Frameworks for Ethical analysis.

Question 1

Learning outcomes

Answer 1

• Review and apply the main moral theories of deontology, consequentialism and virtue ethics
• Review and apply the four principles of medical ethics
• State and explain the topics of the four quadrant approach
• Demonstrate the four quadrant approach through application to a particular case
• Construct the steps involved in a structured case analysis

Question 2

What are 3 approaches to decision-making in medicine?

Answer 2

• 3 approaches to decision-making in medicine:
  1) Beliefs, values, opinions, viewpoints (formed by upbringing, culture, experience). Also ‘common sense’.
  2) Laws and professional codes – e.g. GMC’s Duties of a Doctor
  3) Moral theories and principles

Question 3

What are the tools we need to make good decisions?

Answer 3

• The tools we need to make good decisions:

1) Legal framework

2) Professional guidelines & codes of practice (GMC)

3) Ethical analysis
* Separate out facts from values
* Reason using principles and theory
* Compare similar cases

Question 4

What are the 4 domains of The Duties of a Doctor from the GMCs good medical practise?

What are a doctors first concern?

Who is accountable for your actions?

Answer 4

• 4 domains of The Duties of a Doctor from the GMCs good medical practise
  1) Knowledge, skills, and performance – The first concern of doctors is the care of their patients.
  2) Safety and Quality
  3) Communication, partnership, and teamwork
  4) Maintaining trust
• You are personally accountable for your professional practise and must always be prepared to justify your decisions and actions

Question 5

What are the 3 common moral theories in medical ethics?

What is an example of each?

Answer 5

• 3 common moral theories in medical ethics
• Basis of theory: An action is right if, and only if:

1) Consequentialism – It promotes the best consequences. Most common form is utilitarianism (the best outcome for the most people)

2) Deontology – It is in accord with a moral rule or principle. Duties and rights-based morality. Moral rule or principle can be decided on universality e.g., telling the truth.

3) Virtue ethics – It is what a virtuous agent would do in the circumstances. A virtue is a character trait a human being needs to flourish. e.g., a good doctor is one who is caring, disciplined, skilful, trustworthy

Question 6

What are shortcomings with each of the 3 common moral theories?

Answer 6

• Shortcomings with each of the 3 common moral theories?

1) Consequentialism
* Which good?
* How do we quantify good?
* Is it practical to make moral decisions with a calculator?
* Inadequate protection for individual rights

2) Deontology
* Consequences matter
* How do we decided on duties?
* How do we decide on duty hierarchy?
* What about situation where we seem to be morally required to break a rule (e.g lying to protect someone from physical harm)

3) Virtue ethics
* How do you decide on virtues?
* May be culturally specific

Question 7

What are the 4 principles of medical ethics?

Answer 7

4 principles of medical ethics:

1) Justice
* Fairness in all decisions regarding a patient’s treatment
* Patients will receive equal access to resources and treatments
* Scarce resources will be distributed as evenly as possible.
* Healthcare professionals will respect the patients’ rights and morally acceptable laws.

2) Beneficence
* Healthcare professionals will make decisions to achieve the best patient outcome possible.
* They will acknowledge that what is the best course of treatment for the patient won’t be the best course for another.
* Doctors will keep their professional skills up to date and act competently to uphold beneficence

3) Non-maleficence
* Do not cause harm to patients or the community
* Ties in with beneficence
* Sometimes harm is unavoidable during certain treatments
* Doctrine of double effect must be considered.

4) Autonomy
* Allows for competent informed patients to make decisions regarding their own course of treatment (informed consent) and respecting those decisions
* This is true whether the decision has a positive or negative effect (such as blood transfusion for a Jehovah’s witness)
* Patients can only reject treatment; they can’t ask for treatment that was not offered.
* Also respecting a patient’s right to confidentiality.

Question 8

What are the four quadrants?

How can the case Not my turn (Arthur Caplan, the Lancet 2012) be approached in terms of the four quadrants?

Answer 8

• The four quadrants are another approach to medical ethics:

1) Medical indications
* Consider each medical condition and its proposed treatment:
* Does it fulfil any of the goals of medicine?
* With what likelihood?
* If not, is the proposed treatment futile?

2) Patient preferences
* What does the patient want?
* Does the patient have the capacity to decide?
* If not, can anyone advocate for the patient?
* Do the patient’s wishes reflect a process that is: informed? understood? Voluntary? Continuing?

3) Quality of life
* Describe the patient’s quality of life in the patient’s terms and from the care providers’ perspectives.

4) Contextual features
* Circumstances that can either influence the decision or be influenced by the decision.

Question 9

What are the steps in Professor Bowman’s guide to helping you think through cases?

Answer 9

• Steps in Professor Bowman’s guide to helping you think through cases:
  1) Summarise the case or problem
  2) State the moral dilemma
  3) State the assumptions that are being made
  4) Analyse the case
  5) Acknowledge other approaches and state the preferred approach with explanation

Question 10

Other medical cases (google title to find out more)

Answer 10

Other medical cases (google title to find out more)