The following is an excerpt from the book Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, 4th Edition. Copyright permission to reproduce this excerpt has been generously granted by McGraw-Hill. We encourage you to read further in this useful resource book, available now in the revised 7th Edition (2010). . Albert R. Jonsen, Mark Siegler, and William J. Winslade, Clinical Ethics: A Practical Approach to Ethical Decisions in Clinical Medicine, 4th edition. New York: McGraw-Hill, Inc., . INTRODUCTION:
Case Analysis in Clinical Ethics
Clinical ethics is a practical discipline that provides a structured approach to assist physicians in identifying, analysing and resolving ethical issues in clinical medicine. The practice of good clinical medicine requires some working knowledge about ethical issues such as informed consent, truth-telling, confidentiality, end-of-life care, pain relief, and patient rights. Medicine, even at its most technical and scientific, is an encounter between human beings, and the physician's work of diagnosing disease, offering advice, and providing treatment is embedded in a moral context. Usually, moral values such as mutual respect, honesty, trustworthiness, compassion, and a commitment to pursue shared goals, make a clinical encounter between physician and patient morally unproblematic. Occasionally, physicians and patients may disagree about values or face choices that challenge their values. It is then that ethical problems arise. Clinical ethics is both about the ethical features that are present in every clinical encounter and about the ethical problems that occasionally arise in those encounters. Clinical ethics relies upon the conviction that, even when perplexity is great and emotions run high, physicians and nurses, patients and families can work constructively to identify, analyze and resolve many of the ethical problems that arise in clinical medicine. The authors have two purposes in writing this book: first, to offer an approach that facilitates thinking about the complexities of the problems that clinicians actually face and, second, to assemble concise representative opinions about typical ethical problems that occur in the practice of medicine. We think it is more important that clinicians develop skill at analyzing the cases they encounter rather than merely have a book in which "to look up answers." Our hope is that every clinician will acknowledge that ethics is an inherent aspect of good clinical medicine and that, ideally, every clinician will become as proficient at clinical ethics as clinical medicine. Our book is intended not only for clinicians and students who provide care to patients, but also for others whose work requires an awareness and sensitivity to the ethical issues raised in clinical care, such as hospital administrators, hospital attorneys, members of institutional ethics committees, quality reviewers and administrators of health plans. In the complex world of modern health care, all of these persons are responsible for maintaining the ethics that lie at the heart of quality care. Many books on health care ethics are organized around moral principles, such as respect for autonomy, beneficence, non-maleficence and fairness, and the cases are analyzed in the light of those principles. Our method is different. While we appreciate the importance of principles, we believe that the practitioner approaching a case needs a method that better fits the realities of the clinical setting and the reasoning of the clinician. Clinical situations are complex since they often involve a wide range of medical facts, a multitude of circumstances and a variety of values. Often decisions must be reached quickly. The authors believe that clinicians need a straightforward way to sort the facts and values of the case at hand into an orderly pattern that will facilitate the discussion and resolution of the ethical problem. We suggest that every clinical...
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