Telling the Truth, and the Duty of Candour Flashcards
Deontology vs utilitarianism on ends justifying means
- D = end does not justify means
- U = end does justify means
What is the principle of utilitarianism?
- Maximise happiness for the most amount of people
- Whether an action is right or wrong depends on the outcome
Advantages of utilitarianism
- Considered a form of distributive justice so can deal with the good of societies, not just individuals
- Flexible - specific for situation, not rigid rules
Problems with utilitarianism
- Consequences difficult to predict
- People have no intrinsic value
- One person could be seen as more valuable than another, if they could cause more happiness
Principles of deontology
- We are rational beings capable of reason
- We can decide our duties, and what actions are right/wrong
- Actions are right and wrong inherently - it is not about outcome
- We can generate a universal list of rules to always be ‘in the right’
Advantages of deontology
- Accords human beings’ moral worth
- Places value on intention
- Offers certainty as doesn’t matter about outcome if action was right
Disadvantages of deontology
- Too rigid
- Allows actions causing immense suffering in defence of principle
- Duties often conflict
4 principles of medical ethics
- Beneficence
- Non-maleficence
- Justice
- Autonomy
What is Aristotle’s model, “virtue ethics”?
- Cultivating a moral character - ‘what would a good person do in this situation?’
- Often based around a mentor or role-model
Advantages of virtue ethics
- Acknowledges complexity of decision-making
- Acknowledges influence from previous experiences
- Many people report they have role-models
- It is a developmental model - doesn’t expect us to be perfect
Problems with virtue ethics
- Vague - doesn’t aid decision-making
- What is a virtue/who is virtuous?
- Centred solely around doctor - where does the patient fit in?
- Perfectionist as focuses on the “perfect doctor”
Why would a utilitarian, deontologist, principalist, virtue or communitarianist tell the truth?
- U = if it increases happiness or diminishes suffering
- D = because it’s your duty
- P = because it enables autonomy
- V = because it’s what a good person would do
- C = because it allows us to trust each other
Problems with a trust model
- How do you quantify trust?
- What if something increases trust but is detrimental to meeting social needs?
Hugo Grotois’ idea of lying not being wrong
A lie is not a wrong if someone has no right to the truth
3 kinds of deception
- Lies of commission
- Lies of omission
- Lies of embellishment
What is a lie of commission?
A direct statement of an untruth
What is a lie of omission?
Omitting to tell someone something that is true that would affect their understanding of the situation
What is a lie of embellishment?
An exaggeration or misrepresentation to generate a misleading interpretation of a situation
Sissela Bok’s “last resort” idea
- Veracity should always be the first principle
- To tell a lie you must have no other option, it must be the last resort
What is integrity?
- You are undivided as a moral agent - you would act the same in all situations
- You don’t deviate in other company or circumstances, or where it is disadvantageous to yourself
What is integrity in a medical context?
- Care of the patient is the first concern - even when it’s disadvantageous to you
- Self-interest must come second to patients’ interests
What does the Duty of Candour say we must do?
Be honest with your patients about mistakes or errors that have happened in their care
What does the 2008 Health and Social Care Act say organisations have a duty to do when a mistake is made?
- Inform people about the incident
- Provide reasonable support
- Provide truthful information
- Provide an apology
What does the GMC say healthcare professionals must do when a mistake is made?
- Tell the patient (or the patient’s advocate, carer or family) when something has gone wrong
- Apologise
- Offer an appropriate remedy or support to put matters right (if possible)
- Explain fully to the patient the short and long term effects of what has happened
