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A Guide to Shaping Shared Solutions, Revised and Expanded Edition
Expanded by two-thirds from the 2004 edition, the new edition features two new role plays, a new chapter on how to write chart notes, and a discussion of new understandings of the role of the clinical ethics consultant. **** Bioethics Mediation offers stories about patients, families, and health care providers enmeshed in conflict as they wrestle with decisions about life and death. It provides guidance for those charged with supporting the patient’s traditional and religious commitments and personal wishes. Today’s medical system, without intervention, privileges those within shared cultures of communication and disadvantages those lacking power and position, such as immigrants, the poor, and nonprofessionals. This book gives clinical ethics consultants, palliative care providers, and physicians, nurses, and other medical staff the tools they need to understand and manage conflict while respecting the values of patients and family members. Conflicts come in different guises, and the key to successful resolution is early identification and intervention. Every bioethics mediator needs to be prepared with skills to listen, “level the playing field,” identify individual interests, explore options, and help craft a “principled resolution”—a consensus that identifies a plan aligned with accepted ethical principles, legal stipulations, and moral rules and that charts a clear course of future intervention. The organization of the book makes it ideal for teaching or as a handbook for the practitioner. It includes actual cases, modified to protect the privacy of patients, providers, and institutions; detailed case analyses; tools for step-by-step mediation; techniques for the mediator; sample chart notes; and a set of actual role plays with expert mediator and bioethics commentaries. The role plays include: • discharge planning for a dying patient • an at-risk pregnancy • HIV and postsurgical complications in the ICU • treatment for a dying adolescent • dialysis and multiple systems failure
“Over the last two decades, medical researchers have become more comfortable wit the idea that serious attention must be given to ethical issues when the tests of new technologies are being designed. They have come to see that experimental trials must meet certain standards, not only of scientific rigour, but also of moral acceptability.” (Introduction)
Presented by an international group of experts, the eight essays included in this volume evaluate the new technologies in fetal care and also wrestle with the new problems, often moral ones, that have accompanied techonological advancement. The opening chapters review state-of-the-art ultrasound imaging and molecular genetics and focus on the new patient—the fetus. From here, the efficacy of fetal therapy, the problem of assessing long-term viability, the ethical issues involved in both clinical practice and medical research, and the legal rights of the new patients and their parents are examined. The final chapter “Are Fetuses Becoming Children?” brings a fresh philosophical perspective to the question of a fetus’s status and rights.
Some of humankind's greatest tools have been forged in the research laboratory. Who could argue that medical advances like antibiotics, blood transfusions, and pacemakers have not improved the quality of people's lives? But with each new technological bre
Healthcare ethics is not just about decisions made at the bedside. It is also about decisions made in executive offices and in boardrooms. Business Ethics in Healthcare offers perspectives that can assist healthcare managers achieve the highest ethical standards as they face their roles as healthcare providers, employers, and community service organizations. Weber suggests guidelines and criteria based on the understanding that the healthcare organization is committed to patients' rights, to careful stewardship of resources, to just working conditions for employees, and to service to the community.
As Weber shows, addressing business ethics issues in a healthcare organization starts with complying with relevant laws and regulations. As a provider of high quality patient care with limited resources, it needs to be able to distinguish between the right way and the wrong way of taking cost into consideration when making decisions about patient care practices. As employer, the organization needs to use good criteria for determining wages and salaries, to know how to make fair decisions about downsizing, and to respond most appropriately to union organizing efforts and employee strikes. As a community service organization, it has particular responsibilities to the community in the way it advertises, how it disposes of medical waste, and the types of mergers it enters into.
Leonard J. Weber is on the faculty of the University of Detroit, Mercy. He has published over 70 articles and is the principal author of the "Case Studies in Ethics" column in Clinical Leadership & Management Review. He serves as an ethics consultant to several healthcare organizations and is a past president of the Medical Ethics Resource Network of Michigan.
Medical Ethics Series -- David H. Smith and Robert M. Veatch, editors
From the Indiana Experiment to the Human Genome Era
In 1907, Indiana passed the world's first involuntary sterilization law based on the theory of eugenics. In time, more than 30 states and a dozen foreign countries followed suit. Although the Indiana statute was later declared unconstitutional, other laws restricting immigration and regulating marriage on "eugenic" grounds were still in effect in the U.S. as late as the 1970s. A Century of Eugenics in America assesses the history of eugenics in the United States and its status in the age of the Human Genome Project. The essays explore the early support of compulsory sterilization by doctors and legislators; the implementation of eugenic schemes in Indiana, Georgia, California, Minnesota, North Carolina, and Alabama; the legal and social challenges to sterilization; and the prospects for a eugenics movement basing its claims on modern genetic science.
Making a Difference through Advocacy
Who will speak for the children? is the question posed by Judith S. Palfrey, a pediatrician and child advocate who confronts unconscionable disparities in U.S. health care—a system that persistently fails sick and disabled children despite annual expenditures of $1.8 trillion. In Child Health in America, Palfrey explores the meaning of advocacy to children's health and describes how health providers, community agencies, teachers, parents, and others can work together to bring about needed change. Palfrey presents a conceptual framework for child health advocacy consisting of four interconnected components: clinical, group, professional, and legislative. Describing each of these concepts in useful and compelling detail, she is also careful to provide examples of best practices. This original and progressive work affirms the urgent need for child advocacy and provides valuable guidance to those seeking to participate in efforts to help all children live healthier, happier lives.
"Because the discipline of medical ethics has developed with autonomy as its foundation, the field has ignored pediatric ethics. The book is resoundingly successful in its effort to rectify this problem.... [A] pleasure to read." -- Eric D. Kodish, M.D., Director, Rainbow Center for Pediatric Ethics, Case Western Reserve University
Using a form of medical ethnography to investigate a variety of pediatric contexts, Richard B. Miller tests the fit of different ethical approaches in various medical settings to arrive at a new paradigm for how best to care for children. Miller contends that the principle of beneficence must take priority over autonomy in the treatment of children. Yet what is best for the child is a decision that doctors cannot make alone. In making and implementing such decisions, Miller argues, doctors must become part of a "therapeutic alliance" with families and the child undergoing medical care to come up with the best solution.
Children, Ethics, and Modern Medicine combines strong philosophical argumentation with firsthand knowledge of the issues facing children and families in pediatric care. This book will be an invaluable asset to medical ethicists and practitioners in pediatric care, as well as parents struggling with ethical issues in the care of their children.
Politics and Policymaking
In his 2006 State of the Union speech, President George W. Bush asked the U.S. Congress to prohibit the most egregious abuses of medical research, such as the creation of animalûhuman hybrids. The president's message echoed that of a 2004 report by the Pr
The cochlear implant debate has changed, as evidenced in this cogent collection that presents 13 chapters by 20 experts, including several who communicate through sign language but also utilize cochlear implants. The impetus for this change stems from recognition that both visual and aural input can enhance the education of deaf children. Divided into four sections, Cochlear Implants: Evolving Perspectives first focuses on the impact of implants in the Deaf community. Chapters in this section examine the issues driving the cochlear implant debate, the ethics of genetic engineering, experiences of implanted adult deaf signers, reflections of deaf mothers who have had their children implanted, and the effects of implants on deaf identity. The second section delves into the mechanics of bimodal processing, including listening strategies that can benefit signing children with cochlear implants. The third section surveys combined aural/visual educational approaches, such as teaching implanted children in an ASL/English bilingual classroom, and applying auditory rehabilitation to a signed communication context. The final section challenges readers to reframe the debate first by exploring sensory politics, then by envisioning an emerging world that requires the Deaf community to connect with it to secure its future. With this information, readers will reach their own conclusions about cochlear implants and auditory and visual approaches to the mastery of both spoken and signed languages.
Ethics and Choices
Cochlear Implants in Children: Ethics and Choices addresses every facet of the ongoing controversy about implanting cochlear hearing devices in children as young as 12 months old and in some cases, younger. Authors John B. Christiansen and Irene W. Leigh and contributors Jay Lucker and Patricia Elizabeth Spencer analyzed the sensitive issues connected with the procedure by reviewing 439 responses to a survey of parents with children who have cochlear implants. They followed up with interviews of the parents of children who have had a year's experience using their implants, and also the children themselves. Their findings shape the core of this useful and telling study. Cochlear Implants begins with a history of their development and an explanation of how implants convert sound into electric impulses that stimulate the brain. The second section focuses on pediatric implants, starting with the ways parents coped with the discovery that their child was deaf. Parents share how they learned about cochlear implants and how they chose an implant center. They also detail their children's experiences with the implants after surgery, and their progress with language acquisition and in school. The final part treats the controversy associated with cochlear implants, particularly the reaction of the Deaf community and the ethics of implanting young children without their consent. Cochlear Implants concludes with sage observations and recommendations for parents and professionals that complete it as the essential book on the pros and cons of this burgeoning technology.