Ethics Flashcards

Question

What do clinicians tend to significantly underestimate

Answer 1

Patient’s willingness to undergo toxic treatments to improve length/quality of life Desire of patients to have full info even if they don’t act on it – or even believe it!

Answer 2

Providing accurate, truthful info Facilitating informed consent Maintaining confidentiality

Answer 3

“…the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others …over himself, over his own body and mind, the individual is sovereign”

Answer 4

Pt’s interest in taking control of their life – incl decisions about who should access personal info Implied promise

Answer 5

No, may be overridden by other concerns

Answer 6

Duty based ethics: Dr/ pt. relationship viewed as a contract Confidentiality an implicit part of this contract Breach of confidentiality involves the violation of terms of contract Breach of confidentiality is a transgression against the integrity of the relationship

Answer 7

Nature of ship | Some types of info deemed intrinsically personal, therefore implicitly confidential (social standards)

Answer 8

Malicious intent (incl gossip) Benefit to an individual e.g pt, or their family Benefitting someone else or the wider public

Answer 9

``` Reliability Trustworthiness Professionalism Integrity Honestly Beneficence, non-maleficence ```

Answer 10

Harm may result from divulging personal info Loss of personal trust in that Dr May spread to general distrust of medical profession – pt. may undermine trust of other pt. Anger/ distress to pt.

Answer 11

English law recognises a breach of confidence. Derived from: - Common law - Statute: Human Rights Act 1998 – Article 8 v Article 10, Data Protection Act/ GDPR GMC and DOH guidance Terms of employment

Answer 12

Hunter v Mann [1974] AG v guardian Newspapers No2 [1990] Campbell v Mirror Group Newspapers [2004]

Answer 13

1. Everyone has the right to respect for his private and family life his home and his correspondence 2. There shall be no interferences by a public authority with this right expect as is in accordance with the law and is necessary in the interest of national security, public safety …. For prevention of disorder or crime, for protection of health or morals

Answer 14

``` Consent of the pt. (implied or expressed) Another member of the healthcare team In the pt.’s best interest Required by law Legislation/ statute Court order/ court proceedings Public interest W v Edgell [1990] X v Y [1998] ```

Answer 15

Pt’s fitness to drive and reporting concerns to the DVLA or DVA Reporting gunshot and knife wounds Disclosing info about serious communicable diseases

Answer 16

``` Dr’s can disclose info to police for detection or prevention of serious crime and in the interests of national security Serious crime (assault, robbery, murder) Police must make a Section 29 request ```

Answer 17

Murder, manslaughter, rape, treason, kidnapping, child abuse or other cases where individuals have suffered serious harm may warrant breaching confidence A knife attack may be sufficient to justify a public interest disclosure of confidential info even where consent is not given, where it likely to assist on the prevention and detections of a serious crime

Answer 18

Critical application of moral theories & principles Identify conflicts Recognise and question initial assumptions Consider counterargument Arrive at a conclusion supported by reasons

Answer 19

Universities and medical schools Commercial organisations Charities Government (incl departments, NHS, public bodies, public health labs)

Answer 20

``` Creation and breeding of genetically modified animals (mainly mice) Basic research (how it works) Regulatory testing Research that translates animal-human Protection of natural environment Preservation of animal species ```

Answer 21

``` Mice Fish Rats Birds ‘Specially protected’ species (cats, dogs, horses and primates) ```

Answer 22

Moral value of animals vs value of research + moral value of humans and human wellbeing Does (potential) benefit to humans justify causing harm and suffering of non-human animals?

Answer 23

In-vitro or in-silico investigations simply cannot replicate the function of complex living systems

Answer 24

Human wellbeing is paramount, and it is even less morally acceptable to experiment on humans

Answer 25

Paying research subjects risks selecting for the neediest, vulnerable groups (economic coercion) Many do regard people as having more moral work than other animals BUT should we trade lives, pain and suffering for human knowledge? However altruistic the aim?

Answer 26

Replacement Reduction Refinement - bredding, accom and care, methods mand procedures used

Answer 27

How important is the possible result (cancer vs eczema)? How likely is it Possible benefit vs certain harm Act certainty v omission possibility: animals will surely suffer by the act, human might suffer without the research

Answer 28

1932 -1972, US 399 AA men w/ untreated syphilis monitored for 40 years Told only that they would be getting free medical care Not told of their dx – given placebos rather than treatment

Answer 29

AA woman’s cancer cells grown in culture An ‘immortal’ human cell line Consent from her or her family never sought Total mass of HeLa cells > 50 million tonnes Still in use today

Answer 30

Nazis claimed not to see some people as fully human but still used for medical research Denial of humanity Indifference to suffering Some experimental results still in use today

Answer 31

Ethical guidelines to ensure that medics never again participate in atrocities Forerunner of ‘four pillars’ approach Enshrines (first rule) voluntary consent of the subject Not officially adopted in any jurisdiction

Answer 32

Not transferable to non-human subjects 1. Obtain informed consent 2. Minimise risk of harm to ppts 3. Protect anonymity and confidentiality 4. Be transparent to subjects (avoid deception) 5. Respect ppt right to withdraw

Answer 33

353, 236 cases worldwide | Although most deaths have been in developing world, 72 children died in Europe

Answer 34

Beneficence – good for the individual Utilitarian – “herd immunity” (60-70%) leads to general reduction in suffering Non maleficence – unvaccinated individuals are at risk of harm Justice – compromising herd immunity by refusing to be vaccinated or to vaccinate one’s own child is not fair to others

Answer 35

Autonomy – individuals right to choose or parent’ right to make treatment decisions for their children Fear of “other kinds of harm” Distrust of medical profession Distrust of ‘big pharma’ Vehemence (sometime violent) of some anti-vaxxers

Answer 36

1998 – paper linking MMR vaccine with conditions incl autism published 2004 – co-authors withdraw support 2010 – Wakefield struck off 2010 – present: Wakefield stands by conclusions

Answer 37

Measles vaccination target for herd immunity 95% (WHO) Threshold for COVID-19 not known (WHO) Should the state override the pt.’s or parents’ decisions? Is the state entitling to restrict individual liberties to protect the group?

Answer 38

Harm vs Benefit – will the vaccine benefit my child Will it harm my child (e.g., MMR “controversy”)? Knowledge vs belief – “do you know that the vaccine is safe?” Individual vs population vs pt autonomy – “why should I put my child at risk for the sake of this ‘herd immunity’?”

Answer 39

Parenthood needs imply and absolute right to choose for children

Answer 40

Can parents choose to risk harm to their own children Is it morally permissible to override parental autonomy if their actions harm their children or others? Is a failure to vaccinate a child ‘harm’ in the same category as abuse or neglect? Consistency – should we override parents’ decisions about education? Or religion? Food?

Answer 41

Causing (albeit unlikely) harm by a +ve arc

Answer 42

How can one prove that something is safe – or establish relative risk? How do we know that journals, clinical trails are reliable - Wakefield Do Dr's always tell truth - Harold Shipman Do policymakers always tell the truth? Do doctors/ policymakers always know the truth?

Answer 43

Certificate to permit access to some venues or transport etc Refusal to admit those without a passport

Answer 44

Not everybody can be vaccinated Might lead to some “collateral damage” - Alienation from health services and professions - Discrimination against groups or those refusing vaccination - Some might feel compelled to get vaccinated

Answer 45

Herd immunity more important than individual freedom Good for community Good for individual child Concerns against vaccines irrational/ ignorant

Answer 46

Individual freedom is more important than herd immunity Right not to vaccinate on a par with other civil liberties Bad for child if there if there are real worries related to vaccines

Answer 47

John Stuart Mill

Answer 48

If, and only if, it is what a virtuous agent would do in the circumstances

Answer 49

If, and only if, it is in accord with a moral rule or principle

Answer 50

If, and only if, it promotes the best consequences

Answer 51

A decision made for the sake of someone’s best interests, against their will

Answer 52

Situations where a pr’s capacity and understanding of a situation are not known E.g. in emergency situations

Answer 53

A pt’s wishes are ignored even though they have relevant facts and capacity