framework for ethical analysis Flashcards
GMC: Good medical practiceDuties of a doctor (2013, 14, 19)
Knowledge, skills & performance
Make the care of your patient your first concern
Safety and quality
Communication, partnership and teamwork
Maintaining trust
Consequentialism
it promotes best consequences.
Most common form is utilitarianism
deontology
it is in accord with a moral rule or principle. Duties and Rights based morality
virtue ethics
it is what a virtuous agent would do in the circumstances.
e.g. a good doctor is one who is: Caring, Disciplined, Skilful Trustworthy
Four Principles of Medical Ethics
autonomy - respecting the patient’s wishes; helping them come to their own decisions
no maleficence - do no harm
justice - fairness in the provision of care; distributive justice; rights based justice; legal justice
beneficence - doing good and acting in the patients best interests
Four Quadrants
medical indications
patient preferences
quality of life
contextual features
medical indications
Consider each medical condition and its proposed treatment:
Does it fulfil any of the goals of medicine?
With what likelihood?
If not, is the proposed treatment futile?
patient preferences
What does the patient want? Does the patient have the capacity to decide? If not, can anyone advocate for the patient?
Do the patient’s wishes reflect a process that is: informed? understood? Voluntary? Continuing?
quality of life
Describe the patient’s quality of life in the patient’s terms and from the care providers’ perspectives.
contextual features
Circumstances that can either influence the decision or be influenced by the decision
Prof Bowman’s guide to helping you think through cases (p10):
- Summarise the case or problem
- State the moral dilemma
- State the assumptions that are being made
- Analyse the case
- Acknowledge other approaches and state the preferred approach with explanation
why do basic errors happen? - Sokol & Bergson
- Stress
- Fatigue
- Covering for colleagues (too little locum support)
- Professional culture (unwillingness to use support structures)
- Feeling that decisions must be made alone
- Unable to admit to uncertainty
bowman - why is it difficult to admit and report errors in medicine
- Consequences:
- Does error = incompetence? (after all, everyone makes mistakes…)
- Whistle-blowing is not without risk (far from it in fact…)
- Medicine is not an exact science
- Some argue that there is a “norm of non-criticism”
Francis Report
• Stafford Hospital
• “They (Stafford Hospital patients) were failed by a system which
ignored the warning signs and put corporate self-interest and
cost control ahead of patients and their safety.“
• 290 recommendations including:
– Duty of Candour: A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes
Duty of Candour (2015)
‘To place a duty of candour on health and social care organisations. This would create a legal requirement for health and social care organisations to inform people when they have been harmed as a result of the care or treatment they have received.
• To establish new criminal offences of ill-treatment or wilful neglect in
health and social care settings; one offence applying to individual health and social care workers, managers and supervisors, and another applying to organisations’