Taking Sides: Clashing Views on Bioethical Issues

Unit 1 Medical Decision Making

YES: Robert M. Arnold and Charles W. Lidz, from “Informed Consent: Clinical Aspects of Consent in Health Care,” in Stephen G. Post, ed., Encyclopedia of Bioethics, vol. 3, 3rd ed. (Macmillan, 2003)

NO: Onora O’Neill, from Autonomy and Trust in Bioethics (Cambridge University Press, 2002)

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. Philosopher Onora O’Neill argues that the most evident change in medical practice in recent decades may be a loss of trust in physicians rather than any growth of patient autonomy. Informed consent in practice, she says, often amounts simply to a right to choose or refuse treatments, not a deeper and more meaningful expression of self-mastery.

YES: Leslie J. Blackhall, Gelya Frank, Sheila Murphy, and Vicki Michel, from “Bioethics in a Different Tongue: The Case of Truth-Telling,” Journal of Urban Health (March 2001)

NO: Mark Kuczewski and Patrick J. McCruden, from “Informed Consent: Does It Take a Village? The Problem of Culture and Truth Telling,” Cambridge Quarterly of Healthcare Ethics (2001)

Leslie J. Blackhall, Gelya Frank, and Sheila Murphy, from the University of Southern California, and Vicki Michel, from the Loyola Law School, advise clinical and bioethics professionals facing truth-telling dilemmas to make room for the diverse ethical views of the populations they serve. Philosopher Mark Kuczewski and bioethicist Patrick J. McCruden argue that by insisting on informed consent or an appropriate waiver process, the health care system respects cultural differences rather than stereotyping them.

YES: Paul Antony, from “Testimony before the Senate Special Committee on Aging, United States Senate” (September 29, 2005)

NO: David A. Kessler and Douglas A. Levy, from “Direct-to-Consumer Advertising: Is It Too Late to Manage the Risks?” Annals of Family Medicine ( January/February 2007)

Paul Antony, Chief Medical Officer of Pharmaceutical Research and Manufacturers of America (PhRMA), asserts that direct-to-consumer advertising can be a powerful tool in educating millions of people and improving their health through better communication with physicians, better adherence to medication regimens, and more active involvement in their own health care. Physicians David A. Kessler and Douglas A. Levy contend that as a result of direct-to-consumer advertising, consumers ultimately take medicines they may not need, spend money on brand medicines that may be no better than alternatives, or avoid healthy behaviors.

Unit 2 End-of-Life Dilemmas

YES: Henry S. Perkins, from “Controlling Death: The False Promise of Advance Directives,” Annals of Internal Medicine (vol. 147, 2007)

NO: Elmer D. Abbo and Angelo E. Volandes, from “A Forced Choice: The Value of Requiring Advance Directives,” The Journal of Clinical Ethics (Summer 2008)

Physician Henry S. Perkins believes that advance directives promise patients a say in their future care but actually have had little effect because they are based on an unrealistic assumption of more control in unforeseeable crises. Physician and attorney Elmer D. Abbo and physician Angelo E. Volandes acknowledge the criticisms of advance directives as they have been used but argue that the solution lies in requiring them, not abandoning them.

YES: Robert W. Donnell, from “A Bright Line,” Medscape (October 3, 2006)

NO: Mary Faith Marshall, from “Oh, the Water . . . It Stoned Me to My Soul,” University of Minnesota Bioethics Examiner (Summer 2006)

Physician Robert W. Donnell believes that the medical profession must apply moral absolutes in matters of life and death, no matter what the conditions, and one of those absolutes is never to administer fatal doses of medication. Philosopher Mary Faith Marshall argues for compassion, not absolutism, when tragic choices have to be made.

YES: Marcia Angell, from “The Supreme Court and Physician-Assisted Suicide—The Ultimate Right,” The New England Journal of Medicine ( January 2, 1997)

NO: Kathleen M. Foley, from “Competent Care for the Dying Instead of Physician-Assisted Suicide,” The New England Journal of Medicine ( January 2, 1997)

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.

YES: Steven H. Miles, from ““Informed Demand for ‘Non-Beneficial’ Medical Treatment,” The New England Journal of Medicine (August 15, 1991)

NO: Felicia Ackerman, from “The Significance of a Wish,” Hastings Center Report ( July–August 1991)

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, when they violate community standards of care, and when they consume an unfair share of collective resources. Philosopher Felicia Ackerman contends that it is ethically inappropriate for physicians to decide what kind of life is worth prolonging and that decisions involving personal values should be made by the patient or family.

Unit 3 Choices in Reproduction

YES: Patrick Lee and Robert P. George, from “The Wrong of Abortion,” in Andrew Cohen and Christopher Heath Wellman, eds., Contemporary Debates in Applied Ethics (Blackwell, 2005)

NO: Margaret Olivia Little, from “The Morality of Abortion,” in Bonnie Steinbock, John D. Arras, and Alex John London, eds., Ethical Issues in Modern Medicine (McGraw-Hill, 2003)

Philosopher Patrick Lee and professor of jurisprudence Robert P. George assert that human embryos and fetuses are complete (though immature) human beings and that intentional abortion is unjust and objectively immoral. Philosopher Margaret Olivia Little believes that the moral status of the fetus is only one aspect of the morality of abortion. She points to gestation as an intimacy, motherhood as a relationship, and creation as a process to advance a more nuanced approach.

YES: Jean Toal, from Majority Opinion, Cornelia Whitner, Respondent, v. State of South Carolina, Petitioner ( July 15, 1997)

NO: Lynn M. Paltrow, from “Punishment and Prejudice: Judging Drug-Using Pregnant Women,” in Julia E. Hanigsberg and Sara Ruddick, eds., Mother Troubles: Rethinking Contemporary Maternal Dilemmas (Beacon Press, 1999)

Jean Toal states the Majority Opinion in a case involving a pregnant woman’s use of crack cocaine, 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. Attorney Lynn M. Paltrow argues that treating drug-using pregnant women as criminals targets poor, African American women while ignoring other drug usage and fails to provide the resources to assist them in recovery.

Unit 4 Children, Adolescents, and Bioethics

YES: Robert F. Weir and Charles Peters, from “Affirming the Decisions Adolescents Make About Life and Death,” Hastin...