Ethics Flashcards
Two patients come into ER both requiring a lung transplant
- 12 year old girl with cystic fibrosis
- 64 year old chronic smoker with wife and two children
Who gets it?
Firstly link to medicine: This is quite a horrible question but it does go to show that in medicine decisions like these need to be made daily
- Look into autonomy which is the patient’s right to choose, so make sure both patients actually want the lung transplant and would be able to carry through with the follow up.
- Look into alternative treatments, for example there could be one that helps one patient more than the other. That said we want to use beneficence and reduce maleficence so do the least amount of harm to the patient who doesn’t receive the lung
- It is worth saying that I would discuss this with my colleagues as isn’t a straightforward decision to make: Medicine is about teamwork and working in a multidisciplinary team
- Look at waiting list to see who has been on it for longer. It is very important that we don’t discriminate based on age or the fact that he has been smoking
- I would probably give the lung to the younger girl with cystic fibrosis
Are there any times when lying can be justified in medicine?
In most cases i believe patients always have the right to the truth about the mistakes of doctors or about their illnesses. This is because of their autonomy.
When I was doing work experience in a hospital near me a 16 year old girl came in who had overdosed on paracetamol.
The doctors prescribed her acetylcysteine to counteract this, but they accidentally gave her double the dosage of it because of miscommunication between them and the nurses.
However the amount given wasn’t actually a toxic amount so they had a group discussion about the pros and cons of telling her. For example a con is that she stops trusting the healthcare staff, however it is also important to respect the pillar of maleficence to do no harm and you could argue that they technically didn’t do any harm.
Overall they made the decision to not tell her to not worry her.
So in this case they technically lied but they believed it was for a good cause and I understand why they made that decision.
You could bring in Gillick competence, that she is 16 so has the right to know about what is happening to her so she can make her own decision about it.
What ethical principal of medicine is the most important?
I believe all principals of medicine are important, for example autonomy, confidentiality, justice, beneficence and maleficence .
Autonomy is important because giving the patient a say in their treatment is vital for maintaining a trusting patient doctor relationship. It is also their body at the end of the day that will have to endure that medication or treatment so it is important they get a say in that.
Justice also ensures that no one is discriminated against when it comes to be treated so helps society become a fairer place.
Beneficence is about always seeking to do good and help people to make a positive change in their lives. This would be the reason I’m very interested in studying medicine because I want to know I’m improving the world in some way.
Overall, I believe Beneficence is the most important pillar because it is important to consider all treatment options to find the best course of action for the patient. Also at the end of a patients life, beneficence requires they feel comfortable and supported thoughout that process, which I believe quite strongly is very important.
You walk in on a doctor drinking from a glass bottle then hiding it in his locker, then he slurs his words and is forgetting things.
I think first it is important not to jump to any conclusions so I would begin by approaching him in a polite manner and possibly making small talk to make him feel for comfortable. Then I would gently ask what is in the bottle, without judging him to see if he wants to voluntarily explain the situation to me.
However the priority here is patient safety so I’d have to make sure he isn’t seeing any patients that day as this could compromise care.
I’d suggest he go home and that we can talk about it tomorrow when he is in a better state.
The next day I would bring it to a higher authority if he admits to it as it is unacceptable to be under the influence whilst being responsible for someone elses life
What is the duty of Candour
The general responsibility to be open and transparent with your patient.
What is Gillicks competence
The ability for teenagers, like people under 16 to make their own decisions about their treatment.
So children under the age of 16 can consent to medical treatment without the consent of their parents.
This can only happen if the doctor is certain the child has the capacity to understand and is emotionally mature enough.
If a child lacks this capacity under the age of 16, someone else can consent on their behalf
So although they are looked after by their parents, it is their decision in medicine unless they don’t have the capacity to make that decision themselves.
What are fraser guidelines
