Ethical Analysis of Clinical Medicine:
A Guide to Self-Evaluation

Glenn C. Graber, PhD; Alfred D. Beasley, MD; John A. Eaddy, MD

(Baltimore & Munich: Urban & Schwarzenberg, 1985)

Sources and Permissions


Chapter One: Physician-Patient Relationships
1 . General Features
1.1 Fantasies: A Thought Experiment
1.2 Expectations
1.3 Conclusion


2. Information Exchange
2.1 Relationships
2.2 Obligations
2.3 Fulfilling These Obligations
2.4 Placebos and the Placebo Effect
2.5 Conclusions


3. Informed Consent
3.1 The Legal and Moral Requirement of Informed Consent
3.2 Practical Applications
3.3 The Paradox of Autonomy
3.4 Mental Competence
3.5 Manipulation


4. Confidentiality
4.1 The Importance of Confidentiality
4.2 The Need for Confidentiality in Medicine
4.3 Confidentiality in Medicine
4.4 Confidentiality and the Law
4.5 Cases
4.6 President's Commission Recommendations
4.7 Review Exercises
5. Conclusion
Further Reading


Chapter Two: Professional Codes and Ethical Theories
1. Professional Codes
1. 1 The Hippocratic Oath
1.2 AMA Principles of Medical Ethics
1.3 American College of Physicians Ethics Manual
1.4 Limitations of Professional Codes
2. Fundamentals of Ethical Theory
2.1 Ethical Judgments
2.2 Some Points About Ethical Theory
2.3 Key Concepts
3. Review Exercise
3.1 Instructions
3.2 Case: "To Make the Parents Happy
3.3 Questions
3.4 Options for Action
3.5 Additional Questions
Further Reading


Chapter Three: The Scope of Professional Responsibility
1 . The Scope of Medical Service
1.1 Case: Joyce and Brent Blackspott
1.2 Analysis: Physician Responsibility for Health and Disease
2. The "Moral Center" of Medicine
2.1 Content of the Moral Center
2.2 Importance of the Moral Center
2.3 The Blackspotts and the Moral Center
2.4 Additional Cases
3. Beyond the Moral Center
3.1 Research
3.2 Other Potential Conflicts of Loyalties
3.3 Conflicts of Loyalties: Toward a Policy Solution
3.4 Family Medicine
3.5 Team Care
3.6 Institutional Delivery of Health Care
4. Expansions of the Scope of Responsibility
4.1 Beyond Treatment
4.2 Beyond the Clinic
4.3 Beyond Illness or Injury
4.4 Palliation, Comforting, and Strengthening Coping Skills
4.5 Conclusion
Further Reading


Chapter Four: Life and Death
1 . Determination of Death
1. 1 "Irreversible
1.2 "Vital Functions"
1.3 Statutory Definitions of Death
1.4 "Pronouncing" Death
2. Other Limits to Treatment
2.1 AMA Policy Statements
2.2 Limits Set by Patients
2.3 Dealing with Families' Decisions


2.4 Other Dimensions of Limits to Treatment
3. Seriously III Newborns
3.1 Issues
3.2 Conclusions
4. Abortion
5. Reproductive Technologies
Further Reading


Chapter Five: Who Gets What?
1 . Allocation of Resources
1.1 Life and Death Resources
1.2 Principles of Allocation
1.3 Case: Who Gets the Protection?
1.4 Triage
1.5 Patient Loyalties and Demands of Justice
1.6 Office Scheduling as an Allocation Problem


2. Allocation on the Social Scale
2.1 Access to Health Care Services
2.2 The Monetarization of Medicine
2.3 Cost Control
3. Reviewing Your Expectations
Sources of Items in Exercise, Section 2.2.3
Further Reading


Appendix 1:More About Ethical Theories
1. Utilitarianism and Other Goal-Based Theories
1.1 Teleologism, the Goal-Based Approach
1.2 The Moral Reference Group
1.3 Theories of Value
1.4 Act vs. Rule Approach
1.5 Applying Goal-Based Theories
1.6 Review Exercise: Goal-Based Theories
2. Deontological Theories
2.1 Duty-Based Theories
2.2 Kant's Deontological Theory
2.3 Ross' List of Prima Facie Duties
2.4 Review Exercise: Deontological Theories
2.5 Conclusion
Further Reading


Appendix II: Summaries of Reports of the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research
1. Making Health Care Decisions
2. Deciding to Forego Life-Sustaining Treatment
3. Securing Access to Health Care


Appendix III: American College of Physicians Ethics Manual:


link to 5th edition of American Collge of Physicians ETHICS MANUAL

Table of Cases