5. Critical thinking and ethics Flashcards
What do you think about the way doctors are perceived in the media?
- I think doctors, like other professions that are in the public domain such as policeman, are scrutinised to a disproportionate extent in the media. On the one hand I do admire the fact that the media is able make transparent some of injustices and scandals in the medical profession such as with the Bristol Heart Hospital Scandal or Northwick Park Hospital trial. This is itself a guiding principle of the NHS, i.e. accountability to the public, community and patients that it serves.
- But, in other news reporting, such as the Bawa Garba case, in my opinion was heavily sensationalised in a way that was not impartial. My objection is that, I’m not against the competence or integrity of select healthcare professions being scrutinised in a free society. But, this should strictly be done so on the basis of accurate, objective reporting. In this case I saw headlines of ‘murderer’ which I think took GNM well out of context. Therefore, whilst I praise the media for shedding light on injustices in the medical field, on the other hand, what I’d like to see is balanced, objecting reporting so as to not damage the fragile trust and confidence that Medicine and healthcare is predicated on.
Do you think doctors should ever go on strike?
- I feel strongly about the right to strike. It’s a right protected under Article 11 of the ECHR, and I believe any profession, doctors included, deserve the right to convey their political grievances
- In fact who is more better versed in healthcare politics than a healthcare professional striking for better salaries, pension contributions or reforms that they feel deserving of
- If the right to strike was removed, it may perpetuate illegal practises e.g. forcing doctors to work longer hours than they are contracted to
- This said, I understand how this might tarnish the image of doctors. The public might perceive them to be ‘greedy’ protesting better pay or conditions, and thus lose faith. So in the public interest doctors reserve the right to strike but they make their grievances loud and clear so as to safeguard their reputation.
- In the interests of public safety, I’d advise that strikes ought to be confined to non-emergency services, or organized in such a way to ensure that emergency departments are sufficiently staffed
- Lastly, I think there should be greater institutional support for doctors to strike. In In 2012 there was a fear that hospital bosses may affect doctors’ career development or that it would increase their workload upon return to work. This fear of the NHS and doctors being overburdened is legitimate, and needs to be addressed to that the right to strike can ever be exercised by doctors.
Was it a good idea to send a man to the moon?
- I do, I think its significance can be boiled down to two things: its contribution to science and its symbolic value.
- I’m actually not fully aware about the facts of this but several years ago I read an article that talked about how the food safety procedures that were recommended by the company hired to research into foods suitable for the space mission, were subsequently statutorily implemented for certain foods in the US and inspired new food regulation. In this way, you can see how research in one sphere of science can have wider benefits that we can reap in our day to day lives.
- I’d also say its value was a symbolic one. It left an impression on humanity set a parameter in science – if we can send a man to the moon, what else can we achieve? I understand that the price to pay for this symbolism was incredibly expensive, but I’d hope that, in inspiring a generation of scientists future discoveries can be made that would mean a multi-billion enterprise like this was worthwhile.
Should the NHS deal with patients who have self-inflicted diseases?
Should alcoholics and smokers receive equal treatment to those who dont?
- Yes. I understand that in an overstretched NHS, difficult budget decisions need to be made, I also understand that we can benefit from a culture where we encourage responsibility for our individual health.
- This said, outright exclusion is not the answer for a healthcare service premised on “comprehensive service, available to all.”
- Our vision of a healthcare system and our understanding of ill health itself should always be communal instead of individualistic, given that our health is interdependent on those around us, our environment and our politics. For example, activities like smoking/drinking correlate with socio-economic status.
- I also think it would encourage stigmatisation, since people would be ready to exclude conditions that garner less sympathy, such as smokers with lung cancer or drug users with hepatitis C, but not athletes with sports injuries? Or those who engage in praiseworthy behaviour such as working long hours, which is also arguably self-induced?
- For this reason, the NHS should stay clear of potentially stigmatizing illnesses and penalizing certain demographics. A better approach would be turning to the public health sphere to address some of the causes that induce people to turn to negative lifestyle changes in the first place, instead of excluding them from treatment.
- ->*Addiction = psychological condition itself
Do you think its right for doctors to have conferences, training sessions and other study material sponsored by corporations/big pharmas?
- I do. I’m of the opinion that, a person with integrity idealistically should be strong minded; their integrity and principles are not swayed so easily by their environment and even commercial interests as in sponsored conferences or events.
- One principle of Good Clinical Governance is making decisions compliant with the latest evidence, something that can be facilitated by sponsored events. This gives doctors access to research on new medication, treatments or equipment that could aid in making more up to date, optimal decisions for patients, which doctors as sworn to do.
- I do understand the commercial focus of such events, of course they are essentially a sales pitch, so I would recommend that doctors attend events with enthusiasm to learn, but a conscientious and critical mind, aware of the commercial interests and undue influence at play.
Do you think its rights for parents to conceive a second child to cure a disease in their first?
- I do, given that the first child may be saved by the second, and also parents should be able to give birth for whatever reasons suit them so long as each child can be financially and emotionally supported. This is ethically analogous to e.g. parents who have several births just so they can have a boy – it may be socially contentious but they’re at liberty to do so.
- In this case, it is important that the child is emotionally supported and valued in the family unit, irrespective of whether his cell or organ ends up being a successful match or not. Otherwise, the child may feel like nothing more than a ‘spare part’ born without love.
- To avoid this, it would be incumbent on the doctor to inform patients that, the first child will be born with the same condition, or that the child may not end up being a successful donor.
- Otherwise, the child might develop a guilt complex, and so may need psychotherapy to address this.
- This may also be as slippery slope leading to issues of genetic selection (e.g. if the second child must fulfil specific criteria in order to constitute an appropriate donor).
Is the government right to impose that NHS should only allow the MMR vaccine rather than 3 individual vaccines?
- One of the guiding principles of the NHS, is to provide the best value for taxpayers’ money. This signals the NHS mediating both cost-effectiveness and what the institution and health professionals regard as the safest, most effective treatment.
- In this case, the consensus is that the combined vaccine is safer and more effective since children are not put at risk of catching the diseases whilst they are waiting for full immunisation. Secondly, the link between autism and the vaccine have been disproved and this is not widely contested in the medical field.
- For this reason, the NHS is right to allow only the MMR vaccine whilst also informing patients that three separate vaccines can be available to them on a private basis. This allows individual choice and also a comprehensive service that is available to all.
Describe what ‘inequalities in healthcare’ means
Any understanding of inequity in a healthcare context should span a range of other inequities, such as education, government policies, and even inequalities in legal access, given that inequality is pervasive and interlinks other facets of life. For example
(1) Socio-economic inequalities
- An example of socio-economic inequalities is in education. I remember reading a study by Koonal Shah et al which talked about how health education campaigns tend to be successful amongst groups that are comparatively healthy. Unable to penetrate certain demographics, health services may not be used to their optimum by the people who would be most reliant on them.
- Another example of socio-economic inequalities is in access to legal aid. I read a study about Hazel Genn which talked about how, a large proportion of healthcare issues dealt with in GPs are largely legal ones too, borne out of, for example, poor housing and sanitation standards that fall short of legal requirements. This is something that only those more middle class or more educated would be aware of thereby subjecting lower classes to ill health due to legal inaccessibility.
(2) Postcode lottery
- This means that patients receive a non-uniform level of care, depending on the area in which they live i.e. a postcode lottery
- For example, there inequality in the geographic concentration of resources and skill these may be more accessible in urban areas than cities, alienating those less mobile from accessing healthcare facilities
- Further, the structure of the NHS means Primary Care Trusts can make independent decisions for treatments based on their available budgets meaning treatments available aren’t uniform.
Rationing
- Cultural shift from medical professionals previously ‘converting’ political decisions on resource allocation into clinical decisions about treatment. This worked when there was greater patient-doctor trust.
- Now, there is a shift from implicit to explicit rationing since internet access patients are more informed about the treatments available to them
- Daniel and Sabin (physician and philosopher): unpopular decisions can secure legitimacy if based on relevant criteria and sound evidence: publicity (transparent and open), relevance (decisions based on relevant criteria), prospect for appeal and enforcement (regulation to ensure compliance)
- More should be done to interrogate assumptions about scarcity. The idea that the budget will never meet the demand is itself premised on the idea that the current budget is enough.
Arguments for and against people paying for their own healthcare
- Impinges on guiding principles of the NHS
- Perpetuates inequality
- Transactional
+Deter inappropriate uses
+Create a market economy
+Incentive effect
+Personal liberty and individual choice
Alternative therapies?
- Conventional Medicine
- Clinical training
+Alleviate side effects
+Offer a spiritual component
- Address poor evidential base
- Understanding
- Alternative practitioners come from traditional
Should the NHS fund non-essential surgery
Yes, but in a nutshell, as a last resort instead of a readily available option, in order to keep in line with a doctor’s duty to make decisions in the best interests of patients.
Wouldn’t support an outright ban:
+Psychological problem
+Treatment abroad
But, would make access more stringent:
- Surgery ineffective
- New insecurities
For this reason, I would support the development of some sort of rough criterion on who should be entitled to non-essential surgery, and a case by case analysis undertaken by a panel of healthcare professions. This is because what constitutes inessential/essential may be difficult to demarcate, so should be done holistically.
How should healthcare be funded?
- I’m a supporter of socialised healthcare, and despite the reputation of the NHS as often slow and cumbersome, still believe it enough worth to be seen as a benchmark for a healthcare system
- As a Law student, and someone passionate about human rights, I believe that healthcare, like education should not be an asset but a basic entitlement, and its for this reason that I’m proud of the NHS support for a comprehensive service, available to all. Therefore, I support a taxpayer funded system of socialized healthcare.
- This is largely driven by my understanding of ill health and vision of a healthcare system that is communal, given that our health is interdependent on those around us, our environment, and government policies.
- For this reason, I’m more critical of countries like the US which is more private healthcare dominated. Not only does it perpetuate individual responsibility for health, but insurance pay-outs are expensive, such that about 15% of the population is uninsured.
- In my opinion this encourages exactly what a healthcare system should be fighting against: inequality.
- -> Scandinavia: healthcare funded solely by taxpayers = taxation high, private healthcare not that prominent
- -> France: taxation high to finance a public system used by everyone. Individual practitioners charge whatever. Set tariff reimbursed by patient. Difference between fee and tariff may be covered by private insurance
Why do some people want cosmetic surgery?
- They feel insecure about a particular feature, through societal pressure. For example, social media sells may sell a particular beauty standard, and the rise of filters, though initially harmless, may inadvertently distort how someone views their natural features.
- They may feel embarrassed by a particular deformity or feature, such as a prominent birthmark. This may make them subject to bullying, this contributing to poor self-esteem and poor social integration.
- They may be physically inconvenienced by a physical feature, for example, large breasts may be causing them a backache. Cosmetic surgery would therefore aid in their mobility and everyday comfort.
In what ways can doctors promote good health, other than through direct treatment of an illness?
(1) Conduct
(2) Opportunistic
(3) Education
(4) Preventative rather than curative culture
(1) CONDUCT: patient’s are more likely to trust and have confidence in the medical profession if they appear to be credible. This means publicly refraining from practices or behaviours that they themselves discourage, so as to not diminish faith in their profession and the science substantiating it e.g. smoking, eating healthy, keeping fit
(2) OPPORTUNISTIC: something I observed when sitting in a diabetic clinic is the medicative culture we live in, given that patients were specifically requesting medication even when the doctor suggested exercise was more effective. One way to move against a sole medicative culture to a healthier lifestyle culture is therefore to clarify the benefits of a healthy lifestyle in patient doctor consultations dietician, physiotherapist, promoting support groups e.g. smoking cessation, Alcoholics Anonymous
(3) EDUCATION: through the distribution of leaflets. I read a study by Koonal Shah et al, which talked about how health campaigns tend to be successful amongst groups that are comparatively health – this reveals the importance of producing leaflets written in accessible, layman language, distributed in targeted areas to reach the right demographics.
(4) PREVENTIVE RATHER THAN CURATIVE CULTURE: indeed, ‘prevention is better than cure’ is a message championed by the NHS. This includes screening programs for e.g. breast cancer, cervical cancer, immunisation campaigns, specialist clinics for e.g. diabetes, sexual health, such that medical advice is accessible in communities.