Who Decides?

Many of the demands being voiced for a "humanizing" of health care center on the public's concern that they have some say In determining what happens to the individual in health care institutions. The essays in this volume address fundamental questions of conflicts of rights and autonomy as they affect four selected, controversial areas in health care ethics: the Limits of Professional Autonomy, Refusing! Withdrawing from Treatment, Electing "Heroic" Measures, and Advancing Reproductive Technology. Each of the topics is addressed in such a way that it includes an examination of the locus of responsibility for ethical decision­ making. The topics are not intended to exhaustively review those areas of health care provision where conflicts of rights might be said to be an issue. Rather they constitute an examination of the difficulties so often encountered in these specific contexts that we hope will illuminate similar conflicts in other problem areas by raising the level of the reader's moral awareness. Many books in bioethics appeal only to a limited audience in spite of the fact that their subject matter is of deep personal concern to everyone. In part, this is true because they are frequently written from the perspective of a single discipline or a single profession. As a result, one is often left with the impression that such a book views the philosophical, historical, and! or theological problems as essentially indifferent to clinical, legal, and! or policy-making problems.

Contenu

1 Introduction.- 1 Introduction.- 2 Patients and Their Healers: Historical Studies in Health Care.- 2 Patients and Their Healers: Historical Studies in Health Care.- I: Limits of Professional Autonomy.- 3 Goals of Medical Care: A Reappraisal.- 4 Establishing Limits to Professional Autonomy: Whose Responsibility? A Nursing Perspective.- 5 Limits to Responsibility and Decision-Making: Some Comments.- 6 Can Physicians Mind Their Own Business and Still Practice Medicine?.- 7 Allocating Autonomy: Can Patients and Practitioners Share?.- II. Refusing/Withdrawing from Treatment.- 8 The Right to Refuse Treatment: A Critique.- 9 Refusal of Psychiatric Treatment: Autonomy, Competence, and Paternalism.- 10 Consent and Competence: A Commentary on Szasz and Macklin.- III. Death and Dying: electing Heroic Measures.- 11 What is Heroic?.- 12 The Moral Justification for Withholding Heroic Procedures.- 13 Response to Bryan and Beauchamp.- IV. Advancing Reproductive Technology.- 14 Ethics and Reproductive Biology.- 15 Fathers Anonymous: Beyond the Best Interests of the Sperm Donor.- 16 Law and Ethics: Three Persistent Myths.- Further Readings.