Ethics in Medical Practice

Question 1

What are the basic ethical principles?

Answer 1

Autonomy
Beneficence
Non-maleficence
Justice
Privacy

Question 2

When must informed consent be obtained?

Answer 2

Before performing any sort of medical intervention, invasive or not

Question 3

Is informed consent just an ethical requirement?

Answer 3

No, also legal requirement

Question 4

What are the elements of informed consent?

Answer 4

Information
Understanding
Voluntariness

Question 5

What is a pre-condition to informed consent?

Answer 5

Patients are competent

Question 6

How can informed consent be expressed?

Answer 6

Written
Verbal
Implied

Question 7

What is the idea of informed consent?

Answer 7

Decision ultimately patient’s, not doctor’s

Although will often be based on doctor’s expertise and recommendation

Question 8

What are some practical guides to obtaining informed consent?

Answer 8

Conversation
Transparency
Shared decision-making

Question 9

What is competence?

Answer 9

Capacity to understand information and make considered decision

Question 10

How do you determine competence in practice?

Answer 10

Have conversation

• Look for patient’s reasons for what they want
• Look to see if patient’s decision lines up with their goals, values, and preferences
• Look to see if patient’s thinking responsive to new/altered information

Question 11

What are the risk-related standards of competence?

Answer 11

Higher the stakes, the greater the capacity needed to make decisions

Question 12

What is the process for ethical decision-making?

Answer 12

1. Identify/characterise ethical issue
2. Gather relevant information
3. Identify possible options
4. Ethically evaluate options
5. Decide on option which best fulfills ethical principles

Question 13

Autonomy vs beneficence/non-maleficence?

Answer 13

Informed choice of competent patient outweighs benefit/non-harm to patient

Question 14

Privacy vs non-harm?

Answer 14

Competent and informed patient, risk of harm to self
- Privacy outweighs prevention of harm
- Don’t disclose to 3rd parties
Competent and informed patient, risk of harm to others
- Non-harm to others outweighs privacy of patient, if probability and level of harm high
- Disclose to 3rd party, minimum necessary to prevent harm
Non-competent patient, risk of harm to self/others
- Prevention of harm outweighs privacy
- Disclose to proxy, minimum necessary to prevent harm

Question 15

How is benefit and harm calculated by the patient?

Answer 15

What it is + how it feels

Question 16

What are the ethical bottom lines?

Answer 16

Any intervention proposed should be reasonably expected to produce more benefits than burdens to patient overall
Prioritise patient perspective