1. Theories Flashcards
Teleological/consequentialist theories
- Judge rightness/wrongness on an outcome based analysis
- E.g. utilitarianism (maximising welfare by securing the greatest happiness for the greatest number of people)
Deontological theories
The intrinsic rightness/wrongness of an action depends only on whether its consistent with certain basic moral principles
Secker: individuals barely resemble the Kantian free, independent, rational individual
Virtue ethics
A person acts virtuously if they do the right thing for the right reason
E.g. causing a person’s death may be virtuous only if her life lacks the most basic human goods
4 Ethical Principles (Principles of Biomedical Ethics by Childress and Beauchamp)
(1) Autonomy: respecting the right of competent adults to make informed decisions about their healthcare
(2) Beneficence: duty to do good and make decisions in patient’s best interests
(3) Non-maleficence: duty to avoid harm
(4) Justice: duty to treat everyone equally, fairly and in a balanced way
AUTONOMY
- Define
- Pros (Entwistle et al)
- Define
- Respecting the right of competent adults to make informed decisions about their healthcare
- Pinnacle of patient centered care
- Patients have right to refuse/consent treatment offered, but not to request treatment
(1) Capacity
(2) Consent: voluntary, informed, capacitous
- Pros
+Increased trust in the profession
+More adherence to treatment
+Better outcomes
Informed consent
- Define
- Pros
- Cons (Heywood and Akkad)
- Define
Where the patient has consented to a procedure/treatment, having been given and having considered all the facts necessary for them to make a decision in their own best interests - Pros
+Redresses imbalance of power between doctors and patients
+Encourages partnership model of decision making
+Consequentialist justification
+Teleological justification
Cons
- Heywood et al: simply necessary for treatment
- Akkad et al: protection for hospital
- Heywood et al: lengthy and elaborate forms detract from consent process
What should the patient be told?
- Options
- Aim of the procedure
- Details of the procedure
- Consequences
- Details of secondary interventions
- Who
- Reminder
- Layman’s terms
- Enough time so that they aren’t making a pressurised decision
Montgomery v Lanarkshire Health Board (2015)
- Facts
- Key legal question
- Dicta by Lords Reid and Kerr
- Test of materiality
- Pros and cons
- Dicta by Lord Reid and Kerr
“Patients are now regarded as persons holding rights rather than passive recipients of care” instead of a culture of “medical paternalism”
“It would be a mistake to view patients as uninformed, incapable of understanding medical matters”
- Test of materiality: “whether, in the circumstances of the case, a reasonable person in the patient’s position would be likely to attach significance to the risk”
- Pros and cons
+Subjective test better protects individual patients
+Redresses imbalance of power
+Bridges gap
-Court ruled that patient should have been offered a C section
-Information doctor should garner about patient is prescriptive
Abortion Act 1967
- Grounds within 24 weeks
- Grounds beyond 24 weeks x3
- If there is a risk to the physical or mental health of the patient or existing children
- Beyond 24 weeks:
- 1 Prevent grave physical injury
- 2 Risk to the life of pregnant woman
- 2 Substantial risk that if the child were born it would suffer from physical or mental abnormalities so as to be seriously handicapped
Fraser competence
- Definition
- Where it applies x3
- Guidelines x5
- Child has “sufficient maturity and intelligence to understand the nature and implications of the proposed treatment”
- Advice/treatment on contraception, terminating pregnancy and STIs
- Guidelines x 5
- 1 Sufficient maturity and intelligence
- 2 Cannot be persuaded to tell her parents or allow the doctor to tell them
- Likely to begin or continue sexual intercourse
- 4 Physical or mental health is likely to suffer unless advice refused
- 5 The advice or treatment is in their best interest
BENEFICENCE
Doctors have a moral duty to do good to their patients and must act in patients’ best interests
- Will this option RESOLVE the patient’s medical problem
- Is it PROPORTIONATE to the SCALE of the medical problem?
- Is this option COMPATIBLE with the patient’s individual circumstances
- -> GMC GMP: adequately assess patient’s conditions, taking into account psychological, spiritual, social and cultural factors, views and values - Is this option and its outcomes IN LINE with the patient’s EXPECTATIONS of treatment?
Non-maleficence
Doctors should do no harm to patients. Any decision in patients’ best interest should reduce or avoid harm
- What are the ASSOCIATED RISKS with intervention/non-intervention
- Do I possess the SKILLS AND KNOWLEGE to perform this action?
- Is the patient being treated with DIGNITY AND RESPECT?
- Is the patient being put at risk through other factors e.g. staffing, resources
Statutory Duty of Candour
Doctors have a duty to be open and honest to patients when mistakes or near mistakes have been made
They must
(1) Explain
(2) Apologise
(3) Find strategies to prevent mistakes happening
- E.g. prescribes wrong medication
- E.g. nearly gives medication to which a patient is allergic
- E.g. forgetting to book a patient for a scan, where no more slots are available
- GMC Document
JUSTICE
To treat everyone equally, fairly, in a balanced way
Lends itself to the idea of maximising beneficence (good)
- Is this action LEGAL?
- Does it infringe HUMAN RIGHTS?
- Does it PRIORITISE one group over another?
- If so, can it be justified in terms of overall benefit to society or does it agree with moral conventions?
QALY
+Objective attempt
+Values quality
+Holistic
-Assumes that society is neutral as to how health benefit are distributed
-Exacerbates discrimination against elderly and disabled
-Approach may be inconsistent with the principle of justice
-Emphasis upon maximising health gains is utilitarian
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