Clinical Ethics - Rights and Resources, Social Media

Question 1

What factors influence resource allocation

Answer 1

• Life threatening or life limiting
• Cost of treatment and also future cost saving
• *Patient age (QUALYs take age into account)
• Innocence (haven’t fulfilled life potential)
• Self-inflicted disease – lifestyle choices? Autonomy?
• Effectiveness of treatment/ contribution to evidence
• Dependents (children to look after)
• What would the public say? (politics)/ stereotypes

Question 2

Rationing resources has vecome more important because (3)

Answer 2

• shift from acute illness to chronic long term
• normal physiological events medicalised (HRT?)
• increase in choice of and increase cost of medications

Question 3

3 allocation theories

Answer 3

Egalitarian
Maximising
Libertarian

Question 4

Egalitarian principle and its challenge and criticism

Answer 4

NHS was founded on a requirement to provide all care that is necessary and appropriate to everyone (equal access) - Aristotelian equality/justice

Challenge: how to resolve the tensions between egalitarian aspirations and finite resources (Rawlins and Dillon)

Criticism: resources are finite

Question 5

Maximising principle and its challenge, and criticism and benefits

Answer 5

Criteria that maximise public utility

Challenge: Who is best to decide this? Should drs be involved in rationing decisions?

Criticism: lacks compassion

Benefit: more prevalent conditions treatment improves productivity (benefits most people)

Question 6

Libertarian principle

Answer 6

Each is responsible for their own health, wellbeing and fulfilment of life plan.

John Stuart Mills - Harm principle:

• Should be free to do what you want unless you dont cause anyone else harm
• Censorship is the enemy of progress
• Freedom of speech - offence isnt harm

Question 7

German health care incentive scheme

Answer 7

Contributions are a percentage of income earned; so well off shoulder more burden

Incentives to change individual health behaviour. E.g., bonuses (cash, sports or kitchen eqpt, or reduction for insurance contributions) for participation in routine screening, health promotion and check-up programmes.

The pay out must come from the savings made by better health behaviour.

Question 8

The question of equity

Answer 8

Private programmes attract and retain higher income groups because they contribute more and cost less

Question 9

Sustainability in medicine definition

Answer 9

Meeting the needs of the present without compromising the ability of future generations to meet their own needs

Question 10

How can you address sustainability as F1

Answer 10

• Antibiotics
• over investigating - managing expectations
• Polypharmacy - medication reviews
• Prescription - OTC analgesics

Question 11

What is the rule of rescue (Jonsen)

Answer 11

RR describes the imperative people feel to rescue identifiable individuals facing avoidable death

‘anethical imperativeto save individual lives even when money might be more efficiently spent to prevent deaths in the larger population’ (Doughety)

‘the powerful human proclivity to rescue a single identified endangered life, regardless of cost, at the expense of any nameless faces who will therefore be denied health care’ (Osborne and Evans)

Question 12

Article 14 of Human Rights

Answer 12

The enjoyment of the rights and freedoms set forth in this convention shall be secured without discrimination on any ground such as sex, race, colour, language, religion, political or other opinion, national or social origin, association with a national minority, property, birth or other status.

Underlying assumptions:

• The irreducible moral status of individuals demands that people are treated in ways that are compatible with that moral status
• These claims can be made against a duty bearer such as the state and are universal

Question 13

Humans Right Act 1998 - what is its relation to healthcare

Answer 13

Health is the state of complete physical, mental and social wellbeing and not merely the absence of disease or informity…the highest attainable level of health is the fundamental right of every human being.

Question 14

Rights that are frequently engaged in healthcare

Answer 14

2: Right to life (Denied treatment)- limited
3: Right to be free from inhumane and degrading treatment (Mental Capacity Act- MCA)- absolute
5. Right to liberty (Deprivation of Liberty Safeguards-DOLS)
8: Right to respect privacy and family life (eg. Confidentiality)
12: Right to marry and found a family (eg. IVF)

Question 15

Absolute rights

Answer 15

• righttoprotection fromtorture,inhumananddegradingtreatment
  andpunishment(Article3),
• theprohibition onslaveryandenforcedlabour(Article4)
• Protectionfromretrospectivecriminal penalties(Article7)

Question 16

Limited/qualified rights - define and give eg

Answer 16

These rights are limitedunderexplicit andfinitecircumstances, eg. righttoliberty (Article5) – DEPRIVATION OF LIBERTY (need to know about)

• Article 8(2) - state can restrict the right to respect for private and family life; To protect health or morals, or the protection of the rights and freedoms of others; social needs

Question 17

“Refusing treatment because of advanced age alone” defies which 2 human right articles

Answer 17

Article 2 and Article 14 (prohibition on discrimination).

Question 18

‘Deny resources because of gender or sexuality” defies which human rights article -

Answer 18

Article 14

Question 19

What happens if patient wants to challenge the exercise of power by a public body (eg NHS)

Answer 19

Judicial review

English law case that sets out the standard of unreasonableness of public-body decisions that would make them liable to be quashed on judicial review, known as Wednesbury unreasonableness.

The Court held that it could not intervene to overturn the decision of the defendant simply because the court disagreed with it.
To have the right to intervene, the court would have to conclude that:

1. in making the decision, the defendant took into account factors that ought not to have been taken into account, or
2. the defendant failed to take into account factors that ought to have been taken into account, or
3. the decision was so unreasonable that no reasonable authority would ever consider imposing it.

Question 20

Benefits of social media in healthcare x4

Answer 20

1. establish wider and more diverse social and professional networks
2. engage with public and colleagues in debates
3. facilitate public access to accurate health information
4. improving patient access to services

Question 21

Risks of social media in healthcare x4

Answer 21

1. loss of personal privacy
2. potential breaches in confidentiality
3. online behaviour that may be perceived as unprofessional, inappropriate or offensive by others
4. future employers

Question 22

Absolute VS Limited Rights

Answer 22

Absolute – always have (right to protection)

Limited – under special circumstance (eg right to liberty and dols)