Ethics

Question 1

What do we mean by ethics?

Answer 1

• Doing good versus bad, preventing harm (beneficence)
• Respecting other peoples’ wishes, confidentiality, anonymity. (Respect, confidentiality and data protection)
• May involve making difficult, emotionally charged decisions (autonomy) Patients’ best interest
• Deciding on priorities, thinking about resources, costs. (Who is more important in the sense of priority of life or death situation)
• considering peoples; beliefs and values (respect and autonomy)
• ethics applies to diagnosis, treatment and research.

Question 2

Name the four ethics principles

Answer 2

• Justice - legally, equity and everything is done fairly.
• Respect and autonomy - confidentiality, privacy, data protection.
• Beneficence - doing the right thing
• Non- maleficence - do no harm, doing more good than bad.

Question 3

What is Beneficence

Answer 3

BENEFICENCE - acting in patient’s best interest to increase benefits and reduce harm.

• Might conflict with autonomy of patient - wishes of patient should be respected.
• Issue - Autonomous refusal of treatment could result in chronic problems of patient leading to inc cost on NHS.
• Benefits of treatment:
  -Issue- a branded drug - expensive but effective while cheaper might be available to more people.
• Feeding people at a soup kitchen is an example of beneficence. Preventing a patient from taking a harmful medication is an example of non-maleficence.

Question 4

Can you think of any issues around beneficence that might arise in healthcare?

Answer 4

Beliefs of patients may prevent them from receiving the treatment they require and due to respect and autonomy you are unable to disrespect their wishes - in this case you could be doing more harm by listening to the patient’s wishes.

Question 5

What is non-maleficence?

Answer 5

Non-maleficence - do no harm, prevent harm caused to patients as a result of negligence.

• Obligation not to inflict harm intentionally.
• many forms of treatment cause unavoidable discomfort/pain, however these unwanted side effects should be kept to a minimum.

Primum non nocere - first do no harm

Question 6

Can you think of any issues around non-maleficence that might arise in healthcare?

Answer 6

Doseage through X-ray imaging is inevitable and can cause dose which could cause harm in the future, e.g. cancer - example of stochastic effects.

Question 7

What is justice?

Answer 7

JUSTICE- treating others equitably and with fairness. Fair distribution of ideas - EBP, resources for treatment of patients.

Ensure that no one is unfairly disadvantaged in access to healthcare (free prescription for lower income individuals) Treat similar cases alike.

-Allocation of resources should be equal when decision makers are determining how to divide costs and benefits. Treat patients according to their needs.

Question 8

Can you think of any issues around justice that might arise in healthcare?

Answer 8

Lack of communication if there is no translator present patient will not fully understand the procedure/ treatment they are about to undergo.

Question 9

What is autonomy?

Answer 9

Autonomy - patient right to make their own decisions free from being forced or coerced.

• make their own choice, hold their own views, take actions based on own personal value& belief systems.
• decision - must be informed one, patient must have capacity to understand info given.
• autonomous decision not always medically correct.
• even if patient isn’t autonomous their feelings should be respected as much as practically possible.
• Mental Health Act (1983)(amended 2007) and Mental capacity Act (2005)

Question 10

Can you think of any issues around autonomy that might arise in healthcare?

Answer 10

Can lead to patients’ decisions causing more harm than good.

Question 11

What are the ethical concepts?

Answer 11

Veracity- telling truth giving correct info.

Privacy - having respect for confidentiality and anonymity.

Fidelity - keeping our promises, giving information/ providing things when we have undertaken to do so.

Consent - getting patients’ permission before doing things involving them e.g. treatments, tests and research.

Question 12

State the origins of Ethics

Answer 12

Hippocratic oaths - no harm, respect for privacy and sharing knowledge about best treatments.

Nuremberg code - ethical principles - human experimentation/research - voluntary consent, reduce risks. etc

1948 - UN Universal declarations of human rights.

Question 13

State the theories of Ethics

Answer 13

• Utilitarianism (logic of consequences) - taking overall consequences of our actions into consideration - greater good - small harm to occur.
• Deontology (logic of principles) - basing our actions on fixed duties - any form of harm is not permitted even for greater good.

Question 14

Alternative definitions of Ethics

Answer 14

• A field of study that helps people to understand the morality of human behaviour.
• The practices or beliefs of a certain group (medics, nurses etc).
• The expected standards of moral behaviour of a particular group as described in the group’s formal code of professional ethics.
• The values that guide a health practitioner’s behaviour or judgement (e.g. Health and Care Professions Council).

Question 15

State the Codes of Ethics

Answer 15

• They may be sets of guiding principles that clarify an organization’s mission, values and principles.
• They may be a collective statement about a group’s moral judgment.
• They may act as a standard for professional actions.
• They may be benchmarks against which individual and organizational performance can be measured.

Question 16

State the purpose of a Code of Ethics

Answer 16

• To inform the public about the minimum standards of the profession and help them understand professional healthcare conduct.
• To provide a sign of the profession’s commitment to the public it serves.
• To outline the major ethical considerations of the profession.
• To provide general guidelines for professional behaviour.
• To guide the profession in self-regulation.
• To remind healthcare workers of the special responsibility they assume when caring for the sick.

Question 17

The HCPC code of conduct is an example which theory of ethics?

Answer 17

• Utilitarianism (Logic of Consequences) – taking the overall consequences of our actions into consideration.
• for example the “greater good” idea – it is ethical for some small harm to occur, if it means that benefit occurs overall.
• Deontology (Logic of Principles) – basing our actions on a fixed set of duties.
• For example any form of harm is not permitted (even if it’s for the “greater good”)

Question 18

What conditions need to be satisfied in order for consent to be valid?

Answer 18

Consent, all three must be satisfied:
-Voluntary
-Informed
-Capacity

Question 19

What does the term Gillick competence refer to?

Answer 19

Gillick competence is a term originating in England which is used in medical law to decide whether a child (under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge.

Question 20

What is an Advance Decision used for?

Answer 20

Advance Decision- used in law to state in advance the medical procedures which a person with deteriorating health would want to refuse later when they lose capacity.

Example DNR, treatment explained prior to losing capacity, where an agreement has been established on course of treatment.

Question 21

List the 5 laws protecting the public

Answer 21

• The Mental Health Act (2007) – health professionals, in some circumstances, have the power to assess and treat people with mental health disorders in the interests of their own safety.
• The Mental Capacity Act (2005) – someone with capacity under the act is autonomous.
• Public Health (Control of Disease) Act 1984 – can insist on examining people with notifiable diseases.
• The Court of Protection – has jurisdiction over the welfare of people who are unable to make autonomous decisions for themselves.
• The Advance Decision – used in law to state in advance the medical procedures which a person with deteriorating health would want to refuse later when they lose capacity.

Question 22

What are the eight key principles outlined in the Data Protection Act 2018

Answer 22

• Fairly and lawfully processed
• Processed for limited purposes
• Adequate, relevant, not excessive
• Accurate and up-to-date
• Not kept longer than necessary
• Processed in accordance with individual rights
• Secure and with restricted access to it
• Not transferred to countries outside the European Economic area unless adequate security mechanisms are in place.

Question 23

What individual rights are identified within the Data Protection Act (2018)?

Answer 23

People have four rights within the Data Protection Act:

• To see what information is held about them

• To prevent its distribution if it causes distress

• To prevent processing for marketing purposes

• To request that incorrect information is corrected, blocked or erased

Question 24

What 7 types of information is classified as sensitive or personal?

Answer 24

• Racial or ethnic origin
• Political opinion
• Religious or other beliefs
• Union memberships
• Physical or mental health
• Sexual life
• Criminal offences

Question 25

What are the 6 key principles outlined in the Caldicott report (1997)?

Answer 25

• Justify the purpose
• Don’t use patient identifiable information unless its necessary
• Use the minimum patient identifiable information
• Access on a strict “need to know” basis
• All should be aware of their responsibilities
• Understand and comply with the law

Question 26

What was the 7th principle added in 2013?

Answer 26

To share or not to share?” (2013)
• Arose as a result of increasing concerns about how information was used or under-used within the NHS

• This was based on the 6 Caldicott report key principles and added a seventh one – the duty of health professionals to share information where it is in the best interests of their patients