1. Assessing Ethics in CbDs
Hasna Begum

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, Assessment
Group work: case discussions - how to incorporate into practice 2

3. RCGP Rationale for Ethics
Professional Codes of Conduct – incorporates some ethical principles
Minimum standards
Limits of accepted professional behaviour
Application and interpretation to specific cases or situations
Identify ethical issues in practice
Evaluate moral justification for different courses of actions
Make appropriate and justifiable decisions
Doctors 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 Values
Professional Codes of Conduct
Health
Professional
Case Specifics
As 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-making
Personal Values
Evidence

5. 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

6. 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

7. 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

8. In the GMC context GMC guidance Respect for Autonomy Beneficence
Non-maleficence
Justice
Duty of confidence ✔
Public interest Disclosures
Informed consent
Safeguarding
Mental capacity
Providing good clinical care
Access to medical care
Conduct 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 consequences
Most 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 outcome
The 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 case
The 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 case
Relevance of codes of conduct
Values of the individuals involved
Impact on decision making

14. 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

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.
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.