Why Tell The Truth?

Question 1

Utilitarianism

Answer 1

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

Question 2

What is act vs rule

Answer 2

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

Question 3

Advantages of utilitarianism

Answer 3

Intuitive
Form of distributive justice - good of societies not just individuals
Flexible - not rigid rules

Question 4

What is rule utilitarianism

Answer 4

Albeit rules which are designed to achieve optimal welfare
Could have overall bad outcome

Question 5

Disadvantages of utilitarianism

Answer 5

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

Question 6

What are deontological ethics

Answer 6

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

Question 7

Advantages of deontology

Answer 7

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

Question 8

Disadvantages of deontology

Answer 8

Too rigid - situations that don’t fit so huge lists of exceptions needed
Allows acts that cause immense suffering
Duties often cause conflict

Question 9

Four principles by Beauchamp and Childress

Answer 9

Beneficence - doing good
Non maleficence - avoiding harm
Justice - rights, the law, fairness, distribution of resources
Autonomy - self determination

Question 10

How is autonomy similar to deontological view

Answer 10

Both rational

Question 11

What is the myth of objectivity

Answer 11

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

Question 12

What is virtue ethics

Answer 12

Aristotle model of ethics
Cultivates a moral character
Cultivating right values and phronesis (practical wisdom)

Question 13

Advantages of virtue ethics

Answer 13

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

Question 14

Problems with virtues model

Answer 14

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

Question 15

Why tell the truth (due to different theories)

Answer 15

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

Question 16

What is supporting trust

Answer 16

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

Question 17

Problems with trust model

Answer 17

Like utilitarianism decision making can be complex
Is smth increases trust, but would be detrimental to meeting social needs

Question 18

What is probity

Answer 18

Means being honest and trustworthy and acting with integrity
Heart of medical professionalism

Question 19

Can dishonesty be advantageous

Answer 19

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

Question 20

Why is complete honesty is bad

Answer 20

Total honesty would pose social disadvantage
Concealing feelings is a skill

Question 21

Kinds of deception

Answer 21

Lies of comission
Lies of omission
Lies of embellishment

Question 22

What are lies of comission

Answer 22

Direct statement of an untruth - something we know is false
E.g. inaccurate result

Question 23

What are lies of omission

Answer 23

Omitting to tell someone something that is true that would materially affect their understanding of situation
E.g. not mentioning Side effect of treatment

Question 24

What is nocebo effect

Answer 24

If tell someone about side effect it will cause them to experience side effect

Question 25

Lies of embellishment

Answer 25

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

Question 26

What is the last resort theory

Answer 26

Truth has inherent value that a lie does not
To outweigh truth need sufficient reasons
Deception acceptable as last resort

Question 27

Definition of integrity

Answer 27

As a moral agent, you are undivided
Follow same principles in all situations
Do not deviate

Question 28

Medical integrity

Answer 28

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

Question 29

Go over mid staff scandal on pp

Question 30

Why mid staff scandal was caused

Answer 30

Staff were cut to meet financial targets to become foundation trust
Complaints were ignored
Culture of fear, bullying and intimidation

Question 31

Mismanagement during mid staff scandal

Answer 31

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

Question 32

Why was mid staff crisis an ethical failure

Answer 32

HCP were competent
But Failure to provide adequate care and learn from mistakes
Basic personal care failure - washing, feeding, hydration
Went unchallenged by HCP

Question 33

Consequence for patients during mid staff crisis

Answer 33

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

Question 34

How midstaff crisis came to an end

Answer 34

Increased mortality flagged up with NHS system
Cure the nhs campaign launch
Became national scandal led to sig changes

Question 35

Transparency and honesty in healthcare

Answer 35

Be honest with patients about mistakes or errors that have happened in their care

Question 36

What does the duty of candour mean for organisations

Answer 36

Duty to:
Inform people about incident
Provide reasonable support
Provide truthful info
Provide apology

Question 37

GMC review of how HCP should approach a mistake

Answer 37

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