1. Introduction to Medical Ethics Ray Noble Centre for Reproductive Ethics and Rights UCL Institute for Women’s Health University College London

2. Moral and Ethical Responsibility What is Ethics?

3. Moral and Ethical Responsibility How best we may deal with conflicting moral decisions or actions

4. Moral and Ethical Responsibility Ethics usually considers alternative courses of action in relation to moral imperatives.

5. Moral and Ethical Responsibility Ethics is a systematic approach to decision making

6. Moral and Ethical Responsibility Ethics is NOT simply following ‘the rules’

7. Moral and Ethical Responsibility How can I act in the ‘best interests’ of my patients and my community?

8. Moral and Ethical Responsibility How best can I fulfil duties to my patients and my community?

9. Moral and Ethical Responsibility Ethics is a) analytical and b) practical

10. Moral and Ethical Responsibility Ethics seeks to set up ‘guidelines’ for good practice. But ethical practice is case-sensitive.

11. ‘All humans are equal’ Consider this simple analytical problem. Is this an ethical statement?

12. ‘All humans are equal’ But we are not equal! We are all different with different abilities and needs.

13. ‘All humans should be treated equally’ Is this an ethical approach?

14. ‘All humans should be treated equally’ But this would be unfair because we are not the same! Ethics should take account of our differences.

15. ‘All humans should be treated Fairly’ Is this an ethical approach?

16. ‘All humans should be treated Fairly’ This looks better. So now we need to define what we mean by ‘fairly’

17. ‘All humans should be given an equal consideration of their interests. This says that we should a) treat our patients as individuals and b) consider their interests as individuals.

18. ‘All patients should be given an equal consideration of their interests. This says that we should a) treat our patients as individuals and b) consider their interests as individuals.

19. ‘All patients should be given an equal consideration of their interests. This says that we should a) treat our patients as individuals and b) consider their interests as individuals.

20. ‘All patients should be given an equal consideration of their interests. We should avoid unfair stereotypes and assumptions about patients.

21. The ethical doctor – ethical tools Consequences Benefits Harms Duties To whom? How extensive?

22. The ethical doctor – ethical tools First define the ethical dilemma Consequences Benefits Harms Duties To whom? How extensive?

23. A premature baby A baby born prematurely at 24 weeks is put in intensive care. She is not thriving and scans suggest she has profound brain damage. She cannot breathe unassisted and the care team believe she is suffering and it is not in her best interest to keep her alive. The parents do not agree. What should the clinicians do?

24. The ethical doctor – ethical tools Consequences Benefits Harms Duties To whom? How extensive?

25. Principles Four fundamental principles are often applied in modern medical ethics: Respect for individual autonomy – individuals are regarded as moral agents with duties and obligations and the capacity to understand and make ethical decisions. Principle of beneficence – seek to do good Principle of non-maleficence – avoid doing harm Principle of Justice – people should be treated fairly. Beauchamp, T.L and Childress, J.F. Principles of biomedical ethics (5th Edition, 2001).

26. Autonomy and informed consent A pregnant woman decides to have a triple marker test for Down’s screening. After she has given the blood she decides she does not want to know the result as she wants to have the baby. The test result shows a high risk of Down’s syndrome. The clinician feels there will be a high social and economic burden on the family and would like to convey the test result to the patient to inform her decision making. What should the obstetrician do?

27. Case scenario 1 ) What are the major ethical dilemmas? 2) Consequences: what are the consequences of any given course of action? Consider both benefits and harms 3) Duties and Obligations: what are the duties of the clinician? Is this a case of conflict of duties? To whom does the clinician owe these duties? If so how best can this dilemma be resolved? 4) Consider the categorical imperatives. Is this a case of respect for autonomy and informed consent? If so are there sufficient grounds to ignore her wishes? 5) Application of principles. How might the four key ethical principles of ethical clinical practice be applied?

28. Autonomy and informed consent You are a doctor working in a busy practice in London, UK. One of your patients is a fifteen year old girl who has come to see you to ask advice about contraception and sexually transmitted diseases. She explains that she has a regular boyfriend with whom she is now having sexual intercourse. At age fifteen in the UK she is considered a minor.

29. Introduction to Medical Ethics Ray Noble Centre for Reproductive Ethics and Rights UCL Institute for Women’s Health University College London