Principles of Medical Ethics and Law

Question 1

what does medical law and ethics allow students to do?

Answer 1

pass exams - now

make better clinical decisions – now and in the future

avoid trouble – now and in the future

The main aim is to ensure that you always put the best interests of patients first

Question 2

are doctors trusted?

Answer 2

yes

one of the most trusted professions

Question 3

What Do you Know About Professional Governance?

Answer 3

What do you know about:

• The General Medical Council?
• The Professional Standards Authority?
• Health Boards?
• NHS Trusts?
• Responsible Officers?
• Medical Directors?
• The law as it affects medicine and doctors?
• Public interest?
• Insight?

Question 4

what are ethics?

Answer 4

The body of moral principles or values governing or distinctive of a particular culture or group

Question 5

Where do Ethical Principles Come From?

Answer 5

Two traditions:

1. Duties: “right” & “wrong”; actions by individuals or groups

‘absolute values’

2. Considering the benefits and harms to individual and society; looking at the consequences not just to the individual

Question 6

what are some parts of the Hippocratic Tradition?

Answer 6

“As to diseases, make a habit of two things – to help and not to harm.”

“I will never give a poison to anyone to cause death, not even if asked.”

“Into whatever houses I enter, I will enter to help the sick, and I will abstain from all intentional injustice and harm, especially from abusing the bodies of man or woman, bond or free.”

“[The sick put themselves] into the hands of their physicians in an intimate way and, in so doing, physicians encounter wives and maidens and precious possessions toward which self-control must be exercised”

Question 7

What Comprises Ethics?

Answer 7

• Principles
• Values
• Honesty
• Standards, rules of behaviour that guide the decisions, procedures and conduct of individuals that respect the rights of all stakeholders affected by its operations”.
• Do you have anything you would wish to add?

Question 8

What Do we Mean by Morality?

Answer 8

Our attitudes, behaviours and relations to one another

Are morals important in a secular society?

Question 9

What is Consequentialism?

Answer 9

The moral worth of an action is determined by its outcome

Question 10

Where do Ethical Principles Come From?

Answer 10

Two traditions:

1. Duties, “right” & “wrong” actions, absolute values

DEONTOLOGY

2. Look at benefits and harms to individuals but also society as a whole; look at the consequences.

UTILITARIANISM (a type of consequentialism)

• The greatest good for the greatest number (maximising pleasure/ happiness and minimising pain/ unhappiness)

Question 11

Ethics and Clinical Decisions and based on what?

Answer 11

1. Duties
2. Four Principles

Question 12

whata re the duties of a doctor?

Answer 12

Question 13

What are the four principles?

Answer 13

1. Respect for Autonomy
2. Non-malfeasance
3. Beneficence
4. Justice

Question 14

what is respect for autonomy?

Answer 14

Promote the right to self determination

Confidentiality, informed consent, promote capacity

Question 15

what is non-malfeasance

Answer 15

The avoidance of harm

Question 16

what is Beneficence?

Answer 16

to do good

Question 17

what is justice?

Answer 17

Fairness/equity:

• Non discrimination
• Equal treatment for equal need

Individual vs. population:

• Rationing
• Limits to autonomy

Question 18

THink about this in regards to the 4 principles:

• Do you give iv fluids to an elderly cancer patient who is too drowsy to drink?

Answer 18

1. Respect for autonomy

Can we promote her autonomy?

Living will, treat delirium etc.

2. Non-malfeasance

What are the harms of giving/not giving fluids?

3. Beneficence

What are the benefits of giving/not giving fluids?

4. Justice

What are the opportunity costs?

Are we being ageist/sexist etc.?

Question 19

What things are particular relevant ethically when dealing with a patient?

Answer 19

• Non-judgmental approach
• Not imposing personal views & respecting patients’ views
• Confidentiality
• Not exceeding your competency
• Fitness to practise

Question 20

How is a non-judgmental approach carried out?

Answer 20

Deserving vs. undeserving patients?

It doesn’t matter how the patient got his/her condition/complaint

GMC guide 2006: you must not discriminate on grounds of age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status

Question 21

What is importnat in regards to Not Imposing Your Personal Views and Respecting Patients’ Views?

Answer 21

• Fair presentation of facts/options
• Not letting your views affect your advice/actions (Should you divulge your opinions?)
• Willingness to refer elsewhere
• Not bullying/belittling etc (also applies to colleagues, juniors, other health workers etc)

Question 22

What is confidentiality?

Answer 22

Basis of trust

“Need to know” basis (including discussion of cases with others)

Rare occasions where confidentiality may / should be breached

(When might that be?)

Question 23

Not Exceeding Your Competency - when is this important?

Answer 23

Applicable at all stages of the undergraduate medical course and your subsequent career

Question 24

What do You know About Fitness to Practise?

Answer 24

It is not just about competency

You have a specific duty to take appropriate action to protect patients, not just by your own actions but also to protect patients if you or others are unfit to practise

Question 25

what needs to be thought about in regards to raising concerns?

Answer 25

• What does this mean?
• Drugs?
• Alcohol?
• Poor performance - What is underperformance? When is it difference of opinion?
• How do we raise concerns?
• When do we raise concerns?
• What about problems with ‘superiors’?

Question 26

The Ethical Code Includes: “I understand and will uphold that all those caring for and treating patients are bound by a Duty of Candour”

who does the Duty of Candour apply to and what is it?

Answer 26

This means that you must be open and honest with patients when something goes wrong with a patient’s treatment or care which causes, or has the potential to cause, harm or distress

If you are unsure of the consequences immediately seek the advice of an appropriate senior colleague to peer review your view and subsequently tell the patient (or the patient’s advocate, carer or family) when something has gone wrong even if the patient is not aware or has not complained

You must apologise to the patient and offer an appropriate remedy or support to put matters right (if possible) and explain fully the short and long term effects of what has happened

This duty requires you to be open and honest with all parties as well as any relevant organisations such as your employer, practice principal or the Health Authority or Board; you must take part in reviews and investigations when requested

You must raise concerns where appropriate if you believe a patient’s best interests potentially have been or actually have been compromised

As a doctor or a student you should encourage other peers and colleagues to be open and honest; you must not stop someone who has concerns from raising concern

Question 27

Other Questions You Might Like to Consider?

Answer 27

1. Is “letting die” the same as “killing”?
2. Can you have ethics in the absence of religion?
3. Is ethics the same as law?
4. Is medical ethics a conspiracy by doctors to dupe the general public?