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When physicians in training enter their clinical years and first begin to become involved in clinical decision making, they soon find that more than the technical data they had so carefully learned is involved. Prior to that time, of course, they were aware that more than technology was involved in practicing medicine, but here, for the first time, the reality is forcefully brought home. It may be on the medical ward, when a patient or a patient's relatives ask that no further treatment be given and that the patient be allowed to die; it may be in ob/gyn, when a 4- or 5-month pregnant lady with two other children and just deserted by her husband pleads for an abortion; it may be in the outpatient setting, where patients unable to afford enough to eat cannot afford to buy antibiotics for their sick child or provide him or her with the recom mended diet. Whatever the setting, students soon find themselv. es con fronted with problems in which an answer is not given by the technical possibilities alone; indeed, students may have to face situations in which, all things considered, the use of these technical possibilities seems ill-advised. But choices need to be made. Some of us may choose to hide behind a mastery of technology.
List of contents
1 Historical Introduction.- 2 Theoretical Considerations.- 3 Decision Making, Fallibility, and the Problem of Blameworthiness in Medicine.- 4 Doctors and Their Patients, Patients and Their Doctors.- 5 The Ongoing Dialectic Between Autonomy and Responsibility.- 6 The Physician as Citizen.- 7 Physicians and Patients in a Pluralist World.- 8 Risk Taking: Health Professionals and Risk.- 9 Organ Donation.- 10 Problems in the Care of the Terminally Ill.- 11 Problems at the Beginning of Life.- 12 Problems of Macro-Allocation.- 13 "Solving" Ethical Problems.- Appendix Summary of Sources.
Summary
When physicians in training enter their clinical years and first begin to become involved in clinical decision making, they soon find that more than the technical data they had so carefully learned is involved. Prior to that time, of course, they were aware that more than technology was involved in practicing medicine, but here, for the first time, the reality is forcefully brought home. It may be on the medical ward, when a patient or a patient's relatives ask that no further treatment be given and that the patient be allowed to die; it may be in ob/gyn, when a 4- or 5-month pregnant lady with two other children and just deserted by her husband pleads for an abortion; it may be in the outpatient setting, where patients unable to afford enough to eat cannot afford to buy antibiotics for their sick child or provide him or her with the recom mended diet. Whatever the setting, students soon find themselv. es con fronted with problems in which an answer is not given by the technical possibilities alone; indeed, students may have to face situations in which, all things considered, the use of these technical possibilities seems ill-advised. But choices need to be made. Some of us may choose to hide behind a mastery of technology.
