The Cambridge Textbook of Bioethics Medicine and healthcare generate many bioethical problems and dilemmas that are of great academic, professional and public interest. This comprehen- sive resource is designed as a succinct yet authori- tative text and reference for clinicians, researchers, bioethicists, and students seeking a better under- standing of the ethical problems in the healthcare setting. Each chapter illustrates an ethical problem that might be encountered in everyday practice; defines the concepts at issue; examines their implications from the perspectives of ethics, law, and policy; and then provides a practical resolution. There are 10 key sections presenting the most vital topics and clinically relevant areas of modern bio- ethics. International, interdisciplinary authorship and cross-cultural orientation ensure suitability for a worldwide audience. This book will assist all clinicians in making well-reasoned and defensible decisions by developing their awareness of ethical considerations and teaching the analytical skills to deal with them effectively. Peter A. Singer is Director Emeritus, University of Toronto Joint Centre for Bioethics; Senior Scientist, McLaughlin-Rotman Centre for Global Health, University Health Network, University of Toronto; Sun Life Financial Chair in Bioethics and Professor of Medicine, University of Toronto. A.M. Viens is a Senior Scholar at Hertford College, Oxford, a Doctoral Student in the Faculty of Phil- osophy at the University of Oxford and a member of the Joint Centre for Bioethics, University of Toronto. The Cambridge Textbook of Bioethics Editor-in-Chief Peter A. Singer University of Toronto and University Health Network, Canada Executive Editor A.M. Viens Hertford College, Oxford, UK CAMBRIDGE UNIVERSITY PRESS Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, São Paulo CamIbnrfiodrgme aUtinoinve orsni ttyh Pisr teistsle: www.cambridge.org/9780521872843 The Edinburgh Building, Cambridge CB2 8RU, UK Publi©sh eCda minb trhide gUe nUitneidv eSrtsaiteys P orfe sAsm 20er0i8ca by Cambridge University Press, New York www.cambridge.org This publication is in copyright. Subject to statutory exception and to the provision of relevant collective licensing agreements, no reproduction of any part may take place without the written p g 2008 ermission of Cambrid e University Press. ISBN-13 978-0-511-37859-1 eBook (NetLibrary) First published in print format ISBN-13 978-0-521-87284-3 hardback ISBN-13 978-0-521-69443-8 paperback g pp p Cambridge University Press has no responsibility for the persistence or accuracy of urls for external or third-party internet websites referred to in this publication, and does not uarantee that any content on such websites is, or will remain, accurate or a ro riate. Contents List of contributors page ix Acknowledgements xvi 1 Introduction 1 A.M. Viens and Peter A. Singer Section I Information problems Introduction 9 Anne Slowther 2 Consent 11 John R. Williams 3 Capacity 17 Julie Chalmers 4 Disclosure 24 Lori d’Agincourt-Canning and Carolyn Johnston 5 Voluntariness 31 Mary Jane Dykeman and Kate Dewhirst 6 Truth telling 36 Philip C. He´ bert, Barry Hoffmaster, and Kathleen C. Glass 7 Confidentiality 43 Anne Slowther and Irwin Kleinman Section II End of life care Introduction 51 James A. Tulsky v vi Contents 8 Quality end of life care 53 18 Non-therapeutic pediatric Peter A. Singer, Neil MacDonald, interventions 127 and James A. Tulsky David Benatar 9 Substitute decision making 58 19 Child abuse and neglect 132 Robert A. Pearlman Benjamin H. Levi 10 Advance care planning 65 James A. Tulsky, Linda L. Emanuel, Section IV Genetics and biotechnology Douglas K. Martin and Peter A. Singer 11 Euthanasia and assisted Introduction 143 suicide 72 Abdallah S. Daar Bernard M. Dickens, Joseph M. Boyle Jr., 20 Organ transplantation 145 and Linda Ganzini Linda Wright, Kelley Ross, 12 Conflict in the healthcare setting and Abdallah S. Daar at the end of life 78 21 Regenerative medicine 153 Susan Dorr Goold, Brent C. Williams, Heather L. Greenwood and Robert Arnold and Abdallah S. Daar 13 Brain death 85 22 Genetic testing and screening 160 Sam D. Shemie, Neil Lazar, Ruth Chadwick and Bernard M. Dickens 23 Bio-banking 166 Bartha Maria Knoppers and Madelaine Saginur Section III Pregnant women and children 24 Behavioral genetics 174 Jason Scott Robert Introduction 95 John Lantos 14 Ethical dilemmas in the care of Section V Research ethics pregnant women: rethinking ‘‘maternal–fetal conflicts’’ 97 Introduction 185 Franc¸oise Baylis, Sanda Rodgers, Richard E. Ashcroft and David Young 25 Research ethics 187 15 Prenatal testing and newborn Eric M. Meslin and Bernard M. Dickens screening 104 26 Innovation in medical care: Lainie Friedman Ross examples from surgery 194 16 Assisted reproduction 112 Randi Zlotnik Shaul, Jacob C. Langer, Roxanne Mykitiuk and Martin F. McKneally and Jeff Nisker 27 Clinical trials 201 17 Respectful involvement of children Richard E. Ashcroft and A.M. Viens in medical decision making 121 28 Epidemiological research 207 Nuala Kenny, Jocelyn Downie, Richard E. Ashcroft and Christine Harrison Contents vii 29 Clinical research and the Section VII Using clinical ethics to make an physician–patient relationship: impact in healthcare the dual roles of physician and researcher 214 Introduction 309 Nancy M. P. King and Larry R. Churchill Susan K. MacRae 30 Financial conflict of interest 40 Clinical ethics and systems in medical research 222 thinking 313 Trudo Lemmens and Lori Luther Susan K. MacRae, Ellen Fox, and Anne Slowther 31 Embryo and fetal research 231 Ronald M. Green 41 Innovative strategies to improve effectiveness in clinical ethics 322 Jennifer L. Gibson, M. Dianne Godkin, C. Shawn Tracy, and Susan K. MacRae Section VI Health systems and institutions 42 Teaching bioethics to medical Introduction 241 students and postgraduate Ross Upshur trainees in the clinical setting 329 Martin F. McKneally 32 Organizational ethics 243 and Peter A. Singer Jennifer L. Gibson, Robert Sibbald, Eoin Connolly, and Peter A. Singer 33 Priority setting 251 Section VIII Global health ethics Douglas K. Martin, Jennifer L. Gibson, and Peter A. Singer Introduction 339 Solomon R. Benatar 34 Disclosure of medical error 257 Philip C. He´ bert, Alex V. Levin, 43 Global health ethics and and Gerald Robertson cross-cultural considerations in bioethics 341 35 Conflict of interest in education Solomon R. Benatar and patient care 266 Ann Sommerville 44 Physician participation in torture 350 Jerome Amir Singh 36 Public health ethics 274 Halley S. Faust and Ross Upshur 45 Access to medicines and the role of corporate social responsibility: 37 Emergency and disaster the need to craft a global scenarios 281 pharmaceutical system with Harvey Kayman, Howard Radest, integrity 359 and Sally Webb Jillian Clare Cohen-Kohler 38 Rural healthcare ethics 289 and Patricia Illingworth William A. Nelson and 46 Global health and non-ideal Jared M. Schmidek justice 369 39 Community healthcare ethics 299 Gopal Sreenivasan Kyle W. Anstey and Frank Wagner viii Contents Section IX Religious and cultural perspectives Section X Specialty bioethics in bioethics Introduction 445 Introduction 379 A.M. Viens Joseph M. Boyle, Jr. and 56 Surgical ethics 447 David Novak James Andrews and Larry Zaroff 47 Aboriginal bioethics 383 57 Anesthesiology ethics 454 Jonathan H. Ellerby Gail A. Van Norman 48 Buddhist bioethics 391 58 Critical and intensive care ethics 462 Damien Keown Phillip D. Levin and Charles L. Sprung 49 Chinese bioethics 397 59 Emergency and trauma Kerry W. Bowman medicine ethics 469 and Edwin C. Hui Arthur B. Sanders 50 Hindu and Sikh bioethics 403 60 Primary care ethics 475 Harold Coward and Tejinder Sidhu Margaret Moon, Mark Hughes, 51 Islamic bioethics 408 and Jeremy Sugarman Abdallah S. Daar, Tarif Bakdash, 61 Infectious diseases ethics 481 and Ahmed B. Khitamy Jay A. Jacobson 52 Jehovah’s Witness bioethics 416 62 Psychiatric ethics 487 Osamu Muramoto Sidney Bloch and Stephen A. Green 53 Jewish bioethics 424 63 Neuroethics 495 Gary Goldsand, Zahava Eric Racine and Judy Illes R.S. Rosenberg-Yunger, and Michael Gordon 64 Pharmacy ethics 505 Margaret L. Eaton 54 Protestant bioethics 430 Merril Pauls 65 Alternative and complementary and Roger C. Hutchinson care ethics 513 Michael H. Cohen 55 Roman Catholic bioethics 436 Hazel J. Markwell and Barry F. Brown Index 521 Contributors Editor-in-Chief Peter A. Singer Executive Editor A.M. Viens Section Editors Richard E. Ashcroft, Solomon R. Benatar, Joseph M. Boyle, Jr., Abdallah S. Daar, John Lantos, Susan K. MacRae, David Novak, Anne Slowther, James A. Tulsky, Ross Upshur, and A.M. Viens. James Andrews School of Medicine, Stanford University, Palo Alto, CA, USA Kyle W. Anstey Bioethicist, University Health Network, Toronto, Canada Robert Arnold Leo H. Criep Chair in Patient Care, Institute to Enhance Palliative Care, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, USA Richard E. Ashcroft Professor of Bioethics, School of Law, Queen Mary, University of London, UK Tarif Bakdash Pediatric Neurologist; Lecturer, Damascus University, Syria ix