A Casebook for Health Care Ethics

Introduction

1 Professional Roles and Responsibilities
1.1 Withholding Bad News from a Patient
1.2 A Depressed Patient Refuses Heart Surgery
1.3 A Cancer Patient Prefers an Alternative Treatment Plan
1.4 Parents Choose an Alternative Treatment
1.5 A Mature Minor and her Mother Refuse Chemotherapy
1.6 A Doctor Refuses a Patient’s Request to Modify Medication
1.7 Pressure to Prescribe
1.8 Request for an Off-Label Prescription
1.9 Accepting Gifts from Pharmaceutical Representatives
1.10 Investing in a New Imaging Center
1.11 The Oncology Nurse and Informed Consent
1.12 The Office Nurse and Informed Consent
1.13 Informed Consent and Cultural Differences
1.14 Nurses Vote to Strike
1.15 Substandard Care by a Nurse Colleague
1.16 An Inferior Heart Surgeon
1.17 Treating a Racist Patient
1.18 A Difficult Dialysis Patient
1.19 A Belligerent Surrogate
1.20 Confidentiality and the Duty to Warn
1.21 Sharing Genetic Information with a Patient’s Family

2 Acute and End-of-Life Care
2.1 An Oncologist Orders Questionable Interventions
2.2 A Cognitively Impaired Patient Refuses Amputation
2.3 An Elderly Patient Requests CPR on Religious Grounds
2.4 A Disagreement about Code Status
2.5 Access to Physician-assisted Suicide for an ALS Patient
2.6 A Hospice Patient Seeks Humane Relief
2.7 Euthanasia for Alcoholism
2.8 A Patient Asks to Deactivate his LVAD
2.9 Removing Artificial Nutrition and Hydration
2.10 A Family Disagreement about Life-sustaining Treatment
2.11 A Proxy Makes Questionable Decisions
2.12 Honoring a Living Will
2.13 Following a Dementia Patient’s Advance Directive
2.14 Escalation of Care for a COVID-19 Patient
2.15 Treatment Decisions for an Unrepresented Patient
2.16 Aggressive Interventions for a Patient in a Persistent Vegetative State
2.17 A Patient Resists Hospice Care
2.18 Aggressive Interventions for a Severely Impaired Neonate
2.19 Withholding Life-sustaining Surgery from a Neonate with Down Syndrome
2.20 A Disagreement over Resuscitating a Premature Infant

3 Reproductive Ethics
3.1 Obtaining Abortion Medication in a State with an Abortion Ban
3.2 Access to Treatment for an Early Term Miscarriage
3.3 Abortion to Protect a Woman’s Health: How Sick is “Sick Enough”?
3.4 Abortion for an Intellectually Disabled Patient
3.5 Prenatal Decisions concerning a Severely Impaired Fetus
3.6 Can Having a Child Be Immoral?
3.7 Recruiting a Commercial Surrogate
3.8 A Surrogate Violates the Terms of her Contract
3.9 Surrogacy: A Disagreement over Selective Reduction and Parental Rights
3.10 Selling Eggs to a “Selective” Fertility Clinic
3.11 Using IVF for a “Savior Sibling”
3.12 Sex Selection for Family Balancing
3.13 Selecting Embryos for Deafness
3.14 Advising a Patient about Direct-to-Consumer Prenatal Test Results
3.15 Fringe Benefits for Family Planning
3.16 Assisted Reproduction for an Older Couple
3.17 A Woman’s Request for Tubal Ligation Is Denied
3.18 Request to Sterilize an Intellectually Disabled Girl

4 Research and Technologies
4.1 Using Nazi Data
4.2 Research on Prisoners: The Salt Study
4.3 Enrolling a Minor in a Clinical Trial
4.4 Guinea Pigs: Now Hiring
4.5 Vaccine Research for Childhood Diseases in Developing Countries
4.6 Hacking an Insulin Pump
4.7 Direct-to-Consumer Genetic Testing: A Stressful Outcome
4.8 Making Better Babies 
4.9 Deep Brain Stimulation for a Parkinson’s Patient
4.10 Using Wearables to Monitor the Health and Wellness of Employees
4.11 Physicians Consider Using AI for Diagnosis and Treatment Recommendations
4.12 Tracking Dementia Patients   

5 Behavioral and Mental Health
5.1 A Halfway House Patient Discontinues Psychiatric Medication
5.2 A Patient Refuses Medication in a Psychiatric Advance Directive
5.3 A Patient Refuses to Be Cleaned
5.4 A Homeless Patient Leaves the Hospital against Medical Advice
5.5 Pain Treatment for an Addict
5.6 An Affair of the Demented
5.7 Covert Administration of Medication to a Nursing Home Resident
5.8 Following a Patient’s Social Media Use
5.9 Force Feeding an Anorexic Patient
5.10 DNR for a Previously Suicidal Patient
5.11 Boarding Psychiatric Patients on the Emergency Department
5.12 A Political Duty to Warn?
5.13 Telehealth Across State Lines

6 Social Justice and Access to Health Care
6.1 An Insured Worker Struggles with Medical Expenses
6.2 A Patient Faces Impediments to Medications and Health Care
6.3 Rationing Insulin: A Dangerous Decision
6.4 Relinquishing Child Custody to Obtain Mental Health Treatment
6.5 Providing Care for a Frequent Visitor to the Emergency Room
6.6 Withholding Surgery from a Patient with a History of Non-Adherence
6.7 Repeat Heart Surgery for an IV Drug User
6.8 Ignoring the Symptoms of an Obese Patient
6.9 Talking with Patients About Weight Loss
6.10 Using Race in Clinical Algorithms
6.11 Closing a Rural Primary Care Clinic
6.12 Medical Records in a Rural Setting
6.13 Gender Affirming Hormones for an Adolescent
6.14 Treating a Native American with Suicidal Tendencies
6.15 Suspected Abuse of an Adolescent Patient
6.16 Drug Testing Prisoners without their Consent
6.17 Race and Medical School Admissions

7 Public Health Ethics
7.1 A Parent Refuses to Vaccinate
7.2 Mandatory Vaccinations for Health Care Workers
7.3 COVID-19 Triage and Fairness
7.4 Rationing CPR for COVID-19 Patients
7.5 A COVID-19 Positive Health Care Worker
7.6 Mandatory A1C Reporting
7.7 HIV Surveillance in Commercial Sex Workers 
7.8 Tracking Down a TB Patient
7.9 House Arrest to Prevent Spread of an Infectious Disease
7.10 Resource Allocation and Racial Disparities
7.11 Debating a Drop-in Center for Drug Users
7.12 Corporate Sponsorship of Public Health Initiatives
7.13 The Ethical Cost of Free Vaccines

Keyword Index