This Third Edition includes timely discussions on new federal privacy regulations, disclosing medical errors, use of live organ donors, limits on residents' working hours, patient compliance with public health directives, and surrogate decision-making about life-sustaining interventions. Important new material on genetic testing, gifts from drug companies, advance directives, and futile interventions is also included. The revised surgery chapter discusses disclosure of provider-specific outcomes. The paediatrics chapter has more discussion of adolescent confidentiality and consent. The psychiatry chapter has new material on outpatient commitment and use of medication to enhance functioning in persons without major psychiatric illness. This edition also includes more real-life cases.

Table of Contents

SECTION I: Fundamentals of Clinical Ethics An Approach to Ethical Dilemmas in Patient Care 3 Overview of Ethical Guidelines 10 Informed Consent 17 Promoting the Patient's Best Interests 28 Confidentiality 36 Avoiding Deception and Nondisclosure 45 Keeping Promises 54 SECTION II: Shared Decision Making An Approach to Decisions About Clinical Interventions 59 Futile Interventions 61 Decision-making Capacity 67 Refusal of Treatment by Competent, Informed Patients 75 Standards for Decisions When Patients Lack Decision-making Capacity 79 Surrogate Decision Making 90 Persistent Disagreements over Care 95 SECTION III: Decisions About Life-Sustaining Interventions Confusing Ethical Distinctions 105 Ethics Committees and Case Consultations 111 Do Not Attempt Resuscitation Orders 117 Tube and Intravenous Feedings 125 Physician-Assisted Suicide and Active Euthanasia 130 The Persistent Vegetative State 140 Determination of Death 143 Legal Rulings on Life-Sustaining Interventions 147 SECTION IV: The Doctor-Patient Relationship Overview of the Doctor-Patient Relationship 155 Refusal to Care for Patients 157 Gifts from Patients to Physicians 163 Sexual Contact between Physicians and Patients 168 Secret Information about Patients 174 Clinical Research 176 SECTION V: Conflicts of Interest Overview of Conflicts of Interest 185 Bedside Rationing of Health Care 189 Incentives for Physicians to Increase Services 196 Incentives for Physicians to Decrease Services 200 Gifts from Drug Companies 209 Disclosing Errors 213 Impaired Colleagues 221 Ethical Dilemmas Students and House Staff Face 226 SECTION VI: Ethical Issues in Clinical Specialities Ethical Issues in Pediatrics 235 Ethical Issues in Surgery 243 Ethical Issues in Obstetrics and Gynecology 249 Ethical Issues in Psychiatry 256 Ethical Issues in Organ Transplantation 264 Testing for Genetic Conditions 272 Ethical Issues in Public Health Emergencies 280 Cases for Discussion 285 Index 296