2. Programme aims
Definition of Medical Ethics
Scope of Ethics in Medical Practice
Theories and principles
Duties of a Doctor
3. Objectives
Within small groups and by using case
based material you will be able to:
1)Recognise ethical issues
2)Recognise ethical conflicts
3)Practice verbal reasoning skills
4)Be aware of own and others moral
values
4. “Patients are entitled to good standards of
practice and care from their doctors.Essential
elements of this are professional competence,
good relationships with patients and colleagues
and observance of professional ethical
obligations.”
From Good Medical Practice, GMC.
5. Importance of Medical
Ethics
1. Increasing profileRecent press
headlines:
Dr Cox (euthanasia)
Alder hay Enquiry
Jodie and Mary
Destroying frozen embryos
Refusal to fund marrow
transplantsnew drugs
6. Importance of Ethical
Issues (contd.)
2)Increase in technology
3)Better informed society
4)Doctors in Management
5)Public scrutiny
7. Scope of ethics in
Medical Practice
1. Historical background
• Hippocratic oath
• Geneva(1947)
• Sydney(1968)
• Tokyo(1975)
• Lisbon(1981)
1. Multidisciplinary nature
8. Four Misconceptions
1. Clear distinction :clinical and ethical analysis
2. Clear distinction: profess. and everyday ethics
3. Enshrined in lead
4. Medical ethics=matter of opinion
Doctor X is considering whether or not to break
a confidence.
Patient has presented with an STD which he
wishes to have treated confidentially.His wife
is also your patient.What do you do?
9. DEONTOLOGICAL THEORIES
Some principles are intrinsically right
- regardless of resulting consequences.
CONSEQUENTIALIST THEORIES
Consequence alone determines right and
wrong.
- greatest happiness of the greatest
number.
10. Principles
1. Beneficence
2. Non-Maleficence
3. Autonomy
4. Truth telling
5. Confidentiality
6. Preservation of Life
7. Justice
11. Beneficence and Non-
Maleficence
Questions:
1)Is the patient your only concern?
(possible conflict with utility)
2)Do we always know what is good for
the patient?
(patient’s view may differ from ours)
12. 3 constraints on
Beneficence
1. Need to respect autonomy-patient and
doctor may differ re. Management
2. Need to ensure health is not bought at
too high a price
3. Need to consider rights of others
13. Autonomy
1. Capacity to think, decide, take action
2. Mental incompetence= no autonomy
3. Autonomy –v-Paternalism
When patient not autonomous –no
clash. When patient autonomous-
questionable procedure
14. Truth Telling
“In much wisdom is much
grief:and he that increaseth
knowledge increaseth
sorrows”
(Ecclesiastics 1,18)
15. Truth telling (cont)
If you override it you endanger
doctor/patient relationship(based on
trust)
You offend against the principle of
autonomy(Dr.C Mooreland)
At times there are good reasons for
overriding the truth telling principle
16. The case for deception
is founded on three
fallacies
1. Hippocratic obligations
2. Not in a position to know the
truth
3. Patients do not want the truth
if the news is bad
17. Confidentiality
Act against this principle and you
destroy patient’s trust
Clash –when keeping confidentiality
would harm others eg child abuse
Should patients have access to their
notes?
18. Against
Layman unable to cope with data
Opinions not facts cause anxiety
Third party information
Defensive medicine
19. For
Data belongs to patient
Accuracy improved by sharing
20. Access to Records
Data Protection Act (1998)
What records are covered?
Does it matter when the record was made?
Who can apply?
Are their exemptions?
Must copies be given if requested?
Access to records of deceased patients?
21. Exceptions to Medical
Confidentiality
Pt gives written and valid consent
To other participating professionals
Where undesirable to seek patients consent
info can be given to a close relative
Statutory requirements
Ordered by Court
Public interest
Approved Research
22. Preservation of Life
At what stage does human life begin?-
coil, pill
Can we assess another persons quality
of life?-Jehovah's Witness
23. Euthanasia
Active: an active intervention to end life
Passive:deliberately withholding treatment
that might help a patient live longer
Voluntary :euthanasia is performed
following a request from a patient
Doctor assisted suicide : a doctor
prescribes a lethal drug which is self
administered by the patient
Non-voluntary :ending the life of a patient
who is not capable of giving permission
Involuntary:ending life against a patients will
24. Other Moral doctrines
Acts and Omissions Doctrine -held
by those who believe that passive
euthanasia is not killing(killing is an
act,and an omission is not an act)
Doctrine of Double effect -makes a
distinction between what I intend and
what I merely foresee
25. Living Wills
Patient unconsciousseverely mentally
disabled , and two docs agree it unlikely
he will be able to communicate
treatment decision
Refuse treatment if prolongs life with no
further benefit to patient
26. Justice
How to allocate scarce healthcare
resources?
1. Medical need
2. Medical Benefits
3. Social worth-discriminates against
underprivileged
4. Merits/contribution to society-very
contentious
5. Desert
6. Market Forces
7. A lottery
27. Contaception and Minors
1. Jane aged 15 yrs requests the OCP
2. Her mum phones you the next day
3. Several weeks later she tells you her
boyfriend slapped her across the face
4. Her boyfriend is her history teacher
28. Lord Fraser’s
reccomendations
The doctor should assess whether the
patient understands hisher advice
The doctor should encourage parental
involvment
The doctor should take into account
whether the patient is liekly to have sexual
intercourse without contraceptive treatment
The doctor should assess whether the
patient’s physicalmental healthare likely to
suffer if she does not receive
advicetreatment
The doctor must consider whether the
patient’s best interestsrequire himher to
provide contraceptive advicetreatment
29. 4th Year- Case history
A 25 yr old lady comes to the treatment
room requesting syringes.She is a
lesbian and wishes to inseminate
herself.
1) What else would you like to know
2)What are the ethical issues
3)What would you do
30. Duties of a Doctor
Please apply ethical principles
to the above list as described
in “Good Medical Practice”
31. Truth Telling Video clip
1. How much information should be
given to patients preoperatively?
2. When/how should we relay
information to a postoperative patient?
3. What lessons can be learned from this
tape?