Patients: Values and Narratives Flashcards
1
Q
Learning outcomes
A
- Explain the value of a patient’s narrative and its role in ethical decision-making
- Explain in what ways values and beliefs may affect patient choice and doctor’s practice and how ethical dilemmas may arise
- Name the 4 key attributes of care which must be maintained, whatever one’s values, as defined by GMC
- Outline the limits of conscientious objection as described by the GMC
- Name the areas in which BMA support conscientious objection, and know which of these are legally protected
- Explain the key points from the ‘Janaway’ case and the ‘Eweida and others’ case
- Recognise why medical students have different guidelines on conscientious objection to medical doctors.
- State 4 reasons why some argue that conscientious objection should not be allowed in medical practice.
2
Q
What is a patient narrative?
A
- Patient narratives are the stories that patients tell about themselves and their illness
- the individuals experience of the disease and can be influenced by social, cultural and political issues.
3
Q
Why are patient narratives important?
A
“.. Sir William Osler stated that it matters more what kind of patient has the disease, than what kind of disease it is. Getting to know the patient requires understanding his or her story and the meaning behind it…
4
Q
what are 2 principal areas that benefit from patient values and narratives?
A
medical ethics and epistemology
- it can develop medical practitioners moral, empathetic and clinical abilities.
5
Q
What does the GMC say about personal beliefs and values in the practise of medicine?
A
- What the GMC says about personal beliefs and values in the practise of medicine:
- “We recognise that personal beliefs and cultural practices are central to the lives of doctors and patients, and that all doctors have personal values that affect their day-to-day practice. We don’t wish to prevent doctors from practising in line with their beliefs and values, as long as they also follow the guidance in Good Medical Practice. Neither do we wish to prevent patients from receiving care that is consistent with, or meets the requirements of, their beliefs and values.”
6
Q
What are 4 questions to think about when reading ethics papers?
A
- Questions to think about when reading ethics papers:
1) When & where was it published?
2) Why was it carried out?
3) Who carried out the research?
* Where?
* How?
4) What were the results and take-home message?
7
Q
What was a story that displayed why a lack of patient narrative lead to poor patient care?
A
- Story that displayed why a lack of patient narrative lead to poor patient care:
- GP in Liverpool found guilty of serious misconduct by the Medical Practitioners Tribunal Service (MPTS)
- The doctor told the patient, who was threatening to kill herself, to “go and jolly well do it now“
- He also told the woman she could look up how to kill herself on the internet.
- Suspended for 3 months
- (Note: he didn’t attend the tribunal, nor did he apologise)
- “it does seem clear that in such an environment there was likely to be a considerable gulf between the life experience of the doctor and that of the patient. Such gulfs can be bridged, but to do so does take time.
- Time to develop a relationship, to learn how to communicate, build trust and understanding. Time that isn’t available in a GP’s seven-minute average appointment slot.”
8
Q
What does the GMC (2013) say about Care provided by a doctor?
A
- Care Provided by a Doctor (GMC 2013)
- Doctors may practice medicine in accordance with their beliefs but they:
1) Must act in accordance with relevant legislation
2) Must not treat patients unfairly
3) Must not deny patients access to appropriate services or care
4) Must not cause patient’s distress
9
Q
What does the GMC say about conscientious objection?
A
- GMC on conscientious objection:
- “You may choose to opt out of providing a particular procedure because of your personal beliefs and values, as long as this does not result in direct or indirect discrimination against, or harassment of, individual patients or groups of patients. This means you must not refuse to treat a particular patient or group of patients because of your personal beliefs or views about them. And you must not refuse to treat the health consequences of lifestyle choices to which you object because of your beliefs.”
- Note also, contractual obligations
10
Q
What is detailed in the Conscientious objection to participation in treatment (from Abortion Act, 1967)?
A
- Conscientious objection to participation in treatment (from Abortion Act, 1967):
- (1) Subject to subsection (2) of this section, no person shall be under any duty, whether by contract or by any statutory or
other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection: - Provided that in any legal proceedings the burden of proof of conscientious objection shall rest on the person claiming to rely on it.
- (2) Nothing in subsection (1) of this section shall affect any duty to participate in treatment which is necessary to save the life or to prevent grave permanent injury to the physical or mental health of a pregnant woman.
- (3) In any proceedings before a court in Scotland, a statement on oath by any person to the effect that he has a conscientious objection to participating in any treatment authorised by this Act shall be sufficient evidence for the purpose of discharging the burden of proof imposed upon him by subsection (1) of this section.
11
Q
What occurred in the Janaway vs Salford HA case?
A
- Janaway vs Salford HA case
- This case concerns the Conscientious objection to participation in treatment (from Abortion Act, 1967)
- “In this case, a secretary was requested to type a letter which referred a patient to a consultant in regards termination of the client’s pregnancy. She refused to carry out the doctor’s instruction claiming conscientious objection under section 4 (1) Abortion Act 1961. This section provided that ‘no person shall be under any duty, whether by contract or by any statutory or other legal requirement, to participate in any treatment authorised by this Act to which he has a conscientious objection.’ The court held that natural meaning of ‘participate in’ should be given to it. It means taking part in the treatment for the purpose of termination the abortion.”
12
Q
What does the European Convention of Human rights say about human rights?
A
- Article 9 of the European Convention of Human Rights:
- “Everyone has the right to freedom of thought, conscience and religion; this right includes freedom to change his religion or belief, and freedom, either alone or in community with others and in public or private, to manifest his religion or belief, in worship, teaching, practice and observance.”
- “Freedom to manifest one’s religion or beliefs shall be subject only to such limitations as are prescribed by law and are necessary in a democratic society in the interests of public safety, for the protection of public order, health or morals, or the protection of the rights and freedoms of others.”
13
Q
What occurred in the Eweida and others vs UK case?
A
- Eweida and others vs UK case
- “Ms Nadia Eweida was a British Airways check-in worker who complained about restrictions placed by her employer on her wearing a cross visibly around her neck.”
- She went to employment tribunal, EAT, CoA and SC – all of which rejected her claims
- “The ECHR found that although the wish of British Airways to maintain a corporate identity was legitimate, its response in sending Ms Eweida home without pay until she complied with the dress code was disproportionate, particularly since BA had subsequently changed its dress code — which demonstrated that the prohibition was not crucial. As there was no evidence of any real encroachment on the interests of others, the UK had failed sufficiently to protect Ms Eweida’s right to manifest her religion, in breach of Article 9.”
- Won damages
14
Q
What are 4 arguments against the practise of CO?
A
- 4 arguments against the practice of CO:
1) Inefficiency & inequity
2) Inconsistency
3) Commitments of a doctor
4) Discrimination
15
Q
What does the GMC say about conscientious objection in med students?
A
- GMC about conscientious objection in med students:
- GMC: Achieving Good Medical Practice (2016):
- As a medical student, you also have the right to hold a conscientious objection to some types of treatment and you should discuss this with your medical school. However, you must meet the GMC’s outcomes for graduates (originally published in Tomorrow’s Doctors) and can’t be exempted from any of these outcomes.
- Treating patients with respect includes not expressing your personal beliefs to patients in ways that exploit their vulnerability or would cause them distress
- As a medical student, you won’t be expected to make decisions about treatment options. But you mustn’t let your own opinions or views affect the way you treat patients and others or the information you give them.
- You must not unfairly discriminate against patients or colleagues on the basis of their lifestyle, culture, or social or economic status.
