Transcript Medical Ethics VTS mg[1]

Medical Ethics
VTS
mg
Some Questions.....
• Have you come across an ethical
dilemma recently?
• Were you comfortable in dealing with
it?
• How did you resolve it?
• Who did you go to for help?
Aims for this session…..
To consider the relevance of ethics in
medicine (and to our daily work)
To discuss some ethical principles
To apply these to some ethical scenarios
Feel better able to recognise and address an
ethical dilemma
PLAN FOR THE SESSION
An interactive presentation
(http://www.bhbt.co.uk/Link.htm)
Ethical dilemmas -examples (split into smaller groups)
Presenting back to the group – principals highlighted
in your ethical dilemmas
Summary
TEA - BREAK
Some more questions for
you…….
• How is medical ethics relevant to your work
as a GP?
• Is medical ethics the special preserve of
doctors?
• Will the advance of scientific medicine
reduce the need for ethical debate?
Why bother? What problems?
Why bother? What problems?
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No clear solutions provided
A mish-mash of conflicting opinions
Increases complexity, excessive choice
It all takes time
Decisions can be delayed
What’s wrong with pragmatism anyway?
(We all use our experience, intuition and
common sense)
Why learn about ethics?
• ESSENTIAL IN DIFFICULT CASES
Almost all consultations have an ethical dimension
• SENSITIVITY
More sensitive to individual situations and more
self-critical. This helps to balance EBM.
Paternalism replaced by partnership
Greater range of options considered
• RISK REDUCTION
Reducing risk of complaint and litigation
• HELPS PASS THE nMRCGP EXAM!!
Should doctors have to swear
an oath when they qualify?
The Hippocratic Oath.doc
Modern Hippocratic Oath.doc
AMA Oath.doc
What is meant by Ethics?
What is meant by Ethics?
• Ethics – the philosophical study of
morality
What is meant by Ethics?
“The philosophical study of the moral value
of human conduct and the rules and
principles that ought to govern it …a code
of behaviour considered correct especially
that of a particular group, profession or
individual”
Collins English Dictionary 1994
What is meant by morality?
What is meant by morality?
• Morality – a system applying to all
rational persons, governing behaviour
that affects others, having the
lessening of harm as its goal
How does it relate to philosophy?
PHILOSOPHY
is the study of beliefs and ideas. It deals
with theories
ETHICS (moral philosophy)
is a branch of philosophy with practical
application.
ETHICAL and MORAL refer to BEHAVIOUR –
good and bad, right and wrong
An attempt to make judgements objectively
MORAL THEORIES
VIRTUE...Individuals with intrinsic good character follow
their conscience (Aristotle)
DUTIES...obligations we owe to each other based on
respect for others. Morality depends on intention (Kant)
UTILITY... Right / wrong judged only by the
consequence. The greatest good for the greatest
number (John Stuart Mill)
RIGHTS...A more recent theory. What a citizen can
expect to be provided. Stated in law.
Three helpful friends….
REALISM…. About what can be changed,
and who can change it
COMPLEXITY… Try shifting the focus and
the view point
SHARING…Responsibility with the patient,
relatives, friends, other professionals
The First Principle
• Do good
• This is BENEFICENCE
• Such aspects as cure / palliation / comfort /
empathy / compassion / treating patients with
dignity
• Such concepts are well understood by medical
and nursing staff
The Second Principle
• Do no harm
• This is NON-MALEFICENCE
• Not injuring patients by what we do
• Non-iatrogenesis
• Well understood but sometimes happens
inadvertently
The Third Principle
• Act fairly
• This is (distributive) JUSTICE
• Such aspects as treating equals equally / if
people are non-equal they should be treated in
proportion to their degree of inequality (? e.g.
those in custody, relatives) / ethical rationing –
should those who are deprived have more?
• A more difficult principle
The Fourth Principle
• Allow people to determine their own futures
• This is AUTONOMY
• Such aspects as honesty / telling the truth /
informed consent / decision sharing / maximising
the ability of patients to make choices
• CONFIDENTIALITY comes under this principle
A further aspect
• There is another aspect to this and that is SCOPE
• To whom do we owe these duties?
• Who are the interested parties?
• Individuals or patients as a group? The Practice?
The NHS? Society? Government?
Other contentious areas:
• Ethical research
• GP (consortium) commissioning
• Do violent patients lose their right to
confidentiality?
• Having health provision
• Having health provision
“Great physicians and nurses, skilled, caring and
unparalleled in their training, intervened in my life and
probably saved it. I was lucky but other Americans are
not. It is time to speak again and stand again for the ideal
that in the richest nation ever on this planet, it is wrong
for 41 million Americans, most of them in working
families, to worry at night and wake up in the morning
without the basic protection of health insurance.”
Senator John Kerry
The “Four Principles” of medical
ethics are:
• Do good
• Do no harm
• Act fairly
• Allow people to determine their own futures
(Confidentiality)
Conclusions and implications
• Things are not always as straightforward as they may seem
• There are ethical aspects to many medical situations
• If the problem is an ethical one, try to generate lots of
options – rule nothing out
• Assess the advantages and disadvantages of each solution
using the four principles
• There may be legal precedents
• There are sources of help and advice – colleagues, GMC,
medical defence companies, RCN
• Impart decisions to patients in an ethical way
• Record everything
Thankyou