Ethics Flashcards
What is Ethics?
Involves study of morality (i.e. study of good and/or the right)
What features does an ethical judgement have?
1) PRESCRIPTIVE (tells you what the right thing to do is)
2) JUSTIFIED THROUGH REASONING
How can we approach ethical problems?
- What kind of person should we be?
- What should I do?
What is Virtue Ethics?
Being a virtuous person
Focuses on excellence on character, ensuring one lives the best life overall
(i.e. achieves flourishing)
MEAN between two opposing vices
Examples of Virtues
Courage - mean between recklessness and cowardice
Generosity - mean between wastefulness and meanness
What is Consequentialism?
Act in such a way to benefit the most people - producing best consequences
What is utilitarianism?
Best known consequentialist theory
RIGHT action produces greatest happiness (or pleasure) for the greatest number (principle of utility)
What are the different types of utilitarianism?
- Act utilitarianism
- Rule Utilitarianism
What is Act Utilitarianism?
Considering the consequences of each specific act
Looks at benefit for that singular action
What is Rule Utilitarianism?
Formulates rules (which will govern acts) that seek to produce the best consequences
Looks at WIDER impacts - what would happen if we kept applying this action generally
What is Deontology?
Fulfilling moral duties
(duty, obligation, responsibility
What is narrative ethics?
Describes a variety of approaches, which focus particularly on the patient’s story
Helps us understand human (moral) life by focusing on communication, perspectives and relationships
How is demand for healthcare increasing?
- ageing population with more chronic illness
- medicalisation (increasing remit of healthcare)
- increased consumer demand
- technological advances making more possible
Why is resource availability not keeping up with demand?
Staff shortages & low recruitment in some areas
Inadequate funding to meet demand
CCG’s choosing to cut/reduce some services
How do prioritise & ration?
Must determine
- who/what to treat first, and why
- what if anything to cut/limit, and why
What stages do we make decisions?
- Nationally
- Locally
- Individually
How do we prioritise & ration nationally?
NICE; DH; PHE
Public Health campaigns targeting specific issues; certain treatments approved
How do we prioritise & ration locally?
CCG; NHS Trusts; Practices
Withdrawing/limiting IVF funding; strategic focusing of services
How do we prioritise & ration individually?§
CLINICIANS
Which treatments to offer; referral decisions
What is Distributive Justice?
Distribution of goods in accordance with the principle of justice
How can we achieve distributive justice?
Consequentialism, Equality, Egalitarianism, Aristotelean, Rawlsian
What is Equality & Egalitarianism?
All persons are equal in their fundamental worth and therefore entitles to be treated equally
How does equality & egalitarianism relate to Distributive Justice?
UNJUST to give one person access/opportunity but not another person, because both persons are of equal worth
What is the Aristotelean Principle?
‘Persons in equal circumstances should be treated equally, persons in unequal circumstances should be treated unequally’
What is non-relevant criteria?
CANNOT influence / change
e.g. race, sex, mental or physical disability
What is relevant criteria?
CAN influence
e.g. health behaviour or lifestyle
What are protected characteristics?
Some criteria UK law prohibits (Equality Act 2010) from being used to discriminate between persons
-> age, disability, gender reassignment, marriage & civil partnership, pregnancy & maternity, race, religion & belief, sex, sexual orientation
What is a Rawlsian (egalitarian) Thought?
Thought Experiment that ensures just distrubution
What is a Rawlsian (egalitarian) Thought?
Thought Experiment that ensures just distribution of goods, ensuring that the greatest benefit goes to the least advantaged
What are sources of the Law?
- Acts of Parliament
- Court Rulings (superiors courts - e.g. Supreme Court)
- European Union (EU)
- European Convention on Human Rights (ECHR): also directly part of English Law, following Human Rights Act 1998
What are branches of Law related to Medicine?
Medical Law is its OWN branch of law, but drawn on various others, such as
- criminal law (punishment)
- civil law (compensation)
What is the role of the GMC?
To protect, promote, & maintain the health & safety of the public by ensuring proper standards in the practise of medicine
Why do we use GMC guidance?
- Broad Principles of GOOD practise
- Ethically based, consistent with law
- Framework for doctors to exercise professional judgement
- Serious or persistent failure could lead to action
Why do we maintain a patient’s confidence?
- keeping a promise
- respecting autonomy
- more people will trust healthcare professionals
- patients will disclose medical history
- healthcare/research will best flourish
What happens if you fail to comply with confidentiality?
Injunction (stopping disclosure)
Financial Compensation (‘damages’)
When can you break confidentiality?
- Patient consents to disclosure
- Disclosure is required by the law
- Disclosure is in the public interest
What is Patient Consent?
If patient has ‘mental capacity’, consent is guiding principle to breaking confidentiality
What are the types of consent?
EXPRESS CONSENT (needed, to employers & insurance companies)
IMPLIED CONSENT (records are secure but may be able to share)
What happens to consent if the patient lacks ‘mental capacity?
‘Best interests’ is guiding principle
Effort would be made to get relevant consent, but break if exceptional & justifiable
Why can you break confidentiality if required by the law?
May be required by statute or court
e.g. notifying authorities of certain communicable diseases (list of notifiable diseases)
e.g. copying with legal/disciplinary proceedings
Why can you break confidentiality in the public interest?
IN public interest, not OF interest
e.g. disclosing in case of alcoholic surgeon OR serious crime committed
e.g. MAINTAINING for HIV statuses of doctors
