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How should modern medicine's dramatic new powers to sustain life be employed? How should limited resources be used to extend and improve the quality of life? In this collection, Dan Brock, a distinguished philosopher and bioethicist and co-author of Deciding for Others (Cambridge, 1989), explores the moral issues raised by new ideals of shared decision making between physicians and patients. The book develops an ethical framework for decisions about life-sustaining treatment and euthanasia, and examines how these life and death decisions are transformed in health policy when the focus shifts from what is best for a patient to what is just for all patients. Professor Brock combines acute philosophical analysis with a deep understanding of the realities of clinical health policy. This is a volume for philosophers concerned with medical ethics, health policy professionals, physicians interested in bioethics, and undergraduate courses in biomedical ethics.

Tabla de contenidos provista por Syndetics

• Sources and acknowledgments(p. vii)
• Introduction(p. 1)
• Part I Physicians and Patients Making Treatment Decisions
• 1 Informed consent(p. 21)
• 2 The ideal of shared decision making between physicians and patients(p. 55)
• 3 When competent patients make irrational choices(p. 80)
• Part II Life-and-Death Decisions in the Clinic
• 4 Moral rights and permissible killing(p. 95)
• 5 Taking human life(p. 123)
• 6 Death and dying(p. 144)
• 7 Forgoing life-sustaining food and water: Is it killing?(p. 184)
• 8 Voluntary active euthanasia(p. 202)
• Part III Life-and-Death Decisions in Health Policy
• 9 The value of prolonging human life(p. 235)
• 10 Quality of life measures in health care and medical ethics(p. 268)
• 11 The problem of low benefit/high cost health care(p. 325)
• 12 Justice and the severely demented elderly(p. 356)
• 13 Justice, health care, and the elderly(p. 388)
• 14 Truth or consequences: The role of philosophers in policy-making(p. 408)
• Index(p. 417)

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CHOICE Review

Philosopher/ethicist Brock focuses on how patients and physicians make treatment decisions, with emphasis on the ethical dimensions of the physician-patient relationship. He begins by exploring traditional (paternalistic) and newly emerging (shared) models of decision making in health and illness care. He discusses the importance of considering objective as well as subjective aspects of thinking, and the values of all participants in the decision process. Part 1 explores the doctrine of informed consent, the "ideal" of shared decision making, and what to consider when competent patients make irrational choices. Part 2 covers the theological, moral, and philosophical "ideals" related to permissible killing, suicide, and physicians' roles in such actions. Brock gives special emphasis to food and water as agents of prolonging one's dying. Part 3 begins with US society's incomplete definition of "quality of life," and moves to selective public policy implications in medical treatment. Of special interest is a discussion of US use of noncostworthy medical treatments and the special case made for using "justice" to decide the extent of treatment for the elderly, including the demented elderly. Overall, important discussions with practical application. Advanced undergraduate through professional. J. E. Thompson; University of Pennsylvania