Pillars of medical ethics

Question 1

What is the pillar of beneficence?

Answer 1

• Promoting a course of action which is believed to be in the best interest of the patient
  ( Must do good for their patients )

Question 2

What is taken into consideration when weighing options using beneficence?

Answer 2

• Will this option resolve the patient’s medical problem?
• Is it proportionate to the scale of the medical problem?
• Is this option compatible with this patient’s individual circumstances?
• Is this option and its outcomes in-line with the patient’s expectations of treatment?
  ( It’s very important to make sure that the treatment is in line with their expectations )

Question 3

What is holistic/ patient - centric care?

Answer 3

• When several considerations are concerned with the patient’s expectations or circumstances

Question 4

Scenario for beneficence:

An eight-year-old child has been admitted to hospital with a significant open fracture to their left leg.
The limb is deformed with significant bleeding and the patient is extremely distressed.
The parents are demanding immediate action be taken.

How would you address this situation?

Answer 4

Extreme one: Amputation

• If the bleeding is life-threatening, the limb sufficiently ( enough or to a certain degree ) injured and the risk of infection extremely high, then amputation could be a treatment option.
• It would be “good” for the patient as the injury would be resolved and the threat to life from bleeding or infection would somewhat be reduced.
• However the treatment would result in a life-changing injury and the risks of infection or massive bleeding aren’t proportionate.
• Physical movement is also limited and could carry other future risks that could result in further physical and mental health issues.
• Therefore there are other procedures that we can use, such as using blood products to manage the bleeding, reducing the fracture if possible and orthopaedic surgery if necessary will have better outcomes for this patient
• This outcome would be better for the patient ( beneficence )
• In practise we should de - promote certain courses of actions when there are better ones available like this example

Question 5

In an interview, how should I consider beneficence?

Answer 5

• You should thoroughly consider every option and weighed up what the best course of action is for the specific patient in the scenario
• Make sure that the best course of action aligns with patient’s expectation

Question 6

Questions that could be asked in the interview about beneficence:

1 ) Why is it important to consider the best interests of a mother in cases involving abortions?

2 ) What should be done if a patient refuses treatment for a life-threatening condition?

Answer 6

1 ) It can prevent the fetus from having a low quality of life if severe deformaties are present, as well as the fact that it would be the most loving thing to do in this case
So considering the patient’s best interest will be the best option

2 ) Beneficence and non - maleficence link in this situation, as the most beneficial thing to do for the patient will be to give the medication, however this is against the patient’s wishes, therefore can do more harm than good, so the doctor must continue to provide the best care in the patient’s best interest

Question 7

Hot topics for beneficence:

Answer 7

• Charlie Gard
• Vaccinations
• Abortions

Question 8

What is the pillar of Non - maleficence?

Answer 8

• Often consider a pillar linked to beneficence

- States that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect.

Question 9

How Is Non - Maleficence Different to Beneficence?

Answer 9

• it acts as a threshold for treatment, so if a treatment causes more harm than good, then this pillar isn’t considered, which contrast with beneficence, where all treatment options are considered and then ranked in order of preference
• Beneficence is used more in a specific situation, such as determining the best treatment for the patient, however non - maleficence is a constant in clinical practise, for example if a patient was to collapse in a corridor you have a duty to provide or seek medical attention to prevent injury

Question 10

Scenario for Non - maleficence:

A 52-year-old man collapses in the street complaining of severe acute pain in his right abdomen.
A surgeon happens to be passing and examines the man, suspecting that he is on the brink of rupturing his appendix.
The surgeon decides the best course of action is to remove the appendix in situ, using his trusty pen-knife.

Answer 10

• From a beneficence perspective, successful removal of the appendix in situ would certainly improve the patient’s life.

However from a non - maleficence perspective:

• The environment is unlikely to be sterile (as is that manky pen-knife) and so the risk of infection is extremely high
• The surgeon has no other clinical staff available or surgical equipment meaning that the chances of a successful operation are already lower than in normal circumstances
• Assuming that the surgeon has performed an appendectomy before, they have almost certainly never done it at the roadside so their experience is decontextualized and therefore not wholly appropriate
• If there is a hospital around for miles, this is an incredibly disproportionate intervention.

Question 11

In an interview, how should I consider non - maleficence?

Answer 11

• The associated risks with intervention or non-intervention
• If you possess the required skills and knowledge to perform the action
• If the patient is being treated with dignity and respect
• If the patient is being put at risk through other factors (e.g. staffing, resources, etc.)

Question 12

Questions that could be asked in the interview about Non - maleficence:

1 ) Does euthanasia have a place in modern medicine?

2 ) What are the ethical issues with abortion?

3 ) What are the ethical issues if a 14-year-old patient asks her GP for the oral contraceptive pill?

Answer 12

1 ) This pillar states to do no harm to the patient, however euthanasia promotes harming the patient as it gives them control over their own fate, which this “ treatment “ is given by the doctor

2 ) Considering harm to the mother and the fetus is essential in discussing abortion, it’s also to consider the sanctity of life and some may disagree with abortion

3 ) Doctors must continue to provide the best care in the patient’s best interests, and their personal views must not interfere with their professional duties.
It is also important to consider confidentiality and the effect on the Doctor-patient relationship, which is built upon trust.

Question 13

Hot topics for Non - maleficence:

Answer 13

• The inequalities suffered by the BAME community
• Public health interventions
• Mental health services
• Medical cannabis prescriptions

Question 14

What is the pillar of Autonomy?

Answer 14

• that a patient has the ultimate decision-making responsibility for their own treatment.
• also means that a medical practitioner cannot impose treatment on an individual for whatever reason except in cases where the individual is unable to make autonomous decisions
• it’s important to remember that historically that the patient doesn’t always get the right to choose
• It’s helpful to think of autonomy as a limiter on how far a clinician can intervene in a patient’s care, if a patient doesn’t give consent, we cannot intervene even if it results in death

Question 15

Why is Autonomy important?

Answer 15

• we need to make sure that the patient is actively involved in their diagnosis and treatment and not just deferring to their Doctor

Question 16

Scenario for Pillar of autonomy:

A 26-year-old male has been involved in a high-speed collision, in which he sustained blunt force trauma to his head as his head hit the front windscreen of his car.
He did not lose consciousness, he is fully responsive and has no indications of neurological damage.
He does, however, have a significant head wound that is bleeding continuously.
This patient has refused treatment on the grounds that he feels “fine” and is refusing to have sutures to close his head wound.
He would like to leave the Department.

Answer 16

• Even though the best interests of this patient would be served by undergoing a CT scan and having sutures, he is an adult with full mental capacity, and so we must respect his autonomy in choosing to leave the Department
• We cannot prevent him from leaving, and if we did it would be unlawful detainment

Question 17

In an interview, how should I consider Autonomy?

Answer 17

• If the medical condition of the patient has been fully explained, their options for treatment and the advantages and disadvantages of those treatments
• If the patient is able to retain this information, evaluate their options and arrive at a decision
• If the patient has provided informed consent for our actions

Question 18

What is a battery?

Answer 18

• A term used that means “ an infliction of unlawful personal violence.”
• This is when a medical practitioner fails to receive consent

Question 19

Questions that could be asked in the interview about autonomy:

1 ) What are the ethical issues involved with a depressed patient that has refused treatment, and admitted they’re having suicidal thoughts?

2 ) Should the NHS fund treatment for smokers?

Answer 19

1 ) In this case, the patient has chosen to refuse treatment and, in general, their decision should be respected.

2 ) The NHS should provide care for everyone indiscriminately, this is also in line with patients have the right to make decisions for themselves, as the patients choose to smoke, we can’t stop them from doing it, therefore the NHS cannot argue against not helping their patients

Question 20

Hot topics for Autonomy:

Answer 20

• Charlie Gard case
• COVID - 19
• Vaccination

Question 21

What is the pillar of justice?

Answer 21

• the principle by which we weigh up if something is ethical or not
• we have to think about whether it’s compatible with the law, the patient’s rights, and if it’s fair and balanced
• we must ensure no one is unfairly disadvantaged when it comes to access to healthcare

Question 22

Scenario for justice:

Patients suspected of having cancer are prioritised within the NHS, with the maximum waiting time for referral being two weeks (as opposed to 18 weeks for non-urgent referrals).
Patients diagnosed with cancer are entitled to a range of treatments including radio- and chemotherapy.
These treatments are expensive and treat a small, but significant proportion of patients.

Answer 22

This raises a couple of dilemmas for justice, and it’s important you can think of arguments on both sides of the issue:

• It could be argued that prioritising cancer patients means you’re limiting the ability of other patients to access healthcare
• A counter-argument might be that by referring these patients to specialist oncology centres, you’re actually freeing up other services
• It could also be argued that spending public money on radio- and chemotherapy on a smaller group of people is taking budget away from less expensive treatments that would benefit a greater number of people for example, an increase in statins for those at risk of cardiovascular disease
• A counter-argument would be that early treatment increases survival rates and actually reduces the cost of cancer treatment

Question 23

In an interview, how should I consider Justice?

Answer 23

• If the action is legal
• If the action unfairly contradicts someone’s human rights
• If the action prioritises one group over another
• If it does prioritise one group over another, can that prioritisation be justified in terms of overall net benefit to society or does it agree with moral conventions?

Question 24

Questions that could be asked in the interview about justice:

1 ) Does euthanasia have a place in modern medicine?

2 ) Discuss the ethical issues involved if a patient discloses that they haven’t told their partner that they have HIV

3 ) Do you think the NHS should fund treatment for smokers?

Answer 24

1 ) Currently, active euthanasia and assisted suicide is against the law in the UK, however legal in many other places like the Netherlands, Colombia, Luxembourg, Belgium, Canada and Spain and assisted suicide is legal in Switzerland, Germany, South Korea, Japan and some states in the US ( Keep up to date with changes )

2 ) The Doctor also has a duty to protect and ensure the safety of society and, based on these grounds, may choose to make a disclosure to the patient’s partner about the patient’s HIV status.
However, this would be a last option and the Doctor would need to inform the patient of their actions.

3 ) On one side of the argument, it can be said that the NHS should provide care for everyone indiscriminately, as supported by the ethical principle of justice.
This is also in line with the ethical principle of autonomy, which means that patients have the right to make decisions for themselves.

Question 25

Hot topics for Justice:

Answer 25

• Health care inequalities suffered by the BAME community
• Public health measures
• Medical cannabis