This timely Third Edition will keep clinicians up to date on a wide range of ethical dilemmas and new ways of thinking about them. Important new material addresses federal privacy regulations, disclosure of medical errors, limits on residents' working hours, patient compliance with public health directives, genetic testing, gifts from drug companies, and more. Also included are revised sections on decision-making near the end of life and an update on organ transplantation, including living donations and financial incentives for donation. This edition also has more real-life cases to illustrate ethical dilemmas and challenge readers' critical thinking skills.

SECTION I: Fundamentals of Clinical Ethics

1. An Approach to Ethical Dilemmas in Patient Care 3
2. Overview of Ethical Guidelines 10
3. Informed Consent 17
4. Promoting the Patient's Best Interests 28
5. Confidentiality 36
6. Avoiding Deception and Nondisclosure 45
7. Keeping Promises 54

   SECTION II: Shared Decision Making

8. An Approach to Decisions About Clinical Interventions 59
9. Futile Interventions 61
10. Decision-making Capacity 67
11. Refusal of Treatment by Competent, Informed Patients 75
12. Standards for Decisions When Patients Lack Decision-making Capacity 79
13. Surrogate Decision Making 90
14. Persistent Disagreements over Care 95

    SECTION III: Decisions About Life-Sustaining Interventions

15. Confusing Ethical Distinctions 105
16. Ethics Committees and Case Consultations 111
17. Do Not Attempt Resuscitation Orders 117
18. Tube and Intravenous Feedings 125
19. Physician-Assisted Suicide and Active Euthanasia 130
20. The Persistent Vegetative State 140
21. Determination of Death 143
22. Legal Rulings on Life-Sustaining Interventions 147

    SECTION IV: The Doctor-Patient Relationship

23. Overview of the Doctor-Patient Relationship 155
24. Refusal to Care for Patients 157
25. Gifts from Patients to Physicians 163
26. Sexual Contact between Physicians and Patients 168
27. Secret Information about Patients 174
28. Clinical Research 176

    SECTION V: Conflicts of Interest

29. Overview of Conflicts of Interest 185
30. Bedside Rationing of Health Care 189
31. Incentives for Physicians to Increase Services 196
32. Incentives for Physicians to Decrease Services 200
33. Gifts from Drug Companies 209
34. Disclosing Errors 213
35. Impaired Colleagues 221
36. Ethical Dilemmas Students and House Staff Face 226

    SECTION VI: Ethical Issues in Clinical Specialities

37. Ethical Issues in Pediatrics 235
38. Ethical Issues in Surgery 243
39. Ethical Issues in Obstetrics and Gynecology 249
40. Ethical Issues in Psychiatry 256
41. Ethical Issues in Organ Transplantation 264
42. Testing for Genetic Conditions 272
43. Ethical Issues in Public Health Emergencies 280 Cases for Discussion 285

    Index 296