Biomedical Ethics A Canadian Focus 3rd Edition by Johnna Fisher, JS Russell, Alister Browne, Leslie Burkholder ISBN 0199022283 9780199022281

1: Morality and Moral Decision-Making: A Brief Introduction

1.1 The Indispensability of Biomedical Ethics

1.2 The Case of Hassan Rasouli

1.3 Taking Morality Seriously

1.4 Normative Ethical Theories

1.5 Moral Reasoning in Biomedical Ethics

1.6 Professional Codes of Ethics and Law

1.7 Looking Ahead

1.8 Study Questions

1.9 Suggested Readings and Resources

2: �Medical Decision-Making: Self-Determination and Deciding for Others

2.1 Introduction

2.2 Determining Decision-Making Capacity

Standards of Competence: Allen E. Buchanan and Dan W. Brock

A Relational Approach to Autonomy in Health Care: Susan Sherwin

2.3 Informed Consent

The Nuts and Bolts of Obtaining Consent to Treatment: L.E. and F.A. Rozovsky

The Concept of Informed Consent: Ruth R. Faden and Tom L. Beauchamp

Transparency: Informed Consent in Primary Care: Howard Brody

Culture, Power, and Informed Consent: The Impact of Aboriginal Health Interpreters on Decision-Makin

Informed Consent and Public Health: Onora O’Neill

2.4 Substituted Judgments

Enough: The Failure of the Living Will: Angela Fagerlin and Carl E. Schneider

Advance Directives for Resuscitation and Other Life-Saving or Life-Sustaining Measures: Canadian Med

2.5 Best-Interest Judgments

Involving Children in Medical Decisions: Christine Harrison, Nuala P. Kenny, Mona Sidarous, and Mary

Position Statement: Treatment Decisions Regarding Infants, Children, and Adolescents: Christine Harr

Withholding or Withdrawing Life-Sustaining Treatment in Children: Royal College of Paediatrics and C

Deciding to Forego Life-Sustaining Treatment: Judicial Council, American Medical Association

Ethical Relativism in a Multicultural Society: Ruth Macklin

2.6 Cases

Case 1 Scott Starson: Refusing Treatment while Incompetent

Case 2 �No Chemotherapy for Anael: Surrogate Refusal of Treatment for a Minor Child

Case 3 �Do Everything for Mom: Advance Directives and a Surrogate’s Right to Demand Treatment

Case 4 Treatment for Jehovah’s Witnesses: Adults and Children

Case 5 Markayla Sault: Caring for an Aboriginal Patient

2.7 Study Questions

2.8 Suggested Further Reading

3: Management of Medical Information

3.1 Introduction

3.2 Patient Access to Information

On the Supposed Right to Lie from Benevolent Motives: Immanuel Kant

Telling the Truth to Patients: A Clinical Ethics Exploration: David C. Thomasma

Telling Patients the Truth: Robert Scott Stewart

Medical Secrecy: Patients’ Right of Access to Medical Records: Arthur Schafer

3.3 Confidentiality of Information

A Defense of Unqualified Medical Confidentiality: Kenneth Kipnis

Breaching Confidentiality: Dave Unger

How Should Health Data Be Used? Privacy, Secondary Use, and Big Data Sales: Bonnie Kaplan

3.4 Genetic Information

Genetic Exceptionalism and “Future Diaries”: Is Genetic Information Different from Other Medical

3.5 Cases

Case 1 George VI’s Cancer

Case 2 Arndt v Smith

Case 3 The Crash of Germanwings Flight 9525

Case 4 Personal Genome Mapping

3.6 Study Questions

3.7 Suggested Further Reading

4: Professional Ethics

4.1 Introduction

4.2 �The Nature and Limits of Professional Autonomy and Professional Responsibility

Patient and Physician Autonomy: Conflicting Rights and Obligations in the Physician–Patient Relati

The Problem with Futility: Robert D. Truog, Allan S. Brett, and Joel Frader

Should Physicians Be Gatekeepers of Medical Resources?: Milton C. Weinstein

Caring in a Crisis: The Ethical Obligations of Physicians and Society during a Pandemic: Canadian Me

Why Medical Professionals Have No Moral Claim to Conscientious Objection Accommodation in Liberal De

The Functions and Limitations of Professional Codes of Ethics: Dale Beyerstein

4.3 Cases

Case 1 Hassan Rasouli and Medical Futility

Case 2 sars in Toronto: A Duty to Care

Case 3 Is It Ever Right to Violate Rules of Rationing?

Case 4 �BC Physicians “Cherry-Picking” Patients for Ease of Care, Refusing Those in Need

Case 5 Helping Residents to Live at Risk

Case 6 When Is Treatment Futile?

4.4 Study Questions

4.5 Suggested Further Reading

5: Reproductive Ethics

5.1 Introduction

5.2 Starting Reproduction

Reproductive Freedom, Autonomy, and Reproductive Rights: Christine Overall

Preconception Gender Selection: John A. Robertson

Preconception Arrangements: Royal Commission on New Reproductive Technologies

5.3 Stopping Reproduction

Why Abortion Is Immoral: Don Marquis

On the Moral and Legal Status of Abortion: Mary Anne Warren

A Defence of Abortion: Judith Jarvis Thomson

A Third Way: L.W. Sumner

Abortion through a Feminist Ethics Lens: Susan Sherwin

5.4 Completing Reproduction

Judicial Intervention in Pregnancy and Birth: Royal Commission on New Reproductive Technologies

Dissent on Judicial Intervention in Pregnancy and Birth (Royal Commission on New Reproductive Techno

5.5 Cases

Case 1 Sex Selection in Canada

Case 2 �Prenatal Diagnosis and Abortion or Infanticide through Declining Treatment

Case 3 Abortion of Suspected Female Fetus

Case 4 Ms G and Refusal of Treatment while Pregnant

Case 5 Endangering Behaviour in a Pregnant Woman

Case 6 Abortion of a Fetus Due to Diagnosis of Down Syndrome

5.6 Study Questions

5.7 Suggested Further Reading

6: End-of-Life Decision-Making

6.1 Introduction

6.2 �Withholding or Withdrawing Life-Sustaining Treatment and Physician-Assisted Death

Withholding and Withdrawal of Potentially Life-Sustaining Treatment: Health Law Institute, Dalhousie

Voluntary Active Euthanasia: Dan W. Brock

Active and Passive Euthanasia: James Rachels

When Self-Determination Runs Amok: Daniel Callahan

Medical Ethics and Double Effect: The Case of Terminal Sedation: Joseph M. Boyle

6.3 Physician-Assisted Dying in Canada

Controlling the Risks of pad: British Columbia Supreme Court

Legislative Background: Medical Assistance in Dying (Bill C-14): Department of Justice

Mature Minors, Mental Illness, Advance Directives, and Conscientious Objection: Provincial-Territori

6.4 The Concept of Death and Its Practical Implications

Defining Death: Alister Browne

6.5 Cases

Case 1 Nancy B.: Withdrawing Life-Sustaining Treatment

Case 2 �Dr Nancy Morrison: Nonvoluntary Active Euthanasia of an Adult

Case 3 Tracy Latimer: Nonvoluntary Active Euthanasia of a Minor

Case 4 Mr McCullough: Recommending Voluntary Passive Euthanasia

Case 5 Elizabeth and Eric MacDonald: Assisted Suicide

6.6 Study Questions

6.7 Suggested Further Reading

7: Delivery of Health Care and Resource Allocation

7.1 Introduction

7.2 Access to Health Care in Canada

Sustaining Medicare: The Commission on the Future of Health Care in Canada: Roy Romanow

7.3 The Right to Health Care, Macroallocation, and Setting Priorities

The Right to a Decent Minimum of Health Care: Allen E. Buchanan

Justice and the High Cost of Health: Ronald Dworkin

Why Undervaluing “Statistical” People Costs Lives: Tony Hope

qalys vs dalys vs lys Gained: What Are the Differences, and What Difference Do They Make for Health

7.4 Microallocation: Decisions at the Bedside

The Allocation of Exotic Medical Life-Saving Therapy: Nicholas P. Rescher

Just Caring: In Defense of Limited Age-Based Healthcare Rationing: Leonard M. Fleck

7.5 Increasing Resources

Human Organs, Scarcities, and Sale: Morality Revisited: R.R. Kishore

7.6 Cases

Case 1 Optimal Care versus Cost Containment: What Is a Doctor to Do?

Case 2 Having an Estate Sale of One’s Organs

Case 3 �Rationing Services to an Elder Who Is Responsible for His Medical Condition

Case 4 Buying a Kidney in India but Requesting Canadian After-Care

Case 5 Does Clifford Olson Deserve Medical Treatment?

7.7 Study Questions

7.8 Suggested Further Reading

8: Public Health

8.1 Introduction

8.2 Collective Action Problems

The Measles and Free Riders: California’s Mandatory Vaccination Law: Katharine Browne

Free Riding and Organ Donation: Walter Glannon

8.3 Screening for Disease

Direct-to-Consumer Genetics and Health Policy: A Worst-Case Scenario?: Timothy Caulfield

The Ethics of Screening: Is “Screeningitis” an Incurable Disease?: Darren Shickle and Ruth Chadw

8.4 Harm Reduction Programs

Canada’s Highest Court Unchains Injection Drug Users; Implications for Harm Reduction as Standard

Virtue Ethics as an Alternative to Deontological and Consequential Reasoning in the Harm Reduction D

8.5 Inequality in Health

When Are Health Inequalities Unjust?—The Social Determinants of Health: Norman Daniels

8.6 Cases

Case 1 Health Care Workers and Flu Shots

Case 2 Students and Study-Enhancing Drugs

Case 3 Breast Cancer Screening

Case 4 Water in First Nations Communities

8.7 Study Questions

8.8 Suggested Further Reading

9: Research with Humans

9.1 Introduction

9.2 The Dark History of Human Research in Canada

Dr Ewen Cameron: Colin A. Ross

Biomedical Conflicts of Interest: A Defence of the Sequestration Thesis—Learning from the Cases of

9.3 Ethical Issues in the Design and Conduct of Clinical Research

An Ethical Framework for Biomedical Research: Ezekiel J. Emanuel, David Wendler, and Christine Grady

A Critique of Clinical Equipoise: Therapeutic Misconception in the Ethics of Clinical Trials: Frankl

Protecting Communities in Biomedical Research: Charles Weijer and Ezekiel J. Emanuel

Repairing Research Integrity: Sandra L. Titus, James A. Wells, and Lawrence J. Rhoades

9.4 Use of Vulnerable Populations in Research

Vulnerability in Research and Health Care; Describing the Elephant in the Room?: Samia A. Hurst

Best Practices for Health Research Involving Children and Adolescents: Genetic, Pharmaceutical, and

9.5 Cases

Case 1 Dr Roger Poisson: Fraud in Breast Cancer Study

Case 2 Mr Halushka: Human Research and Harm to Participants

Case 3 �Luka Magnotta and the Legal Recognition of Research Confidentiality

Case 4 Jesse Gelsinger: Research Conflicts and Ethical Review

9.6 Study Questions

9.7 Suggested Further Reading

Glossary

Index