Why Tell The Truth? Flashcards
Utilitarianism
Maximise happiness and minimise suffering
Depends on outcome more than whether action is right and wrong
Tell truth if will lead to good outcome
Lie if Leads to better outcome than the truth
What is act vs rule
Act: each act evaluated separately
Rule: extrapolate rules such that you could be happy that if people generally
behaved in this way, it would lead to the best outcomes
Advantages of utilitarianism
Intuitive
Form of distributive justice - good of societies not just individuals
Flexible - not rigid rules
What is rule utilitarianism
Albeit rules which are designed to achieve optimal welfare
Could have overall bad outcome
Disadvantages of utilitarianism
Consequence can be difficult to predict
Consequences can be impossible to reach
People have no intrinsic value in this system
One person may be considered more feasible than another - depending on ability to lead to more happiness
What are deontological ethics
We are Rational beings capable of reason
Decide what moral duties - right and wrong actions
Actions are inherently wrong and right
Don’t care about outcome
Generate list of rules which apply universally which allows us to always be in the right
Advantages of deontology
Accords human beings moral worth - people are not expendable
Reflects how some people perceive morality
Places value on intention - right even if leads to bad outcome
Offers certainty - don’t have to worry about probability of outcomes
Disadvantages of deontology
Too rigid - situations that don’t fit so huge lists of exceptions needed
Allows acts that cause immense suffering
Duties often cause conflict
Four principles by Beauchamp and Childress
Beneficence - doing good
Non maleficence - avoiding harm
Justice - rights, the law, fairness, distribution of resources
Autonomy - self determination
How is autonomy similar to deontological view
Both rational
What is the myth of objectivity
None of us are really objective
We all arrive at decisions with pre expiating set of values
One of most important factors influencing decision making
Makes you arrogant
What is virtue ethics
Aristotle model of ethics
Cultivates a moral character
Cultivating right values and phronesis (practical wisdom)
Advantages of virtue ethics
Phronesis (practical wisdom) describes peoples experience of decision making - acknowledges complexity of decision and influence of our previous experience
Most people have role models that they emulate with
Developmental model - doesn’t expect us to be perfect but allows improvement
Problems with virtues model
Nebulous - doesn’t help with decision making
May pick role model whos values u already share
Virtuous character takes ages to develop
Self centred - HCP is central. Virtues exercised in interest of patient. Patient is a denied agency.
Encourages perfectionism - “perfect doctor”
Role model based - can perpetuate problem norms and values
Why tell the truth (due to different theories)
Utilitarianism: increase happiness and decreases suffering
Deontology: because duty
Principlism: enables autonomy. Informs patient of all info.
Virtue: what a good person would do
Communitarianism: allows us to trust each other
What is supporting trust
Without trust we can’t function as a society
Honesty is required for that trust
Being dishonest leads to a net decrease in trustworthiness of the system - unethical
Problems with trust model
Like utilitarianism decision making can be complex
Is smth increases trust, but would be detrimental to meeting social needs
What is probity
Means being honest and trustworthy and acting with integrity
Heart of medical professionalism
Can dishonesty be advantageous
Ethicist have pointed out social norms - ways of behaving in public and professional
Settings are potentially dishonest - conceal the trust
Politeness involves dishonesty
Professional behaviour may involve presentations inaccurate image of ourselves
Why is complete honesty is bad
Total honesty would pose social disadvantage
Concealing feelings is a skill
Kinds of deception
Lies of comission
Lies of omission
Lies of embellishment
What are lies of comission
Direct statement of an untruth - something we know is false
E.g. inaccurate result
What are lies of omission
Omitting to tell someone something that is true that would materially affect their understanding of situation
E.g. not mentioning Side effect of treatment
What is nocebo effect
If tell someone about side effect it will cause them to experience side effect
Lies of embellishment
An exaggeration or misrepresentation to generate a misleading interpretation of a situation
E.g. plastic surgeon overstating how bad feature looks, overemphasising the risks of diabetic complications to a teenager who has poor glycaemic control
What is the last resort theory
Truth has inherent value that a lie does not
To outweigh truth need sufficient reasons
Deception acceptable as last resort
Definition of integrity
As a moral agent, you are undivided
Follow same principles in all situations
Do not deviate
Medical integrity
Making care of patient first concern
Even when not advantageous to you
Self interest must come second to patients interests
This can mean challenging authority or system itself
Go over mid staff scandal on pp
Why mid staff scandal was caused
Staff were cut to meet financial targets to become foundation trust
Complaints were ignored
Culture of fear, bullying and intimidation
Mismanagement during mid staff scandal
Chronically understaffed wards
Receptionists with no medical training triaging in A and E
Inadequate training of staff
Junior docs left to manage alone overnight
Complete failure” of management to address serious problems, or monitor performance
Why was mid staff crisis an ethical failure
HCP were competent
But Failure to provide adequate care and learn from mistakes
Basic personal care failure - washing, feeding, hydration
Went unchallenged by HCP
Consequence for patients during mid staff crisis
Physical needs unmet: dehydration, depletion of resources, poor healing, poor immune function
Emotional/ social needs unmet: stress response, alter neuroendocrine function, poor IMS, bad wound healing
Mortality rates increased
How midstaff crisis came to an end
Increased mortality flagged up with NHS system
Cure the nhs campaign launch
Became national scandal led to sig changes
Transparency and honesty in healthcare
Be honest with patients about mistakes or errors that have happened in their care
What does the duty of candour mean for organisations
Duty to:
Inform people about incident
Provide reasonable support
Provide truthful info
Provide apology
GMC review of how HCP should approach a mistake
Tell patient when something gone wrong
Apologise
Offer an appropriate remedy/ support
Explain fully to patient long and short term effects of what has happened
