Medical Ethics

Question 1

What are the 4 pillars of medical ethics?

Answer 1

-Beneficence
-Non-maleficence
-Autonomy
-Justice

Question 2

What is consequentialism?

Answer 2

An ethical ideology that states the morality of an action is dependent purely on its consequences
“The ends justify the means”

Question 3

Give an example of consequentialism

Answer 3

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 4

What is utilitarianism?

Answer 4

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.

Question 5

Give an example of utilitarianism.

Answer 5

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 6

What is deontology?

Answer 6

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.

Question 7

Give an example of deontology

Answer 7

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 8

What is beneficence?

Answer 8

Beneficence means that all medical practitioners have a moral duty to promote the course of action that they believe is in the best interests of the patient.

Question 9

What aspects should be taken into account with beneficence?

Answer 9

-Will this option resolve the patient’s medical problem
-Is it proportionate to the scale of the medical problem
-Is this option compatible with this patient’s individual circumstances
-Is this option and it’s outcomes in-line with the patient’s expectations of treatment

Question 10

Why is beneficence important?

Answer 10

It ensures that healthcare professionals consider individual circumstances and remember that what is good for one patient may not be necessarily be great for another.

Question 11

Give examples of beneficence questions which you could be asked at interview.

Answer 11

-Why is it important to consider the best interests of a mother in cases involving abortions?
-What should be done if a patient refuses treatment for a life-threatening condition?

Question 12

What is Non-Maleficence?

Answer 12

Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence.

Question 13

How is Non-Maleficence different from Beneficence?

Answer 13

First of all, it acts as a threshold for treatment. If a treatment causes more harm than good, then it should not be considered. This is in contrast to beneficence, where we consider all valid treatment options and then rank them in order of preference.
Second, we tend to use beneficence in response to a specific situation – such as determining the best treatment for a patient. In contrast, non-maleficence is a constant in clinical practice. For example, if you see a patient collapse in a corridor you have a duty to provide medical attention to prevent injury.

Question 14

What aspects should be taken into account with Non-Maleficence?

Answer 14

-What are the associated risks with intervention or non-intervention?
-Do I possess the required skills and knowledge to perform this action?
-Is the patient being treated with dignity and respect?
-Is the patient being put at risk through other factors (e.g. staffing, resources, etc.)?

Question 15

What is Autonomy?

Answer 15

Autonomy means that a patient has the ultimate decision-making responsibility for their own treatment.
Autonomy also means that a medical practitioner cannot impose treatment on an individual for whatever reason – except in cases where that individual is deemed to be unable to make autonomous decisions

Question 16

What aspects should be taken into account with Autonomy?

Answer 16

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

Question 17

What is it called when a medical practitioner fails to obtain consent and respect autonomy?

Answer 17

battery – a legal term that means “an infliction of unlawful personal violence.”

Question 18

What questions about Autonomy could we be asked about at interview?

Answer 18

-What are the ethical issues involved with a depressed patient that has refused treatment, and admitted they’re having suicidal thoughts?
-Should the NHS fund treatment for smokers?

Question 19

What is Justice?

Answer 19

Justice – in the context of medical ethics – is the principle that when weighing up if something is ethical or not, we have to think about whether it’s compatible with the law, the patient’s rights, and if it’s fair and balanced.
It also means that we must ensure no one is unfairly disadvantaged when it comes to access to healthcare. Justice is one reason why the NHS has certain entitlements, such as free prescriptions for lower-income individuals.

Question 20

What aspects should be taken into account with Justice?

Answer 20

-Is this action legal?
-Does this action unfairly contradict someone’s human rights?
-Does this action prioritise one group over another?
-If it does prioritise one group over another, can that prioritisation be justified in terms of overall net benefit to society or does it agree with moral conventions?

Question 21

What is confidentiality?

Answer 21

Confidentiality is one of the core duties of a Doctor towards their patients. 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.

Question 22

In what situations can a medical practitioner break confidentiality?

Answer 22

-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 23

How can we apply the effects of breaking confidentiality in reference to autonomy?

Answer 23

-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.

Question 24

How can we apply the effects of breaking confidentiality in reference to beneficence and non-maleficence?

Answer 24

-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

Question 25

How can we apply the effects of breaking confidentiality in reference to justice?

Answer 25

-If confidentiality is continuously broken without justifiable reasons, the public perception of healthcare professionals will be tarnished.
-Suspicions of healthcare professionals could mean patients purposefully withhold information in fears of who it will be passed on to.

Question 26

What is capacity?

Answer 26

Capacity is the ability to give consent. It relies on the patient being able to understand the risks and benefits and make a decision.

Question 27

In order to have capacity, a person must?

Answer 27

-Be able to understand the information related to the decision
-Be able to retain the information for long enough to make a decision
-Be able to weigh up or use the information to make a decision
-Be able to communicate the decision in any way at all

Question 28

What is consent?

Answer 28

Consent is when a patient gives permission before receiving any form of medical treatment, examination or test.

Question 29

What criteria is needed for consent to be valid?

Answer 29

-It’s voluntary. Deciding to consent or not consent is made by a patient and is not influenced by pressures of relatives, friends or healthcare professionals.
-It’s informed. A patient is given all the information about what the treatment in question involves. This will include the benefits, the potential risks and what would happen if the treatment didn’t go ahead.
-The patient has capacity. This means that the patient has the ability to give consent is important.

Question 30

If a child is unable to demonstrate competence, who can consent on their behalf?

Answer 30

-The child’s mother or father
-Legally appointed guardian
-Local authority designated to care for the child
-A person with a residence order concerning the child
-A local authority/person with an emergency protection order for the child.

Question 31

What must a medical practitioner keep in mind to deem a child Gillick competent?

Answer 31

-How old are they? How mature are they?
-What’s their mental capacity?
-Does the child understand what the treatment entails, including the pros, cons and long-term impact?
-Does the child understand the risks, implications and consequences that could result from their decision?
-Has the child understood the advice and information they’ve been given?
-Is the child aware of alternative options, if available?
-Does the child possess the ability to explain the rationale behind their decision making?

Question 32

What are the Fraser guidelines?

Answer 32

The Fraser guidelines outline the scenario in which advice can be given to an under 16 about contraception and sexual health without parental consent.

Question 33

What do the 5 Fraser guidelines consist of?

Answer 33

The five points are
-Is the child mature and intelligent enough to understand the nature and implications of the treatment proposed?
-Is it impossible to persuade the child to tell their parents, or let the Doctor tell them?
-Are they likely to begin or continue having sexual intercourse with or without contraception?
-Are their physical or mental health likely to suffer unless they get the advice or treatment?
-Is the advice or treatment in their best interest?

Question 34

What is the difference between Fraser guidelines and Gillick competency?

Answer 34

Gillick competence is used to assess a child’s capability to make and understand their decisions in a wider context. Fraser guidelines are applied specifically to advice and treatment that focuses on a young person’s sexual health and contraception.

Question 35

How are the Fraser guidelines and Gillick competency applied to under 13s when it comes to contraception?

Answer 35

When it comes to contraception and sexual health, any information about sexual activity would be acted on regardless of whether the child is competent or not – because a child under 13 is not legally able to consent to sexual activity.

Question 36

How are the Fraser guidelines and Gillick competency applied to under 16s when it comes to contraception?

Answer 36

If they are Gillick competent and disclosure is thought to be essential to protect them from danger, the healthcare professional should escalate concerns through safeguarding measures
If they aren’t Gillick competent, the healthcare professional is obliged to escalate concerns through safeguarding measures
If it is both cases, the young person must be informed – unless doing would cause significant risk to their safety

Question 37

What is a QALY

Answer 37

Quality Adjusted Life Year

Question 38

Describe what QALY means?

Answer 38

For every medical treatment, we consider the number of years of life which is added on and the quality of life. We use this information to calculate a numerical value between 0 and 1, where 1 is one year in perfect health.

Question 39

At what price does NICE consider 1 QALY to be cost effective?

Answer 39

<~£30000