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Medical Ethics mg VTS. Some Questions..... Have you come across an ethical dilemma recently?Have you come across an ethical dilemma recently? Were you.

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Presentation on theme: "Medical Ethics mg VTS. Some Questions..... Have you come across an ethical dilemma recently?Have you come across an ethical dilemma recently? Were you."— Presentation transcript:

1 Medical Ethics mg VTS

2 Some Questions..... Have you come across an ethical dilemma recently?Have you come across an ethical dilemma recently? Were you comfortable in dealing with it?Were you comfortable in dealing with it? How did you resolve it?How did you resolve it? Who did you go to for help?Who did you go to for help?

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4 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

5 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

6 Some more questions for you……. How is medical ethics relevant to your work as a GP? How is medical ethics relevant to your work as a GP? Is medical ethics the special preserve of doctors? Is medical ethics the special preserve of doctors? Will the advance of scientific medicine reduce the need for ethical debate? Will the advance of scientific medicine reduce the need for ethical debate?

7 Why bother? What problems?

8 No clear solutions provided No clear solutions provided A mish-mash of conflicting opinions A mish-mash of conflicting opinions Increases complexity, excessive choice Increases complexity, excessive choice It all takes time It all takes time Decisions can be delayed Decisions can be delayed What’s wrong with pragmatism anyway? (We all use our experience, intuition and common sense) What’s wrong with pragmatism anyway? (We all use our experience, intuition and common sense)

9 Why learn about ethics? ESSENTIAL IN DIFFICULT CASES ESSENTIAL IN DIFFICULT CASES Almost all consultations have an ethical dimension SENSITIVITY 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 RISK REDUCTION Reducing risk of complaint and litigation HELPS PASS THE nMRCGP EXAM!! HELPS PASS THE nMRCGP EXAM!!

10 Should doctors have to swear an oath when they qualify? The Hippocratic Oath.doc The Hippocratic Oath.doc Modern Hippocratic Oath.doc Modern Hippocratic Oath.doc AMA Oath.doc AMA Oath.doc

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12 What is meant by Ethics?

13 Ethics – the philosophical study of moralityEthics – the philosophical study of morality

14 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

15 What is meant by morality?

16 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 goalMorality – a system applying to all rational persons, governing behaviour that affects others, having the lessening of harm as its goal

17 How does it relate to philosophy? PHILOSOPHY is the study of beliefs and ideas. It deals with theories is the study of beliefs and ideas. It deals with theories ETHICS (moral philosophy) is a branch of philosophy with practical application. good and bad, right and wrong ETHICAL and MORAL refer to BEHAVIOUR – good and bad, right and wrong An attempt to make judgements objectively

18 MORAL THEORIES...Individuals with intrinsic good character follow their conscience (Aristotle) VIRTUE...Individuals with intrinsic good character follow their conscience (Aristotle)...obligations we owe to each other based on respect for others. Morality depends on intention (Kant) DUTIES...obligations we owe to each other based on respect for others. Morality depends on intention (Kant). Right / wrong judged only by the consequence. The greatest good for the greatest number (John Stuart Mill) UTILITY... Right / wrong judged only by the consequence. The greatest good for the greatest number (John Stuart Mill) A more recent theory. What a citizen can expect to be provided. Stated in law. RIGHTS...A more recent theory. What a citizen can expect to be provided. Stated in law.

19 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

20 The First Principle Do goodDo good This is BENEFICENCEThis is BENEFICENCE Such aspects as cure / palliation / comfort / empathy / compassion / treating patients with dignitySuch aspects as cure / palliation / comfort / empathy / compassion / treating patients with dignity Such concepts are well understood by medical and nursing staffSuch concepts are well understood by medical and nursing staff

21 The Second Principle Do no harmDo no harm This is NON-MALEFICENCEThis is NON-MALEFICENCE Not injuring patients by what we doNot injuring patients by what we do Non-iatrogenesisNon-iatrogenesis Well understood but sometimes happens inadvertentlyWell understood but sometimes happens inadvertently

22 The Third Principle Act fairlyAct fairly This is (distributive) JUSTICEThis 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?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 principleA more difficult principle

23 The Fourth Principle Allow people to determine their own futuresAllow people to determine their own futures This is AUTONOMYThis is AUTONOMY Such aspects as honesty / telling the truth / informed consent / decision sharing / maximising the ability of patients to make choicesSuch aspects as honesty / telling the truth / informed consent / decision sharing / maximising the ability of patients to make choices CONFIDENTIALITY comes under this principleCONFIDENTIALITY comes under this principle

24 A further aspect There is another aspect to this and that is SCOPEThere is another aspect to this and that is SCOPE To whom do we owe these duties?To whom do we owe these duties? Who are the interested parties?Who are the interested parties? Individuals or patients as a group? The Practice? The NHS? Society? Government?Individuals or patients as a group? The Practice? The NHS? Society? Government?

25 Other contentious areas: Ethical researchEthical research GP (consortium) commissioningGP (consortium) commissioning Do violent patients lose their right to confidentiality?Do violent patients lose their right to confidentiality? Having health provisionHaving health provision

26 “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.” “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

27 The “Four Principles” of medical ethics are: Do goodDo good Do no harmDo no harm Act fairlyAct fairly Allow people to determine their own futuresAllow people to determine their own futures(Confidentiality)

28 Conclusions and implications Things are not always as straightforward as they may seemThings are not always as straightforward as they may seem There are ethical aspects to many medical situationsThere are ethical aspects to many medical situations If the problem is an ethical one, try to generate lots of options – rule nothing outIf 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 principlesAssess the advantages and disadvantages of each solution using the four principles There may be legal precedentsThere may be legal precedents There are sources of help and advice – colleagues, GMC, medical defence companies, RCNThere are sources of help and advice – colleagues, GMC, medical defence companies, RCN Impart decisions to patients in an ethical wayImpart decisions to patients in an ethical way Record everythingRecord everything

29 Thankyou


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