Medical Ethics and Scenarios Flashcards
Imagine you are the head of the surgical department in a hospital. There are two patients, A and B, both requiring an urgent liver transplant, but there is only one viable liver. Patient A is a 32-year old social activist with a drug abuse history. Patient B is a 78-year old woman who takes care of 3 children whose parents died in a car accident. How would you decide who to allocate the liver to, and why?
Consequences - inquire consequences of not getting the transplant for both patients. Could one wait a bit longer?
Clinical aspects of care - Is one more likely to benefit from a certain treatment than the other?
Quality-adjusted life years - number of years in perfect health that the intervention is predicted to give.
Age - besides younger patients living longer, is the younger less likely to suffer from complications due to treatment.
Circumstantial factors - Commitment to maintain a lifestyle appropriate to maximimise success? - are they going to continue to pursue an unhealthy lifestyle.
Dependants - In line with utilitarian approach, maximise positive effect to larger number of people.
Many contradictions that come into the debate and further information is required . Multidisciplinary staff come to a conclusive decision.
What are the underpinning values of modern medicine?
Beneficience - moral and legal duty to promote actions in the best interest of the patient.
Non maleficence - pillar derived from the Hippocratic oath (set of rules historically accepted by physicians) to do no home. Duty for all doctors to do not harm.
Autonomy - patients rights to make decisions regarding their treatment.Children under the age of 16 have to go under Gillicks competence to see if they have the capacity/competence to consent.
Justice - rule to treat all patients equally and fairly. Regardless of financial or non financial resources.
What are the ethical arguments for and against abortion?
For:
Autonomy : If the mother is competent enough and believes she does not want a child yet, as the foetus is still part of the mothers body, the woman should have a say in what should happen to her body.
Non-maleficence: If foetus has life limiting conditions – birth can prolong their suffering. Taking care of the child can cause mental and physical pain aswell. So abortion can sometimes be considered, where the harm is lower in the long term.
Non maleficence: If abortion becomes illegal and some may conduct it in unsafe environments making it worse.
Against:
Some beliefs and religion believe that human life begins at the moment of conception. Following this logic, the foetus needs should also be taken to account.
Non-maleficence: healthcare professionals are duty bound to prevent harm - can be argued that performing an abortion goes against primary ethical duty.
In England, most abortions are allowed up to the 24th week of pregnancy. Can you think of some reasons why abortion is strictly illegal in other countries, such as Poland or in the state of Alabama in the US?
To protect human life from the moment of conception. Unless poses danger to woman’s health or they have been sexually assaulted.
pain inflicted through an abortion - pyschological and physical
What have you heard about the abortion referendum in Northern Ireland in 2018?
In 1983 the amendment was that babies was guaranteed the right of life, making abortion illegal unless pregnancy was life threatening.
In 2018, there was a referendum and protests where woman spoke out saying our bodies our rights. Hence 66.4% voted yes that abortion should be allowed
Now abortion is allowed up to 12 weeks of pregnancy.
You are an FY2 doctor, currently working on a paediatrics ward. You have been taking care of a 5-year old child with suspected leukaemia. As you walk through the hospital hallway, you stumble across the child’s parents, who look distressed. As they ask you about the blood results, you realise you forgot to take the samples to the lab. How would you explain to the parents that they have to wait another few hours because of your mistake?”
SPIKES
Settings - quiet/private space
Perception - How much do you know about the reason we have met today?
Information - I am afraid I do have some bad news today, is it ok if we could discuss it together now?
Knowledge -
Emotions - I understand, please take time
Strategy - “Now that we know what’s going on, we can start targeted treatment and try to solve the problem
You are an FY1 3-weeks into a neurology rotation in a new hospital. While walking into the changing room, you notice one of the fellow FY1’s nervously placing a bottle into his locker. As they pass you by, you smell the odour of alcohol. What would you do?”
First analyse the risks.
Being under the influence of alcohol can impair the person’s judgement and manual abilities putting patients at risk.
FY1s reputation may be at risk - eyes of patients and team. Patients seeing a doctor tipsy may lose trust towards the physical and the healthcare profession in general.
Actions -
Talk to them about the weather and sense the odour of alcohol. Approach them sensitively and respectfully and in a quiet space. Address the concerns in a tactful, non judgemental way.
If conversation is unresolved then escalate situation to senior colleague - but should be last resort.
Aftermath -
If they are not under the influence of alcohol, apologise for misjudging them.
If it is true - conversate with them.
Why did they drink? Explain the situation it can pose to patients trust towards healthcare? Where they should stay until sober?
You are duty-bound to formally report the accident - under GMC Section 23 - clear that you believe a doctor is placing patients at risk you have a duty to report your concerns.
Try not to embarrass them.
If he pleads to not say anything - understand, empathetic but u can’t resolve, issue to be dealt with department. Real alcohol problem - no favours are being done.
A young mother comes with their 12-month-old child to your GP practice as a part of the routine immunisation schedule. However, the mother reveals that she decided not to vaccinate their child against measles, mumps and rubella (MMR) and appears to be anxious. What would you do?
Ideas - I understand the point you are making. I would clarify any uncertainties they may have and ask them if they know the benefits of an MMR Vaccine.
Concern - ask what the specific reason the mother refuses to vaccinate their child?
Open ended question - “Is there anything you are particularly worried about?”
Expectations - Is there any reason why they came? Anything they were expecting from the consultation?
Should the NHS deal with patients who have self inflicted diseases?
Self inflicted diseases -
1. Skin cancer following prolonged exposure to sun rays
2. Lung cancer due to smoking
3. Liver cirrhosis following excessive drinking
FOR -
1. large majority of diseases are self inflicted to some extent
2 Some self inflicted behaviours
3. Justice
4. In a free society where individuals choice is of crucial importance
AGAINST -
1. Patients often relapse
2. allow treatment of self inflicted disease may remove individual responsibility for ones health
3. In a system where resources are scarce, it is important to prioritise how budgets need to be allocated.
How does politics influence healthcare decisions?
Working hours - European time directive 48 hours - need for more doctors and more focused training
Funding - level of care that the NHS can provide is dictated by the budget that government makes available. Politicans trade off between well funded healthcare and not losing votes because of high taxes.
Public health - major awareness campaigns for issues of public importance can help the NHS pass on messages to the general public ( MMR vaccinations).
Ten years ago, most doctors wore white coats. Now, few of them do. Why?
- White coats were originally clothes protectors - minimise risk of infection - easy to clean
Ego booster aswell, easy to identify doctors in emergencies - Few wear them now as white coat is an artificial barrier to doctor patient relationship.
scrubs
Why do people on aeroplanes suffer from Deep Vein Thrombosis from being still in one position, yet this doesn’t affect people when they are asleep?
DVT is a blood clot that forms in a deep leg vein.
DVT is caused by inactivity. When you sleep - u change position. When you fly, small confined space, so less movement
DVT - reduced cabin pressured, dehydration less likely to drink water. When sleeping easier to get up and help themselves to a glass of water.
Do you think it is right for patients to make the choice as to what is in their own best interest?
For:
1. Autonomy - patients are responsible for their own body.
2. Having to explain different options to a patient encourages doctors to take a more thorough approach rather than rushing into preferred options.
3. Patient and doctor share responsibility for the outcome should anything go wrong.
4. Objectively better treatment - choosing best
Against
1. Patient may not have background knowledge
2. Patient may be influenced by other parties
What would you do if a known Jehovah Witness arrived in A&E unconscious, needing an urgent blood transfusion
First try to stop the bleeding
Dont jump to conclusion - patient may be Jehovah witness but may not follow religion in orthodox manner. Thus cannot assume patient will be against transfusion.
What are the arguments for and against euthanasia?
Euthanasia is the act of delibrately ending a person life to relieve suffering
It is illegal in the UK - but legal in Belgium , Canada, Switzerland.
For euthanasia:
Autonomy - Patients should be able to choose what is personally best for them (If they have to capacity and is not influence by anyone else).
Non maleficence - lengthy suffering could be eased through the action of euthanasia
Beneficence - prematurely ending a persons life may allow them to die with dignity and free from pain
Justice - Ending an individuals life before a disease advances may mean expensive treatment, financial resources can be used elsewhere to help larger number of people.
Against -
- Non maleficience: primary duty of a doctor is to protect patients from harm, not to inflict harm on them
- Suicide devalues human life
- palliative care patients should be able to die free of pain, in comfort and with dignity. Furthermore, the resources that would otherwise be intended for the practice of euthanasia could be utilised to improve palliative care services and achieve a similar aim.
Are the patients competent in making the decision regarding life and death?
