General ethics

Question 1

4 medical ethical pillars?

Answer 1

beneficence
justice
non - maleficence
autonomy

(confidentiality)

Question 2

Autonomy defintion

Answer 2

Autonomy is the right of patients to make informed decisions about their own medical care as long as they are competent. This includes choosing to refuse treatment.

Question 3

Justice definition

why is it important?

Answer 3

Justice refers to fair access and distribution of medical care. This considers the rights of a patient and whether something is compatible with the law.

Whether an action is fair across a population in terms of legality and societal expectations. Benefits, costs and risks must also be spread fairly, especially when in short supply.

It’s in place to ensure that no one is unfairly disadvantaged when it comes to access to healthcare. For example, providing free prescriptions to low income households.

Question 4

Beneficence definition

Answer 4

The duty to good.

This may vary based on the circumstances

Question 5

Non-maleficence definition

Answer 5

The duty to do no harm

the definition of harm may vary based on the situation or person defining it.

Question 6

Which pillar is most important?

Answer 6

I think that all the pillars only completley focus on the patients benefit when they work together.

However, I think I could say that beneficence is the most important pillar.

This is because the duty to do good could be the considered the basis of every action of a medic.

You could even say all pillars are based on the duty to do good

you follow non - maleficence because maleficence contradicts beneficence

you follow autonomy because respecting a patients right to make decisions about their healthcare is doing good by showing them respect and dignity

you follow justice because you do the most good by being non-discriminatory and making sure healthcare is accessible to all.

Question 7

Which pillar could be the hardest to follow?

Answer 7

I think the hardest pillar to follow may be Autonomy.

This is because as medics we have vast knowledge on conditions and their treatments, and like any person we may form an opinion on the best course of treatment while trying to form and give patients your proffesional advice. If patients disagree with the options we provide we may inclined to try to persuade them, we can justify this by saying we are trying to make sure they are fully informed. However after you’ve explained all the treatments options and their advantages and disadvantages, after a certain point patients may feel pressurised. As doctors we have to be very conscious of this line.

Question 8

+ and - of justice

Answer 8

1) Is this action legal?
2) Does this action unfairly contradict someone’s human rights?
3) Does this prioritise one group over another?
4) If it does prioritise one group over another, can that prioritisation be justified in terms of overall benefit to society or in terms of morality?

Question 9

+ and - of maleficence

Answer 9

1) What are the risks associated with intervention/non-intervention?
2) Do I possess the required skills and knowledge to carry this out?
3) Is the patient being treated with dignity and respect?
4) Is the patient being put at risk by other factors (e.g. staffing, resources)?

Question 10

+ and - of beneficence

Answer 10

1) Will this choice resolve the medical problem?
2) Is this proportionate to the scale of the problem?
3) Is this compatible with the patient’s individual case?
4) Is this in line with the patient’s expectations?

• It only applies if it outweighs maleficence
• What is good is highly dependent on the circumstances

Question 11

+ and - of autonomy

Answer 11

1) Have we explained fully the patient’s medical condition, their options for treatment and the advantages and disadvantages of those treatments?
2) Is the patient able to retain this information, evaluate their options and arrive at a decision?
3) Has the patient provided informed consent for our actions?

• A patient cannot simply demand any treatment they like. They can only choose from the options outlined to them.
• In cases where a parent makes a decision for a child, the beneficence may outweigh the parents’ decision. (e.g. A parent refusing treatment for a life-threatening condition that their child has can be overruled by the doctor acting in the child’s interest)

Question 12

confidentiality definition

Answer 12

The duty of confidentiality requires Doctors, and other healthcare professionals, to keep their patients’ information private within the healthcare team, apart from some very specific circumstances.

These circumstances include the following:

Where the patient has consented to the sharing of information.

Where not sharing the patient’s information puts the patient, or others, in danger.

Where the patient lacks capacity and sharing information is of overall benefit to the patient.

Question 13

+ and - of confidentiality (to breach)

Answer 13

Is it likely that anyone will be harmed as a result of the consultant’s drinking?

What impact will revealing this information without consent have on the consultant?

Is there anything else that can be done which does not involve a break in confidentiality?

Question 14

What are the 6 NHS values

Answer 14

1) working together for patients. Patients come first in everything we do

2) respect and dignity. We value every person – whether patient, their families or carers, or staff – as an individual, respect their aspirations and commitments in life, and seek to understand their priorities, needs, abilities and limits

3) commitment to quality of care. We earn the trust placed in us by insisting on quality and striving to get the basics of quality of care – safety, effectiveness and patient experience right every time

4) compassion. We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person’s pain, distress, anxiety or need

5) improving lives. We strive to improve health and wellbeing and people’s experiences of the NHS

6) everyone counts. We maximise our resources for the benefit of the whole community, and make sure nobody is excluded, discriminated against or left behind.

Question 15

What are the 7 NHS constitutions

Answer 15

1. The NHS provides a comprehensive service, available to all - does not discriminate against factors such as gender, religion, sexual orientation etc. It has a wider social duty to promote equality through the services it provides and to pay particular attention to groups or sections of society where improvements in health and life expectancy are not keeping pace with the rest of the population.
2. Access to NHS services is based on clinical need, not an individual’s ability to pay - NHS services are free of charge, except in limited circumstances such as non-emergency dental treatments
3. The NHS aspires to the highest standards of excellence and professionalism - It provides high quality care that is safe, effective and focused on patient experience
4. The patient will be at the heart of everything the NHS does - It should support individuals to promote and manage their own health + the NHS will actively encourage feedback from the public, patients and staff, welcome it and use it to improve its services.
5. The NHS works across organisational boundaries - It works in partnership with other public sector and volunteer sector organisations in the interest of patients
6. The NHS is committed to providing best value for taxpayers’ money - most effective, fair and sustainable use of finite resources + Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves.
7. The NHS is accountable to the public, communities and patients that it serves - The system of responsibility and accountability for taking decisions in the NHS should be transparent and clear to the public, patients and staff + the government provides an up-to-date statement of NHS accountability

Question 16

Equity

Answer 16

Another name for justice

Question 17

Consequentialism

Answer 17

Consequentialism is an ethical ideology that states the morality of an action is dependent purely on its consequences. A simpler way to phrase this would be that the “ends justify the means”. If your action has an overall benefit, then it does not matter about the action itself.

Example: Your patient has a terminal illness and is not likely to survive the operation she is about to undertake. Just as she is about to be anaesthetised, she asks you: “Doctor, will I be okay?” A consequentialist ideology supports that lying in this circumstance is acceptable, even though lying itself is not a moral action.

Question 18

Utilitarianism

Answer 18

Utilitarianism says the best action is that one that brings about the best increase in utility (benefit). Utility is generally considered on a broad scale, often taking into consideration wider society and not just the patient in question. It’s a form of consequentialism.

Example: You have a sum of money to either fund a very expensive treatment for one patient with a rare disease or five patients with a very common and easy-to-treat disease. Utilitarian ethics dictates that treating the five patients is morally superior as a greater overall benefit is achieved.

Question 19

Deontology

Answer 19

Deontology is also known as “duty-based ethics”. This ideology states that the correct course of action is dependent on what your duties and obligations are. It means that the morality of an action is based on whether you followed the rules, rather than what the consequence of following them was.
This is in direct contrast with consequentialism.

Example: If your terminally ill patient asks if they’ll be ok after a surgery they’re unlikely to survive, a deontological approach would suggest you don’t lie to comfort them. That’s because according to this concept, lying isn’t morally acceptable because it’s our obligation not to lie – no matter the consequences.

Question 20

Competency

Answer 20

The ability to understand, retain and reproduce information to make informed decision.

Understand the information they are given
Remember the information
Use the information (weighing up benefits and risks, etc) to make a decision
Communicate their decision

Question 21

+ and - of competency

Answer 21

A person’s capacity can change over time, so it should be assessed at the time when consent is needed.

Capacity is usually assessed by the medical professional who is recommending the treatment and/or carrying it out. If they determine that the patient has capacity to consent, the patient’s decision will be accepted.

Even if they lose capacity at a later stage, the patient’s decision that was made when able to consent will continue to be respected.

Question 22

Gillick’s competence

Answer 22

The term used to describe whether a child under 16 years of age can consent to their own treatment without parental permission.

There is no defined set of questions but there is a list of factors to consider - eg) their rationale, their understanding of risk, their age and the mental capacity.

Question 23

Informed consent

Answer 23

When the patient has consented to a procedure or treatment, having been given and having considered all the facts that were necessary for making a decision.

Question 24

What are the other ways of gaining consent other than informed consent? / How does informed consent play a role in emergency situations?

Answer 24

express consent - permission for something that is given specifically, either verbally or in writing.

implied consent - Consent that is inferred from someone’s actions

In emergency situations, for example in cases where patients cannot speak, doctors must follow the principle of beneficence and act without a patient’s verbal consent. They may just nod or may be unconscious.

They can’t get informed consent when they are not competent and have no one else to direct their care. Must follow any advanced directive, then principles of beneficence and non - maleficence, also confer with multidisciplinary team.

Question 25

Euthanasia

Answer 25

Active euthanasia: When the acting person deliberately intervenes to end someone’s life. For example – a Doctor injecting a patient who has terminal cancer with an overdose of muscle relaxants to end their life would be considered active euthanasia.

Passive euthanasia: Where a person causes death by withholding or withdrawing treatment that is necessary to maintain life. For example – withholding antibiotics from someone who has bacterial pneumonia.

Question 26

Assisted suicide

Answer 26

The only difference between this and euthanasia is the person who actually performs the final act. In assisted suicide, the physician intentionally gives the patients the means to take the lethal medication themselves whereas for active euthanasia, the physician is the one who commits the act that directly causes death.

Question 27

Power of Attorney

Answer 27

A written authorization to represent or act on another’s behalf in private affairs, business, or some other legal matter.

Question 28

Battery

Answer 28

When consent for a treatment is not obtained by the doctor.

Question 29

Revalidation

Answer 29

The mechanism used to ensure the continuing competence of health practitioners, making sure they are fit to practise.

Question 30

Audits

Answer 30

-Systematic examinations of current practice to assess how well an institution or practitioner is performing against set standards.
-Used to reflect, review and improve practice.

Question 31

Notifiable diseases

Answer 31

Diseases that doctors have a duty to report to authorities (even against patient confidentiality). NOTE: This does not include HIV and AIDS.

Eg) Cholera - infection water due to faeces

Question 32

Assisted dying

Answer 32

Assisted dying: This is a sub-term of assisted suicide but is only used in the context of when a patient who is already dying, i.e. terminally ill, asks for help to die. Assisted dying is not usually used in the context of bringing about the deaths of patients who are not already dying (for example, paralysed patients or those who have found out that they have developed a condition in the future i.e. Huntington’s Disease).

Question 33

Fraser guidlines

Answer 33

The Fraser guidelines apply specifically to advice and treatment about contraception and sexual health for patients under the age of 16

Eg) They can’t be persuaded to inform parents, is it in their best interests? are they going to continue without medical help?

Question 34

Why is confidentiality important?

Answer 34

Ensuring the patient’s right to confidentiality is key to building trust in the Doctor-patient relationship.
It is proven that patients will under-report their symptoms, or even avoid seeking medical help if they think that their confidential information will be disclosed without consent. This makes the Doctor’s job of caring for the patient much more difficult, to the detriment of the patient.
However, knowing the boundaries of medical confidentiality is also important, because not only is appropriate information sharing within the healthcare team needed for safe and effective care provision, but sometimes, you are required by law to break confidentiality if somebody will come to serious harm if you do not.

Question 35

How does confidentiality relate to the pillars?

Answer 35

For autonomy, you should think about:
Breaking confidentiality without a patient’s consent breaks their autonomy.
It also undermines trust and may cause patients to be reluctant to seek help from healthcare professionals in the future, even if they desperately need medical attention.
This applies to children, too. If a child is Gillick competent, their autonomy should be respected the same as an adult.
However, there may be reasons you can break patient confidentiality for reasons of autonomy. For example, if a patient has told you they’ve done something illegal or have intentions to hurt someone, you may be able to nullify autonomy.

When it comes to beneficence and non-maleficence, you need to consider:
How breaking confidentiality could put a patient at risk (with the police or their parents, for example) or cause avoidable distress.
Whether you can advise a patient to tell the right people about their situation to avoid breaking confidentiality.
If you can gain consent to break confidentiality.
It’s also worth knowing that a breach of confidentiality can only occur when it is in the best interest of those involved. In some cases, it will allow patients to get the extra support they need. In other cases, it could prevent harm coming to the patient, their relatives or the general public.

When it comes to justice, keep in mind:
If confidentiality is continuously broken without justifiable reasons, the public perception of healthcare professionals could be tarnished.
Suspicions of healthcare professionals could mean that patients purposefully withhold information in fears of who it will be passed on to.
However, Doctors must always consider the impact of a situation on society as a whole. If a Doctor learns of information that will assist non-healthcare services (e.g. social services/DVLA/police) in protecting the public, it is their responsibility to disclose the confidential information if the patient refuses to.