Biomedical Ethics

1. Morality and Moral Decision-Making: A Brief Introduction
1.1 The Indispensability of Biomedical Ethics
1.2 The Case of Hassan Rasouli
1.3 Taking Morality Seriously
1.4 Normative Ethical Theories
1.5 Moral Reasoning in Biomedical Ethics
1.6 Professional Codes of Ethics and Law
1.7 Looking Ahead
1.8 Study Questions
1.9 Suggested Readings and Resources
2. Medical Decision-Making: Self-Determination and Deciding for Others
2.1 Introduction
2.2 Determining Decision-Making Capacity
- Standards of Competence, Allen E. Buchanan and Dan W. Brock
- A Relational Approach to Autonomy in Health Care, Susan Sherwin
2.3 Informed Consent
- The Nuts and Bolts of Obtaining Consent to Treatment, L.E. and F.A. Rozovsky NEW
- The Concept of Informed Consent, Ruth R. Faden and Tom L. Beauchamp
- Transparency: Informed Consent in Primary Care, Howard Brody
- Culture, Power, and Informed Consent: The Impact of Aboriginal Health Interpreters on Decision-Making, Joseph Kaufert and John O'Neil
- Informed Consent and Public Health, Onora O'Neill NEW
2.4 Substituted Judgments
- Enough: The Failure of the Living Will, Angela Fagerlin and Carl E. Schneider NEW
- Advance Directives for Resuscitation and Other Life-Saving or Life-Sustaining Measures, Canadian Medical Association
2.5 Best Interest Judgments
- Involving Children in Medical Decisions, Christine Harrison, Nuala P. Kenny, Mona Sidarous, and Mary Rowell
- Position Statement: Treatment Decisions Regarding Infants, Children, and Adolescents, Christine Harrison; Canadian Paediatric Society, Bioethics Committee NEW
- Withholding or Withdrawing Life-Sustaining Treatment in Children, Royal College of Paediatrics and Child Health NEW
- Deciding to Forego Life-Sustaining Treatment, Judicial Council, American Medical Association NEW
- Ethical Relativism in a Multicultural Society Ruth Macklin
2.6 Cases
- Scott Starson: Refusing Treatment While Incompetent
- No Chemotherapy for Anael: Surrogate Refusal of Treatment for a Minor Child
- Do Everything for Mom: Advance Directives and a Surrogate's Right to Demand Treatment
- Treatment for Jehovah's Witnesses: Adults and Children
- Markayla Sault: Caring for an Aboriginal Patient NEW
2.7 Study Questions
2.8 Suggested Further Reading
3. Management of Medical Information
3.1 Introduction
3.2 Patient Access to Information
- On the Supposed Right to Lie from Benevolent Motives, Immanuel Kant NEW
- Telling the Truth to Patients: A Clinical Ethics Exploration, David C. Thomasma
- Telling Patients the Truth, Robert Scott Stewart NEW
- Medical Secrecy: Patients' Right of Access to Medical Records, Arthur Schafer NEW
3.3 Confidentiality of Information
- A Defense of Unqualified Medical Confidentiality, Kenneth Kipnis NEW
- Breaching Confidentiality, Dave Unger NEW
- How Should Health Data Be Used? Privacy, Secondary Use, and Big Data Sales, Bonnie Kaplan NEW
3.4 Genetic Information
- Genetic Exceptionalism and "Future Diaries": Is Genetic Information Different from Other Medical Information?, Thomas H. Murray NEW
3.5 Cases
- George VI's Cancer NEW
- Arndt v Smith NEW
- The Crash of Germanwings Flight 9525 NEW
- Personal Genome Mapping NEW
3.6 Study Questions
3.7 Suggested Further Reading
4. Professional Ethics (NEW CHAPTER)
4.1 Introduction
4.2 The Nature and Limits of Professional Autonomy and Professional Responsibility
- Patient and Physician Autonomy: Conflicting Rights and Obligations in the Physician-Patient Relationship, Edmund D. Pellegrino
- The Problem with Futility, Robert D. Truog, Allan S. Brett, and Joel Frader
- Should Physicians Be Gatekeepers of Medical Resources, Milton C. Weinstein
- Caring in a Crisis: The Ethical Obligations of Physicians and Society During a Pandemic, Canadian Medical Association
- Why Medical Professionals Have No Moral Claim to Conscientious Objection Accommodation in Liberal Democracies, Udo Schuklenk and Ricardo Smalling
- The Functions and Limitations of Professional Codes of Ethics, Dale Beyerstein
4.3 Cases
- Hassan Rasouli and Medical Futility
- SARS in Toronto: A Duty to Care
- Is It Ever Right to Violate Rules of Rationing?
- BC Physicians "Cherry-Picking" Patients for Ease of Care, Refusing Those in Need
- Helping Residents to Live at Risk
- When Is Treatment Futile?
4.4 Study Questions
4.5 Suggested Further Reading
5. Reproductive Ethics
5.1 Introduction
5.2 Starting Reproduction
- Reproductive Freedom, Autonomy, and Reproductive Rights, Christine Overall NEW
- Preconception Gender Selection, John A. Robertson NEW
- Preconception Arrangements, Royal Commission on New Reproductive Technologies NEW
5.3 Stopping Reproduction
- Why Abortion Is Immoral, Don Marquis
- On the Moral and Legal Status of Abortion, Mary Anne Warren
- A Defence of Abortion, Judith Jarvis Thomson
- A Third Way, L. W. Sumner NEW
- Abortion Through a Feminist Ethics Lens, Susan Sherwin
5.4 Completing Reproduction
- Judicial Intervention in Pregnancy and Birth, Royal Commission on New Reproductive Technologies NEW
- Dissent on Judicial Intervention in Pregnancy and Birth (Royal Commission on New Reproductive Technologies),Suzanne Rozell Scorsone NEW
5.5 Cases
- Sex Selection in Canada NEW
- Prenatal Diagnosis and Abortion or Infanticide Through Declining Treatment
- Abortion of Suspected Female Fetus
- Ms G and Refusal of Treatment While Pregnant
- Endangering Behaviour in a Pregnant Woman
- Abortion of a Fetus Due to Diagnosis of Down Syndrome
5.6 Study Questions
5.7 Suggested Further Reading
6. End-of-Life Decision-Making
6.1 Introduction
6.2 Withholding or Withdrawing Life-Sustaining Treatment and Physician-Assisted Death
- - Withholding and Withdrawal of Potentially Life-Sustaining Treatment, Health Law Institute, Dalhousie University
- Voluntary Active Euthanasia, Dan W. Brock
- Active and Passive Euthanasia, James Rachels
- When Self-Determination Runs Amok, Daniel Callahan
- Medical Ethics and Double Effect: The Case of Terminal Sedation, Joseph M. Boyle
6.3 Physician-Assisted Dying in Canada
- Controlling the Risks of PAD, British Columbia Supreme Court NEW
- Legislative Background: Medical Assistance in Dying (Bill C-14), Department of Justice NEW
- Mature Minors, Mental Illness, Advance Directives, Conscientious Objection, Provincial-Territorial Expert Advisory Group on Physician-Assisted Dying and the Special Joint Committee on Physician-Assisted Dying NEW
6.4 The Concept of Death and Its Practical Implications
- Defining Death, Alister Browne NEW
6.5 Case Studies
- Nancy B: Withdrawing Life-Sustaining Treatment NEW
- Dr Nancy Morrison: Nonvoluntary Active Euthanasia of an Adult
- Tracy Latimer: Nonvoluntary Active Euthanasia of a Minor
- Mr McCullough: Recommending Voluntary Passive Euthanasia
- Elizabeth and Eric MacDonald: Assisted Suicide
6.6 Study Questions
6.7 Suggested Further Reading
7. Delivery of Health Care and Resource Allocation
7.1 Introduction
7.2 Access to Health Care in Canada
- Sustaining Medicare: The Commission on the Future of Health Care in Canada, Roy Romanow
7.3 The Right to Health Care, Macroallocation, and Setting Priorities
- The Right to a Decent Minimum of Health Care, Allen E. Buchanan
- Justice and the High Cost of Health, Ronald Dworkin NEW
- Why Undervaluing "Statistical" People Costs Lives, Tony Hope NEW
- QALYs vs DALYs vs LYs Gained: What Are the Differences, and What Difference Do They Make for Health Care Priority Setting?, Bjarne Robberstad
7.4 Microallocation: Decisions at the Bedside
- The Allocation of Exotic Medical Life-Saving Therapy, Nicholas P. Rescher
- Just Caring: In Defense of Limited Age-Based Healthcare Rationing, Leonard M. Fleck NEW
7.5 Increasing Resources
- Human Organs, Scarcities, and Sale: Morality Revisited, R.R. Kishore
7.6 Cases
- Optimal Care versus Cost Containment: What Is a Doctor to Do? NEW
- Having an Estate Sale of One's Organs
- Rationing Services to an Elder Who Is Responsible for His Medical Condition
- Buying a Kidney in India But Requesting Canadian After-Care
- Does Clifford Olson Deserve Medical Treatment?
7.7 Study Questions
7.8 Suggested Further Reading
8. Public Health (NEW CHAPTER)
8.1 Introduction
8.2 Collective Action Problems
- The Measles and Free Riders: California's Mandatory Vaccination Law, Katharine Browne
- Free Riding and Organ Donation, Walter Glannon
8.3 Screening for Disease
- Direct-to-Consumer Genetics and Health Policy: A Worst-Case Scenario?, Timothy Caulfield
- The Ethics of Screening: Is "Screeningitis" an Incurable Disease?, Darren Shickle and Ruth Chadwick
8.4 Harm Reduction Programs
- Canada's Highest Court Unchains Injection Drug Users; Implications for Harm Reduction as Standard of Healthcare, Dan Small
- Virtue Ethics as an Alternative to Deontological and Consequential Reasoning in the Harm Reduction Debate, Timothy Christie, Louis Groarke, and William Sweet
8.5 Inequality in Health
- When Are Health Inequalities Unjust? - The Social Determinants of Health, Norman Daniels
8.6 Cases
- Health Care Workers and Flu Shots
- Students and Study-Enhancing Drugs
- Breast Cancer Screening
- Water in First Nations Communities
8.7 Study Questions
8.8 Suggested Further Reading
9. Research with Humans
9.1 Introduction
9.2 The Dark History of Human Research in Canada
- Dr Ewen Cameron, Colin A. Ross
- Biomedical Conflicts of Interest: A Defence of the Sequestration Thesis - Learning from the Cases of Nancy Olivieri and David Healy, Arthur Schafer
9.3 Ethical Issues in the Design and Conduct of Clinical Research
- An Ethical Framework for Biomedical Research, Ezekiel J. Emanuel, David Wendler, and Christine Grady NEW
- A Critique of Clinical Equipoise: Therapeutic Misconception in the Ethics of Clinical Trials, Franklin G. Miller and Howard Brody NEW
- Protecting Communities in Biomedical Research, Charles Weijer and Ezekiel J. Emanuel NEW
- Repairing Research Integrity, Sandra L. Titus, James A. Wells, and Lawrence J. Rhoades
9.4 Use of Vulnerable Populations in Research
- Vulnerability in Research and Health Care: Describing the Elephant in the Room?, Sonia A. Hurst NEW
- Best Practices for Health Research Involving Children and Adolescents: Genetic, Pharmaceutical, and Longitudinal Studies, D. Avard, L. Black, J. Samuël, G. Griener, and B.M. Knoppers NEW
9.5 Cases
- Dr Roger Poisson: Fraud in Breast Cancer Study NEW
- Mr Halushka: Human Research and Harm to Participants
- Luka Magnotta and the Legal Recognition of Research Confidentiality NEW
- Jesse Gelsinger: Research Conflicts and Ethical Review
9.6 Study Questions
9.7 Suggested Further Reading
Glossary
Index

E-Book ISBN 9780199022298

The late Johnna Fisher received her doctorate in ethical theory and biomedical ethics from the University of British Columbia in 2001. She was an instructor in the Department of Philosophy at both the University of British Columbia and Langara College. She was the long-time leader of the UBC Ethics Bowl team.

J. S. Russell, Ph.D., has been chair of the Langara College Research Ethics Board since 2012 and an ethics member on the University of British Columbia Clinical Research Ethics Board since 2001. He is a member and past chair of the Department of Philosophy at Langara College. Russell has published in the areas of biomedical ethics, political philosophy, philosophy of law, and philosophy of sport. He is a former president and executive director of the BC Civil Liberties Association.

Alister Browne is a faculty emeritus instructor and former chair of the philosophy department at Langara College, where he served from 1987 to 2005. His contributions to the philosophy and bioethics communities are profound, with 56 peer-reviewed publications. From 1995-2003, while at the University of British Columbia, he served as the director of its Division of Health Care Ethics and subsequently as the ethics theme director of its medical school, before retiring as a clinical professor in 2013. Browne has served on ethics committees of several area hospitals for over 30 years and as a board member of the BC Civil Liberties Association.

Leslie Burkholder is a senior instructor at the University of British Columbia, where he teaches biomedical ethics. Prior to this position, he was an instructor and researcher at Carnegie Mellon University in Pittsburgh. His research interests are in the philosophy of medicine. He has published articles and edited books in biomedical and applied ethics, game theory, logic, and computing and philosophy.

Bioethics in Canada - Edited by Charles Weijer and Anthony Skelton
Doing Right - Philip C. Hebert and Wayne Rosen
Bioethics - Lewis Vaughn
Principles of Biomedical Ethics - Tom L. Beauchamp and James F. Childress
Contemporary Bioethics - Jessica Pierce and George Randels

Special Features

• The most up-to-date Canadian biomedical ethics text on the market ensures that students are exposed to cutting-edge thinking and changing legislation in this rapidly advancing field.
• Classic and contemporary readings offer students a range of perspectives on the key issues and ethical dilemmas faced by health care professionals on a daily basis.
• Coverage of Canadian cases, standards, values, and policies gives students insight into the health care system in this country.
• End-of-chapter case studies cover current biomedical ethics cases and technological advances in medicine, as well as important historical cases.
• Helpful pedagogy - including chapter introductions, study questions, suggested further readings, and end-of-chapter case studies - get students thinking critically about the moral dilemmas discussed throughout the text.

New to this Edition

• Two new chapters on professional ethics (Ch. 4) and public health (Ch. 8) give students perspective on these two important areas of biomedical ethics study.
• Over half of the readings - 44 in total - are new to this edition, bringing students up-to-date on the most recent research in biomedical ethics, covering topics such as informed consent, living wills, medical secrecy, genetic privacy, and more.
• Half of the case studies - almost 20 cases - are new to this edition, covering topics such as health care workers and the flu, personal genome mapping, sex selection in Canada, King George VI's cancer, and more.
• Fully revised introductory chapter (Ch. 1) provides more coverage of moral theory and reasoning to help ground the debates and issues in the subsequent chapters.
• Up-to-date coverage of end-of-life decision-making (Ch. 6) includes discussion of the new Medical Assistance in Dying legislation (Bill C-14) and excerpts from related legislative documents, plus a new article written expressly for this chapter by volume editor Alister Browne (Section 6.5: Defining Death).
• Fully revised and lengthened chapter introductions describe each reading, highlight the major concepts and issues, and help students better engage in debates that arise from the readings.