Zwitter Medical Ethics in Clinical Practice

1. Auflage 2019
ISBN: 978-3-030-00719-5
Verlag: Springer International Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 216 Seiten, eBook

This book discusses medicine from an ethical perspective, whereas books on medical ethics more commonly present ethics from a bio-medical standpoint. The book is divided into 23 chapters. The introductory chapters present some basic concepts of medical ethics, such as the relation between the legal system and ethics, ethical documents, ethical theories, and ethical analysis. The following chapters address issues of importance in all fields of medicine: respecting autonomy, communication, relations within a healthcare team, professional malpractice, limited resources, and the portrait of a physician. In turn, the third part of the book focuses on ethical aspects in a broad range of medical activities - preventive medicine, human reproduction, genetics, pediatrics, intensive care, palliative medicine, clinical research, unproven methods in diagnostics and treatment, and the role of physicians who aren't directly responsible for patient care. The last part presents students' seminars with case stories. The book offers a valuable resource for physicians of all specialties, students of medicine, professionals, and students from other fields devoted to human health, journalists, and general readers with an interest in medicine.


Matjaž Zwitter is a Professor and Chair of the Department of Ethics and Law at the University of Maribor, Slovenia, a Professor of Oncology and Radiotherapy at the Faculty of Medicine in Ljubljana, Slovenia, and a Senior Consultant Physician at the Institute of Oncology in Ljubljana, Slovenia. He has authored more than 45 papers included in the PubMed database and has co-edited two books: Communication with the cancer patient: information and truth (The New York Academy of Sciences, 1997) and New challenges in communication with the cancer patient (Springer, 2013). In addition to his formal achievements and positions, his main qualification is 40 years of personal experience devoted to treating patients with cancer.

Zielgruppe

Professional/practitioner

Autoren/Hrsg.

Zwitter, Matjaž

Zwitter, Matjaz

Inhaltsverzeichnis

1;Preface;5
2;Contents;7
3;1: Ethics and Law;14
3.1;1.1 Law;15
3.2;1.2 Ethics;15
3.3;1.3 Law and Ethics: Why Do We Need Two Systems?;16
3.4;Suggested Reading;17
4;2: Ethical Codes and Declarations;19
4.1;2.1 Hippocratic Oath and Other Ancient Documents;20
4.2;2.2 Medical Ethics in Modern Documents;22
4.3;2.3 Advantages and Disadvantages of Normative Ethics;23
4.4;References;23
4.4.1;Suggested Reading;23
4.4.2;Selected Codes of Medical Ethics;24
5;3: Ethical Theories;26
5.1;3.1 Utilitarian Ethics;28
5.2;3.2 Deontological Ethics;29
5.3;3.3 Virtue Ethics;30
5.4;3.4 The Four Principles and Common Morality Ethics;31
5.5;Reference;33
5.5.1;Suggested Reading;33
6;4: Moral Status;34
6.1;4.1 Who Has Moral Status?;35
6.2;4.2 Criteria for Moral Status;36
6.3;Reference;38
6.3.1;Suggested Reading;38
7;5: Ethical Analysis;39
7.1;Suggested Reading;44
8;6: Autonomy and Its Limitations;45
8.1;6.1 Right to Information;47
8.2;6.2 Right to Confidence;47
8.3;6.3 Right to Privacy;49
8.4;6.4 Voluntary Surrender of Autonomy;50
8.5;6.5 Patients’ Autonomy and Cultural Diversity;50
8.6;6.6 Persons with Limited Autonomy;50
8.7;6.7 Surrogate Decision-Makers;51
8.8;6.8 Advanced Directives;52
8.9;6.9 Physician’s Autonomy and Conscientious Objection;53
8.10;Suggested Reading;53
9;7: Communication;55
9.1;7.1 Information Flows in Multiple Directions;56
9.2;7.2 Communication as a Process;57
9.3;7.3 Modern Media and the Internet;57
9.4;7.4 The Broad Scope of the Conversation;58
9.5;7.5 The Opaqueness of the Medical Jargon;59
9.6;7.6 Cultural Diversity;60
9.7;7.7 Practical Advice;60
9.8;Suggested Reading;61
10;8: Relations in the Medical Team;63
10.1;8.1 Professional Competence;64
10.2;8.2 Communication in a Medical Team;64
10.3;8.3 Disagreement and Conflicts;65
10.4;8.4 Positive Team Spirit;66
10.5;Suggested Reading;66
11;9: Professional Malpractice;67
11.1;9.1 Mistake, Error, Neglect, Unfortunate Coincidence?;68
11.1.1;9.1.1 Limited Resources, Compromises in Probability-Based Medicine, and the Right to Compensation;69
11.2;9.2 Criminalization of Professional Malpractice;70
11.3;9.3 The Media, the Public, and Professional Mistakes;70
11.4;9.4 Support for the Accused Physician;71
11.5;Reference;71
11.5.1;Suggested Reading;71
12;10: Limited Resources, Priorities, and Corruption;73
12.1;10.1 Consequences of Poorly Organized Healthcare;74
12.2;10.2 Probability-Based Medicine;76
12.3;10.3 Priorities;77
12.4;10.4 Corruption;79
12.5;Reference;80
12.5.1;Suggested Reading;80
13;11: Image of a Physician;82
13.1;11.1 The Physician in Exceptional Circumstances;84
13.2;11.2 Who Is a Good Physician?;85
13.3;11.3 Who Is Draining the Idealism from Our Profession?;86
13.4;11.4 Burnout and the Anchor Outside Medicine;86
13.5;11.5 Conscientious Objection and the Respect of Personal Values;87
13.6;11.6 Digressions;88
13.7;Reference;89
13.7.1;Suggested Reading;89
14;12: Preventive Medicine;90
14.1;12.1 Vaccination;91
14.2;12.2 Healthy Lifestyle;92
14.3;12.3 Protection of Vulnerable Groups of Society;93
14.4;12.4 Epidemiology and Epidemiological Studies;93
14.5;12.5 Return to the Introductory Parable;93
14.6;Suggested Reading;94
15;13: Ethics at the Beginning of Life;95
15.1;13.1 Natural Conception;96
15.1.1;13.1.1 Contraception;96
15.1.2;13.1.2 Morning-After Pill;96
15.1.3;13.1.3 Abortion;96
15.1.4;13.1.4 Prenatal Diagnostics;97
15.1.5;13.1.5 Delivery at Home;98
15.2;13.2 Sterilization;98
15.3;13.3 Insemination or Egg Cell Donation;98
15.4;13.4 Medically Assisted Insemination for Healthy Women;99
15.5;13.5 In Vitro Fertilization;100
15.6;13.6 Surrogate Motherhood;101
15.7;References;102
15.7.1;Suggested Reading;102
16;14: Pediatrics;104
16.1;14.1 The Newborn;105
16.2;14.2 Vaccination;106
16.3;14.3 Child Neglect and Maltreatment;108
16.4;14.4 Chronic Disease and Communication;109
16.5;14.5 Genetics;109
16.6;14.6 Death of a Child;110
16.7;14.7 Research;110
16.8;References;111
16.8.1;Suggested Reading;111
17;15: Genetics;112
17.1;15.1 What Information Can Be Gained from Genetic Testing?;113
17.2;15.2 Disease Exclusion, Choice of Gender, and Selection of Other Traits of the Future Child;114
17.3;15.3 Genetic Testing in Childhood and Adulthood;116
17.4;15.4 Accidental Findings;117
17.5;Suggested Reading;118
18;16: Emergency Medicine and Transplantation;120
18.1;16.1 Admission to the Intensive Care Unit;122
18.2;16.2 Introducing, Withholding, and Withdrawing Intensive Care;122
18.3;16.3 Futile Intensive Care;123
18.4;16.4 Determining Death;123
18.5;16.5 Organ Transplantation;124
18.6;Reference;125
18.6.1;Suggested Reading;125
19;17: The Elderly and the Mentally-Ill;126
19.1;17.1 Who Are the Elderly?;128
19.2;17.2 Who Are the Mentally Ill?;129
19.3;17.3 Impaired Critical Judgement and Loss of Autonomy;130
19.4;17.4 Surrogate Decision-Making;130
19.5;17.5 Acting Against the Will of the Patient;131
19.6;17.6 Hunger Striking and Anorexia Nervosa;131
19.7;17.7 Social Status and Stigmatization;132
19.8;Suggested Reading;132
20;18: Dying and Death;134
20.1;18.1 The Wish to Die and Suicide;136
20.2;18.2 What Is Not Euthanasia?;137
20.3;18.3 Euthanasia and Physician-Assisted Suicide;137
20.4;18.4 Persistent Vegetative State;139
20.5;18.5 On Immortality;140
20.6;18.6 Education and Research;141
20.7;References;141
20.7.1;Suggested Reading;141
21;19: Research;143
21.1;19.1 The Four Phases of Clinical Trials;145
21.2;19.2 Patient Information;147
21.3;19.3 Academic Clinical Trials;148
21.4;19.4 Clinical Trials with a Commercial Sponsor;149
21.5;19.5 Progress, Patient Solidarity, and Honesty;152
21.6;References;153
21.6.1;Suggested Reading;154
22;20: Unproven Methods of Diagnostics and Treatment;156
22.1;20.1 Alternative Diagnostics;158
22.2;20.2 Supplementary and Alternative Treatment;159
22.3;20.3 Right to Try;159
22.4;References;161
22.4.1;Suggested Reading;161
23;21: Physicians Beyond Patient Care;162
23.1;21.1 Managerial Responsibilities and Politics;163
23.2;21.2 Expert;164
23.3;21.3 The Physician, the Pharmaceutical Industry, and Medical Equipment Providers;164
23.4;21.4 Teacher;165
23.5;21.5 The Physician in Public;166
23.6;21.6 Sports Medicine;166
23.7;21.7 Physician as Patient;167
23.8;References;168
23.8.1;Further Reading;168
24;22: Student Seminars;170
24.1;22.1 Surrogate Motherhood;173
24.2;22.2 Physician’s Confidentiality;174
24.3;22.3 Eluana Englaro;174
24.4;22.4 Love Life;175
24.5;22.5 Donor for Bone Marrow Transplantation;175
24.6;22.6 Unsolicited Medical Intervention;176
24.7;22.7 Elderly Driver;176
24.8;22.8 Posthumous Insemination;177
24.9;22.9 Physician as Patient;177
24.10;22.10 Crime Due to Mental Disease;178
24.11;22.11 Conscientious Objection;178
24.12;22.12 Ethics and Gladiators in Professional Sports;179
24.13;22.13 Medical Malpractice and the Right to Compensation;179
24.14;22.14 Anorexia Nervosa;180
24.15;22.15 Prevention of Pregnancy in Psychiatric Patient;180
24.16;22.16 Placebos in Clinical Trials;181
24.17;22.17 Choosing the Gender of the Newborn;181
24.18;22.18 Vegan Diet for Children;182
24.19;22.19 Accusation of Medical Malpractice: Disclosure of Personal Information;182
24.20;22.20 Boxing;183
24.21;22.21 Gifts;183
24.22;22.22 Drug Addicts, Pregnancy, and Parenthood;184
24.23;22.23 Who Is a Good Physician?;184
24.24;22.24 Parents Declining Mandatory Vaccination of Their Children;184
24.25;22.25 Collaboration Between the Psychiatrist and the Family Physician;185
24.26;22.26 Medically Assisted Insemination for Healthy Women;185
24.27;22.27 Physicians as Leading Politicians;186
24.28;22.28 Shooting as an Olympic Sport;186
24.29;22.29 Fine-Needle Biopsy of the Breast for a 12-Year-Old Girl;187
24.30;22.30 The Death of Ivan Ilyich;187
24.31;22.31 Waiting Periods for Funerals;187
24.32;22.32 Cancer Ward;188
24.33;22.33 Physician-Alcoholic;188
24.34;22.34 Disappearance of Inexpensive Drugs with Long-Lasting Positive Experience;188
24.35;22.35 Empathy and Trust;189
24.36;22.36 Medical Treatment of Patients Without Health Insurance;189
24.37;22.37 Doping in Sports;190
24.38;22.38 Intimate Relationships with a Patient;190
24.39;22.39 Paulo Coelho: Veronica Decides to Die;191
24.40;22.40 Communication with a Troublesome Patient;191
24.41;22.41 The Franja Partisan Hospital;192
24.42;22.42 Donor of Embryonic Stem Cells and Anonymity;192
24.43;22.43 Addiction to Prescription Drugs;193
24.44;22.44 Literature as a Medication;194
24.45;22.45 Sinclair Lewis: “Arrowsmith”;194
24.46;22.46 Female Genital Mutilation;194
24.47;22.47 Accusation of Medical Malpractice;195
24.48;22.48 Transport of a Dying Chronic Patient to the Emergency Department;196
24.49;22.49 Dr. Catherine Hamlin;196
24.50;22.50 An Aggressive Patient;197
24.51;22.51 Legalization of Marihuana;197
24.52;22.52 Lay People’s Attitudes Towards Euthanasia;197
24.53;22.53 Discrimination;198
24.54;22.54 Is Pedophilia a Disease?;199
24.55;22.55 The Nuremberg Trial Against Nazi Physicians;199
24.56;22.56 Humor in Communication with Patients;199
24.57;22.57 Obamacare—American Healthcare Reform: Successes and Difficulties;200
24.58;22.58 Child Abuse;200
24.59;22.59 Ethical Questions in Self-Inflicted Diseases;201
24.60;22.60 Homeopathy;202
24.61;22.61 Treatment of the Demented Patient;202
24.62;22.62 The Physician in Commercials;203
24.63;22.63 The Ebola Epidemic: Ethical Questions;203
24.64;22.64 Gene Testing in Underage Daughters;204
24.65;22.65 Revocation of Driver’s License;204
24.66;22.66 Airplane Seats for Overweight Persons;205
24.67;22.67 Individual Consent for Review of Old Biopsies;205
24.68;22.68 Love in a Nursing Home;206
24.69;22.69 Professional Sports in Children;206
24.70;22.70 Medical Strike;207
24.71;22.71 Artificial Womb;207
24.72;22.72 Genetic Testing for Prediction of a Disease;207
24.73;22.73 Cancerphobia;208
24.74;22.74 Communication in the Waiting Room;209
24.75;22.75 Traditional Medicine;209
24.76;22.76 Late Termination of Pregnancy;209
24.77;22.77 Postponement of Prison Sentence Service for Health Reasons;210
24.78;22.78 Animals in Biomedical Research;210
24.79;22.79 Death of Grandparents;210
24.80;22.80 Guerilla Surgeon;211
24.81;22.81 Loneliness;211
24.82;22.82 Mental Health of Political Leaders;212
24.83;22.83 Eugenics;212
24.84;22.84 Fatherhood;212
24.85;22.85 Mark Langervijk;213
24.86;22.86 Molière and the Characters of Physicians;213
24.87;22.87 Alternative Diagnostics;213
24.88;22.88 Trade with Human Organs for Transplantation;214
24.89;22.89 Dr. Thomas Percival: Medical Ethics;215
24.90;22.90 Mielke and Mitscherlich: “Doctors of Infamy—The Story of the Nazi Medical Crimes”;215
24.91;22.91 Oregon: The Death with Dignity Act;216

Preface.- Ethics and law.- Ethical codes and declarations.- Ethical theories.- Ethical analysis.- Autonomy and its limitations.- Communication.- Relations in health care teams.- Professional malpractice.- Limited resources, priorities, and corruption.- Image of a physician.- Preventive medicine.- Ethics at the beginning of life.- Paediatrics.- Genetics.- Emergency medicine and transplantation.- Elderly and psychiatric patients.- Dying and death.- Research.- Unproven methods of diagnostics and treatment.- Physicians beyond patient care.- Students’ seminars.

Über Autor(innen)

Matjaž Zwitter is a Professor and Chair of the Department of Ethics and Law at the University of Maribor, Slovenia, a Professor of Oncology and Radiotherapy at the Faculty of Medicine in Ljubljana, Slovenia, and a Senior Consultant Physician at the Institute of Oncology in Ljubljana, Slovenia. He has authored more than 45 papers included in the PubMed database and has co-edited two books: Communication with the cancer patient: information and truth (The New York Academy of Sciences, 1997) and New challenges in communication with the cancer patient (Springer, 2013).In addition to his formal achievements and positions, his main qualification is 40 years of personal experience devoted to treating patients with cancer.