Ethics

Question 1

Define Medical Ethics.

Answer 1

Moral Principles those in the medical profession conduct themselves by.

Question 2

Whats an ethical framework?

Answer 2

Complex guiding ideologies to help decision making in ethics.

Question 3

What is Consequentialism?

Answer 3

Morals based on consequence (ends justify the means).

Example: limited drug supply, 1 severely sick or 5 less sick. Pick 5 as it helps more people.

Question 4

What is Utilitarianism?

Answer 4

Provides the most good, benefits the most people.

Example: 1 severely sick or 5 less sick. Pick 5 as it helps more people is the same as a consequentialist would choose to do.

Question 5

What is Deontology?

Answer 5

Duty-based ethics, follow rules, how you get there is what matters.

Question 6

What is Virtue Ethics?

Answer 6

Morality dependant on the motivations behind their actions, aim to be good and will be moral.

Flaw: someone is dictating what is moral and what isn’t.

Question 7

What is Principlism?

Answer 7

Universal four pillars of medical ethics to find the most moral choice.

Flaw: no ranking of importance between pillars to come to a choice with conflicting interests

Question 8

Alternative medicine: definition, examples

Answer 8

Alternative medicine: Form of medicine taken instead of conventional treatment, different to complementary medicine.

Aromatherapy, reflexology, herbalism and acupuncture are a few.

Question 9

Alternative Medicine: considerations

Answer 9

For
Can help relieve side effects of conventional treatment.

Mental health benefits: support and relaxation.

Beneficence: reduces side effects and can have placebo effect benefits if used a as complementary medicine.

Autonomy: they should be able to use it if they feel it works.

Against

Non-maleficence: unregulated in the UK so can these medications do harm or interact with other medications? If no harm is done (e.g. used as adjuvant therapy) is it ethical?

Not evidence based, usually anecdotal. (Placebo is evidence based)

Question 10

What are the Fraser Guidelines?

Answer 10

Set of guidelines to help practitioners make decisions regarding the prescription of contraception in minors.

Subset of Gillick competence and are 5 principles.

· Cannot be persuaded to involve their carers.
· Must understand the advice being given.
· They are likely to suffer physically or mentally without the contraception.
· In the patient’s best interest to receive the advice or treatment.
· They are likely to continue having sex.

Question 11

What is Big Pharma?

Answer 11

the lucrative pharmacological industry leading to pharmaceutical companies persuading doctors that their drug is the most effective. Issues with beneficence here as pharmaceutical companies aim to profit over providing the best care.

Question 12

What is Publication Bias?

Answer 12

the notion that only significant results tend to be published after being peer reviewed by journals. However insignificant results can be important to allow doctors to know there is no difference between certain treatment options, meaning that this can do harm as doctors are not getting all the information required for patient care.

Question 13

Fertility Treatment: define, NICE, success rate, CCG

Answer 13

Fertility Treatment: assisting those with fertility problems with conception.
NICE says women under 40 can be offered 3 rounds of IVF, and above 40 1 round.

They must be criteria like how long their willing to try or any previous attempts made, but there is a low success rate of 20-35%.
If NHS does not fund it you can go private.

CCG (Clinical Commissioning Groups): 12% of CCGs offer women funding for 3 cycles under 30, some for only under 35-year-olds, this goes against NICE guidelines.

Question 14

Fertility Treatment: considerations

Answer 14

For
Justice everyone has reproductive rights.

Beneficence: Gives patients a chance to have a family,

Non-maleficence: emotional harm to not provide a chance?

Against

Low success rate waste of resources?

Autonomy: postcode lottery restricts patient choice

Beneficence: increases risk of birth complications as they allow IVF for older women

Question 15

Colleague Absence: Define, Considerations

Answer 15

A colleague missing ocmpulsory education or work.

Responsibility: if it impacts patient safety, it is your responsibility to act.

Non-maleficence: missing key info could cause harm, clinical year knowledge.

Beneficence: creates awareness for the colleague to understand the consequence of their absence.

Justice: Only fair they should attend all sessions.

Question 16

Genome editing: Considerations

Answer 16

Case study: Lulu and Nana

For:
Beneficence: removing genetic diseases does good.

Non-maleficence: we have the possibility but aren’t using it?

Justice: reducing frequency of genetic diseases

Against:
We don’t know side effects yet?
designer babies?

Perpetuating inequalities.

Religious: editing with nature too much.

Question 17

Learning Disabilities: Define, considerations

Answer 17

Significantly reduced ability to understand new or complex information as well as a reduced ability to cope independently.

Spectrum of learning disabilities, we should adapt practice towards individual patients.

Autonomy: right of patient to have control over treatment

Mental capacity act 2005: may have to check using these criteria. (DoLs)

Question 18

Guardian Responsibilities: Define, Considerations

Answer 18

Guardian: individual in charge to care for another person. Responsibility to protect.

Sunscreen debate: mentioned on GMB, should parents be fined for not putting sunscreen on their children, clear risk of melanoma from sunburns. Should we prioritise education of sun damage over fines? If parents now the risks are they being neglectful?

Beneficence: wanting to do good for the patient who has put trust in you, needs have a strong line of communication.

Justice: how can this be enforced in a non-targeted way?

+:
Non-maleficence: preventing children from coming to harm.

-:
Autonomy: fines could limit individual autonomy, who would be responsible in this case prioritise education.

Question 19

Lost communication: define, considerations

Answer 19

family member finds out they have a chronic inheritable condition but is no longer in contact with other family for reasons such as a family dispute (complex).

Sensitivity is vital here to make patients aware of the issue but respecting it’s a difficult topic to discuss.

NM: prevent harm coming to patient that could have inherited this condition

B: doing good for the patient by potentially managing it.

J: right to know or not know, but they should be informed that they could have it.

Question 20

Neglect: define, case

Answer 20

substandard care provided by a medical professional (misdiagnoses, incorrect treatment, surgical errors) and can lead to legal action, compensation, disciplinary action.

Case: Dr Bawa-Garba Case

Question 21

Identifying negligence: duty of care, steps to identify

Answer 21

Duty of care:
GPs to all patients/ people within practise

NHS trusts owe duty of care to all those admitted

Doctors outside of the NHS owe care to those who they offer and accept care.

Steps:
review situation, establish whether negligence occurred, duty of care was present, breached, caused harm. Consult with senior staff members or med school and establish next steps.

Question 22

Organ Market: define, info, considerations

Answer 22

Trading of human organs, tissues usually for transplantation.

Usually in Developing countries but two cases of trafficking in 2014 in the UK, little known but stopped before any operations occurred.

Source of organs not known so we do not know if there was a monetary, voluntary or involuntary supply. Incredibly lucrative and often exploitative.

N: matching isn’t done that well can cause harm, donation or purchasing of organs are likely to be exploited.
J: wealth gap, those with more money can access organs quicker.

Question 23

Paternalism: define, consierations

Answer 23

ideology that doctors have all control over patient care and ‘know best’, no patient consultation, using medical jargon to isolate the patient.

A: against this by dictating medical decisions and distrust of the profession.

N: can go against wishes and cause harm through anxiety and confusion.

Patient centred care: empowering patients to make own decisions in care.

Autonomy, dignity, respect and trust. Creates confidence in medical community and betters mental health through a higher doctor-patient satisfaction.

Question 24

Physical Abuse: define, experiences as a med student, responsibility, legislation

Answer 24

Non-accidental, physical injury to an individual, Can be violence or sexual

Experience of abuse as a medical student: patients may confide in you, examining a patient to notice signs, reporting of abuse by another family member, noticing a dynamic between partners or children.

Responsibility: to identify and not dismiss them, consult in a safe and supportive environment, signposting or reporting to helplines charities or senior staff or authorities.

Legislation: United National Convention on the Rights of the child, The Care Act.
NHS professionals must ensure safeguarding principles are applied.

Question 25

Private Practice: Define, Privatisation define, considerations

Answer 25

NHS is free at the point of use available for everyone at any time. Alongside runs a private sector which is often faster and more extensive.

Privatisation: different to private practice but involves increasing funding for the NHS coming from the private sector.

+:
Reduces waiting lists, freeing NHS resources
Private patients still pay national insurance so still support NHS.
Autonomy: should be able to access private care if they wish to.
Doctors can use private sector to supplement income

-:
Wealth gap: better healthcare through paying for medications.
Health gap: those with chronic conditions require higher insurance prices.
· Unfair: effectively queue jumping
· Doctor-patient relationship: adding commercial elements may erode trust, knowing whether a doctor is advising a scan as it will bump their salary or be in the patients’ best interests?

Question 26

Racial Abuse: define, considerations

Answer 26

Series of incidents intended to offend or harm an individual because of their ethnic origin, race, religion or nationality.

N: prevent harm of yourself colleagues or patients.

B: do good for yourself and support against racial abuse whilst upstanding a quality of care.

J: treat everyone as equal within NHS, act against any instances as your duty.

Question 27

Verbal Abuse: define, considerations

Answer 27

Verbal abuse: form of emotional abuse consisting of the use of abusive and demeaning language.
N: need to prevent harm and protect against your own harm.

B: doing good for the patient vs own protection.

J: treat everyone as equal in NHS, including those who have been verbally abusive.

Question 28

Climate Change and Health: Determinants, threat

Answer 28

Determinants: affects social and environmental determinants of health – clean air, safe drinking water, sufficient food, secure shelter.

Threat: single biggest health threat facing humanity, health professionals are already responding to health harms caused by unfolding crises.

Question 29

Climate Change and Health: coping, tackling, costs

Answer 29

Coping: developing countries with weak infrastructure will struggle to prepare and respond

Tackling: reducing emissions from transport, food and energy use can result in improved health usually through reduced air pollution.

Costs: direct damage costs to health is estimated to be between $2-4 billion per year by 2030.

Question 30

Climate Change and Health: Direct impacts, Indirect Impacts

Answer 30

Direct impacts of climate change on health:
· Air pollution: lung function, hospital admissions, asthma, premature deaths
· Allergens: higher pollen, longer pollen seasons, more suffering from allergens, more anaphylaxis and antihistamine use.
· Wildfires: smoky exposure, respiratory and cardiovascular hospitalisations, A&E Visits.
· Heat: heat stroke, increased cardiovascular, respiratory, cerebrovascular and renal disease are all increased during heat waves.
· Precipitation: floods are deadly due to drowning.
· Vector borne diseases: changes in season distribution.
· Diarrheal disease: air and water temperatures and seasonal variations affect disease transmission.
· Mental health: increase in mental health problems following natural disasters.

Indirect consequences:
Population displacement, Food scarcity, financial insecurity and health inequalities.

Question 31

Abortion: Define, legislation, types, covid

Answer 31

Abortion: terminating a human pregnancy surgically or through medication.

An abortion can only be legally carried out if 2 doctors agree that the continuation of pregnancy may negatively impact her mental or physical health or of her children.

Surgical: up to 14 weeks, vacuum or suction aspiration.

Medical: up to 10 weeks, mifepristone and misoprostol, inhibits progesterone release, and uterine contraction. Two pills 24 to 48 hours apart.

In 2018 it was legalised to take the second pill at home without medical supervision.

Surgical abortion:
Up to 14 weeks: suction aspiration. After 14 weeks, dilatation and evacuation.

Current legislation: 1967 abortion act up to 24 weeks in pregnancy.

Legal after 24 weeks if life is at risk due to pregnancy or the child will be born with a severe disability.

Northern Ireland: 1981 criminalised, 2018 referendum on abortion and 2019 decriminalised. The abortion regulations 2020 came into effect April 2020 allowing unconditional abortion up to 12 weeks, then up to 24 weeks for mental or physical risk then after 24 for severe risk to the child.

Termination must only be carried out by medical professionals however ordering pills and using them at home will not be prosecutable.

During Covid, it was allowed to take these medications at home following a telemedical consultation.

Question 32

Abortion: Considerations

Answer 32

For
Mothers suffering: rape/incest may cause psychological damage.

Legalising prevents harm and death due to unregulated home abortions.

Autonomy: patient choice to terminate should be respected.

Most abortions occur within first 3 months, when the foetus cannot exist independently.

Against

Religious and social objects: the beginning of human life. Tantamount to murder

Rape/incest experiences cause the child to be punished through abortion

Psychological distress of an abortion (regret)

Other possibilities: adoption, no termination required.

Question 33

Capacity: define, info, legislation

Answer 33

Capacity: Using info about an illness and treatment options to make an informed decision congruent with one’s own preferences.

Key to autonomy: patient must understand the decision they are making.

Consent: must be voluntary informed and have capacity to give permission to a form of medical treatment.

Mental Capacity Act 2005: All adults have capacity is assumed, need be able to understand, retain, weigh up and communicate explaining their reasoning back to the doctor.

Question 34

Euthanasia: define, active/passive, voluntary/involuntary, assisted, legislation

Answer 34

Euthanasia: actions taken to end someone’s life and relieve suffering.

Active/passive: Deliberate intervention e.g. OD on muscle relaxants/ Withholding treatment that is required to maintain life.

Voluntary/Involuntary: Requested/manslaughter

Assisted dying: helping a patient by providing them with the means to end their own life when they are already dying.

Assisted suicide: giving someone the medication required to end their own life.

Illegal in the UK.
2018 ruling that legal permission from the court is not required to withdraw treatment from patients in a permanent vegetative state.

Legal in Switzerland, Netherlands, Colombia, Luxembourg, Belgium, Canada, Spain, New Zealand and parts of Australia.

In Australia a voluntary assisted drying scheme was introduced which also allows for assisted suicide.

Question 35

Euthanasia: considerations

Answer 35

Acknowledge the ethical implications, state frameworks, provide balanced argument, provide conclusion.

Ethically complex, illegal in UK, Assisted dying bill moving through parliament and rejected, Consequentialism and deontology then prinicplism. Should be legalised, protect patient autonomy.

Ethics:
Autonomy: allowing patients to decide for themselves would be the compassionate thing to end intolerable suffering.

Acting in best interests: you are the best judge of what’s best for you

Double effect is legal, legalising euthanasia would not lead to more deaths but more people having a good death.

Against
non-maleficence, doctors into executioners

Assumes doctors are always beneficent, assisted dying or suicide may be an easier route for the doctors, increasing potentially avoidable deaths.

Could be bullied into choosing death
The possibility of the premature ending of lives could outweigh the small number of people this would benefit.

Question 36

Doctor Strikes: Considerations

Answer 36

For
Shouldn’t have to accept poor working conditions.

Improve quality of life will make them better clinicians.

Evidence shows mortality of patients remains at the same level during strike action.

Industrial action must be impactful to be effective.

Understaffing will get worse with more doctors working abroad for better pay.
Right to strike recognised by the UN, but Conflict of rights and ethical employees (Justice).

Striking is required to ensure long term patient safety by ensuring better standards for doctors, the short-term drop is a necessary consequence (beneficence/ consequentialism and deontology).

Against

Longer emergency wait times, compromises safety.

Cancellation of appointments and theatre lists understaffed.

Fewer doctors, more stress, more errors. (NM)

Erosion of doctor patient relationship.

Costs NHS 1bn since start of year, could be used for med equipment.

Extra stress on MDT.

Question 37

Language Barriers: define, considerations

Answer 37

Language Barriers: increasingly multicultural, more frequent non-English patients.

Ethics:

Non-maleficence: prevent harm by thorough communication, misdiagnoses, ignoring a red flag, wrong medication

Beneficence: wanting to do good for the patient who has put trust in you, needs have a strong line of communication.

Justice: treat equally within the NHS to ensure quality of care is not compromised.

Question 38

Organ Donation: define, conditions to donate, supply?, current policies in UK, covid impacts

Answer 38

Organ donation: removal or an organ with the intention of transplantation.

Living donation of non-essential organ or donation of organs from a dead patient. Must match organs using testing and also immunosuppressants.

Disparity in supply and demand. Increase in safety equipment in vehicles have led to less brainstem deaths leading to less viable organs from the dead.

UK used to have an opt in system, now opt-out system, in Scotland and Wales they operate on opt-out namely deemed consent (Wales)/ authorisation (Scotland). NI has opt out
Opt-out policy: assumed consent.

Covid impacts: concerns of transmission of covid through organ transplant (isn’t the case now known), increased mortality of patients waiting, organ transplantation was still maintained at 75% capacity even during covid, will require recovery time to regain transplantation capacity.

Question 39

Organ Donation: Considerations

Answer 39

For

More organs donated, 421 people died in 2022 waiting for an organ, could be avoidable in future.

Prioritisation: arguable that patients waiting for organs should be prioritised over deceased people who have not expressed a preference.

Normalisation: opt-out would make organ donation seem more normal than the heroic stance the opt-in system takes.

Against

Autonomy: not knowing of the system may end up going against their wishes, education is vital

Respect: could be argued to priotise the dead, especially due to religious objections.
Alternatives such as more encouragement to opt in could be trialled.

A: is it a breach of autonomy to assume yes without people understanding what this means for them? Does the opt part provide a solution to this by still providing and advertising the choice to people? Education is vital here.

J/B: potential breach of A made up for by benefiting the wider community?