Synopses & Reviews
Tough Decisions presents many of the complex medical-ethical issues likely to confront practitioners in critical situations. Through fictional but true-to-life cases, vividly described in clinical terms, the authors force the reader to choose among different courses of action and to confront a range of possible consequences. A two-year-old has been diagnosed with a malignant brain tumor. Who should be allowed to make decisions about the child's surgery and subsequent therapy, and on what basis? A family history of Huntington's disease emerges when a fiancee seeks genetic counseling. Who should be informed? An elderly patient suffers a cardiac arrest. Should "do-not-resuscitate" orders always be followed? How should legal liability affect medical decisions?
Other ethical issues considered include surgical complications, patient autonomy, rights of the retarded, informed consent, euthanasia, and the fair allocation of finite resources. Each case presented conveys the drama and pressure of weighing alternatives, and the realistic consequences of the choices made. The authors show that ethical decision-making is not limited to "matters of life and death", and that it is not the decision but the ethical process by which it is made that gives the decision moral integrity. With realistic detail, Tough Decisions brings to life and makes the student share in the many complexities of ethical decision-making when the health and lives of patients are at stake.
Synopsis
Life is full of tough decisions that must be made ethically and under the pressures of time. This book places readers in realistic situation where they experience the difficulties of making tough medical decisions. The cases are composites of actual cases the authors have seen or managed. In the role of decision-maker, the reader helps to determine what happens in the case as his or her decision often shapes the course of events and the patient's outcome. This gives a compelling sense of the pressures that bear on clinical decision-making. The authors assume that the reader wants to do the right thing, but faces the problem of determining what the right thing will be when information is necessarily incomplete and the future unknown. Ethical theory emerges as others involved in the case offer different views of what is right in a particular medical situation. Two concluding chapters discuss the major theories of medical ethics, but there are no answers in the back of the book. Instead, the book will familiarize readers with some of the ethical principles and issues critical to the practice of medicine to patients and their families.
Synopsis
Tough Decisions places readers in realistic composites of cases the au thors have actually seen or managed where they must make tough medical decisions. What happens in them often depends on the reader's decisio ns and thus gives a sense of pressures that bear on clinical-decision making.
Table of Contents
1. Maggie: Should a patient's request not to be resuscitated always be followed?
2. Monica: Can a father refuse treatment of his toddler's brain tumor?
3. Leroy: Who will care for this 83-year-old after his cataract surgery?
4. Joey, Jessica, Roger, TomandMarti: Who should be moved from the crowded ICU to make space for new patients?
5. Tom Revisited: Who should decide to stop treatment? When and how?
6. Marti Revisited: Should a quadriplegic 12-year-old be allowed to give up?
7. Edgar Jones: What about Euthanasia?
8. Rebecca: Sterilization: What are the rights of the retarded?
9. Christie: Decision-making for a child with spina bifida.
10. The Smyth Saga: Risks of a view of the future for a family with Huntington's disease
11. Baby James: Is a baboon heart transplant research or innovative therapy - and does it matter?
12. Castelli: After you've begun treating a newborn, when can you stop?
13. Amanda: Is a baby without a brain a person?
14. Ethical Theory and Medical Ethics
15. Making Good Decisions