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Tough Decisions: A Casebook in Medical Ethics

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