Originally published in 1999, this classic textbook includes twenty-six cases with commentary and bibliographic resources designed especially for medical students and the training of ethics consultants. The majority of the cases reflect the day-to-day moral struggles within the walls of hospitals. As a result, the cases do not focus on esoteric, high-tech dilemmas like genetic engineering or experimental protocols, but rather on fundamental problems that are pervasive in basic healthcare delivery in the United States: where to send a frail, elderly patient who refuses to go to a nursing home, what role the family should play in making a treatment decision, what a hospital should do when it is getting stuck with too many unpaid bills. This thoroughly revised and updated second edition includes thirteen new cases, five of which are designated as "skill builder" cases aimed specifically at persons who wish to conduct clinical ethics case consultations. The new cases highlight current ethical challenges that arise in caring for populations such as undocumented immigrant patients, persons with substance use disorders involving opioids, and ethical issues that arise beyond the bedside at the organizational level. The reader is invited to use the supplemental videos and assessment tools available on the website of the Loyola University Chicago ACES project (www.LUC.edu/ethicsconsult).
Preface Acknowledgments Section 1: Consent and Capacity Case 1: Truth Telling and Cultur--Using an Interpreter in a Consultation (Skill Builder Case) Case 2: What Does She Really Want? Coercion, Persuasion, and the Family Case 3: "He Doesn't Know What He's Saying" Advance Directives in Emergency Setting Case 4: "Please Don't Cut Off My Leg" Going from a Wish to a Plan of Care Case 5: Consent and the Elderly-Is the Patient Her Own Best Spokesperson? Case 6: "I Don't Want Any Tubes" Capacity and the Care of a Patient with a Kidney Transplant Case 7: Caring for a Patient Who Uses Heroin-Fairness and Professional Responsibility Practical Commentary and Cheat Sheet Conceptual Framework Further Reading Section 2: End-Of-Life Decision Making Case 8: The Stroke Case-"I Can't Be Responsible for Killing Your Mother" (Skill Builder Case) Case 9: Futility-"But She Said She Wanted Everything" (Skill Builder Case) Case 10: Withdrawing Treatment-Easier Said Than Done Case 11: The Letter and Spirit of a Directive-Making Decisions with a Patient of Variable Capacity Case 12: How Competent Does a Surrogate Need to Be? A Decison Maker Who Might Not Appreciate the Choice to Be Made Case 13: How Does a POLST Form Help? When a Surrogate Contradicts a Valid DNR Order Case 14: Withdrawing Treatment and the Family's "Returning Hero"-When One Family Member Says "Go" but the Surrogate Says "No" Case 15: "They're Crazy!" The Micromanaging Family Practical Commentary and Cheat Sheet Conceptual Framework Further Reading Section 3: Decision Making for Minors Case 16: "God Can Do Miracles, and He Will Heal Jessica" A Pediatric Patient Wants to Forgo Treatment but Her Parent Disagrees (Skill Builder Case) Case 17: Transfusions as a Preventive Measure for a Witness Child-Do the Child's Medical Interests Outweigh Family Integrity? Case 18: IV Drug Addiction and the Perfect Son-Difficult Decisions in Treating a Chronic Opiod User Case 19: "She'll Never be Able to Take Care of That Child!" Family Integrity and the Newborn's Best Interest Case 20: Families and Hope-Fostering the Patient's Self-Determination Case 21: Who's the Patient? Dealing with a Formidable Advocate Practical Commentary and Cheat Sheet Conceptual Framework Further Reading Section 4: Organizational Ethics Case 22: "If We Do This, They'll All Come Here" A Kidney Transplant for an Undocumented Immigrant? (Skill Builder Case) Case 23: "But She's Our Patient" Margin and Medical Mission Case 24: Charity Care-What Are The Criteria? Case 25: "What's the Use?" Capacity, Addiction, and Fairness Case 26: A Teaching's Hospital Transfer Policy-Who is Responsibile for This Patient? Practical Commentary and Cheat Sheet Conceptual Framework Further Reading Index About the Authors
