Ethics Flashcards
(29 cards)
In medicine how is ethics used in the allocation of resources
How should be treat patients
How should we allocate resources
Who gets what
Who should we treat
There is limited resources and unlimited demand
We use a free market approach to health care no state intervention to more money more goods more health - thatcher
Used to be capitalism market determines distribution - price determines how goods are distributed
Keynes welfare state
Opposite of free market - role of the state to invest in - stimulate and increase jobs especially in times of financial hardship
Financial benefits State education Public housing Employment creation and development Health service aimed to help individuals be healthy
Beveridge plan - welfare states
Fight the giants of want Ignorance Squalor Idleness Disease
What was the catalyse for the welfare state
WW2
Decided we should have class distinctions anymore
We,fare state was a Antione fit for heros
Healthcare for all free at the point of delivery
Who created the NHS
What was is aims
Aneurin Bevan
Provide equitable distribution of health services
Provide services which were accountable for the nation
Give a sense of collective purpose or mission
And to promote the health of the nation
Who were opposed to the NHS
Carlton club - Tory
BMA: said the state regulating medicine will limit professional freedom, earn less, and patients will not be able to choose a doctors
Inevitability of rationing
Budget needed to be increased almost immediately
Bevan: rush to get things that are free also things they couldn’t get before
Had to introduce a prescription charge
Concepts of justice -
Formal justice - treating everyone the same but maintaining existing inequalities, how our law system works
Substantive justice/ Aristotle’s formal principle of justice takes into account inequalities
Justice as a desert
Treating people equally according to how deserving they are:
Lung transplant to CF patient compared to smoker
If in poverty - deserving or undeserving
Can be used to justify a to tier health system or private system
Noble failures tried to stop smoking vs someone who gave up and found it easy
Justice as maximising utility
Benthams utilitarianism: maximum benefit for the most Number of people,
But may mean people don’t have a say- Jehovahs witnesses and blood transfusions
Trivial poor health of the majority would outweigh the serious need of the few
Desert wouldn’t come into it, if the majority smoked then more would go to helping smokers
Justice as satisfying need
Karl Marx - from each according to his ability, to each according to his need
Money spent on those who have lots on healthcare needs
Need not just naturally generated but also from the social environment
Want vs need - children IVF
Subjective vs objective
Value of life - fair innings approach
Elderly fit person had a fair innings will get lower priority in the distribution of health gains than a young person who without treatment will certainly not reach the societal norm of age of death
Cancer and great ormond street more money given than Alzheimer’s - people determined that they have run their course at their age
QALYS
Measurement of life
Justice - judicial review
Balance of power between the government, parliament, and judiciary rule of law
Parliament is sovereign but had to act within the law
Judiciary acts to check on the government
The Secretary of State, DoH, NHS part of the government so is subject to review
Double jeopardy
A person already disadvantaged due to disease has further disadvantage due to lack of resources
Who decides what is best for patients
Prior to mental capacity act 2005 it was mainly courts and Drs
Since then parliament changed this to give lawyers/ courts/ patients a greater role
Ethical principles behind the mental capacity act
Freedom in the individual - in a liberal western democracy
Human rights - no one can tell you what to think believe
Ability to think, reason, and choose the way we live our lives - autonomy
Individuals are important - we are all unique - and the choices we make define our personalities and existence as human beings
Autonomy means that if we make mistakes we should live with the consequences
Mental capacity act 2005
Clarifies the law dealing with the incapacitated
Codifies capacity (Re C test) and best interest patients rights
Autonomy via:
ADVANCED DIRECTIVES
Introduces the concept of substrates decision making
Court of protection
Key principles - liberalism
Purpose to support not restrict / control
Presumes capacity
All practical steps must be taken to help
Unwise decisions don’t mean incapacity
Acts done to the incapacitated must be in their best interests
Least restrictive too should be chosen
Lack of capacity
Patient lacks capacity if they are unable to make a decision for themselves because of impairment/ disturbance in the function of their mind / brain
Maybe permanent or temporary
Decision specific : may have he capacity to ale one decision but not at another time - Gilliick Fraser competence
Equal consideration can’t make assumption based on age, appearance or other unjustified assumptions.
Tests for capacity
Need to be able to Understand Retain Use or weigh the information Communicate the decision
Who should assess
No longer just the Dr - the determinator
Could be Carer lawyer or doctor
Temporary incapacity causes
Alcohol drugs Pass out Pain Emotion Fear Medication
