Ethical issues are an integral part of clinical practice and the organization of health care. This bibliography is intended to supplement the most recent American College of Physicians (ACP) bibliography on this topic (entry 99) and to help physicians keep up with the burgeoning literature on medical ethics. It includes articles published between 1 July 1988 and 1 April 1994 and generally follows the organization of topics used in the ACP Ethics Manual (entry 1). The references it contains can assist physicians who wish to read more about the ethical issues that arise in their work or that are discussed in the Manual. Topics that have captured professional and public attention since the previous ACP bibliography, such as medical futility, assisted suicide, and conflicts of interest, have received particular attention.
In developing this bibliography, we first identified articles on medical ethics using MEDLINE searches and our personal files. Second, we selected articles on the basis of quality and availability in hospital libraries, omitting books and journal articles that are difficult to obtain. Third, we selected articles that represent a balance of viewpoints in the literature. Because of space limitations, we excluded empirical articles on ethical issues and articles on doctor-patient communication regarding ethical problems. Finally, the selection of articles was agreed on by all authors, with guidance from the ACP Ethics Committee. We tried to ensure that diverse viewpoints were represented on controversial topics.
1. American College of Physicians Ethics Manual. Third edition. Ann Intern Med. 1992; 117:947-60.
Succinct summary of ethical guidelines for internists.
2. Pellegrino ED. The metamorphosis of medical ethics. A 30-year retrospective. JAMA. 1993; 269:1158-62.
Review and critique of various approaches to medical ethics.
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The Physician-Patient Relationship
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Initiating and Discontinuing the Physician-Patient Relationship
3. Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. JAMA. 1992; 267:2221-6.
Discusses four models of the physician-patient relationship: paternalism, information, interpretation, and deliberation.
4. Gordon HL, Reiser SJ. Do physicians have a duty to treat Medicare patients? Arch Intern Med. 1993; 153:563-5.
Argues that physicians may not ethically decline to treat Medicare patients as a group.
5. Gostin LO, Turek-Brezina J, Powers M, Kozloff R, Faden R, Steinauer DD. Privacy and security of personal information in a new health care system. JAMA. 1993; 270:2487-93.
Analyzes the ways in which traditional ideas of privacy, security, and confidentiality can be respected in the computer era.
6. Annas GJ. Informed consent, cancer, and truth in prognosis. N Engl J Med. 1994; 330:223-5.
Discusses Arato v. Avedon, an important informed-consent case about disclosure of prognosis.
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Disclosure of Information and Truth-telling
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7. Novack DH, Detering BJ, Arnold R, Forrow L, Ladinsky M, Pezzullo JC. Physicians' attitudes toward using deception to resolve difficult ethical problems. JAMA. 1989; 261:2980-5.
When asked to respond to case vignettes, many physicians were willing to deceive patients, families, and insurers.
8. Surbone A. Truth telling to the patient. JAMA. 1992; 268:1661-2.
In most other cultures, families and physicians shield patients from disturbing information about their diagnosis or prognosis.
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Assessing Decision-making Capacity
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9. Appelbaum PS, Grisso T. Assessing patients' capacities to consent to treatment. N Engl J Med. 1988; 319:1635-8.
Physicians should assess the patient's capacity to communicate a choice, understand relevant information, appreciate the current situation and its consequences, and manipulate information rationally.
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Responding to Patient Demands
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10. Brock DW, Wartman SA. When competent patients make irrational choices. N Engl J Med. 1990; 322:1595-9.
Describes different types of irrational treatment choices. Suggests that physicians try to change patients' irrational, but not unusual, choices.
11. Miles SH. Informed demand for "non-beneficial" medical treatment. N Engl J Med. 1991; 325:512-5.
Discusses the case of Helga Wanglie. Argues that patient preferences do not create an entitlement to care that the public and professionals deem "inappropriate."
12. Orentlicher D. Denying treatment to the noncompliant patient. JAMA. 1991; 265:1579-82.
The obligation to treat noncompliant patients is not absolute. However, the circumstances in which denial of treatment is permissible should be carefully limited.
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Sexual Relationships between Physicians and Patients
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13. Council on Ethical and Judicial Affairs, American Medical Association. Sexual misconduct and the practice of medicine. JAMA. 1991; 266:2741-5.
Argues that any sexual contact during an ongoing physician-patient relationship is unethical.
14. Johnson SH. Judicial review of disciplinary action for sexual misconduct in the practice of medicine. JAMA. 1993; 270:1596-1600.
Reviews legal liability for sexual misconduct by physicians.
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Care of the Physician's Family
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15. La Puma J, Priest ER. Is there a doctor in the house? An analysis of the practice of physicians' treating their own families. JAMA. 1992; 267:1810-2.
Analyzes the ethical and practical issues that occur when a physician provides care to family members.
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Decisions Near the End of Life
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Surrogate Decision Making
16. Emanuel EJ, Emanuel LL. Proxy decision making for incompetent patients. An ethical and empirical analysis. JAMA. 1992; 267:2067-71.
Argues that proxy decision making currently fails to realize its objective of promoting the patient's medical care preferences. Discusses several potential solutions to this problem.
17. Annas GJ. The health care proxy and the living will. N Engl J Med. 1991; 324:1210-3.
Discusses different types of written advance directives.
18. Menikoff JA, Sachs GA, Siegler M. Beyond advance directives—health care surrogate laws. N Engl J Med. 1992; 327:1165-9.
Health care surrogate laws dictate which persons serve as surrogate when an incompetent patient has not given advance directives.
19. Wolf SM, Boyle P, Callahan D, Fins JJ, Jennings B, Nelson JL, et al. Sources of concern about the Patient Self-Determination Act. N Engl J Med. 1991; 325:1666-71.
Discusses reservations physicians may have about advance directives and proxy appointments. Physicians are encouraged to take responsibility for discussing advance directives with patients.
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Withholding and Withdrawing Life-sustaining Interventions
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20. American Thoracic Society. Withholding and withdrawing life-sustaining therapy. Am Rev Respir Dis. 1991; 144:726-31.
Argues that physicians may unilaterally limit interventions that are highly unlikely to result in meaningful survival or that threaten the ethical integrity of the medical profession.
21. Annas G. Nancy Cruzan and the right to die. N Engl J Med. 1990; 323:670-3.
Discusses the important ruling by the U.S. Supreme Court in the Cruzan case.
22. Council on Ethical and Judicial Affairs, American Medical Association. Decisions near the end of life. JAMA. 1992; 267:2229-33.
Argues that physicians must respect a competent patient's decision to forego any medical treatment and should provide palliative treatments even though they may have fatal side effects. Argues that physicians must not perform euthanasia or participate in assisted suicide.
23. Edwards MJ, Tolle SW. Disconnecting the ventilator at the request of a patient who knows he will then die: the doctor's anguish. Ann Intern Med. 1992; 117:254-6.
Acknowledges the emotional impact that withdrawing mechanical ventilation has on physicians and describes ways to optimize patient comfort.
24. Lo B, Steinbrook R. Beyond the Cruzan case: the U.S. Supreme Court and medical practice. Ann Intern Med. 1991; 114:895-9.
Discusses the ruling by the U.S. Supreme Court in the Cruzan case and its implications for clinical practice.
25. Miles SH, Singer PA, Siegler M. Conflicts between patients' wishes to forego treatment and the policies of health care facilities. N Engl J Med. 1989; 321:48-50.
Emphasizes the importance of respecting the mission of health care institutions and the moral beliefs of physicians. Ideally, patients would seek care from physicians and institutions that share their values.
26. Wanzer SH, Federman DD, Adelstein SJ, Cassel CK, Cassem EH, Cranford RE, et al. The physician's responsibility toward hopelessly ill patients. A second look. N Engl J Med. 1989; 320:844-9.
Reviews care at the end of life. Over the past decade, many previously controversial aspects of terminal care have become standard practice.
27. Weir RF, Gostin L. Decisions to abate life-sustaining treatment for nonautonomous patients: ethical standards and legal liability for physicians after Cruzan. JAMA. 1990; 264:1846-53.
If an appropriate decision-making process has been followed, physicians need not fear civil or criminal liability for discontinuing life-sustaining treatment in nonautonomous patients.
28. Paris JJ, Schreiber MD, Statter M, Arensman R, Siegler M. Beyond autonomy—physicians' refusal to use life-prolonging extracorporeal membrane oxygenation. N Engl J Med. 1993; 329:354-8.
Discusses a case in which physicians unilaterally refused a family's requests for care that they considered inappropriate.
29. Schneiderman LJ, Jecker NS, Jonsen AR. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990; 112:949-54.
Suggests that therapies should be deemed futile if they have not been successful in the previous 100 cases or if they fail to end dependence on intensive care.
30. Tomlinson T, Brody H. Futility and the ethics of resuscitation. JAMA. 1990; 264:1276-80.
Argues that restricting futile care secures the patient's best interests and that the fiduciary role of physicians requires them to make judgments about futility.
31. Truog RD, Brett AS, Frader J. The problem with futility. N Engl J Med. 1992; 326:1560-4.
Criticizes the term "futility" because statistical thresholds are unworkable and because qualitative judgments involve ambiguities and hidden assumptions.
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Do-Not-Resuscitate Orders
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32. Cohen CB, Cohen PJ. Do-not-resuscitate orders in the operating room. N Engl J Med. 1991; 325:1879-82.
Suggests that when patients with do-not-resuscitate orders undergo surgery, the orders should be reconsidered during and immediately after surgery.
33. Emergency Cardiac Care Committee and Subcommittees of the American Heart Association. Guidelines for cardiopulmonary resuscitation and emergency cardiac care. VIII: ethical considerations in resuscitation. JAMA. 1992; 268:2282-8.
Revised American Heart Association guidelines on ethical issues regarding cardiopulmonary resuscitation (CPR). Compared with previous guidelines, places more emphasis on the question of when CPR may be appropriately withheld or terminated.
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Artificial Nutrition and Hydration
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34. Committee for Pro-Life Activities, National Conference of Catholic Bishops. Nutrition and hydration: moral and pastoral reflections. Issues Law Med. 1992; 8:387-406.
Articulates the Roman Catholic teaching that the withholding and the withdrawal of artificial nutrition and hydration are acceptable in certain circumstances.
35. Pearlman RA. Forgoing medical nutrition and hydration: an area for fine-tuning clinical skills. J Gen Intern Med. 1993; 8:225-7.
Reviews ethical grounds foregoing artificial nutrition and hydration and advocates patient-centered assessments and therapeutic trials.
36. Sullivan RJ. Accepting death without artificial nutrition and hydration. J Gen Intern Med. 1993; 8:220-4.
Argues that dehydration and total caloric deprivation do not add to patient suffering.
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Persistent Vegetative State
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37. American Neurological Association Committee on Ethical Affairs. Persistent vegetative state: report of the American Neurological Association Committee on Ethical Affairs. Ann Neurol. 1993; 33:386-90.
Recent review of clinical and ethical issues regarding the persistent vegetative state.
38. Council on Scientific Affairs and Council on Ethical and Judicial Affairs, American Medical Association. Persistent vegetative state and the decision to withdraw or withhold life support. JAMA. 1990; 263:426-30.
Describes conditions under which it would be ethical to discontinue life-prolonging therapy.
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Brain Death and Determination of Death
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39. Field DR, Gates EA, Creasy RK, Jonsen AR, Laros RK. Maternal brain death during pregnancy: medical and ethical issues. JAMA. 1988; 260:816-22.
Argues that the life of a brain-dead pregnant woman may be ethically prolonged so that her fetus can be delivered safely.
40. Halevy A, Brody B. Brain death: reconciling definitions, criteria, and tests. Ann Intern Med. 1993; 119:519-25.
Reviews and critiques various criteria for brain death. Suggests that three clinical questions require different definitions of death: "When can care be unilaterally withheld? When can organs be harvested? When can the undertaker begin his services?"
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Assisted Suicide and Active Euthanasia
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41. Dying well? A colloquy on euthanasia and assisted suicide. Hastings Cent Rep. 1992; 22:6-55.
This symposium contains eight articles on assisted suicide and euthanasia. Includes articles concerning the Netherlands and Germany.
42. Orentlicher D. Physician participation in assisted suicide. JAMA. 1989; 262:1844-5.
Opposes physician-assisted suicide for the hopelessly ill.
43. Pellegrino ED. Compassion needs reason too. JAMA. 1993; 270:874-5.
Argues that assisted suicide is morally wrong, even when it is motivated by compassion.
44. Quill TE. Death and dignity: a case of individualized decision making. N Engl J Med. 1991; 324:691-4.
Narrates the story of the author's terminally ill patient, Diane, for whom he wrote a barbiturate prescription to assist in her suicide.
45. Quill TE. Doctor, I want to die. Will you help me? JAMA. 1993; 270:870-3.
Stresses other considerations that clinicians must explore before turning to assisted suicide.
46. Quill TE, Cassel CK, Meier DE. Care of the hopelessly ill: proposed clinical criteria for physician-assisted suicide. N Engl J Med. 1992; 327:1380-4.
Seven clinical criteria are proposed as guidelines for acts of physician-assisted suicide.
47. Singer PA, Siegler M. Euthanasia—a critique. N Engl J Med. 1990; 322:1881-3.
Condemns the practice of voluntary euthanasia because euthanasia conflicts with the moral norms of a healing profession and because of likely abuse.
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The Relationship of the Physician to Society
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Access to Health Care and Allocation of Health Care Resources
48. Brock DW, Daniels N. Ethical foundations of the Clinton Administration's proposed health care system. JAMA. 1994; 271:1189-96.
Discusses ethical principles that should guide health care reform.
49. Callahan D. Symbols, rationality, and justice: rationing health care. Am J Law Med. 1992; 18:1-13.
Analyzes the reasons why Americans are reluctant to face the issue of rationing health care.
50. Emanuel EJ, Emanuel LL. The economics of dying: the illusion of cost savings at the end of life. N Engl J Med. 1994; 330:540-4.
Argues that greater use of advance directives and avoidance of futile care will not substantially reduce health care costs.
51. Hadorn DC. Setting health care priorities in Oregon. Cost-effectiveness meets the rule of rescue. JAMA. 1991; 265:2218-25.
Points out how the duty to save identifiable endangered lives at any cost, known as "the rule of rescue," will confound a ranked list of therapies arrived at by cost-effectiveness analysis.
52. Kalb PE, Miller DH. Utilization strategies for intensive care units. JAMA. 1989; 261:2389-95.
The framework of this article can be applied to many therapies. After defining "value," "efficacy," and "cost," it discusses justice and allocation principles.
53. Light DW. The practice and ethics of risk-rated health insurance. JAMA. 1992; 267:2503-8.
Argues that setting health insurance premiums according to health risks is morally unfair because it leads to less coverage for those people with the greatest medical needs.
54. Morreim EH. Fiscal scarcity and the inevitability of bedside budget balancing. Arch Intern Med. 1989; 149:1012-5.
While yielding bedside rationing decisions to third parties is an attractive option, it removes the physician from what are essentially medical decisions.
55. Orentlicher D. Rationing and the Americans with Disabilities Act. JAMA. 1994; 271:308-14.
Discusses the Americans with Disabilities Act and how it might apply to decisions to allocate or ration health care.
56. Council on Ethical and Judicial Affairs, American Medical Association. Conflicts of interest. Physician ownership of medical facilities. JAMA. 1992; 267:2366-9.
Describes the American Medical Association's position: with rare exceptions, physicians should not refer patients to facilities outside their office practice if they have an investment interest in those facilities.
57. Iglehart JK. Efforts to address the problem of physician self-referral. N Engl J Med. 1991; 325:1820-4.
Discusses laws and regulations that limit physician ownership and investment in facilities to which they refer patients.
58. Morreim EH. Conflicts of interest: profits and problems in physician referrals. JAMA. 1989; 262:390-4.
Argues that the institution of sweeping prohibitions would be an undesirable solution to the complex issue of self-referral.
59. Rodwin MA. The organized American medical profession's response to financial conflicts of interest: 1890-1992. Milbank Q. 1992; 70:703-41.
Reviews medicine's growing awareness of conflicts of interest and outlines initial efforts to respond to them.
60. Thompson DF. Understanding financial conflicts of interest. N Engl J Med. 1993; 329:573-6.
Describes conflicts of interest and potential remedies. Suggests that a clearer formulation of standards could increase confidence in the medical profession.
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Financial Arrangements with Health Care Organizations
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61. Hillman A. Health maintenance organizations, financial incentives, and physician judgements. Ann Intern Med. 1990; 112:891-3.
Asserts that the crucial question is not whether financial incentives affect physician decisions but whether they distort physician judgment.
62. Lachs MS, Sindelar JL, Horwitz RI. The forgiveness of coinsurance: charity or cheating? N Engl J Med. 1990; 322:1599-602.
Waiving the patient's copayment, often a benevolent and laudable action, may also be a marketing tool or an act of fraud.
63. Povar G, Moreno J. Hippocrates and the health maintenance organization. Ann Intern Med. 1988; 109:419-24.
Examines such ethical issues as provider incentives to reduce spending and restrict subspecialty access and outlines steps to prevent abuse.
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The Physician's Relationship with Industry
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64. American College of Physicians. Physicians and the pharmaceutical industry. Ann Intern Med. 1990; 112:624-6.
Outlines the American College of Physicians' position on physician acceptance of personal gifts, support of continuing education, and support for drug trials.
65. Chren MM, Landefeld CS, Murray TH. Doctors, drug companies and gifts. JAMA. 1989; 262:3448-51.
Accepting a gift establishes a relationship between the physician and the drug company that obliges a reciprocal response from the physician.
66. Council on Ethical and Judicial Affairs, American Medical Association. Gifts to physicians from industry. JAMA. 1991; 265:501.
Defines the American Medical Association's position and describes the types of gifts that remain acceptable.
67. Waud DR. Pharmaceutical promotions—a free lunch? N Engl J Med. 1992; 327:351-4.
Takes the position that all gifts from pharmaceutical manufacturers are bribes.
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Advertising and Marketing
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68. Brett AS. The case against persuasive advertising by health maintenance organizations. N Engl J Med. 1992; 326:1353-7.
The ethical standards that guide the communication between a physician and a patient, such as truth-telling and informed consent, should also guide advertising by health maintenance organizations.
69. Council on Ethical and Judicial Affairs, American Medical Association. Physician participation in capital punishment. JAMA. 1993; 270:365-8.
Argues against physician participation in capital punishment and defines the actions that constitute "physician participation"
70. Troug RD, Brennan TA. Participation of physicians in capital punishment. N Engl J Med. 1993; 329:1346-50.
Argues that physician participation in capital punishment is ethically justifiable only for the provision of medical care for condemned prisoners.
71. Mooreim EH. Am I my brother's warden? Responding to the unethical or incompetent colleague. Hastings Cent Rep. 1993; 23:19-27.
Examines the ways in which physicians should exercise their responsibility to address the incompetent and unethical behavior of their colleagues.
72. Reuben DB, Noble S. House officer responses to impaired physicians. JAMA. 1990; 263:958-60.
Describes responses of house officers to case scenarios involving incompetent and impaired colleagues.
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Ethical Issues and Physicians in Training
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73. Christakis DA, Feudtner C. Ethics in a short white coat: the ethical dilemmas that medical students confront. Acad Med. 1993; 68:249-54.
Identifies nine ethical issues in clinical care and focuses on the unique implications they have for students in training.
74. Orlowski JP, Kanoti GA, Mehlman MJ. The ethics of using newly dead patients for teaching and practicing intubation techniques. N Engl J Med. 1988; 319:439-41.
Justifies such educational methods but condemns the deception of doing so without family consent.
75. Teaching medical ethics. Acad Med. 1989; 64:699-788.
This special issue describes ethics teaching at various medical schools and outlines practical suggestions for curriculum development.
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Ethics Committees and Consultants
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76. Fletcher JC, Hoffmann DE. Ethics committees: time to experiment with standards. Ann Intern Med. 1994; 120:335-8.
Discusses the lack of data on the effectiveness of ethics committees and appeals for the development of quality standards.
77. La Puma J, Schiedermayer DL. Ethics consultation: skills, roles, and training. Ann Intern Med. 1991; 114:155-60.
Advocates the model of the clinical ethics consultant and outlines its similarities to other medical consultations.
78. Swenson MD, Miller RB. Ethics case review in health care institutions: committees, consultants, or teams? Arch Intern Med. 1992; 152:694-7.
Compares the strengths and limitations of methods for ethics consultation ranging from committees to individual consultants.
79. Wilson Ross J, Glaser JW, Rasinski-Gregory D, McIver Gibson J, Bayley C. Health Care Ethics Committees: The Next Generation. Chicago: American Hospital Publishing, Inc.; 1993.
Provides detailed guidance on implementing, restructuring, or evaluating ethics committees. Chapter 11 addresses unique features of committees serving long-term care facilities and community hospitals.
Research
80. Freestone DS, Mitchell H. Inappropriate publication of trial results and potential for allegations of illegal share dealing. BMJ. 1993; 306:1112-4.
Investigators and investors may be tempted to misuse scientific publication for manipulation of stock markets.
81. Friedman PJ. Integrity in biomedical research. Acad Med. 1993; 68(Suppl):S1-S98.
Special issue about scientific misconduct, conflicts of interest, and appropriate institutional responses to these problems. Contains references for additional reading and suggestions for teaching about integrity in research.
82. Lurie P, Bishaw M, Chesney M, Cooke M, Fernandes M, Hearst N, et al. Ethical, behavioral, and social aspects of HIV-vaccine trials in developing countries. JAMA. 1993; 271:295-301.
Discusses ethical guidelines for conducting clinical research in developing countries.
83. Shimm DS, Spece R Jr. Industry reimbursement for entering patients into clinical trials: legal and ethical issues. Ann Intern Med. 1991; 115:148-51.
Argues for full disclosure to prospective participants, elimination of per-patient reimbursement, and removal of the control of funds from individual investigators in industry-sponsored research projects.
84. Cohen C, Benjamin M. Alcoholics and liver transplantation. The Ethics and Social Impact Committee of the Transplant and Health Policy Center. JAMA. 1991; 265:1299-301.
Presents arguments against restricting liver transplants in patients with alcohol-induced liver failure.
85. Moss AH, Siegler M. Should alcoholics compete equally for liver transplantation? JAMA. 1991; 265:1295-8.
Presents arguments for restricting liver transplants in patients with alcohol-induced liver failure.
86. Spital A. The shortage of organs for transplantation. Where do we go from here? N Engl J Med. 1991; 325:1243-6.
Argues for a European model of presumed consent to relieve the scarcity of organs for transplantation.
87. Veatch RM. Routine inquiry about organ donation—an alternative to presumed consent. N Engl J Med. 1991; 325:1246-9.
Proposes routine inquiry about donation to relieve the scarcity of organs for transplantation.
88. Youngner SJ, Arnold RM. Ethical, psychosocial, and public policy implications of procuring organs from non-heart-beating cadaver donors. JAMA. 1993; 269:2769-74.
Analyzes proposals to harvest organs from patients declared dead by traditional cardiorespiratory criteria.
89. Council on Ethical and Judicial Affairs, American Medical Association. Use of genetic testing by employers. JAMA. 1991; 266:1827-30.
Argues that widespread genetic screening of employees is inappropriate and suggests that confidentiality and informed consent are essential.
90. Murray TH. Genetics and the moral mission of health insurance. Hastings Cent Rep. 1992; 22:12-7.
Argues that genetic disorders should not be reasons to exclude people from health insurance.
91. Wilfond BS, Nolan K. National policy development for the clinical application of genetic diagnostic technologies: lessons from cystic fibrosis. JAMA. 1993; 270:2948-54.
Suggests that policy decisions about genetic testing should be made more systematically.
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The Acquired Immunodeficiency Syndrome (AIDS)
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92. American College of Physicians and Infectious Diseases Society of America. Human immunodeficiency virus (HIV) infection. Ann Intern Med. 1994; 120:310-9.
Professional guidelines on the obligation to care for HIV-infected persons, HIV testing, transmission of HIV in the health care setting, and confidentiality.
93. Annas GJ. Not saints, but healers: the legal duties of health care professionals in the AIDS epidemic. Am J Public Health. 1988; 78:844-9.
Discusses the idea that physicians have no legal duty to treat patients in most situations, despite having a strong moral duty to do so.
94. Bayer R, Toomey KE. HIV prevention and the two faces of partner notification. Am J Public Health. 1992; 82:1158-64.
Analyzes partner notification as a public health tool and emphasizes that it should be voluntary and confidential.
95. Daniels N. HIV-infected professionals, patient rights, and the "switching dilemma." JAMA. 1992; 267:1368-71.
Discusses balancing the patient's right to know a provider's HIV status against the rights of infected health care workers. Argues that if individuals try to act solely in their own self-interest, everyone will be worse off in the long run.
96. Lo B, Steinbrook RL. Health care workers infected with the human immunodeficiency virus. The next steps. JAMA. 1992; 267:1100-5.
Discusses the challenges of protecting patients from nosocomial HIV infection while respecting the privacy and livelihood of health care workers.
97. Lo B, Steinbrook RL, Cooke M, Coates TJ, Walters EJ, Hulley SB. Voluntary screening for human immunodeficiency virus (HIV) infection. Weighing the benefits and harms. Ann Intern Med. 1989; 110:727-33.
Suggests ways in which physicians can increase the benefits of voluntary HIV testing and reduce the risks.
98. Murray RH, Rubel AJ. Physicians and healers—unwitting partners in health care. N Engl J Med. 1992; 326:61-4.
Discusses the reasons why patients seek alternative therapies and suggests how physicians might respond.
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Sources for Additional References
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99. Siegler M, Singer PA, Schiedermayer DL. Medical Ethics. An Annotated Bibliography. Philadelphia: American College of Physicians; 1988.
Contains annotated references to literature on medical ethics published through July 1988.
100. BIOETHICSLINE.
On-line database of interdisciplinary articles on medical ethics and health policy. Can be accessed through MEDLARS. For more information, call 1-800-638-8480.
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