Ethics Flashcards
consequentialism
end justifies the means (the morally right action is one that gives rise to the best consequences or outcomes)
John Stuart Mill
give 3 types of consequentialism
utilitarianism
egoism
alturism
utilitarianism
the best course is the one that promotes most happiness/ pleasure and absence of pain for all (lesser of two evils)
egoism
the best course is whats best for you (may be positive, negative, neutral for others)
altruism
the best course is whats best for others well-being
deontology
duty based theories.
duty of care to each other
there are fundamental rules and duties to follow, and as such certain acts are seen as wrong no matter the consequences
moral absolutism
certain acts are good or bad, irrespective of intent or consequences
kantian
one must act from duty, and it is the motives of the decision maker, rather than the consequences of the action that make something right or wrong
contemporary approach (deontology)
centre on ‘permissible harm’
(can divert a train to save 5 but kill 1*, but cant kill 1 to harvest organs for 5)
*some harm inevitable anyway
four principles
autonomy
beneficence
non-maleficence
justice
autonomy
freedom for patient to choose and advocate for their own health
(Problem: mental health, pregnant, children )
beneficence
what is considered in the patients best interests
non-maleficence
balance actions benefits against harm
justice
equity and avoiding discrimination at both an individual and societal level
dynamism
situations are almost always dynamic, a decision taken at one time may not be appropriate at a later stage
clinical truth
contextual, circumstantial, and personal
objective truth
reality
Formula of universal law (Kant)
could you live in a world where everyone acted this way
Formula of humanity (kant)
don’t treat people as a means to an end (don’t use people)
virtue ethics
Compassion, patience, kindness, fidelity - characteristics
Assume person of good character will always act in right way …?
+vs and -ves of virtue ethics
+ve
• Whole person taken into account
• Centres ethics on the person and what it means to be a human
-ve
• No help in moral dilemma
• Virtues not clear
• Virtues dependent on culture they are devised in
ethics in practice
Candour open and honest disclose errors Ethical, regulatory (GMC 2013), contractory (NHS), statutory Consent Capacity Confidentiality Communication
what are 2 types of uncertainty
objective
subjective
2 types of objective uncertainty
aleatory - cant know anymore
epistemic - don’t know anymore
2 types of subjective uncertainty
ethical - i don’t know what i should know
choice - i dont now what i want to know
what does the GMC state about whistle blowing
‘ you must make the care of your patients your first concern’
Seedhouse grid – 4 layers:
- Autonomy (innermost layer – consider first)
- Beneficence , truth (+ non-maleficence)
- Balance pt. and society
- External considerations and law
(outmost layer)
Complexity theory
consider connectedness of living world
Connectivity and interdependence – how the behaviour of one individual affects others
Co-evolution – adaption/ changes of one aspect on another – doctor and pt. co-evolve
Far from equilibrium – essential for pt. surviving and flourishing
History – pt. and doc influence by prev
Feedback – increase returns
Self-organisation, emergence, creation of new order – Gestalt principle
Four quadrant approach
Medical indications
- Beneficence and non-maleficence
- Review tx/ diagnosis
Patient preferences
- Autonomy
Quality of life
- Beneficence and non-maleficence
Contextual features
- Loyalty and fairness
- Encounter Inc. family, law, insurance
Conscientious objection
can opt out of providing procedure because of personal beliefs AS LONG AS no direct/ indirect discrimination, harassment of individual pt./group
Abortion act 1967:
consent (x3)
voluntary
informed
capacity
negligence (x3)
duty of care
breached
resulting in harm
test for whether duty of care was breached
Bolam test - did dr act as majority of peers would have acted
what does consent guard against
- Exploitation
* Medical paternalism
what are 3 forms of consent
implied (hold out arm for vaccine)
written
oral
capacity
understand
retain
decide
communicate decision
which bears most weight, living will or LPA?
Hierarchy:
- Living will
- Lasting power of attorney
- Court of protection
- Deputy court of protection
- Doctors
- (relatives/ patients do not make decisions)
when can you break confidentiality
o Judge o Police and criminal evidence act o Pt. consent o Other involved in pt. care o Coroner o Police – RTA and terrorism
what act does confidentiality come under
Data protection act 1998
when may someone lack capacity
o Unconscious
o Lack understanding
o Severe learning difficulties
(mental capacity act 2005)
what treatment can you give under mental health ac 1983?
- Only enforce treatment for mental health problems e.g. depression, not for medical procedures
what does the Mental capacity act 2005 state (3 things)
- A person must be presumed to have capacity unless it is established that he lacks capacity.
- An act done, or a decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made in his best interests.
- Capacity must be honoured even if unreasonable
what law does negligence come under
law of tort
