Ethics

Question 1

define medical ethics

Answer 1

asking the question of what should be done, rather than what can be done.

Question 2

1. what is consequentialism?
2. what is deontology?
3. what is virtue ethics?

Answer 2

1. morally right action is the one that gives the best overall outcome
2. acts are morally right if they accord with moral rules or duties; an act may be right, even if it leads to the worst consequences overall, as long as moral rules/duties have been followed
3. the right action is the one a virtuous person would perform under the same circumstances; a virtuous person is one with high moral standards.

Question 3

Name and describe the 4 key ethical principles

Answer 3

1. Non-maleficence - must not intentionally cause harm to a patient
2. beneficence - must act in a way that is of benefit of the patient
3. justice - must treat patients in fairness and not discriminate
4. respect - for autonomy of patient.

Question 4

1. name 3 components of autonomy
2. why is autonomy important from a consequentialist view?
3. why is autonomy important from a deontological view?
4. how is the respect for autonomy a negative obligation?
5. how is the respect for autonomy a positive obligation?

Answer 4

1. acting with sufficient understanding; acting free from the control of others; acting in accordance of ones values
2. autonomy leads to the best outcome for the patient (people are generally happier when they make their own decisions)
3. actions are right or wrong, regardless of consequences. By respecting autonomy we are fulfilling a moral duty
4. we should refrain from acting in ways that prevent people from doing what they desire
5. we have to do positive things to respect autonomy, eg. giving people the information they need to make an informed decision

Question 5

1. What does acting in best interests mean?
2. which ethical principles does acting in best interests link with?
3. why do we need to consult the patient whilst making a clinical judgement regarding best interests? (3)
4. name 4 reasons how it might be difficult to assess best interests

Answer 5

1. doing something that will overall have a net benefit for a patient
2. beneficence and non-maleficence
3. to examine whether it is in concordance of what the patient wants
   to consider the patient’s values
   to consider the impact of treatment on patient’s life and emotional wellbeing
4. future/treatment outcome may be uncertain; some patients are unable to communicate relevant information; weighing up conflicting goods - quantity v quality of life; doctors and patient’s views may differ

Question 6

1. what is medical paternalism?

2. name 3 exceptions, in which medical paternalism can be used

Answer 6

1. the interference with a person’s freedom of action or freedom of information or the deliberate dissemination of misinformation, justified by reasons referring exclusively to the welfare, happiness, needs, interests or values of the person(s) being coerced or misinformed
2. • withholding information to prevent serious harm
     - treatment of infants and children, patients who lack capacity, or mentally ill adults
     - if doctor believes treatment would be of no overall benefit to the patient - under no legal or professional obligation to provide unnecessary treatment.

Question 7

1. what is informed consent?
2. name and define 4 types of consent
3. name 4 instances when consent is required

Answer 7

1. the properly informed decision of a competent patient that is freely given
2. oral; written (but not a contract, patient can withdraw at any time); expressed (patient states that they wish to undergo a certain procedure) implied (patient shows by non-verbal means that they are willing to undergo a procedure)
3. before examination, treatment or care; before disclosure of confidential information; before treatment; for participation in research

Question 8

1. name 3 elements of consent required for it to be valid
2. how is consent an ethical requirement? (3)
3. how is consent a legal requirement? (2)

Answer 8

1. informed; voluntary (must not force); capacity
2. respects autonomy; avoidance of harm; important for trust
3. battery - doctor conducts procedure without consent
   negligence - failure to obtain informed consent is seen as negligence

Question 9

name 5 circumstances when consent is not needed

Answer 9

1. emergency situations and not possible or practicable to find out patient’s wishes
2. if being treated under the mental health act
3. when patient lacks capacity and is acting in their best interests
4. public health (control of disease) act - enables magistrates to order that someone is detained in hospital if they impose .an infectious disease risk to the public
5. disclosure of confidential information without consent if acting in the public interest or if patient is at serious risk of harm if not shared

Question 10

1. at what age are children presumed competent to consent?
2. what is gillick competence?
3. who consents if a child is not deemed gillick competent?
4. what happens if a patient is under 18, but refuses to consent to something?

Answer 10

1. 16
2. if a child can understand and reason through information that they are given, then they can consent to a procedure
3. consent is given to those with parental responsibility
4. treatment can be given if approved by parents or the courts.

Question 11

1. what is confidentiality?

2. name 5 reasons why we should maintain confidentiality

Answer 11

1. the principle of not divulging information about patients to others
2. • central to establishing trust (which is central to professionalism)
     - ensures information is not disclosed to the wrong people (do no harm)
     - respects autonomy
     - legal requirement (human rights and data protection act)
     - professional obligation

Question 12

1. name 2 instances when a breach in confidentiality is justified
2. what must be considered prior to breeching confidentiality?
3. name 2 disclosures required by law
4. name 4 things that must be maintained if information is shared

Answer 12

1. when deemed in the public interest; to prevent serious harm coming to another person
2. weigh harms that are likely to arise from non-disclosure to the harm to the patient and trust between doctors and patient
3. cases of possible or certain infectious disease; if there is a court order (but not to police/solicitior)
4. • use anonymised or coded information if practicable and serves purpose
     - gain consent if information is to be disclosed for purposes other than their care
     - keep disclosures to the minimum necessary
     - keep up to date with all legal requirements

Question 13

1. what is justice?
2. what is distributive justice?
3. what is equity?
4. what is the needs based approach?
5. name 3 questions/objections to the needs based approach

Answer 13

1. the principle of treating people in a way that is fair and equitable
2. how to distribute scarce resources in a way that is just or fair or demonstrated equity
3. giving people what they need to enjoy fulfilment. Some people may need more resources to be equitable compared to another
4. the fairest/most equitable healthcare system is one where healthcare is distributed according to those who need it most
5. • what do we mean by need? how do we measure it?
     - sometimes, meeting need is not the only thing we need to consider (e.g. waiting lists)
     - what do we do when we have equal need but can’t provide for everyone?

Question 14

1. what are rights?
2. name 3 rights that all individuals have
3. what are positive rights?
4. what are negative rights?
5. what are active rights?
6. why are rights important? (4)
7. Name 6 rights outlined by the european convention of human rights that are relevant to healthcare

Answer 14

1. the rights to be treated in particular ways
2. right to life, liberty and property
3. rights that you have for certain things to be provided to you
4. rights that you have for someone not to do something towards you
5. rights you have to do particular things
6. • protective boundaries
     - conductive to goods - respecting rights generally builds a happier society
     - provides minimum standards
     - ideal directives - states what a society intends to do
7. • right to life
     - prohibition of torture (inc. inhuman or degrading treatment)
     - right to liberty and security (lack of restraint)
     - right to respect for private and family life (confidentiality; decision making)
     - freedom of thought, conscience and religion (covers patient and doctors beliefs and possible objections)
     - prohibition of discrimination