Clinical Ethics: Due Care and the Principle of NonmaleficenceIn Clinical Ethics, Robert Timko argues that the moral dilemmas of clinical medical practice can best be resolved within a framework of prima facie duties, and that the most stringent duty is that of nonmaleficence. Timko shows that respect for individual autonomy and the principle of beneficence are inadequate for the moral practice of medicine since simple adherence to either principle may be insufficient for the provision of 'due care.' Clinical health care practitioners should know and understand their clients' perceptions of illness and suffering and their life-plans and values if they wish to avoid bringing further harm to their clients. Additionally, Timko argues that the prevention of harm is best served and 'due care' best provided if the clinical relationship is defined within the framework of a covenantal agreement between health-care practitioners and the moral community. Intrinsic to his argument is the belief that it is not only permissible to limit a client's autonomy, but that is sometimes obligatory to do so. In terms of a community's overall good, paternalistic interventions appear to be justifiable and sometimes necessary. Finally, Joan Hoff provides an insightful commentary on the logic of a communitarian ethic as the foundation for a just health-care system and the understanding of virtue and responsibility in health-care practice. |
Contents
Overview | 1 |
Some First Considerations | 2 |
The Nature of Prima Facie Duties | 5 |
The Nature of a Moral Community | 8 |
Harm and the Moral Community | 10 |
Other Duties Which May Arise | 12 |
Some Considerations in Playing Moral Geographer | 13 |
The Duty of Mutuality | 14 |
Conclusion | 87 |
The Question of Informed Consent | 89 |
The Conditions of an Informed Consent | 92 |
Comprehension | 94 |
Voluntariness | 96 |
Competency | 97 |
Specific Competency | 98 |
Legal vs Moral Requirements of Consent | 99 |
Patient Perceptions and Models for the Therapeutic Relationship | 15 |
A First Look at the Questions of Autonomy and Paternalism | 17 |
Autonomy and Informed Consent | 19 |
Constraints on the Autonomy of the HealthCare Practitioner | 22 |
The Question of Beneficence | 24 |
Some Preliminary Conclusions | 25 |
Perceptions of Illness and Suffering | 27 |
The Self as a Lived Body | 30 |
Illness Community and Social Practice | 31 |
The Concept of Suffering | 33 |
Proper Practice in the Sick Role | 36 |
Conclusions | 38 |
Models for the Clinical Relationship | 41 |
The Question of Models in General | 42 |
Veatch and Models | 44 |
The Collegial Model | 52 |
Contracts and Covenants | 53 |
Additionally a covenantal relationship | 55 |
Virtue and the Clinical Relationship | 56 |
Virtues and the Question of a Clinical Relationship as a Practice | 58 |
Conclusions | 59 |
The Questions of Autonomy and Autonomous Choice | 61 |
What are Autonomous Actions? | 64 |
Understanding | 66 |
Noncontrol | 68 |
The Nature of and Kinds of Manipulations | 70 |
Autonomy as Mastery of Ones Life | 73 |
Can Parentalism be Justified? | 76 |
A Further Reflection on Communities Autonomy Parentalism and Duty | 79 |
Perceptions of Illness and Autonomy | 85 |
Conclusion | 102 |
Refusal and the Duty of Informed Choice | 105 |
The Case of Dax Cowart | 106 |
The Duty to be Informed | 108 |
A Final Argument | 112 |
The Principle of Beneficence | 115 |
A First Look at Beneficence | 116 |
Response to Need | 118 |
Mutual Aid | 120 |
Some Limits to Beneficence | 121 |
Beneficence or Nonmaleficence | 123 |
Beneficence and WellBeing | 125 |
The Question of Respect | 127 |
Another Look at Beneficence | 128 |
Conclusions | 130 |
The Principle of Nonmaleficence | 133 |
Due Care | 134 |
Harms and Detriments | 135 |
A Final Criticism and Defense of Nonmaleficence | 137 |
Conclusions and Proposals | 141 |
The Role of Justice in Determining the Boundaries of Health Care | 142 |
The Role of the Virtuous Physician | 150 |
The Role of the Virtuous Patient | 154 |
The Assumption of Responsibilities in Healthcare | 156 |
Health Care as a Common Good | 161 |
BIBLIOGRAPHY | 171 |
| 177 | |
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Common terms and phrases
argue argument autonomous action autonomous choice behaviour beliefs and values Bioethics chlorothiazide claim client clinical encounter clinical medicine clinical practice clinical relationship clinician competency concept consequences considered constraint context covenant covenantal decision Declaration of Helsinki desires diagnostic disclosure disease distribution distributive justice duty of beneficence effective Engelhardt exercise exist facie duties Faden and Beauchamp goal greater harm health-care practitioner individual informed consent institutions justice justifiable knowledge life-plan limited manipulation Medical Ethics medical practice moral community mutuality narrative Nuremberg Code obligation occur one's duties oneself patient perceived performance perhaps person personhood pluralistic political possible practice of medicine prevent priestly model prima facie duties primum non nocere principle of beneficence principle of nonmaleficence procedures professional question rational Rawls reasonable refusal regard responsibility risk self-actualization sense sick role simply social society specific suffering therapeutic therapy Timko treatment understanding understood Veatch virtue virtuous physician well-being wish