Introduction to Medical Ethics Lecture 1 Medical Ethics: Theories and Principles.
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Introduction to Medical Ethics
Lecture 1Medical Ethics: Theories
and Principles
Programme aims
Definition of Medical Ethics Scope of Ethics in Medical Practice Theories and principles Duties of a Doctor
Objectives
Within small groups and by using case based material you will be able to:
1)Recognise ethical issues 2)Recognise ethical conflicts 3)Practice verbal reasoning skills 4)Be aware of own and others moral
values
“Patients are entitled to good standards of practice and care from their doctors.Essential elements of this are professional competence, good relationships with patients and colleagues and observance of professional ethical obligations.”
From Good Medical Practice, GMC.
Importance of Medical Ethics
1. Increasing profile\Recent press headlines:
Dr Cox (euthanasia) Alder hay Enquiry Jodie and Mary Destroying frozen embryos Refusal to fund marrow
transplants\new drugs
Importance of Ethical Issues (contd.)
2)Increase in technology
3)Better informed society
4)Doctors in Management
5)Public scrutiny
Scope of ethics in Medical Practice
1. Historical background• Hippocratic oath• Geneva(1947)• Sydney(1968)• Tokyo(1975)• Lisbon(1981)
2. Multidisciplinary nature
Four Misconceptions
1. Clear distinction :clinical and ethical analysis2. Clear distinction: profess. and everyday ethics3. Enshrined in lead4. Medical ethics=matter of opinion
Doctor X is considering whether or not to break a confidence.
Patient has presented with an STD which he wishes to have treated confidentially.His wife is also your patient.What do you do?
DEONTOLOGICAL THEORIES
Some principles are intrinsically right- regardless of resulting
consequences.
CONSEQUENTIALIST THEORIESConsequence alone determines right
and wrong.- greatest happiness of the greatest
number.
Principles
1. Beneficence2. Non-Maleficence3. Autonomy4. Truth telling5. Confidentiality6. Preservation of Life7. Justice
Beneficence and Non-Maleficence
Questions:
1)Is the patient your only concern?(possible conflict with utility)
2)Do we always know what is good for the patient?
(patient’s view may differ from ours)
3 constraints on Beneficence
1. Need to respect autonomy-patient and doctor may differ re. Management
2. Need to ensure health is not bought at too high a price
3. Need to consider rights of others
Autonomy
1. Capacity to think, decide, take action
2. Mental incompetence= no autonomy3. Autonomy –v-Paternalism When patient not autonomous –no
clash. When patient autonomous-questionable procedure
Truth Telling
“In much wisdom is much grief:and he that increaseth knowledge increaseth sorrows”(Ecclesiastics 1,18)
Truth telling (cont)If you override it you endanger doctor/patient relationship(based on trust)
You offend against the principle of autonomy(Dr.C Mooreland)
At times there are good reasons for overriding the truth telling principle
The case for deception is founded on three fallacies
1. Hippocratic obligations2. Not in a position to know
the truth3. Patients do not want the
truth if the news is bad
Confidentiality
Act against this principle and you destroy patient’s trust
Clash –when keeping confidentiality would harm others eg child abuse
Should patients have access to their notes?
Against
Layman unable to cope with data Opinions not facts cause anxiety Third party information Defensive medicine
For
Data belongs to patient Accuracy improved by sharing
Access to Records
Data Protection Act (1998) What records are covered? Does it matter when the record was
made? Who can apply? Are their exemptions? Must copies be given if requested? Access to records of deceased patients?
Exceptions to Medical Confidentiality Pt gives written and valid consent To other participating professionals Where undesirable to seek patients
consent info can be given to a close relative
Statutory requirements Ordered by Court Public interest Approved Research
Preservation of Life
At what stage does human life begin?-coil, pill
Can we assess another persons quality of life?-Jehovah's Witness
Euthanasia
Active: an active intervention to end life Passive:deliberately withholding treatment
that might help a patient live longer Voluntary :euthanasia is performed following
a request from a patient Doctor assisted suicide: a doctor prescribes
a lethal drug which is self administered by the patient
Non-voluntary :ending the life of a patient who is not capable of giving permission
Involuntary:ending life against a patients will
Other Moral doctrines
Acts and Omissions Doctrine-held by those who believe that passive euthanasia is not killing(killing is an act,and an omission is not an act)
Doctrine of Double effect-makes a distinction between what I intend and what I merely foresee
Living Wills
Patient unconscious\severely mentally disabled , and two docs agree it unlikely he will be able to communicate treatment decision
Refuse treatment if prolongs life with no further benefit to patient
Justice
How to allocate scarce healthcare resources?1. Medical need2. Medical Benefits3. Social worth-discriminates against
underprivileged4. Merits/contribution to society-very
contentious5. Desert6. Market Forces7. A lottery
Contaception and Minors
1. Jane aged 15 yrs requests the OCP2. Her mum phones you the next day3. Several weeks later she tells you her
boyfriend slapped her across the face
4. Her boyfriend is her history teacher
Lord Fraser’s reccomendations
The doctor should assess whether the patient understands his\her advice
The doctor should encourage parental involvment
The doctor should take into account whether the patient is liekly to have sexual intercourse without contraceptive treatment
The doctor should assess whether the patient’s physical\mental healthare likely to suffer if she does not receive advice\treatment
The doctor must consider whether the patient’s best interestsrequire him\her to provide contraceptive advice\treatment without parental consent
4th Year- Case history A 25 yr old lady comes to the
treatment room requesting syringes.She is a lesbian and wishes to inseminate herself.
1) What else would you like to know 2)What are the ethical issues 3)What would you do
Duties of a Doctor
Please apply ethical principles to the above list as described in “Good Medical Practice”
Truth Telling Video clip
1. How much information should be given to patients preoperatively?
2. When/how should we relay information to a postoperative patient?
3. What lessons can be learned from this tape?
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