Introduction. Themes = 3
Schweitzer's "j.s. Bach's Contrapuntal Themes & Keats The Medical Student."
I. The Doctor-patient Relationship = 3
§i. of Personal and Professional Development = 3
§ii. Doctor-patient Relations and The Health Care System = 9
§iii. Conscience and Loyalty to The Relief of Patient Suffering = 15
§iv. Legalism in Doctor-patient Relations = 21
§v. Legalism in a Surrogacy Ethics Committee = 30
Chapter One: Difficulties With Duty = 39
Bergman's "the Seventh Seal" & "wild Strawberries."
I. Near The End of Its Crusade = 39
§i. Doctor-patient Relations in Strife = 39
§ii. The Symbolic Death of Duty = 46
Ii. Genome Difficulties for Doctor to Patient Duty = 51
§i. a Reprieve, Or a Threat to The Ethos = 51
§ii. Confusing The Telos = 55
§iii. Altering The Scope of Duty = 61
§iv. Enticing Temptation from Duty = 69
§v. Unstable Conceptual Foundations = 74
Iii. Violations of Patient Human Rights = 76
§i. Doctors Violating Human Rights = 77
§ii. Doctors As Promoters of Human Rights = 78
§iii. Theoretical Difficulties: Human Rights in Doctor-patient Regulation = 85
Iv. Regulatory Options = 87
§i. Comprehensive Legal Rules Or Self Regulation? = 87
Chapter Two: Exploration of The Foundations = 93
Anton Chekhov, Thorrvalds' "dirty Hands," & Osier's "aequanimitas."
I. The Ideal in Doctor-patient Regulation = 93
§i. The Pedigree of Normative Idealism = 95
§ii. Patient Suffering = 101
§iii. Communal Caring about Health = 105
§iv. Patient Dignity, Trust, Loyalty and Professional Conscience = 106
§v. Ethical Principles = 112
§vi. Foundational Duties Or Rights? = 115
§vii. Problems With The Ideal Approach = 118
Ii. First Regulatory Age: Virtue Ethics = 121
§i. The Hippocratic Oath = 121
§ii. Virtues and Principles from Non-hippocratic Traditions = 125
§iii. Primacy of Virtue over Principles and Rules = 128
Iii. Second Regulatory Age: State and Profession Contract = 132
§i. Influence of The State = 133
§ii. Influence of Clinical Empiricism = 135
§iii. Rules of Etiquette = 140
§iv. State Interference With Foundational Principles = 142
Iv. Third Regulatory Age: Deontology and Codification = 143
§i. Gregory, Rush and Percival Codify Ethical Rules = 144
§ii. Greater Emphasis on Duty to Patients = 147
V. Fourth Regulatory Age: Rise of Law and The Fall of Virtue = 150
§i. Osier's Virtue: Aequanimitas = 151
§ii. Virtue-based Exceptions in Medical Education = 153
§iii. Origins of Managed Care: Relief of Patient Suffering = 155
§iv. Eugenics: a New State Telos = 156
§v. Virtue-based Exceptions in Armed Conflict = 160
§vi. Nuremberg: Reaffirmation of The Ideal = 162
§vii. Post-nuremberg: Recession from The Ideal = 166
§viii. of Ethical Mantras and Legislation in The Interstices = 174
§ix. Ethical Principles Into Human Rights = 177
§x. Summary of Regulatory History = 183
Chapter Three: Virtue Ethics and The Medical Humanities = 185
Boswell and Samuel Johnson
I. Direct Role Modelling Or Principlism = 185
§i. Problems With Direct Role Modelling = 185
§ii. Problems With Principlism = 187
Ii. Virtue Ethics: a "soft" Regulatory Option? = 193
§i. Virtue Ethics and Rules = 193
§ii. The Virtue Ethics Revival = 195
§iii. After Virtue = 200
§iv. Royce and Virtue's Unity = 205
§v. Virtue and Natural Law in Medical Education = 210
§vi. Virtue and Conservative Legal Positivism = 212
§vii. Non-aristotelian Virtue Ethics = 218
§viii. Feminist Virtue Ethics = 224
Iii. Indirect Role Modelling and Narrative Coherence = 226
§i. Literature and Life Narratives = 226
§ii. Medical and Legal Humanities = 228
§iii. Medical Humanities' Normative Role = 232
§iv. Canonical Medical Humanities = 238
Iv. Prayer and Contemplation = 243
§i. Meditation and Narrative Coherence = 243
§ii. Contemplative Suggestions = 245
V. Objections and Implications = 247
§i. Elitist and Circular = 247
§ii. Emotivist = 249
§iii. Conflict With Human Rights = 251
§iv. Literature Lacks Theory = 253
§v. Expense and Impracticability = 254
§vi. Inability of Literature Or Contemplation to Replace Ethical Theory = 255
§vii. Implications of Virtue Theory in Medical Education = 257
Professional Practise
Chapter Four: Institutional Ethical Principles and Rules = 261
Sir Frederick Treves' "the Idol With Hands of Clay," "the Elephant Man," Sinclair Lewis' "arrowsmith" & Eliotts' "middlemarch."
I. a Professional Community of Principle = 261
§i. Misconduct: Medical Boards, Complaints Organisations = 262
Ii. Codes of Medical Ethics = 270
§i. Legalism in Codes of Ethics = 270
§ii. Virtue-based Codes = 273
§iii. Codes and Conscientious Disobedience = 276
§iv. Codes, The Human Genome and Human Rights = 278
Iii. Guidelines = 280
§i. Guidelines and Doctor-patient Regulation = 280
§ii. Guidelines and Foundational Virtues = 283
§iii. Guidelines and Genetics = 285
§iv. Guidelines and Human Rights = 288
Iv. Objections and Implications = 289
§i. Paternalism, Superfluity and Confusion = 289
§ii. Devaluation of Expertise = 292
§iii. Overemphasis on Guidelines = 293
§iv. Implications of An "integrated" Approach = 294
Chapter Five: Health Law Principles and Rules = 295
Aristotle' "poetics," Selzer's "imelda," Kafka's "before The Law" & Shakespeare's "the Tempest."
I. Medical Malpractice As Tragedy = 295
§i. Health Law in a Community of Principle = 295
§ii. Common Law and Personal and Professional Narrative Coherence = 296
§iii. Medical Duty to Rescue = 300
§iv. Misdiagnosis and Mistreatment = 303
§v. Patient Abandonment = 309
Ii Consent: Trust and The Human Right to Inviolability = 310
§i. Consent: An Initial Legalistic Analysis = 311
§ii. Consent: Reconceptualisation = 316
Iii. Informed Consent: Patient Authenticity and Article 7 of The Iccpr = 321
§i. Comparative Law on Informed Consent = 322
§ii. Noncompliance With Legalistic Informed Consent = 325
§iii. Genetic Counselling and Legalistic Informed Consent = 328
§iv. Research and Legalistic Informed Consent = 329
§v. Informed Consent Reconceptualised = 331
§vi. Systems Error and "consent" Forms = 338
Iv. The Medical Fiduciary: Can Virtue Be Coerced? = 345
§i. Legalistic Fiduciaries = 345
§ii. The Doctor-patient Relationship: Fully Fiduciary? = 346
§iii. Medical Fiduciaries Reconceptualised = 349
V. Contract: Can Vulnerable Patients Contractually Bargain? = 354
§i. Contractual Doctor-patient Relations = 355
§ii. Contractual Doctor-patient Relations Reconceptualised = 359
Vi. Confidentiality and Privilege: Protecting Trust and Loyalty = 362
§i. Medical Confidentiality and Privilege = 363
§ii. Legalistic Medical Confidentiality: a Decrepit Concept? = 366
§iii. Medical Confidentiality Reconceptualised = 370
Vii. Medical Legislation and Professional Lifenarratives = 374
§i. Legalistic Approach to Doctor-patient Legislation = 374
§ii. Problems With Doctor-patient Legislation = 380
§iii. Medical Legislation Reconceptualised = 383
Viii. Objections and Implications = 390
§i. Problems in "wicked" Or Corrupt Legal Systems = 390
§ii. Anarchy Or Cultural Imperialism = 392
§iii. Implications of "integrated" Law = 395
Chapter Six: Constitutional and International Human Rights = 399
Franki's "man's Search for Meaning" & Solzhenitsyn's "one Day in The Life of Ivan Denisovich."
I. Doctor to Patient Duty As a Human Right = 399
§i. Expansion of International Humanitarian Law = 400
§ii. Patients and International Civil and Political Rights = 403
§iii. The Human Right to Health = 406
§iv. New Patient Human Rights = 410
Ii. Rationing, Medical Patents and Managed Care = 412
§i. Rationing by Stealth in Health Care = 412
§ii. "integrated" Rationing in Health Care = 418
§iii. "integrated" Patent Protection in Health Care = 422
Iii. Refraining from Eugenics: Therapeutic Loyalty Or Perfectionism? = 425
§i. Eugenics Post The Human Genome Project = 426
§ii. Therapeutic Loyalty and Parental "carrier" Screening = 428
§iii. Therapeutic Loyalty and Screening of The Fetus = 432
§iv. Therapeutic Loyalty and Neonatal Screening = 435
Iv. Torture and Cruel, Inhuman Or Degrading Treatment = 438
§i. Torture and The Primary Telos of "integrated" Regulation = 438
§ii. Treatment Cruel, Inhuman Or Degrading and The Primary Telos = 440
V. Respect, Formal Injustice and Forensic Genetic Sampling = 444
§i. Genetic Evidence: Doctors As State Agents = 444
§ii. Genetic "gate Keeping" and "integrated" Regulation = 447
Vi. Protecting Patients at The Beginning of Life = 450
§i. Therapeutic Loyalty to a Fetus? = 451
§ii. Abortion: Conscientious Objection and Maternal Life Narratives = 454
§iii. The Human Right to Be Born Healthy = 459
Vii. Protecting Patients at The Middle of Life = 462
§i. Patients and The Problem of Genetic Reductionism = 463
§ii. Therapeutic Loyalty and Workplace Genetic Testing = 471
§iii. Therapeutic Loyalty and Genetic Testing for Insurance = 473
§iv. Therapeutic Loyalty and Hiv/aids = 477
Viii. Protecting Patients at The End of Life = 479
§i. Intensive Care and Loss of Narrative Coherence = 479
§ii. Euthanasia and "integrated" Doctor-patient Regulation = 485
§iii. Reconceptualising Organ Donation Regulation = 489
§iv. Patient-related Human Rights Reconceptualised = 492
Ix. Objections and Implications = 495
§i. Objections = 495
§ii. Implications of "integrated" Regulation = 496
Retirement
Chapter Seven: Professional Conscience and Integrated Regulation = 503
Chekhov's "ward Six," De Beauvoir's "a Very Easy Death," Tolstoy's "the Death of Ivan Ilyich" C Thorwald's "the Dismissal."
I. "integrated" Regulation = 503
§i. Regulatory Theory = 503
§ii. Principlism Reconceptualised Within "integrated" Regulation = 506
§iii. Virtue Theory and Human Rights in "integrated" Medical Education = 511
§iv. "hard" Cases = 515
§v. Integrating Legal Principles, Rules and Rights = 517
§vi. a Regulatory Fugue = 522
§vii. Blue Print = 523
§viii. Personal and Professional Narrative Coherence = 526
§ix. Rawls and Dworkin Distinguished = 532
§x. Relief of Patient Suffering: a Primary Telos = 535
§xi. Complementary Not Polarised = 539
Ii. Objections to "integrated" Doctor-patient Regulation = 542
§i. The Single Fountain Or Spring = 542
§ii. Inappropriate Unity = 545
§iii. Helping Only "good" Patients? = 548
§iv. Facilitating The Patient's Objective Good? = 549
§v. Facilitating The Patient's Subjective Good? = 553
§vi. Elitist and Paternalistic = 555
§vii. Undermines Formal Justice = 560
§viii. Human Rights Do Not "fit" = 565
§ix. Summary, Strengths, Weaknesses and Implications = 567
Select Bibliography = 571
Index = 639
Schweitzer's "j.s. Bach's Contrapuntal Themes & Keats The Medical Student."
I. The Doctor-patient Relationship = 3
§i. of Personal and Professional Development = 3
§ii. Doctor-patient Relations and The Health Care System = 9
§iii. Conscience and Loyalty to The Relief of Patient Suffering = 15
§iv. Legalism in Doctor-patient Relations = 21
§v. Legalism in a Surrogacy Ethics Committee = 30
Chapter One: Difficulties With Duty = 39
Bergman's "the Seventh Seal" & "wild Strawberries."
I. Near The End of Its Crusade = 39
§i. Doctor-patient Relations in Strife = 39
§ii. The Symbolic Death of Duty = 46
Ii. Genome Difficulties for Doctor to Patient Duty = 51
§i. a Reprieve, Or a Threat to The Ethos = 51
§ii. Confusing The Telos = 55
§iii. Altering The Scope of Duty = 61
§iv. Enticing Temptation from Duty = 69
§v. Unstable Conceptual Foundations = 74
Iii. Violations of Patient Human Rights = 76
§i. Doctors Violating Human Rights = 77
§ii. Doctors As Promoters of Human Rights = 78
§iii. Theoretical Difficulties: Human Rights in Doctor-patient Regulation = 85
Iv. Regulatory Options = 87
§i. Comprehensive Legal Rules Or Self Regulation? = 87
Chapter Two: Exploration of The Foundations = 93
Anton Chekhov, Thorrvalds' "dirty Hands," & Osier's "aequanimitas."
I. The Ideal in Doctor-patient Regulation = 93
§i. The Pedigree of Normative Idealism = 95
§ii. Patient Suffering = 101
§iii. Communal Caring about Health = 105
§iv. Patient Dignity, Trust, Loyalty and Professional Conscience = 106
§v. Ethical Principles = 112
§vi. Foundational Duties Or Rights? = 115
§vii. Problems With The Ideal Approach = 118
Ii. First Regulatory Age: Virtue Ethics = 121
§i. The Hippocratic Oath = 121
§ii. Virtues and Principles from Non-hippocratic Traditions = 125
§iii. Primacy of Virtue over Principles and Rules = 128
Iii. Second Regulatory Age: State and Profession Contract = 132
§i. Influence of The State = 133
§ii. Influence of Clinical Empiricism = 135
§iii. Rules of Etiquette = 140
§iv. State Interference With Foundational Principles = 142
Iv. Third Regulatory Age: Deontology and Codification = 143
§i. Gregory, Rush and Percival Codify Ethical Rules = 144
§ii. Greater Emphasis on Duty to Patients = 147
V. Fourth Regulatory Age: Rise of Law and The Fall of Virtue = 150
§i. Osier's Virtue: Aequanimitas = 151
§ii. Virtue-based Exceptions in Medical Education = 153
§iii. Origins of Managed Care: Relief of Patient Suffering = 155
§iv. Eugenics: a New State Telos = 156
§v. Virtue-based Exceptions in Armed Conflict = 160
§vi. Nuremberg: Reaffirmation of The Ideal = 162
§vii. Post-nuremberg: Recession from The Ideal = 166
§viii. of Ethical Mantras and Legislation in The Interstices = 174
§ix. Ethical Principles Into Human Rights = 177
§x. Summary of Regulatory History = 183
Chapter Three: Virtue Ethics and The Medical Humanities = 185
Boswell and Samuel Johnson
I. Direct Role Modelling Or Principlism = 185
§i. Problems With Direct Role Modelling = 185
§ii. Problems With Principlism = 187
Ii. Virtue Ethics: a "soft" Regulatory Option? = 193
§i. Virtue Ethics and Rules = 193
§ii. The Virtue Ethics Revival = 195
§iii. After Virtue = 200
§iv. Royce and Virtue's Unity = 205
§v. Virtue and Natural Law in Medical Education = 210
§vi. Virtue and Conservative Legal Positivism = 212
§vii. Non-aristotelian Virtue Ethics = 218
§viii. Feminist Virtue Ethics = 224
Iii. Indirect Role Modelling and Narrative Coherence = 226
§i. Literature and Life Narratives = 226
§ii. Medical and Legal Humanities = 228
§iii. Medical Humanities' Normative Role = 232
§iv. Canonical Medical Humanities = 238
Iv. Prayer and Contemplation = 243
§i. Meditation and Narrative Coherence = 243
§ii. Contemplative Suggestions = 245
V. Objections and Implications = 247
§i. Elitist and Circular = 247
§ii. Emotivist = 249
§iii. Conflict With Human Rights = 251
§iv. Literature Lacks Theory = 253
§v. Expense and Impracticability = 254
§vi. Inability of Literature Or Contemplation to Replace Ethical Theory = 255
§vii. Implications of Virtue Theory in Medical Education = 257
Professional Practise
Chapter Four: Institutional Ethical Principles and Rules = 261
Sir Frederick Treves' "the Idol With Hands of Clay," "the Elephant Man," Sinclair Lewis' "arrowsmith" & Eliotts' "middlemarch."
I. a Professional Community of Principle = 261
§i. Misconduct: Medical Boards, Complaints Organisations = 262
Ii. Codes of Medical Ethics = 270
§i. Legalism in Codes of Ethics = 270
§ii. Virtue-based Codes = 273
§iii. Codes and Conscientious Disobedience = 276
§iv. Codes, The Human Genome and Human Rights = 278
Iii. Guidelines = 280
§i. Guidelines and Doctor-patient Regulation = 280
§ii. Guidelines and Foundational Virtues = 283
§iii. Guidelines and Genetics = 285
§iv. Guidelines and Human Rights = 288
Iv. Objections and Implications = 289
§i. Paternalism, Superfluity and Confusion = 289
§ii. Devaluation of Expertise = 292
§iii. Overemphasis on Guidelines = 293
§iv. Implications of An "integrated" Approach = 294
Chapter Five: Health Law Principles and Rules = 295
Aristotle' "poetics," Selzer's "imelda," Kafka's "before The Law" & Shakespeare's "the Tempest."
I. Medical Malpractice As Tragedy = 295
§i. Health Law in a Community of Principle = 295
§ii. Common Law and Personal and Professional Narrative Coherence = 296
§iii. Medical Duty to Rescue = 300
§iv. Misdiagnosis and Mistreatment = 303
§v. Patient Abandonment = 309
Ii Consent: Trust and The Human Right to Inviolability = 310
§i. Consent: An Initial Legalistic Analysis = 311
§ii. Consent: Reconceptualisation = 316
Iii. Informed Consent: Patient Authenticity and Article 7 of The Iccpr = 321
§i. Comparative Law on Informed Consent = 322
§ii. Noncompliance With Legalistic Informed Consent = 325
§iii. Genetic Counselling and Legalistic Informed Consent = 328
§iv. Research and Legalistic Informed Consent = 329
§v. Informed Consent Reconceptualised = 331
§vi. Systems Error and "consent" Forms = 338
Iv. The Medical Fiduciary: Can Virtue Be Coerced? = 345
§i. Legalistic Fiduciaries = 345
§ii. The Doctor-patient Relationship: Fully Fiduciary? = 346
§iii. Medical Fiduciaries Reconceptualised = 349
V. Contract: Can Vulnerable Patients Contractually Bargain? = 354
§i. Contractual Doctor-patient Relations = 355
§ii. Contractual Doctor-patient Relations Reconceptualised = 359
Vi. Confidentiality and Privilege: Protecting Trust and Loyalty = 362
§i. Medical Confidentiality and Privilege = 363
§ii. Legalistic Medical Confidentiality: a Decrepit Concept? = 366
§iii. Medical Confidentiality Reconceptualised = 370
Vii. Medical Legislation and Professional Lifenarratives = 374
§i. Legalistic Approach to Doctor-patient Legislation = 374
§ii. Problems With Doctor-patient Legislation = 380
§iii. Medical Legislation Reconceptualised = 383
Viii. Objections and Implications = 390
§i. Problems in "wicked" Or Corrupt Legal Systems = 390
§ii. Anarchy Or Cultural Imperialism = 392
§iii. Implications of "integrated" Law = 395
Chapter Six: Constitutional and International Human Rights = 399
Franki's "man's Search for Meaning" & Solzhenitsyn's "one Day in The Life of Ivan Denisovich."
I. Doctor to Patient Duty As a Human Right = 399
§i. Expansion of International Humanitarian Law = 400
§ii. Patients and International Civil and Political Rights = 403
§iii. The Human Right to Health = 406
§iv. New Patient Human Rights = 410
Ii. Rationing, Medical Patents and Managed Care = 412
§i. Rationing by Stealth in Health Care = 412
§ii. "integrated" Rationing in Health Care = 418
§iii. "integrated" Patent Protection in Health Care = 422
Iii. Refraining from Eugenics: Therapeutic Loyalty Or Perfectionism? = 425
§i. Eugenics Post The Human Genome Project = 426
§ii. Therapeutic Loyalty and Parental "carrier" Screening = 428
§iii. Therapeutic Loyalty and Screening of The Fetus = 432
§iv. Therapeutic Loyalty and Neonatal Screening = 435
Iv. Torture and Cruel, Inhuman Or Degrading Treatment = 438
§i. Torture and The Primary Telos of "integrated" Regulation = 438
§ii. Treatment Cruel, Inhuman Or Degrading and The Primary Telos = 440
V. Respect, Formal Injustice and Forensic Genetic Sampling = 444
§i. Genetic Evidence: Doctors As State Agents = 444
§ii. Genetic "gate Keeping" and "integrated" Regulation = 447
Vi. Protecting Patients at The Beginning of Life = 450
§i. Therapeutic Loyalty to a Fetus? = 451
§ii. Abortion: Conscientious Objection and Maternal Life Narratives = 454
§iii. The Human Right to Be Born Healthy = 459
Vii. Protecting Patients at The Middle of Life = 462
§i. Patients and The Problem of Genetic Reductionism = 463
§ii. Therapeutic Loyalty and Workplace Genetic Testing = 471
§iii. Therapeutic Loyalty and Genetic Testing for Insurance = 473
§iv. Therapeutic Loyalty and Hiv/aids = 477
Viii. Protecting Patients at The End of Life = 479
§i. Intensive Care and Loss of Narrative Coherence = 479
§ii. Euthanasia and "integrated" Doctor-patient Regulation = 485
§iii. Reconceptualising Organ Donation Regulation = 489
§iv. Patient-related Human Rights Reconceptualised = 492
Ix. Objections and Implications = 495
§i. Objections = 495
§ii. Implications of "integrated" Regulation = 496
Retirement
Chapter Seven: Professional Conscience and Integrated Regulation = 503
Chekhov's "ward Six," De Beauvoir's "a Very Easy Death," Tolstoy's "the Death of Ivan Ilyich" C Thorwald's "the Dismissal."
I. "integrated" Regulation = 503
§i. Regulatory Theory = 503
§ii. Principlism Reconceptualised Within "integrated" Regulation = 506
§iii. Virtue Theory and Human Rights in "integrated" Medical Education = 511
§iv. "hard" Cases = 515
§v. Integrating Legal Principles, Rules and Rights = 517
§vi. a Regulatory Fugue = 522
§vii. Blue Print = 523
§viii. Personal and Professional Narrative Coherence = 526
§ix. Rawls and Dworkin Distinguished = 532
§x. Relief of Patient Suffering: a Primary Telos = 535
§xi. Complementary Not Polarised = 539
Ii. Objections to "integrated" Doctor-patient Regulation = 542
§i. The Single Fountain Or Spring = 542
§ii. Inappropriate Unity = 545
§iii. Helping Only "good" Patients? = 548
§iv. Facilitating The Patient's Objective Good? = 549
§v. Facilitating The Patient's Subjective Good? = 553
§vi. Elitist and Paternalistic = 555
§vii. Undermines Formal Justice = 560
§viii. Human Rights Do Not "fit" = 565
§ix. Summary, Strengths, Weaknesses and Implications = 567
Select Bibliography = 571
Index = 639