ethical scenarios Flashcards
Discuss the topic of euthanaisia, is it allowed in the UK and other areas of the world?
can doctors ever refuse to treat patients
CAN:
-patients cant demand a treatment just because they want it
-doctor doesnt belive its in their best interest e.g. patient may be too weak to survive another round of chemo
-if it goes against their beliefs e.g. abortion if it goes against their religious beliefs however they’re obligated to offer an alternative solution like referring them to a dif Dr
-abusive patient
-if the treatment is outside their scope of practice
CAN’T:
-discriminating against age, sex, gender, disability, race, sexual orientation, marriage, pregnancy, religion
-emergency, legally and morally and ethically obligated and it’s professional misconduct to deny you’re a doctor
As a UK doctor working in the US, a pharmaceutical company pays you to promote their drug. However you know better alternatives are availiable for your patients. How would you handle this
WHAT ARE THE DILEMMAS:
1) full disclosure of financial conflicts
-patients top priority so should tell them, effective communication (GMC), increases patient comliance and therfore outcomes
2) GMC ethical guidlines
-good practice promotes autonomy, informed consent, patient-centered care
2) patient autonomy + informed consent
-full transparency allows matients to made informed and medically sound decisions abt their care
3) public trust in medicine
-disclosing financial conflicts ensure4s ethical practice and strengthens public confidence in healthcare system
-benificence + non-malificence
-look at risks + benifits of each drug
OVERALL:
-disclosure
-treatment shouldn’t be guided by financial incentive
AI in healthcare is unethical and risky medicine.
Discuss points for and against
AI has become more prevelant in healthcare e.g.
-diagnostic imaging
-robot asssisted surgery
RISKS:
1) confidentiality
-must have robust data protection meausures to safeguard patients medical info
2) inforemed consent and transparency
-healthcare providers must be open abt the use of AI
3) AI should be constantly monitored to ensure it doesnt perpetuate health disparities between pops.
4) risk of inaccurate treatment or diagnosis which goes against non-malificence
5) lose human touch (emotional intelligence and empathy)
6) overeliance on tech diminishes their clinical judgement and decision making skills
7) interpreting how AI arrives at a certain diagnosis can be challenging for drs+patients
BENIFITS
1) ai can efficiently + accurately make diagnosis and can be just as if not more accurate than dr’s
2) can automate routine tasks freeing up professionals to focus on complex aspects of patient care
3) personalised med- tailor traetment plans based on specific characteristics
4) robotic surgery
-enhance precision
-minimise invasiveness
-improve recovery times
in cases of organ transplantation, priority should be given to patients who are registered as donors
discuss the ethical implications of such a policy
-not enough supply of organs
- prioritising donors can incentivise this process
+ve:
1) incentivising
2)fair approach, those willing to contribute recieve preferiential treatment
3) respects autonomy and rewards those who made concious effort to contribute
4) enhances likelihood of timely matches between donors and recipients
-ve:
-ppl with not enough resources or education disadvantged
-ppl with relogious belifs against it shouldnt be punished and should be respected
-can lead to unequal access to transplants based on socio-economic background
-should be based on clinical need and if its a match
-reduced trust in healthcare system
-patients feel presssured/coerced
as a med student, you observe a surgeon make innapropriate and disrespectful remarks about a patients headscarf. how would you adress this situation.
surgeons remarks creates many concerns surrounding cultural competence, patients right to fair and non judgemental treatment, professional integrity
-affects patients trust in NHS and make them feel marginalised
1) in a quiet moment check up on patient and see how theyre feeling and try to find out exactly what the surgeon said
2) raise it with the surgeon as respectfully as possible as it could damage the chances of reaching a collabrative outcome
3) as just a student there are respect and seniority boundaries which make it inappropiate to publicly call out the surgeon
4) either bring it up with the surgeon or trusted member of staff or report to ethics commitee within hospital
dr’s must remain
-professionsal
-culturally competent
-avoid emotional distress to patient
over a 1/4 of NHS staff= ethnic minorities
17 yr old requires blood transfusion. parents disagree based on religious beliefs. how do u navigate the situation
-respect religious beliefs
-autonomy, how does patient want to continue, does it differ to the parents
-non malificence, no harms to patients and not reviecing this treatment poses harm
-benificnce
-risks and benifits
-non judgemental but ensuring they have informed consent
-overall if they disagree you have to respect their choice
what do you understand by informed consent and capacity
-patient can only consent to treatment if they have capacity
Capacity= understand, retain, repeat back info relayed to them for long enough
-Fraser/gillick compentence if under 16- when children have the capacity to consent to treatment without parental knowledge / permission
1. Need to be aware of alternative services or options
2. Explain rationale behind their request
3. Understand the treatment and its risks
4. Age, maturity, mental capacity
(13 to 16 yrs)
What are the Fraser guidelines
Relate to children under 16 but specific or contraception and sexual health- set criteria :
1. Maturity and intelligence to understand treatment
2. Persuade child to tell parents
3. Is the advice/treatment in their best interest (beneficence)
4. Will their physical or mental health suffer if they don’t receive this treatment
Safeguarding importance
UNDER 16: if Gillick competent but disclosure may protect them, the healthcare professional should escalate the situation through safeguarding measures . If Gillick incompetent, situation must be escalated
16-17: capacity to consent but their refusal of treatment can be overridden by court or a guardian e.g if refusal leads to death or irreversible damage
Importance of confidentiality and when can it be broken
Confidentiality= protecting personal information and respecting patients wishes
IMPORTANT:
-keeping rapport with patients
-patients can trust their doctors and the healthcare system
-doctors can be sued
-leads to hostile relationships between patients and doctors and between staff
BROKEN:
-when person is a risk to themselves, family, general public
-child endangerment e.g abuse
-terrorism
-if Gillick incompetent
13 y/o enters and asks for contraception, how do you respond
Issue= age, possibility of pregnancy, possibility of abuse, grooming, coercion, exploitation
-identify her autonomy over her care but also that she’s young so need to speak with empathy to not sound judgemental and to build a rapport
-use Fraser guidelines and Gillick competency to check her capacity and ensure she has informed consent
-is there any alternative options? Could she tell her parents?
-inform her about the importance of safe sex and give her information regarding sexual health clinics, leaflets and brochures etc.
Discuss euthanasia
Euthanasia = painless killing of a patient who’s suffering from an incurable diseases or in a irreversible coma
-ILLEGAL IN UK AS WELL AS ASSISTED SUICIDE
- voluntary or non voluntary
PROS:
-patient can die with dignity
-may be suffering a lot and this is their wish
-autonomy
-relieve suffering (non maleficence)
CONS:
-possibility of coercion or abuse by family or professional
-dr has duty to not kills
-limits to autonomy (death may not be dignified)
-unregulated (exploitative)
Discuss abortion
Pro life:
-wrong to kill (non maleficence)
-human exists from conception so abortion= murder
-religious or cultural beliefs
Proc choice:
-embryo not human
-2 clinicians must agree
-can’t abort after 24 weeks
-woman’s right (autonomy) as child could have been conceived as a result of sexual abuse or grooming or child may not have a good life
-take beneficence into account (what outcome will be best for mother and child)
Would you give a liver to a 14 y/o with liver disease or a 32 y/o male with alcoholic liver disease (he has 2 kids)
-need to assess quality of life
-asses risk of relapse in alcoholic (how long has he been sober, does he have current support, how does the prognosis look)
-utilitarianism (kids in patient 2 so more than 1 life affected)
-who’s a better biological match
-life expectancy
-consult senior dr
