We can freely cross disciplinary boundaries, as well as the line between theory and practice, and allow practices to cast their light back on the theory and show us its deficiencies. In short, this approach reorients some much-discussed issues of professional, business, and military ethics and reveals them as variations on one deeply rooted theme. The author does not treat current institutions as final and unalterable. If these arrangements frustrate moral evaluation, she finds that an argument for change. To make (...) intelligent changes, however, we need a clear view of the reasoning that makes them seem natural and inevitable. That is what this book attempts to do. In the process, the author also reexamines the concept of "person." Not all cultures put so much stress on the idea as Western - and particularly American - cultures do. If we wish to keep this emphasis, then here is another argument for change. (shrink)

With the passage by virtually every state legislature of healthcare proxy laws, the medical profession increasingly can expect to rely on the participation of surrogates in making decisions on behalf of incompetent patients. Several concerns about the legitimacy of proxy decision making have been discussed in the ethical and general medical literature: the lack of concordance between the views of patients and their surrogates have been documented on multiple occasions, and cases of abuse by proxies or potential conflict of interest (...) have been reported. Another dilemma that deserves discussion arises when proxies demand withdrawal of treatment that physicians and nurses regard as essential to the wellbeing of the patient. The following case highlights this dilemma. (shrink)

A 78 year old married woman with progressive Alzheimer's disease was admitted to a local hospital with pneumonia and other medical problems. She recognized no one and had been incontinent for about a year. Despite aggressive treatment, the pneumonia failed to resolve and it seemed increasingly likely that this admission was to be for terminal care. The patient's husband (who had been taking care of her in their home) began requesting that the doctors be less aggressive in her treatment and, (...) as the days wore on, he became more and more insistent that they scale back their aggressive care. The physicians were reluctant to do so, due to the small but real chance that the patient could survive to discharge. But her husband was her only remaining family, so he was the logical proxy decisionmaker. Multiple conferences ensued, and finally a conference with a social worker revealed that the husband had recently proposed marriage to the couple's housekeeper and she had accepted. (shrink)