Practical Decision Making in Health Care Ethics: Cases and Concepts

Practical Decision Making in Health Care Ethics: Cases and Concepts

Practical Decision Making in Health Care Ethics: Cases and Concepts

Practical Decision Making in Health Care Ethics: Cases and Concepts


For nearly fifteen years Practical Decision Making in Health Care Ethics has offered scholars and students a highly accessible and teachable alternative to the dominant principle-based theories in the field. Devettere's approach is not based on an ethics of abstract obligations and duties, but, following Aristotle, on how to live a fulfilled and happy life -- in short, an ethics of personal well-being grounded in prudence, the virtue of ethical decision making.

This third edition is revised and updated and includes discussions of several landmark cases, including the tragic stories of Terri Schiavo and Jesse Gelsinger (the first death caused by genetic research). Devettere addresses new topics such as partial-birth abortion law, embryonic stem cell research, infant euthanasia in The Netherlands, recent Vatican statements on feeding tubes, organ donation after cardiac death, new developments in artificial hearts, clinical trials developed by pharmaceutical companies to market new drugs, ghostwritten scientific articles published in major medical journals, and controversial HIV/AIDS research in Africa. This edition also includes a new chapter on the latest social and political issues in American health care.

Devettere's engaging text relies on commonsense moral concepts and avoids academic jargon. It includes a glossary of legal, medical, and ethical terms; an index of cases; and thoroughly updated bibliographic essays at the end of each chapter that offer resources for further reading. It is a true classic, brilliantly conceived and executed, and is now even more valuable to undergraduates and graduate students, medical students, health care professionals, hospital ethics committees and institutional review boards, and general readers interested in philosophy, medicine, and the rapidly changing field of health care ethics.


This book offers an alternative approach to health care ethics. The field is currently dominated by ethical theories centered on obligation and duty. These theories make moral principles the centerpiece: they propose a set of general action-guiding principles, rules, and rights that we apply to particular situations to determine what we are obliged to do. Sometimes the principles and rules are derived from ethical theories, sometimes from experience, sometimes from an equilibrium of both theory and experience, sometimes from what some call a universal “common morality,” but it is always the principles and rules that occupy the central position in these moral philosophies.

The ethics proposed in this book is not an ethics of obligation and duty determined by principles, rules, and rights. It is an ethics of personal well-being and fulfillment. These theories make the good life—my good life—the centerpiece: they propose a process of prudential reasoning to determine what habits, feelings, and behaviors in the various situations of life will fulfill the goal we all ultimately share—living a fulfilled and happy life. The ethics proposed in this book is a virtue ethics.

Interest in virtue-based ethics, both on the general level and in particular domains such as health care, has continued to grow steadily in the past few decades. However, many modern accounts of virtue ethics consider the virtues chiefly as character traits, dispositions, or habits—the moral virtues. This book follows Aristotle and focuses more on the pivotal intellectual virtue of prudence, the virtue of ethical decision making. Prudence is not, for Aristotle, a character trait, disposition, or habit but the wisdom to figure out what to do to move toward a good life when we are faced with personal choices involving what is truly good or bad in our lives, and with political choices involving what is truly good or bad for the common good. Prudence is the decision-making virtue for both personal and political practical matters. It is about making good choices for our lives and for the common good.

Aristotle (384–322 B.C.E.) grew up in Macedonia but lived most of his life in Athens, although he never enjoyed the privileges of Athenian citizenship. He accomplished an extraordinary amount of scientific and philosophical research during his lifetime and lectured on many topics, including ethics. Some of his lectures on ethics comprise the first major books in our culture devoted exclusively to ethics—the Nicomachean Ethics and the Eudemian Ethics.

Aristotle's work is impressive because it was extraordinarily profound. It has also proven relevant far beyond its original cultural milieu. Sixteen hundred years after Aristotle, for example, Thomas Aquinas (1224–74) embraced Aristotle's approach in ethics and saw no trouble integrating it with his religious faith and Christian theology. Today, seven hundred years later, we may be able to retrieve something of value from the ethics of Aristotle and Aquinas.

This book will attempt such a retrieval in reference to health care ethics. It does not, however, pretend to explain the ethics of Aristotle or of Aquinas, nor is it a defense of their ethical positions. Rather, the intention is to capture the fundamental intuition of these ethicists and to approach the moral issues of contemporary health care ethics in their philosophical spirit. This move is motivated by the conviction that ethics is more about the virtues than about our obligations, more about flourishing than about duties . . .

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