Communication and Bioethics at the End of Life : Real Cases, Real Dilemmas

Annotation This casebook provides a set of cases that reveal the current complexity of medical decision-making, ethical reasoning, and communication at the end of life for hospitalized patients and those who care for and about them. End-of-life issues are a controversial part of medical practice and of everyday life. Working through these cases illuminates both the practical and philosophical challenges presented by the moral problems that surface in contemporary end-of-life care. Each case involved real people, with varying goals and constraints, who tried to make the best decisions possible under demanding conditions. Though there were no easy solutions, nor ones that satisfied all stakeholders, there are important lessons to be learned about the ways end-of-life care can continue to improve. This advanced casebook is a must-read for medical and nursing students, students in the allied health professions, health communication scholars, bioethicists, those studying hospital and public administration, as well as for practicing physicians and educators

Through twenty case studies that illustrate a wide range of ethical challenges, this book explores the goals, methods, and practices of managed care, and offers practical guidance for addressing the ethical and policy issues inherent in such a system.

Susan S. Braithwaite

The book is a collection of twenty cases that demonstrate recurring ethical challenges derived from managed care. Commentaries by authorities in the fields of ethics, medicine, and healthcare management follow each case. The purpose is to clarify the internal workings of managed care and provide conceptual and practical guidance in addressing ethical issues. The audience includes clinicians, administrators, others involved in managed care, and students in professional, preprofessional, and continuing education. The book is divided into sections on rationing shared resources, incentives to contain costs and improve quality, quality care in a competitive market, responsibilities to patients, managed care for vulnerable populations, and responsibilities to the community. The editors posit that managed care, in efforts to balance cost and quality concerns in ethically justified ways, is a defensible healthcare system. However, in the section on quality care they fail to adequately represent the leadership role that managed care has played in the development of standards and measures of quality, including assessment of patient satisfaction. As in other discussions of managed care, the editors here underscore ways in which interests of the individual patient conflict with the interests of the larger covered population and describe impediments to the doctor-patient relationship. Highlights of the book include exploration of patient requests for investigational interventions for life threatening conditions and the lack of incentive to managed care organizations to support public health activities or medical education. The reader is likely to conclude that some constraint of present-daypractices is necessary. Although the editors provide very few answers on where that constraint should come from, their examples suggest that for some dilemmas corrective self-regulation is possible, as agreed upon by patients, communities, managed care organizations, and the employers and providers with whom they contract.

The rapid rise of managed care in the United States has introduced complexities into ethical dilemmas in health care by changing the traditional relationships among health plans, payers, providers, and patients. This book explores the goals, methods, and practices of managed care.