6. Should Doctors Be Able to Refuse Demands for Futile" Treatment? YES: Steven H. Miles, from Informed Demand for 'Non-Beneficial'' Medical Treatment , The New England Journal of Medicine NO: Felicia Ackerman, from The Significance of a Wish , Hastings Center Report Physician Steven H. Miles maintains that physicians'' duty to follow patients'' wishes ends when the requests are inconsistent with what medical care can reasonably be expected to achieve. Philosopher Felicia Ackerman contends that decisions involving personal values, such as those regarding quality of life, should be made by the patient or family, not by the physician. PART 3. Choices in Reproduction ISSUE 7. Should Abortions Late in Pregnancy Be Banned? YES: M. LeRoy Sprang and Mark G. Neerhof, from Rationale for Banning Abortions Late in Pregnancy , Journal of the American Medical Association NO: David A. Grimes, from The Continuing Need for Late Abortions , Journal of the American Medical Association Physician M. LeRoy Sprang and osteopathic physician Mark G. Neerhof assert that late-term abortion is needlessly risky, inhumane, and ethically unacceptable. They state that all abortions of 23 weeks or later should be considered unethical unless the fetus has a lethal condition or the mother''s life is endangered. While acknowledging that early abortion is safer, simpler, and less controversial, physician David A. Grimes contends that late-term abortion is fundamentally important to women''s health because some medical conditions of both women and fetuses cannot be diagnosed early in pregnancy and because of the prevalence of incest and rape. ISSUE 8. Should Pregnant Women Be Punished for Exposing Fetuses to Risk? YES: Jean Toal, from Majority Opinion, Cornelia Whitner, Respondent, v. State of South Carolina, Petitioner NO: Alexander Morgan Capron, from Punishing Mothers , Hastings Center Report In a case involving a pregnant woman''s use of crack cocaine, a majority of the Supreme Court of South Carolina ruled that a state legislature may impose additional criminal penalties on pregnant drug-using women without violating their constitutional right of privacy. Law professor Alexander Morgan Capron argues that the Supreme Court of South Carolina''s decision may lead society to punish pregnant women who expose fetuses to many different types of risk, including women who have multiple births due to fertility drugs. PART 4. Children and Bioethics ISSUE 9. Should Adolescents Make Their Own Life-and-Death Decisions? YES: Robert F. Weir and Charles Peters, from Affirming the Decisions Adolescents Make About Life and Death , Hastings Center Report NO: Lainie Friedman Ross, from Health Care Decisionmaking by Children: Is It in Their Best Interest?" Hastings Center Report Ethicist Robert F. Weir and pediatrician Charles Peters assert that adolescents with normal cognitive and developmental skills have the capacity to make decisions about their own health care. Advance directives, if used appropriately, can give older pediatric patients a voice in their care. Pediatrician Lainie Friedman Ross counters that parents should be responsible for making their child''s health care decisions. Children need to develop virtues, such as self-control, that will enhance their long-term, not just immediate, autonomy. ISSUE 10. Do Parents Harm TheiLevine, Carol is the author of 'Taking Sides Clashing Views on Controversial Bioethical Issues' with ISBN 9780072430820 and ISBN 0072430826.