Table Of Content(cid:9)
OXFORD
THIRD EDITION
BIOMEDICA
EllICS
A CANADIAN FOCUS
Roma
111
EDITED BY
FISHER RUSSELL BROWNE r BURKHOLDER
1.I
CCM
©40
THIRD EDITION
5\A
I L_
A CANADIAN FOCUS
EDITED BY
JOHNNA FISHER I J.S. RUSSELL
ALISTER BROWNE I LESLIE BURKHOLDER
OXFORD
UNIVERSITY PRESS
11 III I (cid:9) W (cid:9) I I(cid:9) ill(cid:9) 1111111
OXFORD
UNIVERSITY PRESS
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Library and Archives Canada Cataloguing in Publication
Biomedical ethics : a Canadian focus / edited by Johnna Fisher,
J.S. Russell, Alister Browne and Leslie Burkholder. — Third edition.
Includes bibliographical references and index.
Issued in print and electronic formats.
ISBN 978-0-19-902228-1 (softcover).—ISBN 978-0-19-902229-8 (PDF)
1. Medical ethics(cid:9) Canada. 2. Bioethics—Canada. 3. Medical
ethics—Canada—C se studies. I. Fisher, Johnna, 1964-, editor
(cid:9)
R724.8565 2018 174.20971(cid:9) C2017-906106-2
C2017-906107-0
Cover image: Assembly/Iconica/Getty Images
Cover and interior design: Sherill Chapman
Oxford University Press is committed to our environment.
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Printed and bound in the United States of America
1 2 3 4-21 20 19 18
Contents
Preface xiii
1(cid:9) Morality and Moral Decision-Making: A Brief Introduction 1
1.1 The Indispensability of Biomedical Ethics 1
1.2 The Case of Hassan Rasouli 2
1.3 Taking Morality Seriously 3
1.4 Normative Ethical Theories 7
1.5 Moral Reasoning in Biomedical Ethics 17
1.6 Professional Codes of Ethics and Law 19
1.7 Looking Ahead 20
1.8 Study Questions 21
1.9 Suggested Readings and Resources 22
2 Medical Decision-Making: Self-Determination and
Deciding for Others 23
2.1 Introduction 23
2.2 Determining Decision-Making Capacity 32
Standards of Competence 32
Allen E. Buchanan and Dan W. Brock
A Relational Approach to Autonomy in Health Care 35
Susan Sherwin
2.3 Informed Consent 45
The Nuts and Bolts of Obtaining Consent to Treatment 45
L.E. and F.A. Rozovsky
The Concept of Informed Consent 47
Ruth R. Faden and Tom L Beauchamp
Transparency: Informed Consent in Primary Care 51
Howard Brody
Culture, Power, and Informed Consent:The Impact of Aboriginal
Health Interpreters on Decision-Making 56
Joseph Kaufert and John O'Neil
no i(cid:9) LI(cid:9) II JII(cid:9) III Wil
®
Contents
Informed Consent and Public Health 60
Onora O'Neill
2.4 Substituted Judgments 63
Enough:The Failure of the Living Will 63
Angela Fagerlin and Carl E. Schneider
Advance Directives for Resuscitation and Other Life-Saving or
Life-Sustaining Measures 76
Canadian Medical Association
2.5 Best-Interest Judgments 76
Involving Children in Medical Decisions 76
Christine Harrison, Nuala P Kenny, Mona Sidarous, and Mary Rowell
Position Statement: Treatment Decisions Regarding Infants, Children,
and Adolescents 80
Christine Harrison; Canadian Paediatric Society, Bioethics Committee
Withholding or Withdrawing Life-Sustaining Treatment in Children 81
Royal College of Paediatrics and Child Health
Deciding to Forego Life-Sustaining Treatment 82
Judicial Council, American Medical Association
Ethical Relativism in a Multicultural Society 83
Ruth Macklin
2.6 Cases 91
Case 1 Scott Starson: Refusing Treatment while Incompetent 91
Case 2 No Chemotherapy for Anael: Surrogate Refusal ofTreatment for a
Minor Child 92
Case 3 Do Everything for Mom: Advance Directives and a Surrogate's Right
to Demand Treatment 93
Case 4 Treatment for Jehovah's Witnesses: Adults and Children 94
Case 5 Markayla Sault: Caring for an Aboriginal Patient 95
2.7 Study Questions 95
2.8 Suggested Further Reading 96
3(cid:9) Management of Medical Information 98
3.1 Introduction 98
3.2 Patient Access to Information 106
On the Supposed Right to Lie from Benevolent Motives 106
Immanuel Kant
Telling the Truth to Patients: A Clinical Ethics Exploration 107
David C. Thomasma
Telling Patients the Truth 110
Robert Scott Stewart
Medical Secrecy: Patients' Right of Access to Medical Records 113
Arthur Schafer
3.3 Confidentiality of Information 117
A Defense of Unqualified Medical Confidentiality 117
Kenneth Kipnis
Contents
Breaching Confidentiality 128
Dave Unger
How Should Health Data Be Used? Privacy, Secondary Use, and Big Data Sales 134
Bonnie Kaplan
3.4 Genetic Information 147
Genetic Exceptionalism and "Future Diaries": Is Genetic Information Different
from Other Medical Information? 147
Thomas H. Murray
3.5 Cases 153
Case 1 George VI's Cancer 153
Case 2 Arndt v Smith 154
Case 3 The Crash of Germanwings Flight 9525 155
Case 4 Personal Genome Mapping 156
3.6 Study Questions 157
3.7 Suggested Further Reading 158
4 Professional Ethics 159
4.1 Introduction 159
4.2 The Nature and Limits of Professional Autonomy and Professional
Responsibility 165
Patient and Physician Autonomy. Conflicting Rights and Obligations in the
Physician-Patient Relationship 165
Edmund D. Pellegrino
The Problem with Futility 176
Robert D. Truog, Allan S. Brett, and Joel Frader
Should Physicians Be Gatekeepers of Medical Resources? 181
Milton C. Weinstein
Caring in a Crisis:The Ethical Obligations of Physicians and Society during a
Pandemic 188
Canadian Medical Association
Why Medical Professionals Have No Moral Claim to Conscientious Objection
Accommodation in Liberal Democracies 191
Udo Schuklenk and Ricardo Smalling
The Functions and Limitations of Professional Codes of Ethics 201
Dale Beyerstein
4.3 Cases 205
Case 1 Hassan Rasouli and Medical Futility 205
Case 2 MRS in Toronto: A Duty to Care 206
Case 3 Is It Ever Right to Violate Rules of Rationing? 207
Case 4 BC Physicians "Cherry-Picking" Patients for Ease of Care, Refusing
Those in Need 207
Case 5 Helping Residents to Live at Risk 208
Case 6 When Is Treatment Futile? 209
4.4 Study Questions 209
4.5 Suggested Further Reading 210
11(cid:9) I(cid:9) I I(cid:9) ill(cid:9) 111111
Contents
5(cid:9) Reproductive Ethics 211
5.1 Introduction 211
5.2 Starting Reproduction 218
Reproductive Freedom, Autonomy, and Reproductive Rights 218
Christine Overall
Preconception Gender Selection 226
John A. Robertson
Preconception Arrangements 233
Royal Commission on New Reproductive Technologies
5.3 Stopping Reproduction 238
Why Abortion Is Immoral 238
Don Marquis
On the Moral and Legal Status of Abortion 248
Maly Anne Warren
A Defence of Abortion 253
Judith Ja►vis Thomson
A Third Way 262
L.W. Sumner
Abortion through a Feminist Ethics Lens 268
Susan Sherwin
5.4 Completing Reproduction 277
Judicial Intervention in Pregnancy and Birth 277
Royal Commission on New Reproductive Technologies
Dissent on Judicial Intervention in Pregnancy and Birth
(Royal Commission on New Reproductive Technologies) 281
Suzanne Rozell Scorsone
5.5 Cases 282
Case 1 Sex Selection in Canada 282
Case 2 Prenatal Diagnosis and Abortion or Infanticide through
Declining Treatment 282
Case 3 Abortion of Suspected Female Fetus 283
Case 4 Ms G and Refusal of Treatment while Pregnant 283
Case 5 Endangering Behaviour in a Pregnant Woman 284
Case 6 Abortion of a Fetus Due to Diagnosis of Down Syndrome 284
5.6 Study Questions 285
5.7 Suggested Further Reading 286
6 End-of-Life Decision-Making 287
6.1 Introduction 287
6.2 Withholding or Withdrawing Life-Sustaining Treatment and
Physician-Assisted Death 295
Withholding and Withdrawal of Potentially Life-Sustaining Treatment 295
Health Law Institute, Dalhousie University
Voluntary Active Euthanasia 297
Dan W. Brock
Contents ®
Active and Passive Euthanasia 309
James Rachels
When Self-Determination Runs Amok 312
Daniel Callahan
Medical Ethics and Double Effect:The Case of Terminal Sedation 316
Joseph M. Boyle
6.3 Physician-Assisted Dying in Canada 321
Controlling the Risks of PAD 321
British Columbia Supreme Court
Legislative Background: Medical Assistance in Dying (Bill C-14) 323
Department ofJustice
Mature Minors, Mental Illness, Advance Directives, and
Conscientious Objection 328
Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying and the Special Joint
Committee on Physician-Assisted Dying
6.4 The Concept of Death and Its Practical Implications 338
Defining Death 338
Alister Browne
6.5 Cases 341
Case 1 Nancy B.: Withdrawing Life-Sustaining Treatment 341
Case 2 Dr Nancy Morrison: Nonvoluntary Active Euthanasia
of an Adult 341
Case 3 Tracy Latimer: Nonvoluntary Active Euthanasia of a Minor 342
Case 4 Mr McCullough: Recommending Voluntary Passive Euthanasia 344
Case 5 Elizabeth and Eric MacDonald: Assisted Suicide 344
6.6 Study Questions 345
6.7 Suggested Further Reading 345
7(cid:9) Delivery of Health Care and Resource Allocation 349
7.1 Introduction 349
7.2 Access to Health Care in Canada 357
Sustaining Medicare:The Commission on the Future of Health Care in Canada 357
Roy Romanow
7.3 The Right to Health Care, Macroallocation, and Setting Priorities 367
The Right to a Decent Minimum of Health Care 367
Allen E Buchanan
Justice and the High Cost of Health 372
Ronald Dworkin
Why UndervaluingnStatisticar People Costs Lives 377
Tony Hope
QALYs vs DALYs vs LYs Gained: What Are the Differences, and What Difference
Do They Make for Health Care Priority Setting? 382
Bjarne Robberstad
O
Contents
7.4 Microallocation: Decisions at the Bedside 391
The Allocation of Exotic Medical Life-Saving Therapy 391
Nicholas P. Rescher
Just Caring: In Defense of Limited Age-Based Healthcare Rationing 399
Leonard M. Fleck
7.5 Increasing Resources 407
Human Organs, Scarcities, and Sale: Morality Revisited 407
R.R. Kishore
7.6 Cases 412
Case 1 Optimal Care versus Cost Containment: What Is a Doctor to Do? 412
Case 2 Having an Estate Sale of One's Organs 413
Case 3 Rationing Services to an Elder Who Is Responsible for
His Medical Condition 413
Case 4 Buying a Kidney in India but Requesting Canadian After-Care 413
Case 5 Does Clifford Olson Deserve Medical Treatment? 414
7.7 Study Questions 415
7.8 Suggested Further Reading 415
8 Public Health 418
8.1 Introduction 418
8.2 Collective Action Problems 427
The Measles and Free Riders: California's Mandatory Vaccination Law 427
Katharine Browne
Free Riding and Organ Donation 431
Walter Glannon
8.3 Screening for Disease 434
Direct-to-Consumer Genetics and Health Policy: A Worst-Case Scenario? 434
Timothy Caulfield
The Ethics of Screening: Is "Screeningitis" an Incurable Disease? 436
Darren Shickle and Ruth Chadwick
8.4 Harm Reduction Programs 443
Canada's Highest Court Unchains Injection Drug Users; Implications
for Harm Reduction as Standard of Healthcare 443
Dan Small
Virtue Ethics as an Alternative to Deontological and Consequential
Reasoning in the Harm Reduction Debate 451
Timothy Christie, Louis Groarke, and William Sweet
8.5 Inequality in Health 458
When Are Health Inequalities Unjust?—The Social Determinants of Health 458
Norman Daniels
8.6 Cases 471
Case 1 Health Care Workers and Flu Shots 471
Case 2 Students and Study-Enhancing Drugs 472
