Transcript ethics in CbDs by hasna

Assessing Ethics in CbDs
Hasna Begum
Workshop Format
o Small groups: Fact-Finding Exercise
o How do people do it at the moment?
o Examples of good practice.
o What do people find difficult?
o Ethics theory – Frameworks, Values,
Assessment
o Group work: case discussions - how to
incorporate into practice
2
RCGP Rationale for
Ethics
o Professional Codes of Conduct – incorporates
some ethical principles
o Minimum standards
o Limits of accepted professional behaviour
o Application and interpretation to specific cases or
situations
o Identify ethical issues in practice
o Evaluate moral justification for different courses of
actions
o Make appropriate and justifiable decisions
Wider Societal Values
Case Specifics
Professional
Codes of
Conduct
Health
Professional
Personal Values
Evidence
Decisio
nmaking
The Clinical Encounter
• Each healthcare encounter is informed by
• Facts:
• history, examination findings, investigation results
• evidence of effectiveness of treatment options.
• Values of ALL those involved in the encounter
• Moral, cultural and aesthetic values
• Often implicit rather than explicitly articulated
5
Clinical Ethics and Values
Based Practice
• GPs must:
• Understand the ethical and legal framework
within which they practise
• Identify ethical issues that arise in day-to-day
practice
• Recognise the relevant values of all those
involved
• Demonstrate the moral reasoning on which
their decisions are based
Four Principles
• Beauchamp and Childress (1970s)
•
•
•
•
Respect for autonomy
Beneficence
Non maleficence
Justice
• All of equal importance
• Codes of conduct generally in keeping with
these principles
In the GMC context
GMC guidance
Duty of confidence
Public interest
Disclosures
Informed consent
Safeguarding
Mental capacity
Providing good
clinical care
Access to medical
care
Conduct of
colleagues
Respect for
Autonomy
✔
✔
Beneficence
NonJustic
maleficence
e
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
✔
Values
• What do we mean by this?
• A value is a standard – typically shared by
others in a given community – for judging the
goodness or badness of some thing or some
action.
• Values have moral implications.
• Separate from preferences.
Moral Theory
Deontology
• “The science of duty”
• The morality of an action
is intrinsic to the action
itself rather than the
consequences
• Most societies rely
somewhat on these kinds
of moral rules
Utilitarianism
• “The greatest happiness
of the greatest number”
• People should act in a
way that brings about the
best overall outcome
• The goodness of any
outcome depends on the
amount of happiness
realised
Jim and the Tribespeople
• Jim is an anthropologist, and one day, deep in the
Amazon, he comes across a tribe. The chief is about
to execute a group of ten people from his tribe,
who were chosen at random. The chief hails Jim
and says, “You are a guest amongst us and in order
to honour you, I will allow you to save nine of these
ten people. All you have to do is pick one for
execution and the other nine will go free. If you do
not choose one, then all ten will die.”
• If you were Jim, what would you do?
Trainer’s task
• In the discussion you need to elicit from your
trainee:
1. Their understanding of the ethical dimensions
to the case
2. The relevance of professional codes of conduct
(if appropriate)
3. The values of the individuals involved
(themselves included)
4. How all of the above impacted on their decision
making
Eliciting the Information
Ask questions
that will
ELICIT:
Ethical
dimensions to
the case
Relevance of
codes of
conduct
Impact on
decision
making
Values of the
individuals
involved
Assessing the Information
• Competence Framework
• Competence No. 11: Maintaining an ethical
approach to practice – practising ethically with
integrity and a respect for diversity
• Bloom’s taxonomy: knowledge, skills,
attitudes
NFD
Competent
Excellent
Knowledge
What your trainee
knows
Recognises that people are Identifies ethical conflicts
different. Observes
in clinical practice.
professional codes of
practice.
Anticipates and avoids
situations where personal
and professional interests
might be brought into
conflict.
Skills
What your trainee
does
Treats patients, colleagues
and others equitably and
with respect for their
beliefs, preferences,
dignity and rights.
Discusses ethical conflicts
in clinical practice. Takes
action to address
prejudice, oppression and
unfair discrimination
within the self, other
individuals and within
systems.
Actively promotes equality
of opportunity for patients
to access health care and
for individuals to achieve
their potential.
Attitude
What your trainee
thinks and feels
Does not discriminate
against people because of
their differences. Shows
awareness of own values,
attitudes and ethics and
how these might influence
professional behaviour.
Recognises prejudice,
oppression and unfair
discrimination within the
self, other individuals and
within systems.
Values diversity by
harnessing differences
between people for the
benefit of practice and
patients alike.