Ethics: Medical ethics / Autonomy + Consent

Question 1

What is medical ethics?

Answer 1

• Application of moral code/principles to the practice of medicine

Question 2

Describe the ethical themes of : autonomy , harm and rights.

Answer 2

Autonomy: Self-determination - Principle that we are best placed to know and decide what is in our own best interests
Harm:Do no evil’ - Often less straightforward: a balance of harms, conflicting harms - The right thing to do may cause harm - Harm to individual vs harm to society
Rights: Care with use of ‘rights’ or ‘right to’ in ethical terms - If there is a right to something then individuals or the state have a duty to fulfil that right- Positive or negative - Absolute or limited

Question 3

What is a utilitarian approach?

Answer 3

Action which brings the greatest good (happiness) to the greatest number of people is the morally obligatory action
* Utilitarian calculation
* May make actions morally compulsory in some situations that many may find unacceptable (compulsory organ donation)

Question 4

What is a deontological approach?

Answer 4

Duty based
* Never see individuals as a means to an end
* Even if on individual case undertaking the duty may result in harm, it is seen as a lesser concern than not upholding these duties
*whether that action itself is right or wrong rather than based on the consequences of the action.

Question 5

What is Beauchamp and Childress 4 principle approach?

Answer 5

• Respect for autonomy
• Beneficence - positive duty to actively do something
• Non-maleficence - do not harm
• Justice - personal needs vs recourse availability

Question 6

What is virtue ethics?

Answer 6

Emphasises morals + character of individual rather than either doing one’s duty or acting in order to bring about good consequences.
* Allows for emotions
> A virtue is a trait that it is good for a person to have, manifest by habitual action

Question 7

What is the legal system in England and wales?

Answer 7

• Statutes : A written law passed by a legislative body
  – Mental Capacity Act 2005
  – Mental Health Act/Human Rights Act
• Case Law : the law as established by the judges outcomes of former cases
  – Sets legal precedent
  – Rulings by judges (juries in criminal law)
  – Appeal process

Question 8

What are the 4 main human rights?

Answer 8

• Article 2: The right to life
• Article 3: No-one shall be subjected to torture or inhuman/degrading treatment
• Article 8: Right to respect for private and family life
• Article 14: all the rights must be enacted without discrimination

Question 9

What is autonomy?And the difficulties with respecting autonomy?

Answer 9

• An autonomous person is the author of his own life
• Critically evaluate own wishes and desires
• Need choice to be autonomous

> Can cause patient harm
Patient may refuse to have life saving surgery
Time consuming to fully explore autonomy with every individual

Question 10

Why is autonomy important?

Answer 10

> Patient entered approach
All patients are assumed to have the capacity to make the right (autonomous) decision for themselves
* Shared decision making
* Patients rely on healthcare professional’s advice and knowledge

Question 11

What is paternalistic care? What is the problem with this?

Answer 11

-Act done in the perceived best interests of another without regard for their wishes. -Overrides autonomy
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* Patient may be less likely to comply
* May be more open to complaints
* Encourages passivity and dependency
* Moral obligation to respect autonomy

Question 12

When may you want to explore a patient’s autonomy further?

Answer 12

Their decision seems inconsistent or strange**
* Going against all/any medical advice
* Their chosen course of action may harm them
* NB – A strange/irrational choice can be autonomous

Question 13

What is the relationship between consent and autonomy?

Answer 13

• Consent important for bodily integrity
• Making the correct decision for / with each patient
• Protection for doctor against claims of battery or negligence

Question 14

Define consent. What are the drawbacks?

Answer 14

-A voluntary, uncoerced decision, made by a sufficiently competent or autonomous person, on the basis of
adequate information and deliberation
- * Can be intolerable for patient to choose
* Confusion if alternatives discussed
* How much autonomy can an ill patient muster?
* Are percentages relevant to an individual patient?
* Time

Question 15

When is consent needed? When is it valid?

Answer 15

> For everything we do to a patient
* Legally only if touch the patient
* Not often written eg blood pressure, clinical examination, taking blood
* Written for procedures and surgery
today

1. Given by a competent patient 2. Voluntary 3. Informed

Question 16

When may a patient not have capacity?

Answer 16

1. Impairment of or disturbance in the functioning of the mind or brain.
2. Not understand the information relevant to decision
3. Can not retain the information long enough to make a decision
4. Use or weigh the information
5. Communicate the decision

Question 17

How can you help patients make their own decisions ?

Answer 17

• Simple language
• Limit to necessary information
• Pictures and non-verbal communication
• Help of others eg carers, relatives, therapists
• Choose time of day when patient’s understanding is at its best
• Location where patient is at ease

Question 18

With an incompetent patient what are the statutory requirements? What should they consider when making decisions of their behalf?

Answer 18

• Act in the patients best interest
  -Take into account medical, social, emotional and psychological aspects
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• How to include the patient in the decision
• Past and present wishes ,beliefs and feelings
• Views of family
• Each decision individually
• Views of anyone named by the person to be consulted