2 Workshop Format Small groups: Fact-Finding Exercise How do people do it at the moment?Examples of good practice.What do people find difficult?Ethics theory – Frameworks, Values, AssessmentGroup work: case discussions - how to incorporate into practice2
3 RCGP Rationale for Ethics Professional Codes of Conduct – incorporates some ethical principlesMinimum standardsLimits of accepted professional behaviourApplication and interpretation to specific cases or situationsIdentify ethical issues in practiceEvaluate moral justification for different courses of actionsMake appropriate and justifiable decisionsDoctors are expected to act in accordance with ethical principles laid out in professional codes of conduct.These codes set both minimum standards and limits of behaviour beyond which a practitioner must not go.Within this framework health professionals make decisions that require application and interpretation to the circumstances of particular cases or situations.To do this they must be able to identify ethical issues arising in practice, evaluate the moral justification for different courses of action, and justify their decisions
4 Professional Codes of Conduct Wider Societal ValuesProfessional Codes of ConductHealthProfessionalCase SpecificsAs doctors there are certain professional codes of conduct that we are expected to adhere to. These codes set both minimum standards and limits of behaviour beyond which a practitioner must not go.In daily practice, we apply and interpret the codes of conduct and fit it to the circumstances of the situation we are in, influenced as that might be by factors such as the case specifics, the wider societal values associated with resource allocation, public health and prevention of illness, our own personal values and the evidence that is out there. We then use all of that to make our decisions.Decision-makingPersonal ValuesEvidence
5 The Clinical Encounter Each healthcare encounter is informed byFacts:history, examination findings, investigation resultsevidence of effectiveness of treatment options.Values of ALL those involved in the encounterMoral, cultural and aesthetic valuesOften implicit rather than explicitly articulated5
6 Clinical Ethics and Values Based Practice GPs must:Understand the ethical and legal framework within which they practiseIdentify ethical issues that arise in day-to-day practiceRecognise the relevant values of all those involvedDemonstrate the moral reasoning on which their decisions are based
7 Four Principles Beauchamp and Childress (1970s) Respect for autonomyBeneficenceNon maleficenceJusticeAll of equal importanceCodes of conduct generally in keeping with these principles
8 In the GMC context GMC guidance Respect for Autonomy Beneficence Non-maleficenceJusticeDuty of confidence✔Public interest DisclosuresInformed consentSafeguardingMental capacityProviding good clinical careAccess to medical careConduct of colleagues
9 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.A preference relates to a greater liking for one alternative above others. It is personal and does not have to be shared with anyone. It does not have any intrinsic moral implications.Sometimes it is difficult to differentiate between values and preferences. It is worth remembering that preferences are facts about personal taste and therefore cannot be disputed (eg I like to wear red). Values however related to more than one person and can have ethical significance (eg it is wrong to kill).
10 Moral Theory Deontology Utilitarianism “The science of duty” The morality of an action is intrinsic to the action itself rather than the consequencesMost societies rely somewhat on these kinds of moral rules“The greatest happiness of the greatest number”People should act in a way that brings about the best overall outcomeThe goodness of any outcome depends on the amount of happiness realised
11 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?
12 Trainer’s task In the discussion you need to elicit from your trainee: Their understanding of the ethical dimensions to the caseThe relevance of professional codes of conduct (if appropriate)The values of the individuals involved (themselves included)How all of the above impacted on their decision making
13 Eliciting the Information Ask questions that will ELICIT:Ethical dimensions to the caseRelevance of codes of conductValues of the individuals involvedImpact on decision making
14 Assessing the Information Competence FrameworkCompetence No. 11: Maintaining an ethical approach to practice – practising ethically with integrity and a respect for diversityBloom’s taxonomy: knowledge, skills, attitudes
15 NFD Competent Excellent Knowledge What your trainee knows Skills Recognises that people are different. Observes professional codes of practice.Identifies ethical conflicts in clinical practice.Anticipates and avoids situations where personal and professional interests might be brought into conflict.SkillsWhat your trainee doesTreats 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.AttitudeWhat your trainee thinks and feelsDoes 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.