Ethical Hot Topics Flashcards
What is abortion?
The process of terminating a human pregancy medically either through medication or surgery
What is surgical abortion?
Up to 14 weeks you can use vacuum or suction aspiration
After 14 weeks you can use dilation and evacuation
What is a medical abortion?
If women want to end their pregnancy within the first 10 weeks, they can be offered pills 24 and 48 hours apart.
The first pill is mifepristone which inhibits progesterone which maintains pregnancy
The second pill is misoprostol which induces contractions in the womb and the pregnancy can pass
What is the Abortion Act and what year was it introduced?
Introduced in 1967 and makes abortion in England, Wales and Scotland legal up to 24 weeks of pregnancy. Requires two doctors to sign off on their opinion that the pregnancy will negatively impact the womans physical or mental health.
What is going on in Northern Ireland with abortion?
Before 2018, abortion was criminalised, even in the case of rape or fetal abnormalities. In 2017, Northern Irish women could get abortions on the NHS not only privately. They then had a referendum in 2018 and abortion was decriminalised in 2019.
What is the issue about abortion medication?
From 2018 onwards, medical abortion legislation changed and misoprostol was allowed to be taken from home instead of at the clinic. This reduced the risk of miscarriage on the way home from the abortion clinic which can be very traumatic. People argue this trivialises abortion
From 2020, women could take both pills from home because of lockdown
Arguments for abortion (pro-choice)
. In the case of an unwanted pregnancy be that through rape, incest or just circumstance, keeping the child could inflict psychological damage on the mother. This goes against non-maleficence which states that it is a doctors duty
Arguments for abortion (pro-choice)
. In the case of an unwanted pregnancy be that through rape, incest or just circumstance, keeping the child could inflict psychological damage on the mother. This goes against non-maleficence
. Prevents complications and deaths from unsafe and unregulated home abortions (justice)
. Preserves patient autonomy as the patient always has the right to their own body. If a patient should choose to terminate their pregnancy and they are well informed, they are well within their right to do that.
Arguments against abortion ( pro-life)
. There are religious and social objections centred around the argument of when human life begins and if it counts as murder
. It can also cause psychological distress to have an abortion
. There are other options if the pregnancy is unwanted like adoption which doesn’t involve terminating the pregnancy.
How to approach an abortion question?
. Acknowledge the ethical implications of the scenario
. State some arguments you are going to use and some history
. Provide an answer using the arguments you are aware of
. Reach a balanced conclusion in your answer
What is alternative medicine?
A form of medicine that is taken instead of conventional treatment and is different. Can be aromatherapy, reflexology, herbalism and acupuncture.
What’s the problem with alternative medicine?
Many in the medical community argue that they are no better than a placebo but some have limited evidence supporting them.
What are the features of alternative medicine?
. High levels of contact time between patients and therapist
. It can help relieve some side effects of conventional treatment
. It’s often not based on evidence, rather on anecdotes
. It has mental health benefits like focusing on relaxation
What is the placebo effect?
When patients take an inert compound and perceive their symptoms to be getting better. Alternative medicines can promote this placebo effect and therefore can have benefits
Ethics surrounding alternative medicine
Non-maleficence - no harm done if using a harmless therapy however there could be a possibility of using it wrongly e.g acupuncture need;es that aren’t clean can transfer disease
Beneficence - limited side effects of most of these therapies, if used alongside conventional treatments, could have mental health benefits or placebo effect.
Autonomy - if the patient feels like the treatments work, they should be able to use it
Comparison case study - St Johns Wort
. Plant species which has been shown to have medicinal properties.
. Strong evidence to show it’s effective for mild to moderate depression
. In 2008 study, it was shown to be more effective than a placebo
. Danger of it interacting with other medications
A patient tells you that they are thinking of having an alternative treatment from a reflexologist and ask your advice about using alternative medicine.
S - Is this a good time to discuss this? Are you ok to talk about it now?
P - What do you want from alternative medicine, have you read much about it?
I - Do you have an opinion on the matter already?
K - It’s not evidence based, so doesn’t have a lot of scientific evidence to back it up, but it could be useful in supporting your conventional treatement.
E - How do you feel about this, is this something you are considering?
S - Well it’s ultimately your decision, if this is something you would like to go through with I will support you through it and I’m here if you have any other questions
What is colleague absensce?
This is when a colleague like a medical student or other doctor misses compulsory education or work. If you believe this could impact patient safety, report it
What is colleague absensce?
This is when a colleague like a medical student or other doctor misses compulsory education or work. If you believe this could impact patient safety, report it
What are the ethical impacts of colleague absence?
. Non-maleficence - colleague not attending results in missed information which could lead to patient harm
. Beneficence- doing good through making colleague aware of their absence for them and their patients
. Justice - fair that they attend all of the required teaching
What are the COVID 19 waiting times?
. Due to the COVID 19 pandemic, the NHS has struggled to keep up with the COVID waves and has been overwhelmed by the number of patients. This has meant that these patients have been prioritised and other services have been ignored, resulting in waiting times
What are the reasons behind increased waiting times?
. Peaks of waves meant too many people were coming in with covid so the resources were directed mainly to them and non-essential surgeries were cancelled
. Less staff due to isolation from COVID so there were fewer doctors to treat patients
. GPs have moved online which took time to implement
. Lack of resources because of the interruption of global supply chains and increased use of resources
Impact of waiting times on the NHS?
. Overwhelmed NHS services which are now playing catch up and is likely to impact these services for many years to come
. Due to cancellation of services, patients have suffered either with morbities or mortality
. Many patients have also experienced anxiety and frustration
What is the Junior Doctor Contract?
. in 2013, Department of Health proposed a new contract that supposedly had better pay and created a 7 day NHS
. Under older contract, doctors were paid the standard rate for shifts between 7am and 7pm and 50% added outside of social hours
. New contract increased the basic salary but drastically reduced the supplements for on-call shifts meaning junior doctors were paid less
What is the criticism of the Junior Doctor contract?
. Reduced pay
. Doctor safety was compromised because they had to pick up extra unsociable hours which increased tiredness and anxiety which could also make patients safety due to doctors burnout
. No consultation to this contract, felt like they just threw it on them
Events after the Junior Doctor contract
. November 2015, 98% voted to reject the contract
. January-March of 2016 there were 4 junior doctor strikes each lasting between one and two days
. May 2016 there were talks between the government and BMA resume
. 2018-2020 the contract updated and was accepted in January 2020
Should doctors be allowed to strike?
. Doctors have their rights as employees to strike as recognised by the UN.
. Conflicts between these rights and the moral duties that doctors have
. Reduced number of staff numbers have an impact on patient safety - non
maleficence
. Long term patient safety increases because it ensures better standards of care by helping doctors with better standards (beneficence)
What is medical research?
. Medical research is a wide range of research ranging from preclinical laboratory studies to large scale clinical trials
. Increasing popularity of combining research with clinical work and this is the age of the clinician scientist
. Patients with more unique conditions may get the opportunity to be part of a clinical trial
