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March 1988

Tough Decisions: A Casebook in Medical Ethics

Author Affiliations

Departments of Pediatrics and Neurology University of Arizona Health Sciences Center Tucson, AZ 85724

Am J Dis Child. 1988;142(3):300. doi:10.1001/archpedi.1988.02150030070023

This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.


John Freeman's thoughtful, reasoned approach to managing difficult ethical problems is well known to pediatric audiences. He and his coauthor, philosopher/ethicist Kevin McDonnell, have combined their talents to produce a most stimulating book. Using an innovative and thought-provoking approach, based on clinical situations, they ask the reader to explore options at various "decision points." The implications of various decisions are then discussed, depending on which "ethical road" one chooses. The types of cases include a 2-year-old girl with a malignant brain tumor, a 12-year-old quadriplegic girl on a respirator, a moderately retarded adolescent girl whose parents request sterilization, an infant boy being considered for baboon heart transplant, and newborns with severe hypoxia, hydranencephaly, and spina bifida. The authors "pull no punches" in their dialogue. They note that good decisions result when all involved parties listen to each other, tolerate a diversity of viewpoints, and work toward a consensus about what

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