Medical Ethics mg

VTS

Some Questions.....

•Have you come across an ethical dilemma recently?

•Were you comfortable in dealing with it?

•How did you resolve it?•Who did you go to for help?

Aims for this session…..

To consider the relevance of ethics in medicine (and to our daily work)

To discuss some ethical principles

To apply these to some ethical scenarios

Feel better able to recognise and address an ethical dilemma

PLAN FOR THE SESSIONAn interactive presentation

(http://www.bhbt.co.uk/Link.htm)

Ethical dilemmas -examples (split into smaller groups)

Presenting back to the group – principals highlighted in your ethical dilemmas

Summary

TEA - BREAK

Some more questions for you…….

• How is medical ethics relevant to your work as a GP?

• Is medical ethics the special preserve of doctors?

• Will the advance of scientific medicine reduce the need for ethical debate?

Why bother? What problems?

Why bother? What problems?

• No clear solutions provided• A mish-mash of conflicting opinions• Increases complexity, excessive

choice• It all takes time• Decisions can be delayed• What’s wrong with pragmatism

anyway? (We all use our experience, intuition and common sense)

Why learn about ethics?• ESSENTIAL IN DIFFICULT CASES

Almost all consultations have an ethical dimension

• SENSITIVITYMore sensitive to individual situations and more self-critical. This helps to balance EBM.Paternalism replaced by partnershipGreater range of options considered

• RISK REDUCTIONReducing risk of complaint and litigation

• HELPS PASS THE nMRCGP EXAM!!

Should doctors have to swear an oath when they

qualify?The Hippocratic Oath.doc

Modern Hippocratic Oath.doc

AMA Oath.doc

What is meant by Ethics?

What is meant by Ethics?

•Ethics – the philosophical study of morality

What is meant by Ethics?

“The philosophical study of the moral value of human conduct and the rules and principles that ought to govern it …a code of behaviour considered correct especially that of a particular group, profession or individual”

Collins English Dictionary 1994

What is meant by morality?

What is meant by morality?

•Morality – a system applying to all rational persons, governing behaviour that affects others, having the lessening of harm as its goal

How does it relate to philosophy?

PHILOSOPHY is the study of beliefs and ideas. It

deals with theoriesETHICS (moral philosophy) is a branch of philosophy with practical

application.ETHICAL and MORAL refer to

BEHAVIOUR – good and bad, right and wrong

An attempt to make judgements objectively

MORAL THEORIES

VIRTUE...Individuals with intrinsic good character follow their conscience (Aristotle)

DUTIES...obligations we owe to each other based on respect for others. Morality depends on intention (Kant)

UTILITY... Right / wrong judged only by the consequence. The greatest good for the greatest number (John Stuart Mill)

RIGHTS...A more recent theory. What a citizen can expect to be provided. Stated in law.

Three helpful friends….

REALISM…. About what can be changed, and who can change it

COMPLEXITY… Try shifting the focus and the view point

SHARING…Responsibility with the patient, relatives, friends, other professionals

The First Principle

• Do good

• This is BENEFICENCE

• Such aspects as cure / palliation / comfort / empathy / compassion / treating patients with dignity

• Such concepts are well understood by medical and nursing staff

The Second Principle

• Do no harm

• This is NON-MALEFICENCE

• Not injuring patients by what we do

• Non-iatrogenesis

• Well understood but sometimes happens inadvertently

The Third Principle

• Act fairly

• This is (distributive) JUSTICE

• Such aspects as treating equals equally / if people are non-equal they should be treated in proportion to their degree of inequality (? e.g. those in custody, relatives) / ethical rationing – should those who are deprived have more?

• A more difficult principle

The Fourth Principle

• Allow people to determine their own futures

• This is AUTONOMY

• Such aspects as honesty / telling the truth / informed consent / decision sharing / maximising the ability of patients to make choices

• CONFIDENTIALITY comes under this principle

A further aspect

• There is another aspect to this and that is SCOPE

• To whom do we owe these duties?

• Who are the interested parties?

• Individuals or patients as a group? The Practice? The NHS? Society? Government?

Other contentious areas:

•Ethical research•GP (consortium)

commissioning•Do violent patients lose their

right to confidentiality?•Having health provision

•Having health provision

“Great physicians and nurses, skilled, caring and unparalleled in their training, intervened in my life and probably saved it. I was lucky but other Americans are not. It is time to speak again and stand again for the ideal that in the richest nation ever on this planet, it is wrong for 41 million Americans, most of them in working families, to worry at night and wake up in the morning without the basic protection of health insurance.”  

Senator John Kerry

The “Four Principles” of medical

ethics are:• Do good

• Do no harm

• Act fairly

• Allow people to determine their own futures(Confidentiality)

Conclusions and implications

• Things are not always as straightforward as they may seem

• There are ethical aspects to many medical situations

• If the problem is an ethical one, try to generate lots of options – rule nothing out

• Assess the advantages and disadvantages of each solution using the four principles

• There may be legal precedents• There are sources of help and advice –

colleagues, GMC, medical defence companies, RCN

• Impart decisions to patients in an ethical way• Record everything

Thankyou