Medical Ethics

Question 1

What is ethics?

Answer 1

The philosophical study of right and wrong actions or ways of living for individuals and society.
The nature of human values, how we ought to live and what constitutes right conduct.
Ethics is not certain, it involves our own value claims and it can involve two very different perspectives.

Question 2

What are the different types of ethics?

Answer 2

Meta-ethics: explores fundamental questions of right and wrong
Ethical theory: philosophical attempts to create ethical theories
Applied ethics: recent emergence of ethical investigations in specific areas

Question 3

What are some potential rivals to ethics?

Answer 3

Philosophers argue that ethics provides an authoritative claim about what should be done free from inconsistency, tautology and relativistic claims.
Possible rivals include laws, codes of ethics, religious and/or cultural beliefs, personal conscience.

Question 4

How does ethics interact with the law?

Answer 4

Laws are necessary in an increasingly legally-governed society.
Ethics can influence a range of laws, including negligence, assault, confidentiality, data protection, mental capacity and homicide etc.
BUT medical advances often means that the law is left catching up and the law cannot cover every eventuality.

Question 5

What are codes of ethics? How can they be devised?

Answer 5

Codes of ethics off clear statements of expected conduct. But may be generated by elites or consensus and may be limited by their temporarily.
May be devised by:
- Applying a general medical theory to a medical problem
- Using medical problems to create guides of practice
- Considering theory that best fits own considered beliefs and then applies it

Question 6

Who does ethics apply to?

Answer 6

It’s important to be aware of who and what is subject to ethical decisions and whose values and views should be respected.
Particularly those who lack capacity now (embryos), never will (anencephaly) or who have lesser capacity (children).

Question 7

How can a decision-making model be used to help with an ethical situation?

Answer 7

• Recognise ethical situation
• Break down dilemma into parts
• Seek information from patients and others
• Identify relevant legal and professional guidance
• If no solution is found, apply clinical ethical analysis
• Justify with sound arguments

Question 8

What is utilitarianism?

Answer 8

Maximizing the good/wellbeing/welfare/happiness for the largest number of people.
Preference utilitarianism: utility increases as preference/desire is satisfied.
Act and rule utilitarianism: consider the potential actions and choose one with most value. If adherence to the rule produces more happiness than otherwise, it is a rule that morally must be followed at all times.

Question 9

What is the Act vs. Omission conundrum?

Answer 9

Is harm by omission more wrong than harm by action?
When brain scans were compared between people who said active harm is worse than passive harm and people who said they are morally equal, they found that it required more cognitive effort to see a person allowing harm than doing something wrong.

Question 10

What is Deontology?

Answer 10

Features of the act themselves determine their worth.

• Categorical: unconditional, rational wills, doesn’t not depend on the outcome e.g. do not lie
• Hypothetical: depends on the outcome e.g. healthy eating

Question 11

What is Virtue Ethics?

Answer 11

Focuses on the character of the agent and the values underpinning their lifestyle.
Integrates reason and emotion.
Virtue is character trait manifested in habitual action that is good for a person to have.
Can be learnt.

Question 12

What are the limitations of virtue ethics?

Answer 12

Assessment of virtue is culture-specific.

Emphasis on the moral character of an individual ignores social and communal dimensions.

Question 13

What is care ethics?

Answer 13

Motivation to care for those who are in need/vulnerable.
Emphasizes the dependency within human nature.
‘one-caring’ and the ‘cared-for’ obligation.

Question 14

What are the 4 principles?

Answer 14

-Autonomy: liberty and agency to make a decision
-Beneficence: should leave better off
-Non-maleficience: do no harm
-Justice: like cases like and unlike cases differently
4 principles do not transcend national, religious and cultural barriers. Additional context is needed.

Question 15

What questions should you be considering when you come across an ethical problem?

Answer 15

Is there an ethical dilemma?
What are the key issues?
Taking a multitudinal perspective
Can any of the theories or tools help me?
What are the relevant professional and legal guidelines?
What is my decision?
Can I justify what I have done?

Question 16

What influences must you consider as you develop a clinician-patient relationship?

Answer 16

Connectivity and interdependence – behavior of one individual may affect others or wider system.
Co evolution – adaptation or changes by one organism alters other organisms.
Exploring possibilities – being pushed away from equilibrium (comfort zone) is essential for survival and flourishing.
History – both the patient and doctor are influenced by their individual and collective histories…decision made in one consultation will affect those made in the next.
Feedback – throwaway phrase by the GP can have far reaching effects on the patient…or vice versa!

Question 17

What are Conscientious objections?

Answer 17

Moral claims that are based on an individual’s core ethical beliefs.
Opposition and refusal by a healthcare professional to provide certain treatments, because the individual believes that helping to provide those treatments would violate personal core ethical tenets in a way that compromises his or her moral integrity.

Question 18

What are core ethical beliefs?

Answer 18

Core ethical beliefs refer to beliefs that are the most important to a person constitute a part of his or her identity, and are the basis of his or her moral integrity.

Question 19

How to deal with conscientious objections well?

Answer 19

Balancing conscientious objections with professional obligations. Respect to patient autonomy and informed consent.
Give the patient advance notification - in order to make sure their expectations are realistic.
Publicly disclose your reasons for objecting and help the patient access the appropriate services.

Question 20

How to approach someone with a chronic illness who expresses a desire to die?

Answer 20

Are they mentally competent to make these decisions?
Suicide isn’t illegal but it is illegal to assist suicide
GMC - in favour of prolonging life
Have they been offered appropriate social and mental health support?
Have they left it long enough for antidepressants to work?
Have you done everything in your power to try to improve their quality of life?

Question 21

Who do you have a duty of care to treat?

Answer 21

Anyone who is currently YOUR patient.
If you have not yet started treating them, you do not have a legal duty of care to them, but as soon as you do you are responsible for all your care decisions thereafter.