Case Analysis in Clinical Ethics

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Dedication......Page 7
Contents......Page 9
Alastair Campbell......Page 11
Brian Hurwitz......Page 12
Julian Savulescu......Page 13
Rob Withers......Page 14
Acknowledgements......Page 15
1 Philosophical introduction: case analysis in clinical ethics......Page 17
References......Page 22
2 Families and genetic testing: the case of Jane and Phyllis......Page 23
Jane’s story......Page 24
The general practitioner’s story......Page 26
The oncologist’s story......Page 27
The geneticist’s story......Page 28
Author’s comment......Page 31
References......Page 33
Appendix I Family diagram......Page 34
Appendix II Patient information leaflet......Page 35
How are BRCA genes inherited?......Page 36
Can I have a test to see if the breast cancer in my family is due to a mutation in a BRCA gene?......Page 37
So testing is a two-stage process?......Page 38
Are BRCA1/2 the only genes that can cause hereditary breast cancer?......Page 39
What is the advantage of predictive BRCA testing?......Page 40
I’ve heard of research studies involving people with a family history of cancer. How can I find out more?......Page 41
3 Family access to shared genetic information: an analysis of the narrative......Page 43
Piecing the jigsaw puzzle together......Page 45
Jane and Phyllis’s meeting......Page 46
Jane’s decision......Page 48
The unseen narrator......Page 49
Phyllis’s story......Page 50
The general practitioners’ perspective......Page 51
The geneticist’s story......Page 53
Closure......Page 54
Conclusion......Page 55
Notes......Page 57
References......Page 58
Introducing virtue ethics......Page 61
Elitism and stigma......Page 63
Applicability......Page 64
The case study......Page 65
References......Page 72
5 Interpretation and dialogue in hermeneutic ethics......Page 73
Interpretation and ambiguity......Page 74
Interpretation and ambiguity in the case of Jane and Phyllis......Page 76
Varying perspectives and fusing horizons......Page 80
Perspectives and horizons in the story of Jane and Phyllis......Page 83
Fostering interpretation and sustaining dialogue......Page 86
References......Page 90
6 'Power, corruption and lies' : ethics and power......Page 93
Power and domination......Page 95
Productive power......Page 97
Power and responsibility......Page 99
Power in the story of Jane, Phyllis and the doctors......Page 101
A Romantic note......Page 106
Suggested further reading......Page 108
Bibliography......Page 109
Lost in space: in place of an introduction......Page 111
Rough emotions......Page 114
Refinement......Page 115
Practically reasoning......Page 118
Rationalism......Page 119
A gymnasium called sculptors......Page 120
Trust me, I’m your psychiatrist......Page 122
Proprieties......Page 123
The sleep of unreason......Page 126
Notes......Page 128
References......Page 130
Application......Page 131
Utilitarianism strongly favours disclosure of the result......Page 132
Application......Page 133
Hedonistic utilitarianism......Page 134
Application......Page 135
Act- versus rule-utilitarianism......Page 137
Utilitarianism and lying......Page 138
Decisions about right action require empirical evidence, including knowledge of the details (context) of a particular situation and of all alternative courses of action......Page 139
Application......Page 140
Utilitarianism is demanding......Page 141
Application......Page 142
Utilitarianism and personal autonomy......Page 143
Utilitarianism is not retributive......Page 145
References......Page 146
Care ethics......Page 149
Is care ethics a feminist ethics?......Page 153
The caring relationship......Page 154
Genetics and the need for a relational perspective......Page 156
Responsibility and the value of personal autonomy......Page 157
Care ethics and autonomy......Page 158
Practices of responsibility......Page 161
Notes......Page 162
References......Page 163
Recognition and respect for personhood......Page 165
Having a ‘sense of self’......Page 166
The third necessary aspect of ‘sense of self’ (Self 3)......Page 168
Informal conversational ethics......Page 170
Formal deliberative ethics......Page 171
Formal deliberative ethics......Page 173
The doctor-patient relationship......Page 176
Personal morality......Page 177
Concluding remark......Page 178
Notes......Page 179
Both limbs of this moral dilemma can be defended using a four-principles approach......Page 181
The dilemma considered in terms of the four principles......Page 184
Trying to escape from the dilemma: professional and legal obligations......Page 186
General Medical Council guidelines......Page 187
British Medical Association Ethics Department guidance......Page 188
Legal obligations: self-interest and morality......Page 190
Can ‘scope’ considerations resolve the dilemma?......Page 191
Can virtue ethics resolve the dilemma?......Page 192
Can utilitarianism solve the dilemma?......Page 193
Other ways of trying to resolve the dilemma......Page 195
The dilemma remains: using a sort of casuistry to choose between the horns......Page 197
Some additional checks......Page 198
A concluding reflection......Page 199
References......Page 201
Experience and method......Page 203
Structures of meaning......Page 205
A phenomenological analysis......Page 207
References......Page 215
Bibliography......Page 216
13 An empirical approach......Page 217
The theory-ladenness of social knowledge......Page 218
Identifying empirical premises......Page 219
Men: the forgotten group in genetic counselling......Page 222
Some further observations on the role of the counsellor......Page 223
Resource allocation......Page 224
Notes......Page 225
References......Page 226
14 Response to ethical dissections of the case......Page 229
A bit about the characters......Page 232
Some technical aspects of the case......Page 234
Clinical practice......Page 236
References......Page 238
15 Philosophical reflections......Page 241
The case......Page 243
Method......Page 244
Values......Page 245
References......Page 246
Index......Page 247