Ethics: Who decides

Question 1

Why is ethics important in medicine?

Answer 1

• Medical ethics describe the moral principles by which doctors should conduct themselves
• Medical professionals often find themselves facing moral questions and ethical dilemmas when dealing with patients
• Medical ethics provides a framework to help make judgement calls which are morally sound and right for our patient
• This is important and helpful when looking at the issue of ‘who’ decides in clinical cases and care

Question 2

What are some ethical tools that can be used to to approach and analyse ethical scenarios?

Answer 2

• 4 principles approach - Non-maleficence, beneficence, autonomy, justice
• 4 quadrants
• Paradigm case process
• Ethical grid
• Structured case analysis model

Question 3

What is consent (in terms of a patient)?

Answer 3

Voluntary agreement to treatment, examination or other aspects of health care

A patients permission to examine, investigate or treat

The waiving of a right to bodily integrity

Question 4

What are the components of legally valid consent?

Answer 4

• Information - Patient should be completely aware about what the procedure or treatment will fully entail in terms that are clear and general. They should also be informed about alternative methods/procedures, and they should be fully aware of side effects of treatment and non-treatments
• Voluntariness - The patient should be aware that they do not need to proceed with treatment should they not want it, and that they are in control of their healthcare, as long as they demonstrate sufficient mental capacity. The patients should be free from pressure, duress, threats, deception, coercion or perceived coercion.
• Competence - This is the basis that patients have sufficient mental capacity in order to make decisions about their healthcare. If this is in doubt, the patient may not be able to consent.

Question 5

What determines capacity?

Answer 5

• Understand relevant information
• Retain relevant information
• Weigh up relevant information
• Communicate decisions

Question 6

How does law state that medical decisions be made for patients deemed to not have capacity?

Answer 6

• The choice of treatment or care for patients who lack capacity must be of overall benefit to them
• Patients whose right to consent is affected by law should be supported to be involved in the decision- making process, external assistance to be provided where required (sign language etc)
• Proxy decision makers could be consulted - Spouse, parents, adult children, court appointed guardian, previously expressed wishes, if know would be relevant, and best interest for the patient

Question 7

What is privacy and what are the 3 types of privacy?

Answer 7

Privacy - the legal right of individuals to control access that others could have to that individual

• Physical privacy
• Informational privacy
• Spatial privacy

Question 8

What is confidentiality?

Answer 8

The right to control sharing or disclosure of information about an individual which was exchanged or acquired by another individual in a professional context

Question 9

What circumstances would allow for breaches of confidentiality?

Answer 9

• Patient consent to disclosure- express or implied consent (employment, immigration, education etc).
• Disclosure in Public interest : public health, welfare, safety
• Statutory requirement for notifiable/reportable disease
• Court authorised or mandated disclosure
• Use of anonymised/identifiable patient information for medical training and/ or medical research

Question 10

How is confidentiality managed in infectious diseases?

Answer 10

• Certain diseases are designated as notifiable or reportable - HIV is not one of them, the usual rules of protection of confidentiality applies to this, or other STDs
• However, the GMC recognises the need to balance respect for patient confidences against legitimate concern for the interest of others who may be affected
• For example, spouse, HCWs involved with patient care and other persons known to be at risk