What do we mean by ethics?
- Doing good versus bad, preventing harm (beneficence)
- Respecting other peoples’ wishes, confidentiality, anonymity. (Respect, confidentiality and data protection)
- May involve making difficult, emotionally charged decisions (autonomy) Patients’ best interest
- Deciding on priorities, thinking about resources, costs. (Who is more important in the sense of priority of life or death situation)
- considering peoples; beliefs and values (respect and autonomy)
- ethics applies to diagnosis, treatment and research.
Name the four ethics principles
- Justice - legally, equity and everything is done fairly.
- Respect and autonomy - confidentiality, privacy, data protection.
- Beneficence - doing the right thing
- Non- maleficence - do no harm, doing more good than bad.
What is Beneficence
BENEFICENCE - acting in patient’s best interest to increase benefits and reduce harm.
- Might conflict with autonomy of patient - wishes of patient should be respected.
- Issue - Autonomous refusal of treatment could result in chronic problems of patient leading to inc cost on NHS.
- Benefits of treatment:
-Issue- a branded drug - expensive but effective while cheaper might be available to more people. - Feeding people at a soup kitchen is an example of beneficence. Preventing a patient from taking a harmful medication is an example of non-maleficence.
Can you think of any issues around beneficence that might arise in healthcare?
Beliefs of patients may prevent them from receiving the treatment they require and due to respect and autonomy you are unable to disrespect their wishes - in this case you could be doing more harm by listening to the patient’s wishes.
What is non-maleficence?
Non-maleficence - do no harm, prevent harm caused to patients as a result of negligence.
- Obligation not to inflict harm intentionally.
- many forms of treatment cause unavoidable discomfort/pain, however these unwanted side effects should be kept to a minimum.
Primum non nocere - first do no harm
Can you think of any issues around non-maleficence that might arise in healthcare?
Doseage through X-ray imaging is inevitable and can cause dose which could cause harm in the future, e.g. cancer - example of stochastic effects.
What is justice?
JUSTICE- treating others equitably and with fairness. Fair distribution of ideas - EBP, resources for treatment of patients.
Ensure that no one is unfairly disadvantaged in access to healthcare (free prescription for lower income individuals) Treat similar cases alike.
-Allocation of resources should be equal when decision makers are determining how to divide costs and benefits. Treat patients according to their needs.
Can you think of any issues around justice that might arise in healthcare?
Lack of communication if there is no translator present patient will not fully understand the procedure/ treatment they are about to undergo.
What is autonomy?
Autonomy - patient right to make their own decisions free from being forced or coerced.
- make their own choice, hold their own views, take actions based on own personal value& belief systems.
- decision - must be informed one, patient must have capacity to understand info given.
- autonomous decision not always medically correct.
- even if patient isn’t autonomous their feelings should be respected as much as practically possible.
- Mental Health Act (1983)(amended 2007) and Mental capacity Act (2005)
Can you think of any issues around autonomy that might arise in healthcare?
Can lead to patients’ decisions causing more harm than good.
What are the ethical concepts?
Veracity- telling truth giving correct info.
Privacy - having respect for confidentiality and anonymity.
Fidelity - keeping our promises, giving information/ providing things when we have undertaken to do so.
Consent - getting patients’ permission before doing things involving them e.g. treatments, tests and research.
State the origins of Ethics
Hippocratic oaths - no harm, respect for privacy and sharing knowledge about best treatments.
Nuremberg code - ethical principles - human experimentation/research - voluntary consent, reduce risks. etc
1948 - UN Universal declarations of human rights.
State the theories of Ethics
- Utilitarianism (logic of consequences) - taking overall consequences of our actions into consideration - greater good - small harm to occur.
- Deontology (logic of principles) - basing our actions on fixed duties - any form of harm is not permitted even for greater good.
Alternative definitions of Ethics
- A field of study that helps people to understand the morality of human behaviour.
- The practices or beliefs of a certain group (medics, nurses etc).
- The expected standards of moral behaviour of a particular group as described in the group’s formal code of professional ethics.
- The values that guide a health practitioner’s behaviour or judgement (e.g. Health and Care Professions Council).
State the Codes of Ethics
- They may be sets of guiding principles that clarify an organization’s mission, values and principles.
- They may be a collective statement about a group’s moral judgment.
- They may act as a standard for professional actions.
- They may be benchmarks against which individual and organizational performance can be measured.
State the purpose of a Code of Ethics
- To inform the public about the minimum standards of the profession and help them understand professional healthcare conduct.
- To provide a sign of the profession’s commitment to the public it serves.
- To outline the major ethical considerations of the profession.
- To provide general guidelines for professional behaviour.
- To guide the profession in self-regulation.
- To remind healthcare workers of the special responsibility they assume when caring for the sick.
The HCPC code of conduct is an example which theory of ethics?
- Utilitarianism (Logic of Consequences) – taking the overall consequences of our actions into consideration.
- for example the “greater good” idea – it is ethical for some small harm to occur, if it means that benefit occurs overall.
- Deontology (Logic of Principles) – basing our actions on a fixed set of duties.
- For example any form of harm is not permitted (even if it’s for the “greater good”)
What conditions need to be satisfied in order for consent to be valid?
Consent, all three must be satisfied:
-Voluntary
-Informed
-Capacity
What does the term Gillick competence refer to?
Gillick competence is a term originating in England which is used in medical law to decide whether a child (under 16 years of age) is able to consent to their own medical treatment, without the need for parental permission or knowledge.
What is an Advance Decision used for?
Advance Decision- used in law to state in advance the medical procedures which a person with deteriorating health would want to refuse later when they lose capacity.
Example DNR, treatment explained prior to losing capacity, where an agreement has been established on course of treatment.
List the 5 laws protecting the public
- The Mental Health Act (2007) – health professionals, in some circumstances, have the power to assess and treat people with mental health disorders in the interests of their own safety.
- The Mental Capacity Act (2005) – someone with capacity under the act is autonomous.
- Public Health (Control of Disease) Act 1984 – can insist on examining people with notifiable diseases.
- The Court of Protection – has jurisdiction over the welfare of people who are unable to make autonomous decisions for themselves.
- The Advance Decision – used in law to state in advance the medical procedures which a person with deteriorating health would want to refuse later when they lose capacity.
What are the eight key principles outlined in the Data Protection Act 2018
- Fairly and lawfully processed
- Processed for limited purposes
- Adequate, relevant, not excessive
- Accurate and up-to-date
- Not kept longer than necessary
- Processed in accordance with individual rights
- Secure and with restricted access to it
- Not transferred to countries outside the European Economic area unless adequate security mechanisms are in place.
What individual rights are identified within the Data Protection Act (2018)?
People have four rights within the Data Protection Act:
• To see what information is held about them
• To prevent its distribution if it causes distress
• To prevent processing for marketing purposes
• To request that incorrect information is corrected, blocked or erased
What 7 types of information is classified as sensitive or personal?
- Racial or ethnic origin
- Political opinion
- Religious or other beliefs
- Union memberships
- Physical or mental health
- Sexual life
- Criminal offences
