Evidence-Based Medical Ethics

Case-Based Medical Ethics in PracticePreface by the authorsForewordChapter 1: A brief introduction to medical ethics in Internal MedicineDefinitions of ethics and medical ethicsWhy is medical ethics important? (teaching competency in ethics, teaching professionalism)Evolution of medical ethics and its importance/role in modern medicine (from paternalism to informed consent)Who determines ethical guidelines for medicine?Difference/similarities between ethics and lawPurpose of the book (i.e. to stimulate thought and discussion, not cover all details of all ethical principles)Chapter 2: The underlying principles of ethical patient careBeneficence - a practitioner should act in the best interest of the patient. (Salus aegroti suprema lex.) Non-maleficence - 'first, do no harm' (Primum non nocere). Autonomy - the patient has the right to refuse or choose their treatment (Voluntas aegroti suprema lex.) Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment. Dignity - the patient (and the person treating the patient) have the right to dignity. Veracity - the patient should not be lied to, and deserves to know the whole truth about his/her illness and treatment.Chapter 3: Putting ethics into practice - realities, limitations, and roadblocksPractitioners and personal belief systemsCultural competency and practice of ethical careStatement about pharmaceutical company influence on education and practiceMedical oaths - Are they valid for medicine today? Are they fulfilled by practitioners? The Patient Bill of RightsFederal, state, local, and institutional regulations - how they intertwine and affect each otherChapter 4: Advanced Directives, Living Wills, and the Health Care Power of Attorney (HCPOA)Chapter 5: Case-based ethical dilemmas How the reader should approach these casesWhere to find more information if needed Case 1Topic: Consent in the mentally ill or otherwise unfit (and ’in between’ situations: delirium, psychiatric decompensation)Subtopic: When does forcing an incompetent patient to undergo treatment limit their right to dignity and the principle of ’do-no-harm’?• Narrative of clinical scenario with specific example of ethical dilemma• Questions for thought/discussion• Explanations of underlying ethical and legal principlesCase 2Topic: When the HCPOA neglects their responsibility, or has other personal interests/potential gains• Narrative of clinical scenario with specific example of ethical dilemma• Questions for thought/discussion• Explanations of underlying ethical and legal principlesCase 3Topic: When the patient/their family bullies practitioners into unnecessary diagnostics/therapeutics'C.Y.A.' medicine• Narrative of clinical scenario with specific example of ethical dilemma• Questions for thought/discussion• Explanations of underlying ethical and legal principlesCase 4Topic: When an estranged family member or spouse suddenly appears to make decisions• Narrative of c