Ethics

Question 1

What is Ethics?

Answer 1

Involves study of morality (i.e. study of good and/or the right)

Question 2

What features does an ethical judgement have?

Answer 2

1) PRESCRIPTIVE (tells you what the right thing to do is)

2) JUSTIFIED THROUGH REASONING

Question 3

How can we approach ethical problems?

Answer 3

1. What kind of person should we be?
2. What should I do?

Question 4

What is Virtue Ethics?

Answer 4

Being a virtuous person

Focuses on excellence on character, ensuring one lives the best life overall
(i.e. achieves flourishing)

MEAN between two opposing vices

Question 5

Examples of Virtues

Answer 5

Courage - mean between recklessness and cowardice

Generosity - mean between wastefulness and meanness

Question 6

What is Consequentialism?

Answer 6

Act in such a way to benefit the most people - producing best consequences

Question 7

What is utilitarianism?

Answer 7

Best known consequentialist theory

RIGHT action produces greatest happiness (or pleasure) for the greatest number (principle of utility)

Question 8

What are the different types of utilitarianism?

Answer 8

1. Act utilitarianism
2. Rule Utilitarianism

Question 9

What is Act Utilitarianism?

Answer 9

Considering the consequences of each specific act

Looks at benefit for that singular action

Question 10

What is Rule Utilitarianism?

Answer 10

Formulates rules (which will govern acts) that seek to produce the best consequences

Looks at WIDER impacts - what would happen if we kept applying this action generally

Question 11

What is Deontology?

Answer 11

Fulfilling moral duties

(duty, obligation, responsibility

Question 12

What is narrative ethics?

Answer 12

Describes a variety of approaches, which focus particularly on the patient’s story

Helps us understand human (moral) life by focusing on communication, perspectives and relationships

Question 13

How is demand for healthcare increasing?

Answer 13

• ageing population with more chronic illness
• medicalisation (increasing remit of healthcare)
• increased consumer demand
• technological advances making more possible

Question 14

Why is resource availability not keeping up with demand?

Answer 14

Staff shortages & low recruitment in some areas

Inadequate funding to meet demand

CCG’s choosing to cut/reduce some services

Question 15

How do prioritise & ration?

Answer 15

Must determine
- who/what to treat first, and why
- what if anything to cut/limit, and why

Question 16

What stages do we make decisions?

Answer 16

• Nationally
• Locally
• Individually

Question 17

How do we prioritise & ration nationally?

Answer 17

NICE; DH; PHE

Public Health campaigns targeting specific issues; certain treatments approved

Question 18

How do we prioritise & ration locally?

Answer 18

CCG; NHS Trusts; Practices

Withdrawing/limiting IVF funding; strategic focusing of services

Question 19

How do we prioritise & ration individually?§

Answer 19

CLINICIANS

Which treatments to offer; referral decisions

Question 20

What is Distributive Justice?

Answer 20

Distribution of goods in accordance with the principle of justice

Question 21

How can we achieve distributive justice?

Answer 21

Consequentialism, Equality, Egalitarianism, Aristotelean, Rawlsian

Question 22

What is Equality & Egalitarianism?

Answer 22

All persons are equal in their fundamental worth and therefore entitles to be treated equally

Question 23

How does equality & egalitarianism relate to Distributive Justice?

Answer 23

UNJUST to give one person access/opportunity but not another person, because both persons are of equal worth

Question 24

What is the Aristotelean Principle?

Answer 24

‘Persons in equal circumstances should be treated equally, persons in unequal circumstances should be treated unequally’

Question 25

What is non-relevant criteria?

Answer 25

CANNOT influence / change e.g. race, sex, mental or physical disability

Question 26

What is relevant criteria?

Answer 26

CAN influence e.g. health behaviour or lifestyle

Question 27

What are protected characteristics?

Answer 27

Some criteria UK law prohibits (Equality Act 2010) from being used to discriminate between persons -> age, disability, gender reassignment, marriage & civil partnership, pregnancy & maternity, race, religion & belief, sex, sexual orientation

Question 28

What is a Rawlsian (egalitarian) Thought?

Answer 28

Thought Experiment that ensures just distrubution

Question 28

What is a Rawlsian (egalitarian) Thought?

Answer 28

Thought Experiment that ensures just distribution of goods, ensuring that the greatest benefit goes to the least advantaged

Question 29

What are sources of the Law?

Answer 29

- Acts of Parliament - Court Rulings (superiors courts - e.g. Supreme Court) - European Union (EU) - European Convention on Human Rights (ECHR): also directly part of English Law, following Human Rights Act 1998

Question 30

What are branches of Law related to Medicine?

Answer 30

Medical Law is its OWN branch of law, but drawn on various others, such as - criminal law (punishment) - civil law (compensation)

Question 31

What is the role of the GMC?

Answer 31

To protect, promote, & maintain the health & safety of the public by ensuring proper standards in the practise of medicine

Question 32

Why do we use GMC guidance?

Answer 32

- Broad Principles of GOOD practise - Ethically based, consistent with law - Framework for doctors to exercise professional judgement - Serious or persistent failure could lead to action

Question 33

Why do we maintain a patient's confidence?

Answer 33

- keeping a promise - respecting autonomy - more people will trust healthcare professionals - patients will disclose medical history - healthcare/research will best flourish

Question 34

What happens if you fail to comply with confidentiality?

Answer 34

Injunction (stopping disclosure) Financial Compensation ('damages')

Question 35

When can you break confidentiality?

Answer 35

- Patient consents to disclosure - Disclosure is required by the law - Disclosure is in the public interest

Question 36

What is Patient Consent?

Answer 36

If patient has 'mental capacity', consent is guiding principle to breaking confidentiality

Question 37

What are the types of consent?

Answer 37

EXPRESS CONSENT (needed, to employers & insurance companies) IMPLIED CONSENT (records are secure but may be able to share)

Question 38

What happens to consent if the patient lacks 'mental capacity?

Answer 38

'Best interests' is guiding principle Effort would be made to get relevant consent, but break if exceptional & justifiable

Question 39

Why can you break confidentiality if required by the law?

Answer 39

May be required by statute or court e.g. notifying authorities of certain communicable diseases (list of notifiable diseases) e.g. copying with legal/disciplinary proceedings

Question 40

Why can you break confidentiality in the public interest?

Answer 40

IN public interest, not OF interest e.g. disclosing in case of alcoholic surgeon OR serious crime committed e.g. MAINTAINING for HIV statuses of doctors