Medical Ethics

Question 1

What are the 4 pillars of medical ethics?

Answer 1

Beneficence
Non-maleficence
Autonomy
Justice

Question 2

Consequentialism

Answer 2

The morality of an action is dependent purely on the consequences - ‘ends justify the means’.

Eg. patient unlikely to survive operation asks ‘Will I be okay, Dr?’ - this ideology supports lying in this situation.

Question 3

Utilitarianism

Answer 3

The best action is the one that brings about the best increase in utility (benefit) - takes into account wider society.

Eg. funding treatment for 5 patients with common illness, over 1 patient with rare and hard to treat illness.

Question 4

Deontology

Answer 4

Duty-based ethics - the correct course of action is dependent on what your duties and obligations are.

Eg. not lying to a patient to comfort them - lying isn’t morally acceptable because it’s our obligation not to lie.

Question 5

Deontology vs consequentialism

Answer 5

Directly contrast.

Consequentialism may be most relevant when thinking about broad aims of healthcare, but deontology-based guidance is most relevant to Medicine.

Question 6

Beneficence

What needs to be considered?

Answer 6

Medical practitioners have a moral duty to promote course of action that is in the best interests of the patient - holistic.

• Will it will resolve a patient’s medical problem?
• Is it proportionate to the scale of the problem?
• Is it compatible with individual circumstances?
• Is it in-line with the patient’s expectations of treatment?

Question 7

Non-maleficence

What needs to be considered?

Answer 7

Duty to do no harm or allow harm to be caused to a patient through neglect.

• Associated risks of intervention and non-intervention?
• Do I possess required skills to perform this?
• Is patient treated with dignity or respect?
• Is patient being put at risk through other factors, eg. resources/staffing?

Question 8

How does non-maleficence differ to beneficence?

Answer 8

Acts as threshold for treatment - if treatment does more harm than good, should not be considered (in beneficence you consider all valid treatment and rank in order of preference).

NM is constant in clinical practice.

Question 9

Autonomy

What needs to be considered?

Answer 9

The patient has the ultimate decision-making responsibility for their own treatment - exempt in cases where the individual is deemed unable to make such decisions (mental capacity act, emergency doctrine).

• Has condition and treatment been fully explained?
• Is the patient able to retain, evaluate their options and arrive at a decision?
• Has the patient provided informed consent?

Question 10

Mental Capacity Act

Answer 10

Protects and empowers people lacking the mental capacity to make their own decisions, eg. dementia, brain injury, mental illness, sudden unconsciousness.

May not lack capacity for all decisions.

Question 11

Emergency doctrine

Answer 11

Patient may be treated without consent in an emergency under doctrine of necessity.

Good clinical practice to involve relatives in management of patient, but not legally relevant - only patient can give valid legal consent.

Question 12

In what circumstances can confidentiality be broken?

Answer 12

• patient has consented to sharing of information.
• not sharing information puts patient or others in danger
• patient lacks capacity and sharing info is overall benefit to the patient.

Question 13

Ethically, what should be considered when breaking confidentiality?

Answer 13

Autonomy = breaks autonomy and trust in medical professionals.

B and N-M = would breaking C put patients at risk? Can I gain consent to break C?

Justice = public perception of doctors may be tarnished if unjustifiably broken.