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Case Analysis in Clinical Ethics is an eclectic review from a team of leading ethicists covering the main methods for analysing ethical problems in modern medicine. Anneke Lucassen, a clinician, begins by presenting an ethically challenging genetics case drawn from her clinical experience. It is then analysed from different theoretical points of view. Each ethicist takes a particular approach, illustrating it in action and giving the reader a basic grounding in its central elements. Each chapter can be read on its own, but comparison between them gives the reader a sense of how far methodology in medical ethics matters, and how different theoretical starting points can lead to different practical conclusions. At the end, Anneke Lucassen gives a clinician's response to the various ethical methods described. Practising clinical ethicists and students on upper level undergraduate and Master's degree courses in medical ethics and applied philosophy will find this invaluable.
As the author of the case scenario, I have been asked to describe my thoughts about and reactions to the different ethical treatments of the case. What is it like to work together with a bunch of ethicists? (What is a good collective noun for ethicists: a consideration of ethicists? A quandary, or perhaps a cerebration of ethicists?) I have been fascinated, intrigued, intimidated and impressed in equal measure but above all, I have found the experience immensely enjoyable. I would like to respond to some of the issues raised in the different analyses here and hope that the reader, who has acquired this book to tap into a rich seam of ethical expertise, will bear with an often personal, sometimes perhaps a bit touchy, reaction to some of the comments.
Have these different ethical approaches helped me in deciding how to manage this case? Yes, I think they have. My decision on whether to disclose Phyllis's result may not have altered but it is now more considered and I am clearer as to why I would choose to do so. I have also changed my mind about certain aspects of the case. This is, of course, not to say that I now think there is a ‘correct’ answer to the dilemma. I agree with Gillon that there is no ‘correct’ answer to a true moral dilemma but I am clearer in my own mind why I would opt for one solution rather than the other and I feel this clarity is a result of hearing and reading the different perspectives raised in these chapters.
We share much of our genetic make-up with members of our biological family. This means that genetic information about one person is also sometimes, to a greater or lesser extent, information about that person's relatives. A genetic test can sometimes therefore diagnose or predict disease not only in the individual tested but also in his or her biological relatives.
The familial nature of the information produced by genetic tests raises questions about the legal and ethical obligations of healthcare professionals to disclose or withhold genetic information about patients to their at-risk relatives. Such questions are brought into sharp focus by clinical genetic situations in which different members of the same family are all ‘patients’ of one clinician but each attends the clinic independently with separate issues and agendas that need to be addressed. In such situations each patient is owed a duty of care by that clinician, who may feel pulled in different directions by the differing needs of the family members, and may feel unclear about how to prioritise each. Such questions are particularly difficult when family members are in conflict but they also arise when members have simply lost touch with each other. In such cases, there can be an ethical conflict between preserving the confidentiality of one patient on the one hand and the right of other family members to know information about their genetic status and risk of disease on the other.
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