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Philosophical debates over the fundamental principles that should guide life-and-death medical decisions usually occur at a considerable remove from the tough, real-world choices made in hospital rooms, courthouses, and legislatures. David Orentlicher seeks to change that, drawing on his extensive experience in both medicine and law to address the translation of moral principle into practice--a move that itself generates important moral concerns.
Orentlicher uses controversial life-and-death issues as case studies for evaluating three models for translating principle into practice. Physician-assisted suicide illustrates the application of ''generally valid rules,'' a model that provides predictability and simplicity and, more importantly, avoids the personal biases that influence case-by-case judgments. The author then takes up the debate over forcing pregnant women to accept treatments to save their fetuses. He uses this issue to weigh the ''avoidance of perverse incentives,'' an approach to translation that follows principles hesitantly for fear of generating unintended results. And third, Orentlicher considers the denial of life-sustaining treatment on grounds of medical futility in his evaluation of the ''tragic choices'' model, which hides difficult life-and-death choices in order to prevent paralyzing social conflict.
Matters of Life and Death is a rich and stimulating contribution to bioethics and law. It is the first book to examine closely the broad problems of translating principle into practice. And by analyzing specific controversies along the way, it develops original insights likely to provoke both moral philosophers and those working on thorny issues of life and death.
List of contents
Acknowledgments vii
One: Introduction 1
PART ONE: THE APPROACH OF USING GENERALLY VALID RULES
Two: The Importance of Generally Valid Rules in Implementing Moral Principle 11
Three: The Absence of a Moral Distinction between Treatment Withdrawal and Assisted Suicide 24
Four: The Distinction between Treatment Withdrawal and Assisted Suicide as a Generally Valid Way to Distinguish between Morally Justified and Morally Unjustified Deaths 53
PART TWO: AVOIDING PERVERSE INCENTIVES
Five: The Implications for Practice of a Policy's Perverse Incentives 83
Six: Underlying Moral Principle Permits a Limited Legal Obligation for Pregnant Wowen to Accept Life-Saving Treatment for Their Fetuses 91
Seven: The Problems with a Legal Duty for Pregnant Wowen Because of Perverse Incentives 113
PART THREE: THE "TRAGIC CHOICES" MODEL
Eight: Avoiding Explicit Trade-offs through Implicit Choices 123
Nine: Limitations of the "Futility" Concept in Medical Treatment Decisions 132
Ten: Futility as a Way to Make "Tragic Choices" 153
Conclusion 167
Notes 171
Index 225
About the author
David Orentlicher
Summary
Philosophical debates over the fundamental principles that should guide life-and-death medical decisions usually occur at a considerable remove from the tough, real-world choices made in hospital rooms, courthouses, and legislatures. This title seeks to change that.
Additional text
"By drawing our attention to future real life implications of the implementation of moral principle, this book forces us to reevaluate the balance between theory and practice and is thus well worth reading."---James A. Anderson and Charles Weijer, Journal of the American Medical Association
