Case example

Ms. Carlson is a 45-year-old woman who was recently diagnosed with amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, a severe and eventually fatal neuromuscular disorder that causes progressive weakness and loss of control of one's muscles. Ms. Carlson was admitted to University Hospital three days ago for treatment of persistent and painful leg cramps, a common symptom of ALS. Two days of drug treatment and physical therapy have eased her muscle cramps and restored Ms. Carlson to her level of health and function before this hospitalization. Dr. Yates, her attending neurologist, informs her that she is now ready for discharge from the hospital. Ms. Carlson responds that she is deeply grateful for the excellent medical and nursing care that she has received in the hospital and that she believes that she can benefit further from several additional days in the hospital. Dr. Yates replies that the urgent medical reason for her admission to the hospital, her severe leg cramps, is under control, and so there is no further need for inpatient treatment. Ms. Carlson agrees that the leg cramps are much better, but she adds that she feels weak and is not confident that she can safely care for herself in her apartment, where she lives by herself. Therefore, she says, she will not agree to leave the hospital. Should Ms. Carlson remain in the hospital?

The previous chapter described the emergence of health care ethics in the United States as a new field of inquiry prompted in part by several high-profile events in the 1970s. Scholars responded to the growing public and professional interest in ethical questions about medical treatment by developing and recommending a number of different approaches to moral reasoning in health care contexts. This chapter will describe the first and most widely discussed approach to moral reasoning in health care, the principle-based approach of Tom Beauchamp and James Childress. It will then offer briefer descriptions of several alternative approaches, including the case-based approach of Albert Jonsen and Stephen Toulmin, the systematic, rule-based approach of Bernard Gert, Charles Culver, and Dan Clouser, the virtue-based approach of Edmund Pellegrino and David Thomasma, and the “postmodern” approach of H. Tristram Engelhardt, Jr. Finally, it will suggest a simple practical method for analyzing moral questions in health care that can draw on the resources of all of these approaches.