Table Of Contents:
PREFACE xvii

MORAL PRINCIPLES, ETHICAL THEORIES, AND MEDICAL DECISIONS: AN INTRODUCTION 1(46)

PART I. BASIC ETHICAL THEORIES 2(29)

Utilitarianism 3(8)

Kant's Ethics 11(5)

Ross's Ethics 16(5)

Rawls's Theory of Justice 21(4)

Natural Law Ethics and Moral Theology 25(6)

PART II. MAJOR MORAL PRINCIPLES 31(14)

The Principle of Nonmaleficence 32(2)

The Principle of Beneficence 34(2)

The Principle of Utility 36(1)

Principles of Distributive Justice 37(3)

The Principle of Autonomy 40(5)

PART III. RETROSPECT 45(2)
PART I: TERMINATION 47(158)

1. ABORTION 47(61)

SOCIAL CONTEXT: The Continuing Struggle over Abortion 47(7)

CASE PRESENTATION: The Ordeal of Alice Wilson 54(1)

SOCIAL CONTEXT: The Conflict over RU-486--"The Abortion Pill" 55(2)

CASE RETROSPECTIVE: When Abortion Was Illegal--Mrs. Sherri Finkbine and the Thalidomide Tragedy 57(1)

INTRODUCTION 58(8)

Human Development and Abortion 58(1)

The Status of the Fetus 59(1)

Pregnancy, Abortion, and the Rights of Women 60(2)

Therapeutic Abortion 62(1)

Abortion and the Law 63(1)

Ethical Theories and Abortion 63(1)

Abortion Trends 64(2)

THE READINGS 66(36)

An Almost Absolute Value in History 66(3)

John T. Noonan, Jr.

A Defense of Abortion 69(11)

Judith Jarvis Thomson

On the Moral and Legal Status of Abortion 80(8)

Mary Anne Warren

Why Abortion Is Immoral 88(5)

Don Marquis

Abortion through a Feminist Ethics Lens 93(4)

Susan Sherwin

United States Supreme Court Decision in Roe v. Wade 97(5)

DECISION SCENARIOS 102(6)

2. TREATING OR TERMINATING: THE PROBLEM OF IMPAIRED INFANTS 108(40)

SOCIAL CONTEXT: The Dilemma of Extreme Prematurity 108(3)

SOCIAL CONTEXT: The Baby Doe Cases 111(3)

CASE PRESENTATION: Baby K 114(1)

CASE PRESENTATION: Baby Owens--Down Syndrome and Duodenal Atresia 115(2)

INTRODUCTION 117(5)

Genetic and Congenital Impairments 117(4)

Ethical Theories and the Problem of Birth Impairments 121(1)

THE READINGS 122(19)

Examination of Arguments in Favor of Withholding Ordinary Medical Care from Defective Infants 122(7)

John A. Robertson

Ethical Issues in Aiding the Death of Young Children 129(6)

H. Tristram Engelhardt, Jr.

Life-and-Death Decisions in the Midst of Uncertainty 135(6)

Robert F. Weir

DECISION SCENARIOS 141(7)

3. EUTHANASIA 148(57)

SOCIAL CONTEXT: Dr. Kevorkian and Physician-Assisted Suicide 148(3)

CASE PRESENTATION: Elizabeth Bouvia's Demand to Starve 151(1)

CASE PRESENTATION: The Death of J.K. Collums 152(2)

SOCIAL CONTEXT: The Cruzan Case--The Supreme Court Upholds a Right to Die 154(3)

CASE PRESENTATION: Karen Quinlan 157(2)

INTRODUCTION 159(9)

Active and Passive Euthanasia 159(1)

Voluntary, Involuntary, and Nonvoluntary Euthanasia 160(1)

Defining "Death" 161(2)

The Dutch Experience 163(2)

Living Wills 165(2)

Ethical Theories and Euthanasia 167(1)

THE READINGS 168(30)

The Wrongfulness of Euthanasia 168(3)

J. Gay-Williams

Active and Passive Euthanasia 171(4)

James Rachels

When Self-Determination Runs Amok 175(5)

Daniel Callahan

Voluntary Active Euthanasia 180(7)

Dan W. Brock

Terminal, but Not Hopeless 187(1)

Sandol Stoddard

Must Patients Always Be Given Food and Water? 188(7)

Joanne Lynn

James F. Childress

In the Matter of Karen Quinlan, an Alleged Incompetent, The Supreme Court of New Jersey 195(3)

DECISION SCENARIOS 198(7)
PART II: RIGHTS 205(218)

4. AIDS AND ITS ISSUES 205(54)

CASE PRESENTATION: The Mysterious Infection of Kimberly Bergalis 205(2)

SOCIAL CONTEXT: Mandatory AIDS Testing and Pregnancy 207(3)

CASE PRESENTATION: Tod Thompson 210(2)

SOCIAL CONTEXT: Drug Testing, Autonomy, and Access to Unapproved Drugs 212(4)

INTRODUCTION 216(14)

Discovering the Disease 217(1)

Biomedical Aspects of AIDS 218(6)

Ethical and Social Issues 224(6)

THE READINGS 230(24)

AIDS, Gays, and State Coercion 230(4)

Richard D. Mohr

Harming, Wronging, and AIDS 234(8)

Bonnie Steinbock

Insurers Are Right on AIDS Testing 242(1)

Bob Hunter

Jay Angoff

An Insidious Test for AIDS 243(1)

William C. Gifford III

HIV Infection, Pregnant Women, and Newborns, Working Group on HIV Testing of Pregnant Women and Newborns 244(7)

Ethical Challenges Posed by Zidovudine Treatment to Reduce Vertical Transmission of HIV 251(3)

Ronald Bayer

DECISION SCENARIOS 254(5)

5. PHYSICIANS, PATIENTS, AND OTHERS 259(64)

SOCIAL CONTEXT: Pregnancy and Responsibility 259(3)

CASE PRESENTATION: The Death of Robyn Twitchell 262(2)

CASE PRESENTATION: Juan Gonzalez and the Prediction of Dangerousness 264(1)

INTRODUCTION 265(13)

Autonomy 265(2)

Paternalism 267(2)

Truth Telling in Medicine 269(3)

Confidentiality 272(1)

Autonomy and the Interests of Others 273(2)

Ethical Theories: Paternalism, Truth Telling, Confidentiality 275(3)

THE READINGS 278(38)

Paternalism 278(10)

Gerald Dworkin

On Telling Patients the Truth 288(2)

Mack Lipkin

Lies to the Sick and Dying 290(8)

Sissela Bok

Confidentiality in Medicine--A Decrepit Concept 298(3)

Mark Siegler

Decision in the Tarasoff Case, The Supreme Court of California 301(6)

Pregnant Women as Fetal Containers 307(3)

George J. Annas

Pregnancy and Prenatal Harm to Offspring 310(6)

John A. Robertson

Joseph D. Schulman

DECISION SCENARIOS 316(7)

6. MEDICAL EXPERIMENTATION AND INFORMED CONSENT 323(100)

SOCIAL CONTEXT: The Cold-War Radiation Experiments 323(2)

CASE PRESENTATION: The Willowbrook Hepatitis Experiments 325(2)

SOCIAL CONTEXT: The Artifical Heart--Consent to Disaster? 327(4)

CASE PRESENTATION: Baby Fae 331(1)

CASE PRESENTATION: The Detroit Psychosurgery Case 332(2)

INTRODUCTION 334(22)

Drug Testing 336(1)

The "Informed" Part of Informed Consent 337(1)

The "Consent" Part of Informed Consent 338(1)

Medical Research and Medical Therapy 339(14)

Ethical Theories: Medical Research and Informed Consent 353(3)

THE READINGS 356(56)

Some Ethical Problems in Clinical Investigation 356(6)

Louis Lasagna

Philosophical Reflections on Experimenting with Human Subjects 362(9)

Hans Jonas

Informed (but Uneducated) Consent 371(2)

F. J. Ingelfinger

The Willowbrook Letters: Criticism and Defense 373(4)

Stephen Goldby

Saul Krugman

M.H. Pappworth

Geoffrey Edsall

Judgment on Willowbrook 377(4)

Paul Ramsey

Decision in Canterbury v. Spence, Circuit Judge 381(4)

Spottswood W. Robinson III

Competency to Give an Informed Consent 385(4)

James F. Drane

Of Mice but Not Men: Problems of the Randomized Clinical Trial 389(5)

Samuel Hellman

Deborah S. Hellman

Clinical Trials: Are They Ethical? 394(4)

Eugene Passamani

Animal Experimentation 398(7)

Peter Singer

The Case for the Use of Animals in Biomedical Research 405(7)

Carl Cohen

Principles of the Nuremberg Code 412(1)

DECISION SCENARIOS 412(11)
PART III: CONTROLS 423(130)

7. GENETICS: INTERVENTION, CONTROL, AND RESEARCH 423(66)

SOCIAL CONTEXT: The Human Genome Project 423(6)

CASE PRESENTATION: Gene Therapy 429(3)

CASE PRESENTATION: Huntington's Disease--Genetic Testing and Ethical Dilemmas 432(2)

INTRODUCTION 434(21)

Genetic Intervention: Screening, Counseling, and Diagnosis 435(12)

Eugenics 447(3)

Genetic Research, Therapy, and Technology 450(5)

THE READINGS 455(28)

Genetics and Reproductive Risk: Can Having Children Be Immoral? 455(6)

Laura M. Purdy

Implications of Prenatal Diagnosis for the Human Right to Life 461(8)

Leon R. Kass

Social and Ethical Issues in the Human Genome Project 469(4)

Daniel J. Kevles

Germ-Line Gene Therapy and the Medical Imperative 473(10)

Ronald Munson

Lawrence H. Davis

DECISION SCENARIOS 483(6)

8. REPRODUCTIVE CONTROL: IN VITRO FERTILIZATION, ARTIFICIAL INSEMINATION, AND SURROGATE PREGNANCY 489(64)

CASE PRESENTATION: Louise Brown--The First "Test-Tube Baby" 489(1)

SOCIAL CONTEXT: Motherhood after Menopause 490(2)

CASE PRESENTATION: The Orphaned Embryos of Mario and Elsa Rios 492(1)

CASE PRESENTATION: Embryos in Court: The Davis Case 492(2)

CASE PRESENTATION: Baby M: Surrogate Pregnancy in Court 494(1)

CASE PRESENTATION: The Unclaimed Infant 495(1)

CASE PRESENTATION: The Calvert Case: Gestational Surrogacy 496(1)

INTRODUCTION 497(16)

In Vitro Fertilization 499(6)

Cloning 505(1)

Artificial Insemination 506(4)

Surrogate Pregnancy 510(2)

Ethical Theories and Reproductive Control 512(1)

THE READINGS 513(33)

Instruction on Respect for Human Life in Its Origin and on the Dignity of Procreation, Congregation for the Doctrine of the Faith 513(8)

Creating Embryos 521(5)

Peter Singer

Surrogate Motherhood as Prenatal Adoption 526(8)

Bonnie Steinbock

The Right to Lesbian Parenthood 534(3)

Gillian Hanscombe

Is Women's Labor a Commodity? 537(8)

Elizabeth S. Anderson

Entitled to the Embryo? 545(1)

Susan Jacoby

DECISION SCENARIOS 546(7)
PART IV: RESOURCES 553(111)

9. ACQUIRING AND ALLOCATING SCARCE MEDICAL RESOURCES 553(57)

SOCIAL CONTEXT: Distributing Transplant Organs 553(6)

CASE PRESENTATION: The Ayalas' Solution: Having a Child to Save a Life 559(1)

SOCIAL CONTEXT: Fetal-Cell Implants 560(3)

CASE PRESENTATION: Policy Decision and the Neonatal Unit 563(1)

CASE PRESENTATION: Selection Committee for Dialysis 564(4)

INTRODUCTION 568(5)

Transplants, Kidneys, Machines 568(4)

Ethical Theories and the Allocation of Medical Resources 572(1)

THE READINGS 573(30)

The Allocation of Exotic Medical Lifesaving Therapy 573(9)

Nicholas Rescher

The Prostitute, the Playboy, and the Poet: Rationing Schemes for Organ Transplantation 582(5)

George J. Annas

Take My Kidney, Please 587(1)

Michael Kinsley

Organs for Sale? Propriety, Property, and the Price of Progress 588(5)

Leon R. Kass

Alcoholics and Liver Transplantation 593(5)

Carl Cohen

Martin Benjamin, and others

Rights, Symbolism, and Public Policy in Fetal Tissue Transplants 598(5)

John A. Robertson

DECISION SCENARIOS 603(7)

10. THE CLAIM TO HEALTH CARE 610(54)

SOCIAL CONTEXT: The Unresolved Crisis in Health Care 610(7)

CASE PRESENTATION: Drawing the Line in Oregon: Rationing Health Care 617(4)

CASE PRESENTATION: Employer-Mandated Health Insurance: The Hawaiian Example 621(2)

CASE PRESENTATION: The Canadian System as a Model for the United States? 623(4)

INTRODUCTION 627(4)

Claim-Rights, Legal Rights, and Statutory Rights 628(1)

Moral Rights 628(1)

Political Rights 629(2)

THE READINGS 631(28)

An Ethical Framework for Access to Health Care, President's Commission 631(9)

Autonomy, Equality, and a Just Health Care System 640(5)

Kai Nielson

The Case for a Single-Payer Approach 645(5)

Jim McDermott

It Is Time for Universal Access, Not Universal Insurance 650(3)

James S. Todd

Aging and the Ends of Medicine 653(6)

Daniel Callahan

DECISION SCENARIOS 659(5)
NOTES AND REFERENCES FOR INTRODUCTIONS, CASES, AND SCENARIOS 664(13)
BIBLIOGRAPHY 677