Second Thoughts: Health Care Ethics

This book on health care ethics argues that our reasoning should include second thoughts about our initial reaction to an ethical issue. "Second Thoughts" considers AMA and ANA ethical reasoning, US Supreme Court decisions, aid-in-dying laws, feminist ethics, East Asian and Islamic traditions, as well as Catholic teaching. Each chapter includes case studies and questions. One chapter examines decisions by the Trump administration that impact health care policies and implementation of the Affordable Care Act. Ethical reasoning reflects the values of our community, which make our reasoning persuasive. Reasoning may also "trigger new intuitions," which can alter our community's moral narrative. Our ethical challenge is to consider carefully both our emotional response and our reasoning. We pursue this quest by distinguishing three patterns of reasoning. First, we address ethical choices by identifying a person's duty or rights. At all levels of life our social and political institutions make rules to enforce this reasoning. In health care, for example, we assert that a person's human dignity entails a right to consent to medical treatment. And that this right as a patient means the physician has a duty to inform a patient properly to ensure the patient's informed consent. Second, we use reason to set goals about how we should act as persons and organizations. In health care, we affirm that caregivers should not only provide health care, but also should be caring as they provide health care. To be caring is not a specific action, but a way of being ethical when we take any action. We use this kind of reasoning to affirm that expressing empathy for each patient is good in itself, apart from any calculation of its measurable consequences. Third, we use reason to predict the likely consequences of taking an action. Caregivers weigh the likely benefits of treatment against the probable risks for the patient, in order to decide what is in the patient's best interests. When we reason by predicting consequences, however, we should have second thoughts about what we think we know and about what may be unknowable. Reasoning by setting goals and predicting consequences are both forward looking, but each way of reasoning has a different process for evaluating what is better or best. When we predict likely consequences to justify an action, we usually consider only the more obvious measurable outcomes. We should also recognize, however, that providing health care while having a caring state of mind will likely affect both patients and caregivers in ways we are unable to measure. Robert Traer teaches for the Dominican University of California. He has a JD in law and a PhD in world religious. His books include: "Doing environmental Ethics" (second edition), "Doing Ethics in a Diverse World" (with Harlan Stelmach), and "Faith in Human Rights: Support in Religious Traditions of a Global Struggle." He and his wife, Nancy, have been married fifty years and have five children, including two adopted from East Asia. They are blessed with ten grandchildren.