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RONALD MUNSON

BASIC ISSUES IN MEDICAL ETHICS

EIGHTH EDITION
4/
(
Intervention and Reflection
Basic Issues in Medical Ethics
Eighth Edition
 THOMSON
-*-
WADSWORTH

Production Service: International Typesetting

Philosophy Editor: Worth Hawes
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COPYRIGHT © 2008, 2004 Ronald Munson.

ALL RIGHTS RESERVED. No part of this
work covered by the copyright hereon may be
reproduced or used in any form or by any
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Thomson Higher Education

10 Davis Drive
Belmont, CA 94002-3098
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Library of Congress Control Number:

2006938500

ISBN-13: 978-0-495-09502-6
ISBN-10: 0-495-09502-8
 To Miriam
"Giver of bright rings"
V
Ronald Munson is Professor of the Philosophy
of Science and Medicine at the University of
Missouri-St. Louis. He received his Ph.D. from
Columbia University and was a Postdoctoral
Fellow in Biology at Harvard University. He
has been a Visiting Professor at University of
California, San Diego, Johns Hopkins School
of Medicine, and Harvard Medical School.

A nationally acclaimed bioethicist, Munson is a

medical ethicist for the National Eye Institute
and a consultant for the National Cancer Insti¬
tute. He is also a member of the Washington
University School of Medicine Human Studies
Committee.

His other books include Raising the Dead: Organ

Transplants, Ethics, and Society (named one of
the "Best Science and Medicine Books of 2002"
by the National Library Association), Reasoning
in Medicine (with Daniel Albert and Michael
Resnik), Elements of Reasoning and Basics of Rea¬
soning (both with David Conway), and Outcome
Uncertain: Cases and Contexts in Bioethics. He is
also author of the novels Nothing Human, Fan
Mail, and Night Vision.
Brief Contents

PARTI: RIGHTS 1 Chapter 8: PAYING FOR HEALTH CARE 509

Chapter 1: RESEARCH ETHICS

AND INFORMED CONSENT 2 PART IV: TERMINATIONS 545

Chapter 9: ABORTION 546

Chapter 2: PHYSICIANS, PATIENTS, ---
AND OTHERS: AUTONOMY, TRUTH
TELLING, AND CONFIDENTIALITY 97 Chapter 10: TREATING OR TERMINATING:
THE DILEMMA OF IMPAIRED INFANTS 622

Chapter 3: HIV/AIDS 174

Chapter 11: EUTHANASIA AND
PHYSICIAN-ASSISTED SUICIDE 675
Chapter 4: RACE, GENDER,
AND MEDICINE 211
PARTV: FOUNDATIONS OF BIOETHICS:
ETHICAL THEORIES, MORAL
PART II: CONTROLS 269 PRINCIPLES, AND MEDICAL
DECISIONS 739
Chapter 5: GENETIC CONTROL 270

Chapter 6: REPRODUCTIVE CONTROL 364

PART III: RESOURCES 453

Chapter 7: SCARCE MEDICAL

RESOURCES 454

IX
Contents

PART I: RIGHTS 1 Case Presentation: Jesse Gelsinger:

The First Gene-Therapy Death 30
Chapter 1 RESEARCH ETHICS AND
Social Context: The Cold-War Radiation
INFORMED CONSENT 2
Experiments 35

Case Presentation: Face Transplant: "Highly Case Presentation: The Willowbrook Hepatitis
Risky Experimentation" 3 Experiments 38

Briefing Session 6 Case Presentation: Echoes of Willowbrook

orTuskegee? Experimenting with Children 39
Clinical Trials 8
Case Presentation: The Use of Morally Tainted
The "Informed" Part of Informed Consent 9
Sources: The Pernkopf Anatomy 40
The "Consent" Part of Informed Consent 10
Social Context: Experimental Medicine
Vulnerable Populations 10 and Phase Zero Trials 41
Medical Research and Medical Therapy 11 Case Presentation: Baby Fae 43
Financial Conflict of Interest 12 Readings 44
Placebos and Research 12 Section 1: Consent and Experimentation 44
Therapeutic and Nontherapeutic Research 14 Stephen Goldby, Saul Krugman,
Research Involving Children 14 M. H. Pappworth, and Geoffrey Edsall:
Research Involving Prisoners 17 The Willowbrook Letters: Criticism
and Defense 44
Research Involving the Poor 18
Paul Ramsey: Judgment on Willowbrook 47
Research Involving the Terminally Ill 19
Principles of the Nuremberg Code 51
Research Involving Fetuses 21
National Commission for the Protection of
Research Involving Animals 22
Human Subjects: Belmont Report 52
Women and Medical Research 24
Hans Jonas: Philosophical Reflections on
Summary 25 Experimenting with Human Subjects 55
Ethical Theories: Medical Research Section 2: The Ethics of Randomized Clinical
and Informed Consent 26 Trials 61
Utilitarianism 26 Samuel Heilman and Deborah S. Heilman:
Kant 27 Of Mice but Not Men: Problems of the
Randomized Clinical Trial 61
Ross 27
Eugene Passamani: Clinical Trials: Are They
Natural Law 28
Ethical? 65
Rawls 28
Don Marquis: How to Resolve an Ethical Dilemma
Case Presentation: Stopping the Letrozole
Concerning Randomized Clinical Trials 69
Trial: A Case of "Ethical Overkill"? 29
XI
xii Contents

Section 3: Relativism and Retrospective Case Presentation: The Death of Robyn

Twitchell and Christian Science 123
Judgments 72
Allen Buchanan: Judging the Past: The Case Readings 125
of the Human Radiation Experiments 72 Section 1: Consent to Medical Treatment 125
Section 4: Animal Experimentation 79 Gerald Dworkin: Paternalism 125
Peter Singer: Animal Experimentation 79 Dax Cowart and Robert Burt: Confronting Death:
Carl Cohen: The Case for the Use of Animals in Who Chooses, Who Controls? A Dialogue 134
Biomedical Research 86 Douglas S. Diekema: Parental Refunds of Med¬
Decision Scenarios 92 ical Treatment: The Harm Principle as Threshold
for State Intervention 138

Chapter 2 PHYSICIANS, PATIENTS, AND Section 2: Autonomy and Pregnancy 143

OTHERS: AUTONOMY, TRUTH TELLING, Alexander Morgan Capron: Punishing
AND CONFIDENTIALITY 97_ Mothers 143
John A. Robertson and Joseph D. Schulman:
Case Presentation: Donald (Dax) Cowart
Pregnancy and Prenatal Harm to Offspring 147
Rejects Treatment—and Is Ignored 98
Section 3: Truth Telling 152
Briefing Session ioi
Mack Lipkin: On Telling Patients the Truth 152
Autonomy 102
Susan Cullen and Margaret Klein: Respect for
Paternalism 103
Patients, Physicians, and the Truth 154
State Paternalism in Medical and Health
Section 4: Confidentiality 161
Care 103
Mark Siegler: Confidentiality in Medicine—-A
Personal Paternalism in Medical and Health
Decrepit Concept 161
Care 105
Supreme Court of California: Decision in the
Informed Consent and Medical Treatment 105
Tarasoff Case 164
Free and Informed Consent 106
Decision Scenarios 169
Parents and Children 106
Pregnancy and Autonomy 107
Chapter 3 HIV/AIDS 174
Truth Telling in Medicine 108
Placebos 109 Social Context: The AIDS Pandemic 175

Dignity and Consent 110 Briefing Session 178

Confidentiality (Privacy) lio Combination Therapy: AIDS on the Run 179

Breaching Confidentiality ill Decline in Death Rate 179
Duty to Warn? 112 Infection Rates 179
Managed Care 112 Protease Inhibitors and Combination Drug
HIPA Regulations 112 Therapy 180

Ethical Theories: Autonomy, Truth Telling, Limits of the Therapy 180

Confidentiality 113 Best with New Infections 181
Case Presentation: The Vegan Baby 116 Drug Resistance 181
Case Presentation: Big Brother vs. Big Mac 117 Virus Remains 181
Social Context: Autonomy and Pregnancy 120 Costs 182
 Contents xiii

Side-Effects 182 Causes of Death 220

Difficult Regimen 183 Closing the Gap 220
Prevention 183 Asian Americans and Pacific Islanders and
Social Context: Testing AIDS Drugs in the Health Care 221
Third World 184 Health Profile 221
Social Context: Discovering AIDS 188 Summary 221
Case Presentation: The Way It Was: Tod Hispanic Americans/Latinos and Health Care 222
Thompson, Dallas, 1993-1994 190 Health Profile 222
Social Context: Origin of the AIDS Virus 192 Recent Changes 222
Social Context: Why Isn't There a Vaccine? 193 Undocumented Immigrants 223
Readings 194 Women and Health Care 223
Section 1: AIDS Trials in Africa 194 Include Women, Study Women 224
George J. Annas and Michael A Grodin: Additional Support 225
Human Rights and Maternal-Fetal HFV
Changes in the Right Direction 226
Transmission Prevention Trials in Africa 194
Conclusion 227
Danstan Bagenda and Philla Musoke-Mudido:
We're Trying to Help Our Sickest People, Not Social Context: Race-Based Medicine? 227
Exploit Them 198 Case Presentation: Lee Lor: Caught
Section 2: Responsibility and Confidentiality 200 in a Culture Conflict 231
Social Context: Is Health About Status, Not
Elliot D. Cohen: Lethal Sex: Conditions of
Disclosure in Counseling Sexually Active Clients Race? 233
with HIV 200 Social Context: Backlash on Women's
Bernard Rabinowitz: The Great Hijack 206 Health? 236
Readings 238
Decision Scenarios 207
Section 1: Race and Medicine 238
Chapter 4 RACE, GENDER, Patricia A. King: The Dangers of Difference:
AND MEDICINE 211 The Legacy of the Tuskegee Syphilis Study 238
Jonathan Kahn: "Ethnic"Drugs 241
Case Presentation: Bad Blood, Bad Faith: The
Armand Marie Leroi: A Family Tree in
Tuskegee Syphilis Study 212
Every Gene 242
Briefing Session 215
Section 2: Setting Public Policy 245
African Americans and Health Care 215
James Dwyer: Illegal Immigrants, Health
Disease Differences 216 Care, and Social Responsibility 245
HIV/AIDS 216 H. Jack Geiger: The Demise of Affirmative
Treatment Differences 216 Action and the Future of Health Care 251
Why the Gap? 217 Section 3: Perspectives on Gender and Race 253
The Tuskegee Effect 218 Susan Sherwin: Gender, Race, and Class in
Closing the Gap 219 the Delivery of Health Care 253

American Indians and Alaska Natives and Annette Dula: Bioethics: The Need for a
Health Care 219
Dialogue with African Americans 258

Indian Health Service 219 Decision Scenarios 264

xiv Contents

PART II: CONTROLS 269 Section 2: Genetic Selection: A new Eugenics? 320
Julian Savulescu: Procreative Beneficence:
Chapter 5 GENETIC CONTROL 270
Why We Should Select the Best Children 320
Case Presentation: Stem Cells: Promises and Leon R. Kass: Implications of Prenatal
Problems 271 Diagnosis for the Human Rights to Life 326
Briefing Session 276 Section 3: Dilemmas of Genetic Choice 333
Genetic Intervention: Screening, Counseling, Jeff McMahan: The Morality of Screening for
and Diagnosis 277 Disability 333
Genetic Disease 277 Dena S. Davis: Genetic Dilemmas and the
Child's Right to an Open Future 337
Genetic Screening 279
Laura M. Purdy: Genetics and Reproductive
Genetic Counseling 282
Risk: Can Having Children Be Immoral? 346
Prenatal Genetic Diagnosis 283
Section 4: Genetic Testing for Disease
Ethical Difficulties with Genetic Intervention 286
Predisposition 352
Eugenics 288
Ruth Hubbard and R. C. Lewontin: Pitfalls of
Negative and Positive Eugenics 289 Genetic Testing 352
Use of Desirable Germ Cells 290 Robert Wachbroit: Disowning Knowledge:
Ethical Difficulties with Eugenics 290 Issues in Genetic Testing 355
Genetic Research, Therapy, and Technology 291 Decision Scenarios 359

Recombinant DNA 292

Chapter 6 REPRODUCTIVE CONTROL 364
Gene Therapy 293
Biohazards 294 Social Context: Shopping for Mr. Goodsperm 365

Ethical Difficulties with Genetic Research, Briefing Session 367

Therapy, and Technology 295 Techniques of Assisted Reproduction 369
Social Context: Genetic Testing and IVF 369
Screening 296
GIFT, ZIFT, IVC, ULER, PZD, ICSI, DNA
Social Context: Genetic Testing: Too Much Transfer, and CD 370
Prevention? 300
Need and Success Rates 371
Case Presentation: Huntington's Disease:
Costs 371
Genetic Testing and Ethical Dilemmas 303
Drawbacks 371
Case Presentation: Gene Therapy 306
Potential Risk to Child 372
Social Context: The Human Genome Project:
The Holy Grail of Biology 309 Multiple Births 372

Readings 312 Embryos, Eggs, and Transplants 372

Section 1: Embryonic Stem Cells: The Debate 312 Gestational Surrogates and Donor Ova 374

President's Council on Bioethics: Cloning and Criticisms of Assisted Reproduction

Stem Cells 312 Practices 375

Pontifical Academy for Life: Declaration on the Benefits of IVF and Other Forms of Assisted
Production and the Scientific and Therapeutic Reproduction 375
Use of Human Embryonic Stem Cells 316 Ethical and Social Difficulties 376
Michael J. Sandel: The Moral Status of Human Cloning and Twinning 377
Embryos 318 Artificial Insemination 378
 Contents xv

The Procedure 378 Carson Strong: The Ethics of Human

Reasons for Seeking Artificial Insemination 379 Reproductive Cloning 443
Sperm Donors 380 Decision Scenarios 447

Issues in Artificial Insemination 380

Ova Donors 381 PART III: RESOURCES 453
Surrogate Pregnancy 381
Chapter 7 SCARCE MEDICAL
Ethical Theories and Reproductive Control 383 RESOURCES 454
Case Presentation: Hello, Dolly: The Advent of
Reproductive Cloning 384 Case Presentation: The Prisoner Who Needed
a Heart 455
Case Presentation: Louise Brown: The First
"Test-Tube Baby" 387 Briefing Session 456

Case Presentation: Saviour Sibling 389 Transplants, Kidneys, and Machines 457

Case Presentation: The McCaughey Septuplets: Controlling Rejection 458

The Perils of Multiple Pregnancy 390 Allocation and Scarcity 458
Social Context: Postmenopausal Motherhood 392 Seattle and Kidney Machines 459
Case Presentation: Baby M and Mary Beth Dialysis Costs and Decisions 459
Whitehead: Surrogate Pregnancy in Court 394 Microallocation Versus Macroallocation 460
Case Presentation: The Calvert Case: A Ethical Theories and the Allocation of Medical
Gestational Surrogate Changes Her Mind 395 Resources 461
Readings 396 Social Context: Acquiring and Allocating
Section 1: Assisted Reproduction 396 Transplant Organs 462
Cynthia B. Cohen: "Give Me Children or Case Presentation: Selection Committee for
I Shall Die!"New Reproductive Technologies and Dialysis 470
Harm to Children 396 Case Presentation: Transplants for
Gillian Hanscombe: The Right to Lesbian the Mentally Impaired 473
Parenthood 406 Case Presentation: Drug Lottery: The
Congregation for the Doctrine of the Faith: Betaseron Shortage 474
Instruction on Respect for Human Life in Its Readings 475
Origin and on the Dignity of Procreation 409
Section 1: Allocating Transplant Organs 475
Section 2: Saviour Siblings 414
Jacob M. Appel: Wanted Dead or Alive? Kidney
David King: Why We Should Not Permit Transplantation in Inmates Awaiting Execution 475
Embryos to Be Selected as Tissue Donors 414
Robert M. Sade: The Prisoner Dilemma: Should
S. Sheldon and S. Wilkinson: Should Selecting Convicted Felons Have the Same Access to Heart
Saviour Siblings Be Banned? 416 Transplantation as Ordinary Citizens? 477
Section 3: Surrogate Pregnancy 423 Carl Cohen et al.: Alcoholics and Liver
Bonnie Steinbock: Surrogate Motherhood as Transplantation 479
Prenatal Adoption 423 Section 2: Acquiring Transplant Organs 483
Elizabeth S. Anderson: Is Women's Labor a Ronald Munson: The Donor's Right to Take a
Commodity? 430 Risk 483
Section 4: Human Cloning 438 Janet Radcliffe-Richards et al.: The Case for
Leon R. Kass: The Wisdom of Repugnance 438 Allowing Kidney Sales 484
xvi Contents

Kishore D. Phadke and Urmila Anandh, Ezekiel Emanuel: Health Care Reform: Still
Ethics of Paid Organ Donation 487 Possible 538

Aaron Spital and Charles A. Erin: Conscription Decision Scenarios 540

of Cadaveric Organs for Transplantation: Let's at
Least Talk About It 489 PART IV: TERMINATIONS 545
Section 3: Allocation Principles 492
Chapter 9 ABORTION 546
Nicholas Rescher: The Allocation of Exotic
Medical Lifesaving Therapy 492
Case Presentation: The Conflict Begins:
George J. Annas: The Prostitute, the Playboy, Roe v. Wade 547
and the Poet: Rationing Schemes for Organ
Briefing Session 548
Transplantation 500
Human Development and Abortion 549
Decision Scenarios 505
The Status of the Fetus 550

Chapter 8 PAYING FOR HEALTH CARE 509 Pregnancy, Abortion, and the Rights of Women 551
Therapeutic Abortion 552
Case Presentation: Robert Ingram: Dilemma of
Abortion and the Law 553
the Working Poor 510
Ethical Theories and Abortion 553
Briefing Session 5ii
Social Context: A Statistical Profile of
Claim-Rights, Legal Rights, and Statutory
Abortion in the United States 555
Rights 512
Social Context: Plan B: Pregnancy Prevention
Moral Rights 512
and Politics 559
Political Rights 513
Social Context: RU-486: "The Abortion Pill" 562
Health Care as a Right 513
Social Context: The "Partial-Birth Abortion"
Objections 514 Controversy 565
Social Context: American Dream, American Social Context: Supreme Court Decisions
Nightmare 515 After Roe v. Wade 569
Case Presentation: Massachusetts Takes the Case Presentation: When Abortion Was Illegal:
Lead 519 Mrs. Sherri Finkbine and the Thalidomide
Case Presentation: The Canadian System as a Tragedy 572
Model for the United States 521 Readings 573
Readings 525 Section 1: The Status of the Fetus 573
Section 1: Justice and Health Care 525 John T. Noonan Jr.: An Almost Absolute Value
Allen E. Buchanan: Is There a Right to a Decent in History 573
Minimum of Health Care? 525 Judith Jarvis Thomson: A Defense of Abortion 576
Uwe E. Reinhardt: Wanted: A Clearly Articulated Mary Anne Warren: On the Moral and Legal
Social Ethic for American Health Care 530 Status of Abortion 586
Section 2: Medicine and the Market 533 Don Marquis: Why Abortion Is Immoral 594
Paul Krugman: Health Economics 101 533 Mark T. Brown: The Morality of Abortion and
William S. Custer et al.: Why We Should Keep the the Deprivation of Futures 599
Employment-Based Health Insurance System 534 Section 2: Feminist Perspectives 602
Section 3: Alternatives 536 Susan Sherwin: Abortion Through a Feminist
Allan B. Hubbard: The Health of a Nation 536 Ethic Lens 602
 Contents xvii

Sidney Callahan: A Case for Pro-Life Feminism 605 H. Tristram Engelhardt Jr.: Ethical Issues in
Section 3: Late-Term Abortion 611 Aiding the Death ofYoung Children 646
Peter Alward: Thomson, the Right to Life, and Robert F. Weir: Life-and-Death Decisions in the
Partial-Birth Abortion 611 Midst of Uncertainty 651
Paul D. Blumenthal, The Federal Ban on Section 2: Other Perspectives 657
So-Called "Partial-Birth Abortion"Is a Dangerous Michael L. Gross: Avoiding Anomalous
Intrusion into Medical Practice 615 Newborns 657
Decision Scenarios 617 Section 3: The Groningen Protocol 664

Chapter 10 TREATING OR TERMINATING: James Lemuel Smith: The Groningen Protocol:

THE DILEMMA OF IMPAIRED INFANTS 622 The Why and the What 664
Alan B. Jotkowitz and Shimon Glick: The
Case Presentation: The Agony of Bente Groningen Protocol: Another Perspective 667
Hindriks 623
Decision Scenarios 669
Briefing Session 624

Genetic and Congenital Impairments 624

Chapter 11 EUTHANASIA AND
Specific Impairments 625 PHYSICIAN-ASSISTED SUICIDE 675
Down Syndrome 625
Case Presentation: Terri Schiavo 676
Spina Bifida 625
Briefing Session 682
Hydrocephaly 626
Active and Passive Euthanasia 682
Anencephaly 626
Voluntary, Involuntary, and Nonvoluntary
Esophageal Atresia 626
Euthanasia 682
Duodenal Atresia 626
Defining "Death" 683
Problems of Extreme Prematurity 626
Advance Directives 685
Testing for Impairments 627
Ethical Theories and Euthanasia 687
Amniocentesis and CVS 627
Case Presentation: Karen Quinlan: The
Alphafetoprotein 628 Debate Begins 689
New Noninvasive Tests 628 The Cruzan Case: The
Case Presentation:
Ethical Theories and the Problem of Birth Supreme Court Upholds The Right to Die 691
Impairments 628 Social Context: Physician-Assisted Suicide in
Baby Owens: Down
Case Presentation: Oregon 694
Syndrome and Duodenal Atresia 630 Case Presentation:Dr. Jack Kevorkian, Activist
Social Context: The Dilemma of Extreme and Convicted Felon 697
Prematurity 631 Case Presentation: A Canadian Tragedy 699
Social Context: The Baby Doe Cases 636 Case Presentation: Rip van Winkle, for a Time:
Case Presentation: Baby K: An Anencephalic Donald Herbert 700
Infant and a Mother's Request 638 Social Context:Physician-Assisted Suicide:
Readings 639 The Dutch Experience 701
Section 1: The Status of Impaired Infants 639 Readings 703

John A. Robertson: Examination of Arguments Section 1: The Case Against Allowing

in Favor of Withholding Ordinary Medical Care Euthanasia and Physician-Assisted
from Defective Infants 639 Suicide 703
xviii Contents

J. Gay-Williams: The Wrongfulness of Rawls's Theory of Justice 759

Euthanasia 703 The Original Position and the Principles
Daniel Callahan: When Self-Determination of Justice 759
Runs Amok 706 Rawls's Theory of Justice in the Medical
Section 2: The Case for Allowing Euthanasia Context 761
and Physician-Assisted Suicide 711 Difficulties with Rawls's Theory 763
John Lachs: When Abstract Moralizing Natural Law Ethics and Moral Theology 764
Runs Amok 711 Purposes, Reasons, and the Moral Law as
Peter Singer: Voluntary Euthanasia: A Interpreted by Roman Catholicism 764
Utilitarian Perspective 715 Applications of Roman Catholic
Daniel E. Lee: Physician-Assisted Suicide: A Moral-Theological Viewpoints in the Medical
Conservative Critique of Intervention 722 Context 766
Section 3: The Killing-Letting Die Distinction 725 Difficulties with Natural Law Ethics and
James Rachels: Active and Passive Euthanasia 725 Moral Theology 768
Winston Nesbitt: Is Killing No Worse Major Moral Principles 769
Than Letting Die? 729 The Principle of Nonmaleficence 770
Section 4: Deciding for the Incompetent The Principle of Beneficence 771
Supreme Court of New Jersey: In the Matter of
The Principle of Utility 773
Karen Quinlan, an Alleged Incompetent 733
Principles of Distributive Justice 774
Decision Scenarios 735
The Principle of Equality 775
The Principle of Need 775
PART V: FOUNDATIONS OF BIOETHICS:
The Principle of Contribution 776
ETHICAL THEORIES, MORAL PRINCIPLES,
AND MEDICAL DECISIONS 739 The Principle of Effort 776
The Principle of Autonomy 777
Basic Ethical Theories 742 Autonomy and Actions 778
Utilitarianism 743 Autonomy and Options 778
The Principle of Utility 743 Autonomy and Decision Making 779
Act and Rule Utilitarianism 744 Restrictions on Autonomy 780
Preference Utilitarianism 748 Theories Without Principles 782
Difficulties with Utilitarianism 749 Virtue Ethics 782
Kant's Ethics 750 The Virtues 783
The Categorical Imperative 750 Virtue Ethics in the Medical Context 783
Another Formulation 751 Difficulties with Virtue Ethics 784
Duty 751 Care Ethics 784
Kant's Ethics in the Medical Context 752 Values, Not Principles 785
Difficulties with Kantian Ethics 754 Care Ethics in the Medical Context 786
Ross's Ethics 755 Difficulties with Care Ethics 787
Moral Properties and Rules 755 Feminist Ethics 788
Actual Duties and Prima Facie Duties 756 Feminist Ethics in the Medical Context 789
Ross's Ethics in the Medical Context 758 Difficulties with Feminist Ethics 790
Difficulties with Ross's Moral Rules 758 Retrospect 790
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