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Doing Right


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Cases Preface Acknowledgments 1. Ethics Matters I. Great Expectations: Healthcare Professionals and Ethics II. Four Ethical Principles and Questions II. The Principles and Ethical Reasoning in Medicine IV. Beyond Principles V. The Hidden Curriculum VI. Overcoming Obstacles to Ethics 2. Broadening the Horizon: What Law and Ethics Say I. What the Law Says II. What Ethics Says: Virtue, Rules, and Consequences in Medicine III. Expanding the Horizons of Ethics IV. Professional Ethics 3. Managing Medical Morality I. Managing Ethical Dilemmas II. Really Hard Choices Are Not Always About Ethics III. "Doing Right": A Process For Managing Ethical Choice IV. The Ethics Process in a Little More Detail V. Applying the Ethics Process 4. The Times Are Changing: Autonomy and Patient-Based Care I. The Autonomy Principle II. Autonomy as the Patient's Preference III. The Case of Ms. Malette and Dr. Shulman IV. Choices: The Good, the Bad, and the Ugly 5. Reasonable Persons: The Legal Roots of Informed Consent I. Medical Consent II. Informed Consent: A Brief Legal History III. Informed Consent: The Canadian Context IV. The Significance of Reibl v. Hughes: The Modified Objective Standard 6. Informed Choice and Truthtelling: The Centrality of Truth and Trust I. Disclosure and Truthtelling II. The Elements of Informed Choice III. Consent as Trust IV. Other Special Circumstances V. Special Circumstances and Limits on Truthtelling 7. Keeping Secrets: Confidentiality and Privacy in the Electronic Age I. Confidentiality and Privacy II. Privacy, Confidentiality, and Trust III. New Risks to Privacy IV. Limits to Confidentiality V. To Warn and to Protect 8. The Waning and Waxing Self: Capacity and Incapacity in Medical Care I. Incapacity and its Discontents II. Assessing Capacity III. Capacity and Consent IV. Treating and Protecting the Vulnerable V. Substitute and Assisted Decision-Making VI. Mental Illness and the Right to Refuse VII. Children's Right to Refuse 9. Helping and Not Harming: Beneficence and Non-Maleficence I. The Principles of Beneficence and Nonmaleficence II. A Duty to Attend? III. Risks to the Professional IV. Endangering One's Self V. Parental Refusals of Treatment VI. Parental Requests for Treatment 10. Conduct Becoming: Medical Professionalism I. Maintaining the Connection II. A New Professionalism III. Conflicts of Interest IV. Professionals and Industry V. Boundaries Large and Small VI. Fitness to Practise Medicine 11. The End of Forgetting: Ethical and Professional Issues with Social Media I. Friends, Boundaries, and Privacy in the Age of Social Media II. The Personal and the Private III. Patients Using Social Media IV. Photographs and Patient Privacy V. Internet Etiquette and Telling Others' Stories 12. The Error of Our Ways: Managing Medical Error I. Medical Error II. Error and Being Responsive to Patients III. How to Disclose Error IV. Apologies V. Large-Scale Adverse Events 13. Beyond the Patient: Doing Justice to Justice I. Justice in Everyday Medicine II. A System of Mmutual Recognition III. Distributive Justice IV. Squeezing the Balloon V. Guidelines and Rationing VI. Justice for All? 14. Labour Pains: Ethics and New Life I. Birthing and Reproductive Choice II. Termination and Choice III. The New Age of Reproduction IV. Desperately Seeking Stem Cells 15. A Dark Wood: End-of-Life Decisions I. Allowing Death: Refusals by Patients II. Competent Cecisions, Living Wills, and Advance Directives III. Decisions to Withhold or Withdraw Life-Sustaining Treatment IV. Persistent Vegetative States and Prognostic Error V. Unilateral Decisions Regarding Life-Sustaining Treatment VI. Palliative Sedation 16. Medical Assistance in Dying: The Triumph of Autonomy I. Assisted Death: Terminology and Other Jurisdictions II. Medically-Assisted Death in Canada: A Brief History III. Legislating Medical Assistance in Dying: Bill C-14 IV. MAID: Minors, Advance Requests, and Mental Illness V. MAID and Issues of Conscience 17. Nature and Culture: Of Genes and Memes I. All in the Genome? II. Cultural Connections III. Worlds Apart? IV. Culture and Defying Death V. Transcending Culture 18. The Ethical Regulation of Research I. Medicine's Legacy II. The Purpose of Research III. Consent for Research IV. The Tissue Issue V. Some Questions and Answers Regarding Research Conclusion: Setting our Sights References Index

About the Author

Philip C. Hebert is emeritus professor of family medicine in the Department of Family and Community Medicine at the University of Toronto and former chair of the Research Ethics Board at Sunnybrook Health Sciences Centre. Wayne Rosen is a clinical assistant professor in the Department of Surgery at the University of Calgary.


"Helping and not harming, keeping secrets, truth telling, and much more-Doing Right is a wise, highly readable, and practical guide towards being the kind of doctor or nurse every patient hopes to have. --Priscilla Alderson, PhD, Professor Emerita, University College, London, UK "Hebert and Rosen have accomplished something rare in the world of medical ethics books: they combine a library's worth of real-life clinical cases, with smart ethical analysis, supported by relevant historico-legal perspectives, to produce a thoughtful and practical approach to understanding (and resolving) ethical issues in medicine." --Eric M. Meslin, PhD, FCAHS, and Former Executive Director, US National Bioethics Advisory Commission "For over twenty years Doing Right has been regarded as the premier resource in Canada for teaching clinical ethics to health care professionals. This revised and expanded 4th edition ensures it will maintain that status for years to come" --Daryl Pullman, PhD, Professor of Medical Ethics, Memorial University "The foundational text in Canadian medical ethics has added engaging new material, while retaining its clarity and focus on practical decision-making. Everyone from undergraduate students to practicing clinicians will find this book instructive and inspiring." --Dr Merril Pauls, CCFP(EM), MHSc, Professor & Co-director of Professionalism teaching, University of Manitoba "This Fourth Edition of Doing Right provides an excellent overview of the ethical questions most frequently encountered in contemporary medical practice. Grounded in a diverse array of real-life cases, it will serve as an outstanding resource for ethics educators in Canada." --Dr Mona Gupta, Associate Clinical Professor, Universite de Montreal and Chair of the Ethics Committee of the RCPSC

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