I am a physician taking care of a woman with bad asthma who requires admission to the hospital. She happens to be six months pregnant, which is clinically relevant because low oxygen levels in the blood will affect the fetus. I inform her that if she refuses treatment, her unborn child will suffer oxygen deprivation, and will likely be mentally retarded. She says that "God will take care of us, I'm going home."

The situation that you describes raises all sorts of interestingphilosophical questions,y, I’m not surewhich to address. I'll assume for the sake of this discussion that you’re not wondering whether yourpatient could possibly be right about God’s intentions. So, let’sassume that she’s wrong: God won’t take care of her and her fetus, andshe’s placing her future child at significant risk of harm that would permanently and seriously restrict his (let’s give him a gender for thesake of this discussion) future life opportunities. There are then twoquestions that you might have in mind. One: “Is she doing somethingthat is morally wrong?” Two: “What are my own moral obligations in thissituation?” The answer to neither question is straightforward. First question: The answer to the first question is complicated by two facts– (a) theindividual who would be harmed by your patient’s lack of treatment iscurrently a fetus, and (b) your patient is apparently ignorant of thefact that she really is putting her...

When is it time to get on the medical intervention train and when should you leave well enough alone? As I have gotten older, and my friends have gotten older, every doctor visit feels like stepping on a train that will soon speed up so much you can't get off - so fast you can't even see the landscape outside the window anymore. Chronic medication, more tests...preventive examinations, just one more, just one more. I understand that these things prolong life, but how do you distinguish treatable medical conditions from normal aging? How do you go gently into that good night?

It seems to me that the answer to this question depends on the answerto at least four other questions: (1) Under what conditions does onecount as living a life that is worth living? (2) Would a given medicalintervention allow me to continue to live a life that is worth living?(3) What obligations do I have to others (and in particular, does mycontinuing to live allow me to meet certain obligations to others, ordoes my continuing to live put morally unacceptable burdens on others)?and (4) Would a given medical intervention allow me to meet my moralobligations? Of course, the answers to these questions, and the weight that one should give to the answers to these questions, are verydifficult to determine.

Suppose that I'm working on a medical treatment for a project with no known cure or even treatment. My subjects report that they feel much better after receiving the treatment, but subsequent study shows that the treatment is, in fact, ineffective and all that I'm seeing is the placebo effect. Can I ethically tell them the truth and thereby make them feel worse subjectively? Would that violate the "do no harm" principle of medical ethics?

The injunction “Do no harm” is hard to follow unless one knows whatcounts as harm, and there is no clear consensus about this issue. Itdoes seem that by making a person feel worse, I am harming her. Feelingbad is in itself a bad thing, and it might also lead to other badthings. If I feel bad, then I may not be able to do other things that Iwould otherwise enjoy, things that I might believe have value inthemselves. At the same time, it seems that I could be harmed if I amprevented from learning the truth about my situation. If I have falsebeliefs, I might make choices that I would otherwise not make, choicesthat lead me to feeling worse than I would otherwise have felt. Could Ibe harmed by being led to believe something false about myself even ifthis false belief never leads to any decrease of good feelings or anyincrease in feelings of pain, dissatisfaction, or discontent? Let’simagine that I believe about myself that I am widely admired and deeplyloved by my friends and family and that this belief...