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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.
Orentlicher makes a compelling case that our understanding of bioethical controversies could be improved by considering how moral concerns are translated from principle into practice. Choice A highly thoughtful and useful contribution to our understanding of how moral principles can be translated into practice, with substantial benefit to individual patients and, as well, to the health care system and our larger society. -- Dale H. Cowen The Journal of Legal Medicine 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
| Acknowledgments | p. ix |
| Introduction | p. 1 |
| The Approach of Using Generally Valid Rules | |
| The Importance of Generally Valid Rules in Implementing Moral Principle | p. 11 |
| The Absence of a Moral Distinction between Treatment Withdrawal and Assisted Suicide | p. 24 |
| The Distinction between Treatment Withdrawal and Assisted Suicide as a Generally Valid Way to Distinguish between Morally Justified and Morally Unjustified Deaths | p. 53 |
| Avoiding Perverse Incentives | |
| The Implications for Practice of a Policy's Perverse Incentives | p. 83 |
| Underlying Moral Principle Permits a Limited Legal Obligation for Pregnant Women to Accept Life-Saving Treatment for Their Fetuses | p. 91 |
| The Problems with a Legal Duty for Pregnant Women Because of Perverse Incentives | p. 113 |
| The "Tragic Choices" Model | |
| Avoiding Explicit Trade-offs through Implicit Choices | p. 123 |
| Limitations of the "Futility" Concept in Medical Treatment Decisions | p. 132 |
| Futility as a Way to Make "Tragic Choices" | p. 153 |
| Conclusion | p. 167 |
| Notes | p. 171 |
| Index | p. 225 |
| Table of Contents provided by Syndetics. All Rights Reserved. |
ISBN: 9780691089478
ISBN-10: 0691089477
Audience:
Tertiary; University or College
Format:
Paperback
Language:
English
Number Of Pages: 248
Published: 12th November 2001
Publisher: Princeton University Press
Dimensions (cm): 22.9 x 15.2
x 1.4
Weight (kg): 0.37
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