Evidence-Based Medical Ethics:: Cases for Practice-Based Learning - Brossura

Snyder, John E.; Gauthier, Candace C.

Brossura

ISBN 10: 1617378828 ISBN 13: 9781617378829

Casa editrice: Humana, 2010

Riassunto

This innovative book addresses what has been missing in existing text books and ethics courses to date: clear-cut ethical and legal guidelines essential to the everyday practice of medicine. Ethical dilemmas are enlivened with age, gender and culture issues.

Su questo libro

Recensione

From the reviews:

"Fictional case records that encapsulate many of the problems encountered frequently by comprehensive therapists become the basis for this nice, inexpensive, little manual. ... It becomes an easy reading monograph that can be appropriately sampled as time permits and will spare time when similar cases are encountered in clinical practice." (William H Wehrmacher, Comprehensive Therapy, December, 2008)

"This is the newest addition to case-based clinical ethics books. ... the purpose of this book is `to provide a method for the reader to learn how to systematically manage dilemmas seen in the everyday practice of medicine.' The authors ... have several audiences in mind for the book: medical students and residents, nursing students, undergraduate and graduate medical ethics courses, as well as clinicians." (Michele K. Langowski, Doody's Review Service, November, 2008)

"Synder and Gauthier have taken a very interesting, and surprisingly seductive, approach to teaching medical ethics. ... the book would be a valuable addition to many bookshelves." (Ruth Wilkinson, Public Health Ethics, January, 2009)

Contenuti

Case-Based Medical Ethics in Practice

Preface by the authors

Foreword

Chapter 1: A brief introduction to medical ethics in Internal Medicine

• Definitions of ethics and medical ethics
• Why is medical ethics important? (teaching competency in ethics, teaching professionalism)

• Evolution of medical ethics and its importance/role in modern medicine (from paternalism to informed consent)
• Who determines ethical guidelines for medicine?

• Difference/similarities between ethics and law

• Purpose of the book (i.e. to stimulate thought and discussion, not cover all details of all ethical principles)

Chapter 2: The underlying principles of ethical patient care

• Beneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.)
• Non-maleficence - "first, do no harm" (Primum non nocere).
• Autonomy - the patient has the right to refuse or choose their treatment (Voluntas aegroti suprema lex.)
• Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment.
• Dignity - the patient (and the person treating the patient) have the right to dignity.
• Veracity - the patient should not be lied to, and deserves to know the whole truth about his/her illness and treatment.

Chapter 3: Putting ethics into practice – realities, limitations, and roadblocks

• Practitioners and personal belief systems
• Cultural competency and practice of ethical care
• Statement about pharmaceutical company influence on education and practice
• Medical oaths – Are they valid for medicine today? Are they fulfilled by practitioners?
• The Patient Bill of Rights
• Federal, state, local, and institutional regulations – how they intertwine and affect each other

Chapter 4: Advanced Directives, Living Wills, and the Health Care Power of Attorney (HCPOA)

Chapter 5: Case-based ethical dilemmas

• How the reader should approach these cases
• Where to find more information if needed

 

Case 1

• Topic: Consent in the mentally ill or otherwise unfit (and ‘in between’ situations: delirium, psychiatric decompensation)
• Subtopic: When does forcing an incompetent patient to undergo treatment limit their right to dignity and the principle of ‘do-no-harm’?

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 2

• Topic: When the HCPOA neglects their responsibility, or has other personal interests/potential gains

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 3

• Topic: When the patient/their family bullies practitioners into unnecessary diagnostics/therapeutics

• "C.Y.A." medicine

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 4

• Topic: When an estranged family member or spouse suddenly appears to make decisions

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 5

• Topic: How to deal with an inpatient behaving badly (psych consults, behavioral contracts, room restriction etc.)

• Outbursts
• Substance abuse
• Illegal activity (e.g. drug-dealing)
• Known criminal warrants
• Inappropriate actions or remarks
• Admitted for ulterior motives (secondary psychologic gains, homelessness, etc.)

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 6

• Topic: When DSS consults are needed

• Child abuse/neglect
• Elder abuse/neglect
• Spousal abuse

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 7

• Topic: When a patient has ‘burned all bridges’ and no discharge planning is possible

• No nursing home or rehab center will accept the patient
• No home health services will accept the patient

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 8

• Topic: Can a practitioner refuse to admit a patient? To see a patient in the office (e.g. administrative discharge)?

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 9

• Topic: When a patient makes ‘bad’ decisions (e.g. will accept some therapies and not others, such as some blood products but not others, some procedures but not others, DNI but not DNR, etc.)

• Does a practitioner follow the patient’s wishes? Do they refuse to treat?

• Subtopic: When a patient is guided by incomplete, or misinformation (e.g. from the internet)

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

 

 

Case 10

• Topic: When a patient’s same-sex partner has no legal rights and is excluded by a family

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 11

• Topic: When a patient has a contagious disease (e.g. HIV) and their partner is not aware
• Subtopic: When a partner/family does not have all the information needed to make decisions for a patient (e.g. when to disclose diagnoses such as HIV-positivity, substance abuse, suicidality)
• Subtopic: When confidential information is inadvertently leaked to those who ‘don’t need to know’
• Subtopic: What diseases are ‘reportable’?
• Subtopic: Do patients avoid testing for confidentiality fears?

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 12

• Topic: When a family will not accept a terminal prognosis (i.e. futile ‘full codes’)

• Should a family be present during the code?

• Subtopic: When a patient themselves is unrealistic about prognosis
• Subtopic: When is a patient ‘terminal’? (i.e. definition of brain death)
• Subtopic: When is it appropriate to change the focus of care to comfort/hospice?

• How do a practitioner’s personal beliefs affect this guidance?
• The concept of dignity/therapeutic death v. Euthanasia

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 13

• Topic: When there is no one to make decisions for a patient (e.g. John/Jane Doe in ICU, wards of the state)

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 14

• Topic: When a mistake has been made by a practitioner (what/how to/how much to disclose)

• Mistake by primary practitioner; mistake by other/outside practitioner

• Subtopic: Caring for a patient after a poor outcome or mistake (i.e. how is care affected)
• Subtopic: When a patient makes a reference to a grievance or verbally disparages another practitioner

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 15

• Topic: When what a patient needs cannot be obtained (e.g. financial/insurance limitations)

• Tests/procedures (e.g. colonoscopy in an uninsured/pre-Medicare patient aged 50 to 64 years old)
• Treatments
• A different medical team ("I want a new doctor"), especially when no others will take your "difficult" patient

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 16

• Topic: When next-of-kin (NOK) disagree with each other
• Subtopic: Which of the NOK has ‘seniority’? Are legal definitions for NOK equivalent to ethically ‘best’ choices?

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 17

• Topic: When a toxicology screen is ordered without patient consent and comes back positive
• Subtopic: When tests are ordered ‘in emergency situations’ without patient consent (e.g. HIV tests)
• Subtopic: When a practitioner is potentially exposed to infectious agents (e.g. via a needlestick) and a patient is refusing further testing

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 18

• Topic: When a patient ‘signs out against medical advice’

• Practitioner obligations
• How can competence be quickly assessed and assured?
• What about a patient with contagious disease (e.g. TB)? Can they be allowed to leave?

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 19

• Topic: When a patient requests a clinical interaction be recorded

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 20

• Topic: When a family member requests patient information not be shared with the patient, or with other persons

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 21

• Topic: When a patient requests to not be seen by a (specific, or any) medical resident or student

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 22

• Topic: When a patient requires or demands large amounts of time from a practitioner

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 23

• Topic: How to prescribe medications to someone who has attempted suicide (e.g. with pills)
• Subtopic: How to accurately assess and document safety in a depressed patient

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 24

• Topic: When a colleague demonstrates suspicious behavior

• Memory problems
• Substance abuse
• Outbursts
• Inappropriate relationships with or behavior toward patients, coworkers, etc.
• Dishonesty

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and legal principles

Case 25

• Topic: When a language translator is not available (or only a family member/hospital employee is)

• Narrative of clinical scenario with specific example of ethical dilemma

• Questions for thought/discussion

• Explanations of underlying ethical and l...

Dettagli dell?edizione

• Editore: Humana
• Data di pubblicazione: 2010
• ISBN 10: 1617378828
• ISBN 13: 9781617378829
• Rilegatura: Copertina flessibile
• Lingua: Inglese
• Numero di pagine: 256