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Resolving Ethical Dilemmas: A Guide For Clinicians, Third Edition, by B. Lo (2005) Medical ethics is a complex and constantly evolving topic. Each day clinicians face ethical dilemmas, many of which result from medical advances, practice changes, and challenges in managed care. The author, Dr. Bernard Lo, Professor of Medicine and Director of the Program in Medical Ethics at the University of California, San Francisco, is a leading authority on this topic. His stated goal for writing this book “is to help clinicians resolve the mundane ethical issues in patient care as well as the dilemmas that keep them awake at night.” In this edition he includes important new material, including updates on federal privacy regulations, limits on residents’ working hours, disclosure of medical errors, genetic testing, and gifts from drug companies.
The book is divided into six sections with each section having between six to eight chapters. Certain sections will be of more interest to BCC clients than others. The first section addresses the fundamentals of clinical ethics, with chapters on ethical guidelines, promoting the patient’s best interests, confidentiality, avoiding deception, and keeping promises. Sections II to IV are on shared decision making; decisions about life-sustaining interventions; and the doctor-patient relationship, respectively. These chapters are full of easily readable information that should interest patients and caregivers. Thankfully, this academic textbook has been designed with an easy-to-use format and the goal of helping medical students and practitioners develop an action plan that provides the best possible medical care for patients. The book is packed with case histories that illustrate ethical dilemmas that the author uses to challenge the reader’s thinking. There are discussion points with questions regarding reasons for a treatment plan, often with compelling arguments for or against a course of action. Legal cases that have made news headlines regarding life-sustaining interventions are also discussed. Readers may remember the Terri Schiavo case. In 1998, her husband, the legally appointed guardian, asked the court to discontinue tube feeding (she had been in a permanent vegetative state since 1990). Her parents opposed the withdrawal of tube feedings. The author systematically reviews the case including the legal rulings and ramifications, as well as the disagreement among family members. Landmark court cases like this have helped shape public policy regarding life-sustaining interventions. Also, a case like this reminds us all of the importance of having an advance directive. This is not an uplifting book and some of the topics may be considered “depressing” to the lay reader. On the other hand, I am heartened that this resource is available to guide clinicians because ultimately all patients want to be provided the best and most ethical care by their physicians. |