Ethics

Question 1

‘The top 10 ethical issues medical students should be taught’ (AMA 4/12/23)

Answer 1

1. Maintaining health and wellness as a physician
2. Using social media professionally
3. Reporting incompetent or unethical behaviors by colleagues
4. Involving medical students in patient care
5. Accepting gifts from patients
6. Working with surrogate decision-makers
7. Addressing inequities in health care
8. Managing conflicts of interests
9. Navigating genetics and reproductive medicine
10. Making decisions when professional/personal values diverge

Question 2

‘Medical Students: Expected ethical standards and behaviour’ (MPS 22/11/21)

Answer 2

1. Good medical practice
2. Personal conduct
3. Social media
4. You and colleagues
5. You and your patients
6. Your work
7. Your health

Question 3

Personal Conduct

Answer 3

Personal conduct

Probity – being honest,
trustworthy, and acting
with integrity

Question 4

Benefits of social media for doctors

Answer 4

Benefits of social media for doctors

As a doctor, using social media can help you to:
- build your professional network
- share ideas and information
- offer and access professional and peer support
- campaign on issues important to you
- follow debates and developments around your work

Question 5

Things to think about regarding social media

Answer 5

Things to think about:

Privacy
Trolling, harassment and abuse
Protecting yourself
Confidentiality
Defamation

Question 6

Rural health advocacy project advice

Answer 6

Rural Health Advocacy project advice
Start early and gather all the facts.
Remember, there’s strength in numbers. Organise. Get help if you need it.
Report it to your facility first before escalating the issue at the district, provincial, or national level.
Leave a paper trail. Document all efforts made to improve the situation and allcomplaints, and always follow up in writing.
Use the law.

Question 7

UCT Professional Standards Committee

Answer 7

• Specifically established to allow students to report unprofessional behaviour or abuses of patient rights
• Recommendation is to report the incident with course convener, trusted staff member or a colleague
• And then to report it to the PSC via Vula
• Anonymous submissions not invited (to prevent fraudulent submission) but confidentiality protected

Question 8

Cultural Relativism

Answer 8

The position that an act is right or wrong in so far as it is right or wrong for a particular culture.

As per the BMA:

A cultural relativist would say, for example, that polygamy is neither absolutely right or wrong, merely right in some cultures and wrong in others. Expressions of cultural relativism often stem from the laudable desire to show sensitivity and respect to cultural differences and, in part, to atone for past episodes of cultural imperialism.

A practical example:

If I am treating a patient from a culture that gives moral priority to the family, what am I to
make of confidentiality and consent when it is clear that decisions are made collectively?

A possible approach: Health and the relief of suffering are almost universally recognised as good
things. When deeply held cultural values seem to impede their realisation, it is always worth
exploring whether it is possible to find alternative ways to pursue them, ways that are more
respectful of the values of the patient.

Question 9

Your health

Answer 9

Moral distress
‘The concept of moral distress was defined in 1984 as (a) the psychological distress of (b) being in a situation in which one is constrained from acting (c) on what one knows to be right..’ (Jameton 2017)

Question 10

BMA: Approaches to ethical decision-making

Answer 10

Giving priority to the principles that should guide decisions
Focusing (more) on the outcomes or consequences of decisions
Giving priority to the inner dispositions or virtues of the decision-maker

‘In reality, a combination of approaches that include widely accepted general ethical principles, professional guidelines and previously settled legal cases.’

Useful/common concepts likely to be involved when confronting ethical dilemmas:

Self-determination (autonomy)
Capacity or competence
Confidentiality
Honest and truth-telling
Benefit and harm
Fairness or equity
Rights

Question 11

HPCSA
General ethical guidelines for the healthcare professions

Answer 11

Core ethical values and standards for good practice

2.3.1 Respect for persons
2.3.1 Best interests or well-being of patients
2.3.2.1 Beneficence
2.3.2.2 Non-maleficence
2.3.3 Human rights
2.3.4 Autonomy
2.3.5 Integrity
2.3.6 Truthfulness
2.3.7 Confidentiality
2.3.8 Compassion
2.3.9 Tolerance
2.3.10 Justice
2.3.11 Professional competence and self-improvement
2.3.12 Community

Ethical reasoning:

3.3.1 Formulate the problem
3.3.2 Gather information
3.3.3 Consider the available options
3.3.4 Make an ethical assessment
3.3.4.1 What are the likely consequences of each action?
3.3.4.2 What are the most important values, duties, and rights? Which weighs the heaviest?
3.3.4.3 What are the weaknesses of each option?
3.3.4.4 How would YOU want to be treated under the circumstances?
3.3.4.5 How do you expect the patient would want to be treated?
3.3.5 Discuss your proposed solution with those it may affect
3.3.6 Act on your decision with sensitivity to others who may be affected
3.3.7 Regularly re-evaluate your decision and be prepared to act differently in future

An adult patient refuses treatment because of their religious beliefs.

A patient requests an unnecessary intervention (e.g., diagnostic or therapeutic procedure, medication).

A patient comes for a routine health check and says that he would like to have a vasectomy. His wife is also your patient, and during her last visit, she said that she would like to conceive soon.