Ethics

Question 1

In medicine how is ethics used in the allocation of resources

Answer 1

How should be treat patients
How should we allocate resources
Who gets what
Who should we treat

Question 2

There is limited resources and unlimited demand

Answer 2

We use a free market approach to health care no state intervention to more money more goods more health - thatcher

Used to be capitalism market determines distribution - price determines how goods are distributed

Question 3

Keynes welfare state

Answer 3

Opposite of free market - role of the state to invest in - stimulate and increase jobs especially in times of financial hardship

Financial benefits 
State education 
Public housing 
Employment creation and development 
Health service aimed to help individuals be healthy

Question 4

Beveridge plan - welfare states

Answer 4

Fight the giants of want
Ignorance 
Squalor
Idleness 
Disease

Question 5

What was the catalyse for the welfare state

Answer 5

WW2
Decided we should have class distinctions anymore
We,fare state was a Antione fit for heros
Healthcare for all free at the point of delivery

Question 6

Who created the NHS

What was is aims

Answer 6

Aneurin Bevan
Provide equitable distribution of health services
Provide services which were accountable for the nation
Give a sense of collective purpose or mission
And to promote the health of the nation

Question 7

Who were opposed to the NHS

Answer 7

Carlton club - Tory
BMA: said the state regulating medicine will limit professional freedom, earn less, and patients will not be able to choose a doctors

Question 8

Inevitability of rationing

Answer 8

Budget needed to be increased almost immediately
Bevan: rush to get things that are free also things they couldn’t get before
Had to introduce a prescription charge

Question 9

Concepts of justice -

Answer 9

Formal justice - treating everyone the same but maintaining existing inequalities, how our law system works

Substantive justice/ Aristotle’s formal principle of justice takes into account inequalities

Question 10

Justice as a desert

Answer 10

Treating people equally according to how deserving they are:
Lung transplant to CF patient compared to smoker
If in poverty - deserving or undeserving
Can be used to justify a to tier health system or private system
Noble failures tried to stop smoking vs someone who gave up and found it easy

Question 11

Justice as maximising utility

Answer 11

Benthams utilitarianism: maximum benefit for the most Number of people,
But may mean people don’t have a say- Jehovahs witnesses and blood transfusions
Trivial poor health of the majority would outweigh the serious need of the few
Desert wouldn’t come into it, if the majority smoked then more would go to helping smokers

Question 12

Justice as satisfying need

Answer 12

Karl Marx - from each according to his ability, to each according to his need
Money spent on those who have lots on healthcare needs
Need not just naturally generated but also from the social environment
Want vs need - children IVF
Subjective vs objective

Question 13

Value of life - fair innings approach

Answer 13

Elderly fit person had a fair innings will get lower priority in the distribution of health gains than a young person who without treatment will certainly not reach the societal norm of age of death
Cancer and great ormond street more money given than Alzheimer’s - people determined that they have run their course at their age

Question 14

QALYS

Answer 14

Measurement of life

Question 15

Justice - judicial review

Answer 15

Balance of power between the government, parliament, and judiciary rule of law
Parliament is sovereign but had to act within the law
Judiciary acts to check on the government

The Secretary of State, DoH, NHS part of the government so is subject to review

Question 16

Double jeopardy

Answer 16

A person already disadvantaged due to disease has further disadvantage due to lack of resources

Question 17

Who decides what is best for patients

Answer 17

Prior to mental capacity act 2005 it was mainly courts and Drs
Since then parliament changed this to give lawyers/ courts/ patients a greater role

Question 18

Ethical principles behind the mental capacity act

Answer 18

Freedom in the individual - in a liberal western democracy
Human rights - no one can tell you what to think believe
Ability to think, reason, and choose the way we live our lives - autonomy
Individuals are important - we are all unique - and the choices we make define our personalities and existence as human beings
Autonomy means that if we make mistakes we should live with the consequences

Question 19

Mental capacity act 2005

Answer 19

Clarifies the law dealing with the incapacitated
Codifies capacity (Re C test) and best interest patients rights
Autonomy via:
ADVANCED DIRECTIVES
Introduces the concept of substrates decision making
Court of protection

Question 20

Key principles - liberalism

Answer 20

Purpose to support not restrict / control
Presumes capacity
All practical steps must be taken to help
Unwise decisions don’t mean incapacity
Acts done to the incapacitated must be in their best interests
Least restrictive too should be chosen

Question 21

Lack of capacity

Answer 21

Patient lacks capacity if they are unable to make a decision for themselves because of impairment/ disturbance in the function of their mind / brain
Maybe permanent or temporary
Decision specific : may have he capacity to ale one decision but not at another time - Gilliick Fraser competence
Equal consideration can’t make assumption based on age, appearance or other unjustified assumptions.

Question 22

Tests for capacity

Answer 22

Need to be able to 
Understand 
Retain 
Use or weigh the information 
Communicate the decision

Question 23

Who should assess

Answer 23

No longer just the Dr - the determinator

Could be Carer lawyer or doctor

Question 24

Temporary incapacity causes

Answer 24

Alcohol drugs
Pass out 
Pain
Emotion
Fear
Medication

Question 25

What is best interest treatment

Answer 25

Life saving or diagnostic treatment -has to be justified by the determinator as in the immediate patients best interests
The person making the decision must consider all relevant circumstances and take the following steps
Will the patient regain capacity and can this decision wait until then ?
Involve the patient to the maximum extent ‘practical steps to support’
Consider past and present wishes, relevant beliefs and values
Must take into account the views of anyone’s named by the patient
If it is life sustaining treatment determination of best interests must not be motivated by a desire to bring about death

Question 26

Who decides what is best for those without capacity

Answer 26

Patient - advanced directive
Proxy decision maker - lasting power of attorney
Court of protection
Doctor/ determinator as per best interests

Question 27

Advanced refusal

Answer 27

To apply life sustaining treatment, it must be in writing signed by the patient or at the patients direction and witnessed in writing. If Dr suspects AR exists they must make reasonable efforts to find out what it says, time permitting but act in an emergency.
Refer cases to court of protection and act to save life in the mean time

Question 28

Lasting power of attorney

Answer 28

By proxy substituted healthcare decision making
Extends to welfare and healthcare, not just properly
Donor and recipient must be over 18
Donor may place restrictions on power
Donor can provide for replacement by recipient cannot appoint successor nor delegate authority

Question 29

Court of protection

Answer 29

Deals with all areas of decision making for those who are incapacitated
Objective: impartial, trained in logical reasoning, listening to both sides of the story
Power to make:
One off decision
Substituted decisions
Appoint deputies
Call for reports