Medical Ethics Flashcards
(39 cards)
What are the 4 pillars of medical ethics?
-Beneficence
-Non-maleficence
-Autonomy
-Justice
What is consequentialism?
An ethical ideology that states the morality of an action is dependent purely on its consequences
“The ends justify the means”
Give an example of consequentialism
Your patient has a terminal illness and is not likely to survive the operation she is about to undertake. Just as she is about to be anaesthetised, she asks you: “Doctor, will I be okay?”. A consequentialist ideology supports that lying in this circumstance is acceptable, even though lying itself is not a moral action.
What is utilitarianism?
Utilitarianism says the best action is that one that brings about the best increase in utility (benefit). Utility is generally considered on a broad scale, often taking into consideration wider society and not just the patient in question. It’s a form of consequentialism.
Give an example of utilitarianism.
You have a sum of money to either fund a very expensive treatment for one patient with a rare disease or five patients with a very common and easy-to-treat disease. Utilitarian ethics dictates that treating the five patients is morally superior as a greater overall benefit is achieved.
What is deontology?
Deontology is also known as “duty-based ethics”. This ideology states that the correct course of action is dependent on what your duties and obligations are. It means that the morality of an action is based on whether you followed the rules, rather than what the consequence of following them was.
This is in direct contrast with consequentialism.
Give an example of deontology
If your terminally ill patient asks if they’ll be ok after a surgery they’re unlikely to survive, a deontological approach would suggest you don’t lie to comfort them. That’s because according to this concept, lying isn’t morally acceptable because it’s our obligation not to lie – no matter the consequences.
What is beneficence?
Beneficence means that all medical practitioners have a moral duty to promote the course of action that they believe is in the best interests of the patient.
What aspects should be taken into account with beneficence?
-Will this option resolve the patient’s medical problem
-Is it proportionate to the scale of the medical problem
-Is this option compatible with this patient’s individual circumstances
-Is this option and it’s outcomes in-line with the patient’s expectations of treatment
Why is beneficence important?
It ensures that healthcare professionals consider individual circumstances and remember that what is good for one patient may not be necessarily be great for another.
Give examples of beneficence questions which you could be asked at interview.
-Why is it important to consider the best interests of a mother in cases involving abortions?
-What should be done if a patient refuses treatment for a life-threatening condition?
What is Non-Maleficence?
Non-maleficence states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence.
How is Non-Maleficence different from Beneficence?
First of all, it acts as a threshold for treatment. If a treatment causes more harm than good, then it should not be considered. This is in contrast to beneficence, where we consider all valid treatment options and then rank them in order of preference.
Second, we tend to use beneficence in response to a specific situation – such as determining the best treatment for a patient. In contrast, non-maleficence is a constant in clinical practice. For example, if you see a patient collapse in a corridor you have a duty to provide medical attention to prevent injury.
What aspects should be taken into account with Non-Maleficence?
-What are the associated risks with intervention or non-intervention?
-Do I possess the required skills and knowledge to perform this action?
-Is the patient being treated with dignity and respect?
-Is the patient being put at risk through other factors (e.g. staffing, resources, etc.)?
What is Autonomy?
Autonomy means that a patient has the ultimate decision-making responsibility for their own treatment.
Autonomy also means that a medical practitioner cannot impose treatment on an individual for whatever reason – except in cases where that individual is deemed to be unable to make autonomous decisions
What aspects should be taken into account with Autonomy?
-Have you explained fully the patient’s medical condition, their options for treatment and the advantages and disadvantages of those treatments?
-Is the patient able to retain this information, evaluate their options and arrive at a decision?
-Has the patient provided informed consent for our actions?
What is it called when a medical practitioner fails to obtain consent and respect autonomy?
battery – a legal term that means “an infliction of unlawful personal violence.”
What questions about Autonomy could we be asked about at interview?
-What are the ethical issues involved with a depressed patient that has refused treatment, and admitted they’re having suicidal thoughts?
-Should the NHS fund treatment for smokers?
What is Justice?
Justice – in the context of medical ethics – is the principle that when weighing up if something is ethical or not, we have to think about whether it’s compatible with the law, the patient’s rights, and if it’s fair and balanced.
It also means that we must ensure no one is unfairly disadvantaged when it comes to access to healthcare. Justice is one reason why the NHS has certain entitlements, such as free prescriptions for lower-income individuals.
What aspects should be taken into account with Justice?
-Is this action legal?
-Does this action unfairly contradict someone’s human rights?
-Does this action prioritise one group over another?
-If it does prioritise one group over another, can that prioritisation be justified in terms of overall net benefit to society or does it agree with moral conventions?
What is confidentiality?
Confidentiality is one of the core duties of a Doctor towards their patients. The duty of confidentiality requires Doctors, and other healthcare professionals, to keep their patients’ information private within the healthcare team, apart from some very specific circumstances.
In what situations can a medical practitioner break confidentiality?
-Where the patient has consented to the sharing of information
-Where not sharing the patient’s information puts the patient, or others, in danger
-Where the patient lacks capacity and sharing information is of overall benefit to the patient
How can we apply the effects of breaking confidentiality in reference to autonomy?
-Breaking confidentiality without a patient’s consent breaks their autonomy
-It also undermines trust and may cause patients to be reluctant to seek help from healthcare professionals in the future, even if they desperately need medical attention.
-This applies to children, too. If a child is Gillick competent, their autonomy should be respected the same as an adult.
How can we apply the effects of breaking confidentiality in reference to beneficence and non-maleficence?
-How breaking confidentiality could put a patient at risk (with the police or their parents, for example) or cause avoidable distress
-Whether you can advise a patient to tell the right people about their situation to avoid breaking confidentiality
-If you can gain consent to break confidentiality
