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 the main approaches to decision making in medicine?

Answer 2

1. Beliefs, values, opinions, viewpoints (formed by inter alia upbringing, culture, experience). Also ‘common sense’.
2. Laws and professional codes – e.g. GMC’s Duties of a Doctor
3. Moral theories and principles
4. personal and may vary from person to person
   2 & 3. laws, codes and regulations - have limits, may not address the issue at hand

Question 3

What do we need to make good decisions?

Answer 3

– Legal framework
– Professional guidelines & codes of practice (GMC)
– Ethical analysis
	• Separate out facts from values
	• Reason using principles and theory
	• Compare similar cases

Question 4

What are the GMC: Good medical practice Duties of a doctor (2013, 14, 19)

Answer 4

Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and you must make sure your practice meets the standards expected of you in four domains:

1. Knowledge, skills & performance
   - Make the care of your patient your first concern
2. Safety and quality
3. Communication, partnership and teamwork
4. Maintaining trust

You are personally accountable for your professional practice and must always be prepared to justify your decisions and actions.

Question 5

What are the three common theories on how to decide if an action is right (moral)

Answer 5

Consequentialism (Bentham)
Deontology (Kant)
Virtue ethics (Aristotle)

Question 6

Describe Consequentialism

Answer 6

Basis:
it promotes best consequences.
Most common form is utilitarianism.
(Utilitarianism: “The greatest happiness for the greatest number”; Cost/benefit analysis is determinative of what it is right to do.)

Points:
Must decide how different consequences are going to be morally evaluated and ranked.

Question 7

Describe Deontology

Answer 7

Basis:
it is in accord with a moral rule or principle. Duties and Rights based morality (Duties - GMC guidance)

Points:
A moral rule is one laid on us by God, by reason or would be chosen by rational beings.

Question 8

Describe Virtue ethics

Answer 8

Basis:
it is what a virtuous agent would do in the circumstances.
e.g. a good doctor is one who is: Caring, Disciplined, Skilful Trustworthy

Points:
A virtue is a character trait a human being needs in order to flourish (hence concept of flourishing is crucial)

Question 9

What are the four principles of medical ethics?

Answer 9

Proposed by Beauchamp & Childress
Unlike the moral theories, these are designed for use in medical context

Justice
Autonomy
Non-maleficence
Beneficence

Justice being the most contentious (Respect for people’s rights (rights based justice) and respect for morally acceptable laws (legal justice) (Gillon, 1994) as well as distributive justice + fairness in provision of care)

Question 10

What is the four quadrants approach?

Answer 10

4 quadrants are:
Medical indications
Patient preferences
Quality of Life
Contextual features

Where medical indications means to 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?

Patient preferences means to consider 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?

Quality of life means to describe the patient’s quality of life in the patient’s terms and from the care providers’ perspectives.

and contextual features refers to the circumstances that can either influence the decision or be influenced by the decision.

DK Sokol - The “four quadrants” approach to clinical ethics case analysis; an application and review

Question 11

What is Prof Bowman’s guide to helping you think through cases?

Answer 11

• Summarise the case or problem
• State the moral dilemma
• State the assumptions that are being made
• Analyse the case
• Acknowledge other approaches and state the preferred approach with explanation

Question 12

Summary

Answer 12

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