Medical Ethics Flashcards
Morality
Our attitudes, behaviours and relations to one another
Consequentialism
The moral worth of an action is determined by its outcome
Two traditions of Ethics
DEONTOLOGY
UTILITARIANISM (a type of consequentialism)
DEONTOLOGY
Duties, “right” / “wrong” actions, absolute values
UTILITARIANISM
Look at benefits and harms to individuals but also society as a whole; look at the consequences.
The greatest good for the greatest number
What Comprises Ethics
Principles
Values
Honesty
Standards
Standards
Rules of behaviour that guide the decisions, procedures and conduct of individuals that respect the rights of all stakeholders affected by its operations
Principles
Respect for Autonomy
- Promote the right to self determination
- Confidentiality, informed consent, promote capacity
Non-maleficence, Beneficence
Justice - Fairness/ equity Non discrimination Equal treatment for equal need - Individual vs. population Rationing (allow each person to have a fixed amount of commodity), Limits to autonomy
Fitness to Practise?
It is not just about competency
You have a specific duty to take appropriate action to protect patients, not just by your own actions but also to protect patients if you or others are unfit to practise
Duty of Candour – Applies to all Healthcare Registrants
This means that you must be open and honest with patients when something goes wrong with a patient’s treatment or care which causes, or has the potential to cause, harm or distress.
If you are unsure of the consequences immediately seek the advice of an appropriate senior colleague to peer review your view and subsequently tell the patient (or the patient’s advocate, carer or family) when something has gone wrong even if the patient is not aware or has not complained.
You must apologise to the patient and offer an appropriate remedy or support to put matters right (if possible) and explain fully the short and long term effects of what has happened.
This duty requires you to be open and honest with all parties as well as any relevant organisations such as your employer, practice principal or the Health Authority or Board; you must take part in reviews and investigations when requested.
You must raise concerns where appropriate if you believe a patient’s best interests have been compromised.
Encourage other colleagues to be open and honest;
Euthanasia
Physician-assisted Suicide
Ending the life of a person who is *terminally ill in a way that is either *painless or minimally painful for the *purpose of ending suffering of the individual by administration of a lethal substance with the direct assistance of a physician.
Providing a *competent patient with a prescription for medication for the patient to use with the primary intention of ending his or her own life.
NHS complaints procedure
All NHS Boards, Trust etc. follow a universal complaints procedure
If a complaint involves you a complaints officer will deal with it and you may well be interviewed to provide your response to the complaint.
If your employer thinks the disciplinary procedure needs to be followed
Dealing with complaints
Having strategies to reduce complaints
…
Understanding “Public Interest’
Patients have the right to compensation where they have been harmed by negligent treatment
Understanding the Patient Rights Act and the ramifications for the medical profession
Legislation throughout the UK which is explicitly related to how complaints are to be dealt with
How do you protect yourselves?
Join a Defence Organisation
Be aware of and follow the GMC’s Advice,
- “Good Medical Practice”
Be aware of the local complaints procedure / deal with complaints expeditiously (speed and efficiently)
Patients first and always try to act in their best interests
Do not be judgmental
Do not be afraid to refer or get a second opinion
Clinical Audit, Peer Review
Act responsibly, Do not break the law
Involuntary Treatment
Compulsory
GMC Confidentiality guidance on Serious Communicable Diseases 2017
You may disclose information to a person who has close contact with a patient who has a serious communicable disease if you have reason to think that:
1) The person is at risk of infection that is likely to result in serious harm
2) The patient has not informed them and cannot be persuaded to do so.
GMC Confidentiality guidance on Serious Communicable Diseases 2017
All partners should be tested for STD’s
You may disclose information to a person who has close contact with a patient who has a serious communicable disease if you have reason to think that:
The person is at risk of infection that is likely to result in serious harm
The patient has not informed them and cannot be persuaded to do so.
Dr with STD
His wellbeing ?
- Started on ART. Not in a conventional Rx group
His privacy
The wellbeing of his patients?
- Patient list reviewed for known HIV infected patients.
- Look-back exercise sometimes recommended
His future employment
- If treatment effective, he can resume work under new guidance.
Gene testing
Implications of result being positive/ negative
Insurances
Potential impact of testing on self, family and work
Prenatal diagnosis
First baby - 12 week viability scan reveals increased nuchal fold measurements on USS
Further pre natal testing discussed due to maternal age and increased nuchal fold measurements
Chorionic villus sampling > 11 weeks
- 50% risk of terminating a healthy fetus*
Amniocentesis > 15weeks
BRCA1 and BRCA2 known gene mutations
Significantly increase risk of developing breast and ovarian cancer
NHS funded testing available to those considered at high risk
Eligible for extra breast screening by mammography
Prophylactic surgery an option if found to be a carrier
