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Ethical and Legal Issues in Neurology
1st Edition - December 7, 2013
Editors: James L. Bernat, Richard Beresford
Hardback ISBN:
9 7 8 - 0 - 4 4 4 - 5 3 5 0 1 - 6
eBook ISBN:
9 7 8 - 0 - 4 4 4 - 5 3 5 0 4 - 7
Advances in our understanding of the brain and rapid advances in the medical practice of neurology are creating questions and concerns from an ethical and legal perspective.… Read more
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Advances in our understanding of the brain and rapid advances in the medical practice of neurology are creating questions and concerns from an ethical and legal perspective. Ethical and Legal Issues in Neurology provides a detailed review of various general aspects of neuroethics, and contains chapters dealing with a vast array of specific issues such as the role of religion, the ethics of invasive neuroscience research, and the impact of potential misconduct in neurologic practice. The book focuses particular attention on problems related to palliative care, euthanasia, dementia, and neurogenetic disorders, and concludes with examinations of consciousness, personal identity, and the definition of death.
This volume focuses on practices not only in North America but also in Europe and the developing world. It is a useful resource for all neuroscience and neurology professionals, researchers, students, scholars, practicing clinical neurologists, mental health professionals, and psychiatrists.
- A comprehensive introduction and reference on neuroethics
- Includes coverage of how best to understand the ethics and legal aspects of dementia, palliative care, euthanasia and neurogenetic disorders
- Brings clarity to issues regarding ethics and legal responsibilities in the age of rapidly evolving brain science and related clinical practice
Neuroscience/neurology professionals, researchers, students, scholars and practicing clinical neurologists, mental health professionals and psychiatrists.
Handbook of Clinical Neurology 3rd Series
Foreword
Preface
Contributors
Chapter 1. Ethical principles and concepts in medicine
Abstract
Introduction
Overview of ethics
Ethical theories
Ethical principles
Alternative approaches to medical ethics
Conclusion
References
Further reading
Chapter 2. The analysis and resolution of ethical dilemmas
Abstract
Introduction
A Structured approach to analyzing ethical dilemmas
Relevant legal and professional considerations
Next steps in the absence of resolution
Conclusion
Acknowledgment
References
Chapter 3. Ethics committees and consultants
Abstract
Introduction
Clinical EC
Ethics committees
Maintenance of ethics committees and services
The reported experience with ethics consultation in patients with neurologic diseases
Value of ethics consultation
Conclusion
References
Chapter 4. Legal process, litigation, and judicial decisions
Abstract
Introduction
Autonomy and law
Beneficence and law
Justice and law
Concluding commentary
References
Chapter 5. Law, ethics, and the clinical neurologist
Abstract
Introduction
Law
Ethics
Interplay between ethics and law
Ethics manifested in law – examples relevant to neurology practice
Respect for autonomy
Emerging issues
References
Chapter 6. Religion and medical ethics
Abstract
Introduction
Theonomous decision-making
Transvaluing suffering
Spiritual or mystical beliefs and values
Current areas of debate
Conclusion
References
Chapter 7. Professional conduct and misconduct
Abstract
Introduction
Defining the physician–patient relationship
Initiation of the physician–patient relationship
Communication
Therapeutic privilege
Disclosure of medical errors
Confidentiality
Electronic communication
Empathy
Dual relationships and professional boundaries
Barriers to care
Termination of the physician–patient relationship
Conflicts of interest
Relationships with industry
Practice models and stewardship
Disclosure of conflicts
Honest dealing with third parties
Reporting impaired physicians
Expert testimony
Care of self
References
Chapter 8. Medical error and disclosure
Abstract
Introduction
Definitions
Epidemiology
Causes of medical error
Error reporting
Disclosure of medical errors to patients
Why should neurologists disclose medical errors?
How should physicians disclose medical error?
Gaps in current disclosure practices
Approaches to error disclosure
Planning with teams
Initiating disclosure: what should be told?
Emotional impact of errors on clinicians
Conclusions
References
Chapter 9. The good doctor: professionalism in the 21st century
Abstract
Introduction
Defining medical professionalism
Three hallmarks of professionalism
Challenges to professionalism
Addressing the challenges
Future directions
References
Chapter 10. Palliative treatment of chronic neurologic disorders
Abstract
Introduction
Parkinson's disease and related conditions
Dementia
Multiple sclerosis
Amyotrophic lateral sclerosis
References
Chapter 11. Care of the dying neurologic patient
Abstract
Introduction
Causes of death
End-of-life decisions
Optimizing care of the dying
Medication at the end of life
References
Chapter 12. Withdrawing and withholding life-sustaining treatment
Abstract
Introduction
Distinctions between withholding and withdrawing treatment
Decision-making regarding life-sustaining treatment: principles
Decision-making regarding life-sustaining treatment: practice
Recent research regarding forgoing LST in neurologic practice
References
Chapter 13. European perspectives on ethics and law in end-of-life care
Abstract
Introduction
Withholding and withdrawing life-sustaining treatment
Refusing treatment and advance directives
Alleviating symptoms at the end of life
Assisting in dying
European perspectives on the value of life
References
Chapter 14. Medical futility
Abstract
Terri Schiavo: a case report
Questions raised by the Terri Schiavo case
The mythic power of futile treatment
Medical futility: a brief historic tour
Quantitative futility
Qualitative futility
Establishing standards of practice
Beyond futility to an ethic of care
The heuristic value of medical futility
Futility: the German perspective
References
Chapter 15. Assisted suicide and euthanasia
Abstract
Introduction
Regulations of physician-assisted suicide and euthanasia
The ethical debate
Public and medical-professional opinions
Practices
Concluding remarks
References
Further reading
Chapter 16. Brain death
Abstract
Introduction
Brain death: from a simple to a complex concept and back
Current clinical criteria
Personal beliefs and ethical concerns
Organ donation
Conclusions
References
Chapter 17. Coma and disorders of consciousness
Abstract
Introduction
Managing pain in patients with disorders of consciousness
Ethical challenges in end-of-life care
Assessing quality of life in severely dependent patients
Conclusions
References
Chapter 18. Ethical issues in the care of the neurologically devastated infant
Abstract
Introduction
History
Legal guidelines
The Groningen protocol
Professional codes and bioethics reviews
Religious beliefs
Commentary
Conclusions
References
Further Reading
Chapter 19. Ethical issues in states of impaired communication with intact consciousness and language
Abstract
Introduction
Currently available alternative/augmentative communication strategies
Disorders that may reduce communication while sparing cognition
Medical decision-making once communication is established
The right to withhold and withdraw treatment
Supporting patients who decide to withhold or withdraw life-sustaining treatment
References
Chapter 20. Ethical issues in the neurology of aging and cognitive decline
Abstract
The ethical challenges of preclinical alzheimer's disease
Symptomatic disease and the ethics of impaired decision-making
Ethical issues in advanced dementia
References
Chapter 21. Ethics in neurodevelopmental disability
Abstract
Introduction
Part I: Neurodevelopmental disabilities
Part II: Ethical and social questions in neurodevelopmental disability
Shared decision-making
Assent and dissent
Autonomy, shared decision-making, and the transition to adult healthcare
Personhood, justice, quality of life, and attitudes toward disability
Quality of life with disability
Part III: Responding to requests for unproven or alternative therapies
Conclusion
Acknowledgments
References
Chapter 22. Ethical issues in neurogenetic disorders
Abstract
Background
Targeted genetic testing (Sanger sequencing)
Next-generation sequencing (Whole exome and whole genome sequencing)
Research diagnostic testing
Genetic therapies
Conclusions
References
Chapter 23. Public policy and healthcare systems
Abstract
Introduction
Comparing national systems
Society's healthcare costs
Coding and documentation
Concluding remarks
References
Further reading
Chapter 24. Research involving human subjects: ethical and regulatory issues
Abstract
Some history
Key conceptual foundations
Ethical review boards
IRB Structure and operation
Vulnerable subjects
Conclusion
Author's note
References
Chapter 25. The ethics of clinical research in low- and middle-income countries
Abstract
Introduction
Motivations to conduct clinical research in LMIC
Specific ethical challenges of clinical research in LMIC
Navigating the ethical challenges of clinical research in LMIC
Conclusions
References
Chapter 26. The ethics of surgically invasive neuroscience research
Abstract
Statement of the problem
Degrees of invasiveness
Special considerations of side-effects and harms
What populations are we justified in studying and for which purposes?
Value-rich interpretations: metrics for success and assumptions
Cross-cultural values
Concluding remarks
References
Chapter 27. The ethics of neuroenhancement
Abstract
Statement of the problem
Enhancements
Noninvasive brain stimulation
Ethical dilemmas
Special populations
Future considerations
References
Chapter 28. Neuroethical issues in clinical neuroscience research
Abstract
Introduction
Ethical challenges in neuroimaging research: an overview
Neuroimaging research involving festnis
Ethical challenges in neuroimaging research involving festnis
Summary of recommendations
Conclusion
References
Chapter 29. Neurologic disorder and criminal responsibility
Abstract
Introduction
Voluntary action
Mens rea
The insanity defense
Conclusion
References
Further Reading
Chapter 30. Pragmatic neuroethics: the social aspects of ethics in disorders of consciousness
Abstract
Introduction
Part 1: social dimensions of ethics: a pragmatic perspective on neuroethics and bioethics
Part 2: examining the social aspects of ethics in disorders of consciousness
Understanding the impact of social context and relationships on clinical decision-making
Furthering the commitment to the social nature of ethics
Acknowledgments
References
Chapter 31. The nature of consciousness
Abstract
Concepts
Senses of consciousness and self-consciousness
The neurobiology of conscious states and contents
Contemporary models and theories of consciousness
The philosophy of consciousness
References
Further Reading
Chapter 32. Dementia and personal identity: implications for decision-making
Abstract
Introduction
The “someone else” problem
Is personal identity really what matters?
Dementia and concern for one's own future
Difficulties with critical interests and precedent autonomy
Conclusions
References
Chapter 33. The definition and criterion of death
Abstract
Introduction
History
Biophilosophic analyses and formulations of death
The definition of death
Other areas of controversy
Religious perspectives
Legal perspectives
The future
Acknowledgment
References
Index
- No. of pages: 472
- Language: English
- Published: December 7, 2013
- Imprint: Elsevier
- Hardback ISBN: 9780444535016
- eBook ISBN: 9780444535047
JB
James L. Bernat
Affiliations and expertise
Neurology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USARB
Richard Beresford
Affiliations and expertise
University of Rochester School of Medicine, Rochester NY, and Adjunct Professor of Law, Cornell University, Ithaca, NY, USA