Preface and Acknowledgements -- Image Credits -- Abbreviations -- Abstract -- Introduction. Themes (Schweitzer's "J.S. Bach's Contrapuntal Themes & Keats the Medical Student") -- I. The Doctor-Patient Relationship -- i. Of personal and professional development -- ii. Doctor-patient relations and the health care system -- iii. Conscience and loyalty to the relief of patient suffering -- iv. Legalism in doctor-patient relations -- v. Legalism in a surrogacy ethics committee -- Chapter One: Dificulties with Duty (Bergman's &"The Seventh Seal" & "Wild Strawberries") -- I. Near the End of its Crusade -- i. Doctor-patient relations in strife -- ii. The symbolic death of duty -- II. Genome Dificulties for Doctor to Patient Duty -- i. A reprieve, or a threat to the ethos -- ii. Confusing the telos -- iii. Altering the scope of duty -- iv. Enticing temptation from duty -- v. Unstable conceptual foundations -- III. Violations of Patient Human Rights -- i. Doctors violating human rights -- ii. Doctors as promoters of human rights -- iii. Theoretical difficulties: human rights in doctorpatient regulation -- IV. Regulatory Options -- i. Comprehensive legal rules or self regulation? -- Chapter Two: Exploration of the Foundations (Anton Chekhov, Thorwalds' "Dirty Hands," & Osler's "Aequanimitas.") -- I. The Ideal in Doctor-Patient Regulation -- i. The pedigree of normative idealism -- ii. Patient suffering -- iii. Communal caring about health -- iv. Patient dignity, trust, loyalty and professional conscience -- v. Ethical principles -- vi. Foundational duties or rights? -- vii. Problems with the ideal approach -- II. First Regulatory Age: Virtue Ethics -- i. The Hippocratic Oath -- ii. Virtues and principles from non-Hippocratic traditions -- iii. Primacy of virtue over principles and rules -- III. Second Regulatory Age: State and Profession Contract.

i. Influence of the State -- ii. Influence of clinical empiricism -- iii. Rules of etiquette -- iv. State interference with foundational principles -- IV. Third Regulatory Age: Deontology and Codification -- i. Gregory, Rush and Percival codify ethical rules -- ii. Greater emphasis on duty to patients -- V. Fourth Regulatory Age: Rise of Law and the Fall of Virtue -- i. Osler's virtue: aequanimitas -- ii. Virtue-based exceptions in medical education -- iii. Origins of managed care: relief of patient suffering -- iv. Eugenics: a new State telos -- v. Virtue-based exceptions in armed conflict -- vi. Nuremberg: Reaffirmation of the ideal -- vii. Post-Nuremberg: Recession from the ideal -- viii. Of ethical mantras and legislation in the interstices -- ix. Ethical principles into human rights -- x. Summary of regulatory history -- Chapter Three: Virtue Ethics and the Medical Humanities .............................................................................. 185 Boswell and Samuel Johnson -- I. Direct Role Modelling or Principlism -- i. Problems with direct role modelling -- ii. Problems with principlism -- II. Virtue Ethics: A "Soft" Regulatory Option? -- i. Virtue ethics and rules -- ii. The virtue ethics revival -- iii. After virtue -- iv. Royce and virtue's unity -- v. Virtue and natural law in medical education -- vi. Virtue and conservative legal positivism -- vii. Non-Aristotelian virtue ethics -- viii. Feminist virtue ethics -- III. Indirect Role Modelling and Narrative Coherence -- i. Literature and life narratives -- ii. Medical and legal humanities -- iii. Medical humanities' normative role -- iv. Canonical medical humanities -- IV. Prayer and Contemplation -- i. Meditation and narrative coherence -- ii. Contemplative suggestions -- V. Objections and Implications -- i. Elitist and circular -- ii. Emotivist.

iii. Conflict with human rights -- iv. Literature lacks theory -- v. Expense and impracticability -- vi. Inability of literature or contemplation to replace ethical theory -- vii. Implications of virtue theory in medical education -- Chapter Four: Institutional Ethical Principles and Rules (Sir Frederick Treves' "The Idol With Hands of Clay," "The Elephant Man," Sinclair Lewis' "Arrowsmith" & Eliotts' "Middlemarch.") -- I. A Professional Community of Principle -- i. Misconduct: Medical Boards, complaints organisations -- II. Codes of Medical Ethics -- i. Legalism in codes of ethics -- ii. Virtue-based codes -- iii. Codes and conscientious disobedience -- iv. Codes, the human genome and human rights -- III. Guidelines -- i. Guidelines and doctor-patient regulation -- ii. Guidelines and foundational virtues -- iii. Guidelines and genetics -- iv. Guidelines and human rights -- IV. Objections and Implications -- i. Paternalism, superfluity and confusion -- ii. Devaluation of expertise -- iii. Overemphasis on guidelines -- iv. Implications of an "integrated" approach -- Chapter Five: Health Law Principles and Rules (Aristotle' "Poetics," Selzer's "Imelda," Kafka's "Before the Law" & Shakespeare's "The Tempest.") -- I. Medical Malpractice as Tragedy -- i. Health law in a community of principle -- ii. Common law and personal and professional narrative coherence -- iii. Medical duty to rescue -- iv. Misdiagnosis and mistreatment -- v. Patient abandonment -- II. Consent: Trust and the Human Right to Inviolability -- i. Consent: an initial legalistic analysis -- ii. Consent: reconceptualisation -- III. Informed Consent: Patient Authenticity and Article 7 of the ICCPR -- i. Comparative law on informed consent -- ii. Noncompliance with legalistic informed consent -- iii. Genetic counselling and legalistic informed consent.

iv. Research and legalistic informed consent -- v. Informed consent reconceptualised -- vi. Systems error and "consent" forms -- IV. The Medical Fiduciary: Can Virtue be Coerced? -- i. Legalistic fiduciaries -- ii. The doctor-patient relationship: fully fiduciary? -- iii. Medical fiduciaries reconceptualised -- V. Contract: Can Vulnerable Patients Contractually -- Bargain? -- i. Contractual doctor-patient relations -- ii. Contractual doctor-patient relations reconceptualised -- VI. Confidentiality and Privilege: Protecting Trust and Loyalty -- i. Medical confidentiality and privilege -- ii. Legalistic medical confidentiality: a decrepit concept? -- iii. Medical confidentiality reconceptualised -- VII. Medical Legislation and Professional Life Narratives -- i. Legalistic approach to doctor-patient legislation -- ii. Problems with doctor-patient legislation -- iii. Medical legislation reconceptualised -- VIII. Objections and Implications -- i. Problems in "wicked" or corrupt legal systems -- ii. Anarchy or cultural imperialism -- iii. Implications of "integrated" law -- Chapter Six: Constitutional and International Human Rights ...................................................................................... 399 Frankl's "Man's Search for Meaning" & Solzhenitsyn's "One Day in the Life of Ivan Denisovich." -- I. Doctor to Patient Duty as a Human Right -- i. Expansion of international humanitarian law -- ii. Patients and international civil and political rights -- iii. The human right to health -- iv. New patient human rights -- II. Rationing, Medical Patents and Managed Care -- i. Rationing by stealth in health care -- ii. "Integrated" rationing in health care -- iii. "Integrated" patent protection in health care -- III. Refraining from Eugenics: Therapeutic Loyalty or Perfectionism? -- i. Eugenics post the Human Genome Project.

ii. Therapeutic loyalty and parental "carrier" screening -- iii. Therapeutic loyalty and screening of the fetus -- iv. Therapeutic loyalty and neonatal screening -- IV. Torture and Cruel, Inhuman or Degrading Treatment -- i. Torture and the primary telos of "integrated" regulation -- ii. Treatment cruel, inhuman or degrading and the primary telos -- V. Respect, Formal Injustice and Forensic Genetic Sampling -- i. Genetic evidence: doctors as State agents -- ii. Genetic "gate keeping" and "integrated" regulation -- VI. Protecting Patients at the Beginning of Life -- i. Therapeutic loyalty to a fetus? -- ii. Abortion: conscientious objection and maternal life narratives -- iii. The human right to be born healthy -- VII. Protecting Patients at the Middle of Life -- i. Patients and the problem of genetic reductionism -- ii. Therapeutic loyalty and workplace genetic testing -- iii. Therapeutic loyalty and genetic testing for insurance -- iv. Therapeutic loyalty and HIV/AIDS -- VIII. Protecting Patients at the End of Life -- i. Intensive care and loss of narrative coherence -- ii. Euthanasia and "integrated" doctor-patient regulation -- iii. Reconceptualising organ donation regulation -- iv. Patient-related human rights reconceptualised -- IX. Objections and Implications -- i. Objections -- ii. Implications of "integrated" regulation -- Select Bibliography -- Index.