Evidence-Based Medical Ethics: : Cases for Practice-Based Learning

Case-Based Medical Ethics in Practice

Preface by the authors

Foreword

Chapter 1: A brief introduction to medical ethics in Internal Medicine

• Definitions of ethics and medical ethics
• Why 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 law

• Purpose 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 care

• Beneficence - 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 roadblocks

• Practitioners and personal belief systems
• Cultural competency and practice of ethical care
• Statement about pharmaceutical company influence on education and practice
• Medical oaths - Are they valid for medicine today? Are they fulfilled by practitioners?
• The Patient Bill of Rights
• Federal, state, local, and institutional regulations - how they intertwine and affect each other

Chapter 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 cases
• Where to find more information if needed

Case 1

• Topic: 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 principles

Case 2

• Topic: 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 principles

Case 3

• Topic: 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 principles

Case 4

• Topic: When an estranged family member or spouse suddenly appears to make decisions

- Narrative of c