Ethical Hot Topics

Question 1

What is abortion?

Answer 1

The process of terminating a human pregancy medically either through medication or surgery

Question 2

What is surgical abortion?

Answer 2

Up to 14 weeks you can use vacuum or suction aspiration

After 14 weeks you can use dilation and evacuation

Question 3

What is a medical abortion?

Answer 3

If women want to end their pregnancy within the first 10 weeks, they can be offered pills 24 and 48 hours apart.
The first pill is mifepristone which inhibits progesterone which maintains pregnancy
The second pill is misoprostol which induces contractions in the womb and the pregnancy can pass

Question 4

What is the Abortion Act and what year was it introduced?

Answer 4

Introduced in 1967 and makes abortion in England, Wales and Scotland legal up to 24 weeks of pregnancy. Requires two doctors to sign off on their opinion that the pregnancy will negatively impact the womans physical or mental health.

Question 5

What is going on in Northern Ireland with abortion?

Answer 5

Before 2018, abortion was criminalised, even in the case of rape or fetal abnormalities. In 2017, Northern Irish women could get abortions on the NHS not only privately. They then had a referendum in 2018 and abortion was decriminalised in 2019.

Question 6

What is the issue about abortion medication?

Answer 6

From 2018 onwards, medical abortion legislation changed and misoprostol was allowed to be taken from home instead of at the clinic. This reduced the risk of miscarriage on the way home from the abortion clinic which can be very traumatic. People argue this trivialises abortion

From 2020, women could take both pills from home because of lockdown

Question 7

Arguments for abortion (pro-choice)

Answer 7

. In the case of an unwanted pregnancy be that through rape, incest or just circumstance, keeping the child could inflict psychological damage on the mother. This goes against non-maleficence which states that it is a doctors duty

Question 8

Arguments for abortion (pro-choice)

Answer 8

. In the case of an unwanted pregnancy be that through rape, incest or just circumstance, keeping the child could inflict psychological damage on the mother. This goes against non-maleficence

. Prevents complications and deaths from unsafe and unregulated home abortions (justice)

. Preserves patient autonomy as the patient always has the right to their own body. If a patient should choose to terminate their pregnancy and they are well informed, they are well within their right to do that.

Question 9

Arguments against abortion ( pro-life)

Answer 9

. There are religious and social objections centred around the argument of when human life begins and if it counts as murder

. It can also cause psychological distress to have an abortion

. There are other options if the pregnancy is unwanted like adoption which doesn’t involve terminating the pregnancy.

Question 10

How to approach an abortion question?

Answer 10

. Acknowledge the ethical implications of the scenario
. State some arguments you are going to use and some history
. Provide an answer using the arguments you are aware of
. Reach a balanced conclusion in your answer

Question 11

What is alternative medicine?

Answer 11

A form of medicine that is taken instead of conventional treatment and is different. Can be aromatherapy, reflexology, herbalism and acupuncture.

Question 12

What’s the problem with alternative medicine?

Answer 12

Many in the medical community argue that they are no better than a placebo but some have limited evidence supporting them.

Question 13

What are the features of alternative medicine?

Answer 13

. High levels of contact time between patients and therapist
. It can help relieve some side effects of conventional treatment
. It’s often not based on evidence, rather on anecdotes
. It has mental health benefits like focusing on relaxation

Question 14

What is the placebo effect?

Answer 14

When patients take an inert compound and perceive their symptoms to be getting better. Alternative medicines can promote this placebo effect and therefore can have benefits

Question 15

Ethics surrounding alternative medicine

Answer 15

Non-maleficence - no harm done if using a harmless therapy however there could be a possibility of using it wrongly e.g acupuncture need;es that aren’t clean can transfer disease

Beneficence - limited side effects of most of these therapies, if used alongside conventional treatments, could have mental health benefits or placebo effect.

Autonomy - if the patient feels like the treatments work, they should be able to use it

Question 16

Comparison case study - St Johns Wort

Answer 16

. Plant species which has been shown to have medicinal properties.
. Strong evidence to show it’s effective for mild to moderate depression
. In 2008 study, it was shown to be more effective than a placebo
. Danger of it interacting with other medications

Question 17

A patient tells you that they are thinking of having an alternative treatment from a reflexologist and ask your advice about using alternative medicine.

Answer 17

S - Is this a good time to discuss this? Are you ok to talk about it now?
P - What do you want from alternative medicine, have you read much about it?
I - Do you have an opinion on the matter already?
K - It’s not evidence based, so doesn’t have a lot of scientific evidence to back it up, but it could be useful in supporting your conventional treatement.
E - How do you feel about this, is this something you are considering?
S - Well it’s ultimately your decision, if this is something you would like to go through with I will support you through it and I’m here if you have any other questions

Question 18

What is colleague absensce?

Answer 18

This is when a colleague like a medical student or other doctor misses compulsory education or work. If you believe this could impact patient safety, report it

Question 19

What is colleague absensce?

Answer 19

This is when a colleague like a medical student or other doctor misses compulsory education or work. If you believe this could impact patient safety, report it

Question 20

What are the ethical impacts of colleague absence?

Answer 20

. Non-maleficence - colleague not attending results in missed information which could lead to patient harm
. Beneficence- doing good through making colleague aware of their absence for them and their patients
. Justice - fair that they attend all of the required teaching

Question 21

What are the COVID 19 waiting times?

Answer 21

. Due to the COVID 19 pandemic, the NHS has struggled to keep up with the COVID waves and has been overwhelmed by the number of patients. This has meant that these patients have been prioritised and other services have been ignored, resulting in waiting times

Question 22

What are the reasons behind increased waiting times?

Answer 22

. Peaks of waves meant too many people were coming in with covid so the resources were directed mainly to them and non-essential surgeries were cancelled
. Less staff due to isolation from COVID so there were fewer doctors to treat patients
. GPs have moved online which took time to implement
. Lack of resources because of the interruption of global supply chains and increased use of resources

Question 23

Impact of waiting times on the NHS?

Answer 23

. Overwhelmed NHS services which are now playing catch up and is likely to impact these services for many years to come
. Due to cancellation of services, patients have suffered either with morbities or mortality
. Many patients have also experienced anxiety and frustration

Question 24

What is the Junior Doctor Contract?

Answer 24

. in 2013, Department of Health proposed a new contract that supposedly had better pay and created a 7 day NHS
. Under older contract, doctors were paid the standard rate for shifts between 7am and 7pm and 50% added outside of social hours
. New contract increased the basic salary but drastically reduced the supplements for on-call shifts meaning junior doctors were paid less

Question 25

What is the criticism of the Junior Doctor contract?

Answer 25

. Reduced pay
. Doctor safety was compromised because they had to pick up extra unsociable hours which increased tiredness and anxiety which could also make patients safety due to doctors burnout
. No consultation to this contract, felt like they just threw it on them

Question 26

Events after the Junior Doctor contract

Answer 26

. November 2015, 98% voted to reject the contract
. January-March of 2016 there were 4 junior doctor strikes each lasting between one and two days
. May 2016 there were talks between the government and BMA resume
. 2018-2020 the contract updated and was accepted in January 2020

Question 27

Should doctors be allowed to strike?

Answer 27

. Doctors have their rights as employees to strike as recognised by the UN.
. Conflicts between these rights and the moral duties that doctors have
. Reduced number of staff numbers have an impact on patient safety - non
maleficence
. Long term patient safety increases because it ensures better standards of care by helping doctors with better standards (beneficence)

Question 28

What is medical research?

Answer 28

. Medical research is a wide range of research ranging from preclinical laboratory studies to large scale clinical trials
. Increasing popularity of combining research with clinical work and this is the age of the clinician scientist
. Patients with more unique conditions may get the opportunity to be part of a clinical trial

Question 29

What is big pharma?

Answer 29

. Big pharma is the name given to the worlds pharmacological industry
. Very profitable both in the UK and globally
. Incredibly influential in determining which drugs are administered
. Should you sacrifice beneficence for monetary gain for the most lucrative drugs

Question 30

What is publication bias?

Answer 30

. In order to publish articles, they have to be approved by journals
. Journals often want to publish articles that will have the best sales
. Therefore it’s possible that insignificant results are’t reaching journals or doctors
. This can do harm (non-maleficence) because doctors who are using drugs/treatements are not getting information

Question 31

What is euthanasia?

Answer 31

.Actions that are taken to end someones life and suffering
. An incredibly controversial ethical issue with many arguments for and against
. Ties in with assisted dying which is helping a patient end their own life

Question 32

Current relevance to euthanasia

Answer 32

. Not legal in the UK (both assisted dying and euthanasia)
. It is legal in Belgium, Luxembourg and holland. Assisted dying is legal in Switzerland and Germany
. Assisted dying bill introduced in 2014 is under review in parliament. Terminally ill patients with life expectancy of less than 6 months given option to legally end their life with medical assistance
. Debated in parliament in august 2021

Question 33

Ethical relevance to euthanasia

Answer 33

. Consequentialism vs deontology - considering if it’s just the end result that matters or the actions you took to get there. So if the end result is stopping the suffering of a patient is it morally ok, compared to the morally wrong actions you took to get there
. Beneficence vs non-maleficence - Is helping a patient die doing harm even if the end goal is suffering
. It ties in with autonomy, should all patients have a choice and how can we ensure its entirely their choice and they haven’t been influenced

Question 34

What is fertility treatement?

Answer 34

. Assisting those with fertility problems with conception and can be in forms like medication, surgery or assisted conception
. IVF is an example of assisted conception where they encourage ovulation using medication then remove eggs, fertilise them and return them to the womb

Question 35

What are the options for fertility treatement in the UK?

Answer 35

. NICE recommends that women under 40 can be offered 3 round of funded IVF, 40-42 offered 1 round
. Low success rate of 20-35% per cycle
. Have to have been trying for a baby for a specific amount of time and had previous unsuccessful treatment
. Can go private if you don’t meet the criteria or unsuccessful

Question 36

What is the postcode lottery and how does it relate to fertility treatment?

Answer 36

. Country is split into many clinical commissioning groups (CCGs) which meant not follow NICE guidance e.g. only fund treatment to under 35s
. As CCGs decide where the money goes, this means access to IVF that is funded varies around the country
. Dependent on where you live, access to fertility treatment in different which is why it’s called the postcode lottery. You may be unlucky and someone the next road across can be lucky

Question 37

What are the ethical considerations of fertility treatment?

Answer 37

. Justice - everyone has reproductive rights and depriving individuals of this is unfair
. Autonomy - depriving patients of fertility treatment is restricting their choice about their own care
. Beneficence - gives patients a chance to have a family but does increase risk of children with complications

Question 38

What is genome editing, how do they do it?

Answer 38

. Using technology to edit an organisms DNA
. Many methods to do this but most popular is by using CRISPR-Cas9.
CRISPR is derived RNA and Cas9 are 2 bacterial proteins that can be used to destroy the organisms DNA by chopping it up. Can modify these enzymes to edit our genome for therapeutic uses.
. Genome editing has a great future for therapeutic treatment in the future

Question 39

What is the Lula and Nana Case?

Answer 39

. CCR5 gene is found to be very resistant to HIV infection. Without this gene, HIV is unable to enter white blood cells, so this gene helps them enter
. Lulu and Nana were the first genetically engineered babies born in 2018 with their CCR5 genes edited
. The results are yet to be confirmed, could be resistant to HIV infection

Question 40

Ethical concepts of genome editing

Answer 40

. Beneficence - doing good for patients by eliminating long-term inherited illnesses
. Non-maleficence -is it doing harm to patients top know we have this option to eliminate inherited conditions but we aren’t using it.
- could it harm patients by not knowing the long term side effects
Justice - would be doing benefit for the wider community by eliminating conditions
- designer babies formed from genome editing to change their characteristics and gender, perpetuating injustice
- Religious objections, editing too much

Question 41

What are guardian responsibilities?

Answer 41

. A guardian is a individual who is in charge of the care of another person
. They have a responsibility to protect the individual that they are caring fo
. Guardians that allow the individual to come to harm unintentionally are neglectful

Question 42

What is the suncream debate?

Answer 42

. Should parents be fined if they do not apply sucream to their child and let them get sunburnt
. There are risks of developing skin cancer from going in the sun unprotected
. Education should be prioritised rather than fines
. Knowin the risk of melanom has increased so not applying suncream is neglectful

Question 43

Ethical dilemmas of guardian responsibility

Answer 43

. Autonomy - is imposing fines a limitation of individual autonomy and should we prioritise education
. Non-maleficence - warning to prevent the child from being harmed
. Justice - how can this be enforced fairly in a non-targeted way?

Question 44

What are language barriers?

Answer 44

. With a country that is becoming increasingly multicultural, more frequent non-english speakers encounter the NHS
. This can be a challenging situation and present many ethical issues

Question 45

Ethcial implications of language barriers?

Answer 45

. Non-maleficence - not wanting patients to come to harm through not understanding the issue they are communicating or them being anxious because they don’t understand
. Beneficence - wanting to do good for the patient that has put their trust in you to treat their condition
. Justice - treate everyone equally
. Autonomy - can be an issue with consent if the patient isn’t competent in understanding their treatment

Question 46

What are learning disabilities?

Answer 46

. Significantly reduced ability to understand new or complex information, to lear new skills and reduced ability to cope independently
. 1.5 million people with learning disability
. On a spectrum, each patient individual so have to adapt practice towards individual patients

Question 47

How does capacity and autonomy link to learning disabilities?

Answer 47

. Autonomy - right of the patient to have control over their own healthcare
. Mental Health capacity act of 2005
. Learning disabilities mght not have capacity so double check with the criteria

Question 48

What is lost communication in terms of medicine?

Answer 48

. Situation - a family member finds out they have a chronic condition that is inheritable but is no longer in contact with the relative

Question 49

Ethical Implications to lost communication

Answer 49

. Non-maleficence - prevent harm coming to this relative that may have inherited this condition
. Beneficence- doing good for the relative who could identify risk and treat early
. Justice - Right of patient to know or not know if they have inherited a disease not fair to withhold info

Question 50

What is medical negligence?

Answer 50

. Substandard care provided by a medical professional
. Can be a misdiagnosis, incorrect treatment or surgical mistakes
. Legal action can be taken, patient compensated, doctor disciplined
. Responsibility to report negligence

Question 51

What is organ donation?

Answer 51

. This is the removal of an organ from the body with the intention of transplanting it into another individual
. ‘Living donation of the non-essential organ from living donor. Organ donation refers to donation of organs from a dead patient
. Large gap in supply of organs and demand for transplantation. Need to match organ specifically to make sure not rejected. Over 470 people waiting for a transplant

Question 52

What is the UK regulation on organ donation?

Answer 52

. USed to be an opt-in system to consent for an organ to be donated
. In England all adults are considered to be a donor unless they decide not to
. In wales and Scotland if you haven’t registered against it you are considered to have no objection

Question 53

What is the opt-out policy?

Answer 53

. Individuals are assumed to consent to organ donation unless they register to opt-out
. Autonomy - is assumed consent a breach of autonomy?
. Is thee potential breach made up by benefiting the wider community?

Question 54

Impact of COVID on organ donation?

Answer 54

. Initial concern is about the transmission of COVID via organ transplant to vulnerable patients
. 487 patients died waiting last year for a transplant compared to 372 the year before
. Like all aspects of the NHS, organ donations will take time to recover

Question 55

What is the organ market?

Answer 55

. Organ transplantation is the removal of an organ from the body with intention of transplanting it into another individual
. There is a large gap in the supply of organs
. The organ market is the trading of organs, tissues or other body parts for transplantation

Question 56

What is the organ market in the UK?

Answer 56

. Largely considered to be a phenomenon that is more popular in the developing world
. Two cases of organ trafficking in 2014 but little known about cases. Stopped before operation
. Source of organs is not often known, usually for money or can be involuntary
. Incredibly lucrative industry due to the high demand for organs

Question 57

Ethical implications of the organ market

Answer 57

. Non-maleficence - organ donation is a complex process that requires the specific matching of organs to donors this is not regulated in the organ market, more risk of rejection. Also people donating organs on the market are more likely to be exploited
. Justice - creates a wealth gap in those with which more money are able to access organs quickly

Question 58

What is paternalism?

Answer 58

. This is the idealogy that doctors have all control over patient care and know best
. This means there is no patient consultation in decisions and medical jargon is used to isolate patients
. Increases anxiety and confusion surrounding their care
. Paternalism was dominant in healthcare with autonomy being ignored

Question 59

Ethical and current relevance to paternalism

Answer 59

Autonomy - paternalism goes against patient autonomy because they are excluded from making decisions about their own health
Non-maleficence - can harm patients by isolating them and giving them anxiety, which can also make them distrust medical professionals
. Has moved to patient-centred care, empowering patients to make their own decisions.
. Patient-centred care involves: autonomy, dignity, respect and trust

Question 60

What is physical abuse?

Answer 60

. Any non-accidental physical injury to an individual
. Can be any form of violence including sexual
. 1/4 of women and 1/6 men have experienced abuse before 16

Question 61

What is physical abuse?

Answer 61

. Any act of violence against another person that is intentional
. 1/4 of women and 1/6 of men experience abuse before they are 16

Question 62

How could a medical student come into contact with someone who has been experiencing physical abuse?

Answer 62

. Confide - patients may confide in you that they are in danger
. Examination - noticing of physical abuse
. Reporting - another family member may report abuse to you
. Noticing - through the dynamic between partners or with child

Question 63

What is your responsibility as a doctor if you notice physical abuse?

Answer 63

. Identifying it and knowing what signs to look for, don’t dismiss
. Consult in a safe and supportive environment with the patient and introduce topics
. Signpost to different helplines and consult senior members of staff, safeguarding

Question 64

Legal responsibilities when you see physical abuse

Answer 64

. Safeguarding - responsibility for safeguarding is made clear in the national and international legislation
. United National convention on the right of the child
. Must ensure safeguarding principles apply

Question 65

What is private practice?

Answer 65

. In the UK we have a healthcare service that is free at the point of use for everyone
. Also has a private sector in the Uk which offers faster and more extensive service
. Privatisation is different to private practice but refers to increased funding coming to the NHS from the private sector.
Critisised because it’s destabilising the NHS

Question 66

Arguments for private practice

Answer 66

. Reduces NHS waiting lists because they move to private practice, so people on the NHS get treated faster
. Private patients still pay national insurance so support NHS
. Patients should be able to access private care if they wish to
. Supplements incomes to incentivise staying and working in the UK

Question 67

Arguments against private practice

Answer 67

. Creates a wealth gap because those who have money get better healthcare
. Disadvantages to those with chronic conditions as the insurance prices rise
. Unfair as this can count as queue jumping
. Adding commercial elements could erode trust between patient and doctor

Question 68

What is racial abuse?

Answer 68

. Series of incidents intended to cause harm to an individual because of their race, origin, religion or nationality
. Could happen to you or a patient
. Has a variety of impacts like patient care as well as career progression

Question 69

Ethical implications of racial abuse

Answer 69

. Non-maleficence - prevent harm to yourself, colleagues or patients that could come from racial abuse
. Wanting to do good for yourself or others by supporting them from racial abuse is beneficence
. Justice - Nhs principles is to treat everyone equally including patients and healthcare professionals

Question 70

What is verbal abuse?

Answer 70

. Emotional abuse consisting of using abusive or demeaning language
. Can happen to you or someone around you
. Can extremely difficult to undergo