Week 3

Question 1

What is dignity?

Answer 1

Human dignity is the basic value of human beings entitling them to respect

Question 2

Who is Josef Mengele?

Answer 2

• Assigned to Auschwitz
• performed research protocols using twins as test subjects throughout the
  1930s.
• performed a broad range of agonizing and often lethal experiments
  mostly with children twins

Question 3

What was the outcome of world wars?

Answer 3

The human being needs to be protected.

Question 4

Explain dignity fully.

Answer 4

A state, quality or manner worthy of esteem and respect; and (by extension) self-respect
* Dignity in care means the kind of care that supports and promotes, and does not undermine, a
person’s self-respect regardless of any difference
* “being treated like I am somebody”
This includes:
* Respect
* Privacy
* Autonomy
* Self-worth

Question 5

What are the principles of dignity?

Answer 5

• Dignity in care is inseparable from the wider context of dignity as a
  whole
• Dignity is about treating people as individuals
• Dignity is not just about physical care
• Dignity thrives in the context of equal power relationships

Question 6

When is human dignity at risk?

Answer 6

• In sickness
• Decline /towards death
• Childhood
• Elderly
• In prison
• People with disabilities
• People lacking capacity

Question 7

Why does dignity become at risk?

Answer 7

When individuals become more vulnerable and their rights get compromised.

Question 8

What is the aim of The Universal Declaration of Human Rights?

Answer 8

Aims to militate against oppression of people (especially minorities)

Question 9

What do human rights do?

Answer 9

place a duty on the state & healthcare providers to
comply with minimum standards.
* Rights impose moral and legal constraints on collective social goals
(Savulescu et al, 2020)
* Claims for state provisions; Healthcare as major ethical duty

Question 10

What is the aim of medical ethics?

Answer 10

• Focus on doctor-patient relationship
• Doctor’s duties of care

Question 11

What are legal rights?

Answer 11

Human rights in national legal frameworks.

Question 12

What is civil law?

Answer 12

Civil law concerns dealings between private individuals or groups

Question 13

What is criminal law?

Answer 13

concerns matters serious enough to be considered
offences against the whole community

Question 14

What is the entitlement of the patient?

Answer 14

• The Doctor treats a Patient
• A Patient is a Person
• Each Person is entitled to enjoy all HUMAN RIGHTS
• Respect and give recognition - HUMAN DIGNITY
• In one word-BENEFICENCE meaning to do the good for his or her patient

Question 15

Examples of patient rights being compromised.

Answer 15

• Leaving a patient in soiled sheets
• Leaving trays of food when the patient needs help to eat
• Using excessive force to restrain someone in care

Question 16

Summary

Answer 16

Question 17

Summary part 2

Answer 17

Question 18

What are the 4 principles of healthcare ethics?

Answer 18

• autonomy,
• beneficence,
• non-maleficence,
• and justice.

Question 19

What is the framework of principles?

Answer 19

• principles are general norms that leave
  considerable room for judgement in many
  cases
• Not precise action guides

Question 20

What is respect for autonomy?

Answer 20

• self-rule, self-determination
• ability to think, to decide and to act on the basis of such
  thought and decision, freely and independently
• a medical practitioner cannot impose treatment on an
  individual for whatever reason
• Respect for autonomy requires health professionals to
  help patients come to their own decisions and to respect
  and follow those decisions

Question 21

What does patient autonomy depend on?

Answer 21

-capacity
-necessity
-risk to others

Question 22

What is beneficence?

Answer 22

• refers to the moral importance of
  doing good to others (patients)
• performing deeds of “mercy,
  kindness, friendship, charity and the
  like”
• people take actions to benefit and
  promote the welfare of other people.
• process of ranking the available treatment options

Question 23

What are the rules of beneficence?

Answer 23

❑ Protect and defend
the rights of others
❑ Prevent harm from
occurring to others
❑ Remove conditions
that will cause harm
to others
❑ Help persons with
disabilities
❑ Rescue persons in
danger

Question 24

Autonomy vs Beneficence?

Answer 24

• Who should be the judge of what is best for the patient?
• Assessment of health professional vs patient’s own views
• Divergence between medical interest/medical benefit
  and patient’s best interests/wishes/preferences
• Medical interests; treatment and prevention of disease
• Best interests; broader concept to
  physical, mental and social well-being
• Include patient perspective

Question 25

What is non-maleficence?

Answer 25

* It states that health professionals should avoid harm on patients * Most medical treatments have some chance of doing harm. It does not follow that such treatment should always be avoided * The potential benefits and harms and their probabilities need to be weighed up to decide what is overall in the patient’s best interests

Question 26

Non-maleficence vs. Beneficence

Answer 26

Question 27

What is justice?

Answer 27

* Health professionals have to make decisions about distribution of time, money, clinical resources * The principle of justice emphasizes two points: * Patients in similar situations should have access to the same healthcare * In determining what level of care should be available for one set of patients, we must take into account the effect of such use of resources on other patients * fair distribution of resources (distributive justice) * Benefits and burdens should be distributed fairly among members of a society and with respect for people’s needs/rights (social justice/rights based justice)

Question 28

What are the two principles of John Rawl's theory of justice?

Answer 28

(1) everyone should be given equal liberty regardless of their adversities (2) differences among people should be recognised by making sure the least-advantaged people are given opportunities for improvement. (Equal access to healthcare services)

Question 29

How do the 4 principles interact with eachother?

Answer 29

* The four principles are non-hierarchical. * For ethical clinical reasoning, one may be required to take all principles into account when they are applicable to the clinical case under consideration. * Yet, when two or more principles apply, we may find that they are in conflict

Question 30

What is the contribution of the 4 principles approach?

Answer 30

* Identifies key principles for ethical clinical practice * “common morality” * Draws attention to the values/rights/norms underlying moral dilemmas * Reflects doctor’s duties * Allows for multiple moral considerations

Question 31

What are the criticisms for the 4 principles approach?

Answer 31

* Strictly adhering to the same principles/guidelines for different situations can be problematic * the principles are nonspecific, appearing to simply remind the decision maker of considerations that should be taken into account * there is no agreed upon method for resolving conflicts when two different principles conflict about what ought to be done *The four principles should not be treated as a general moral theory, but rather, they assist in reflecting on moral problems and in moving to an ethical resolution.

Question 32

What is the structured case analysis model?

Answer 32

* Summarise the case * State the moral dilemma(s) * State the assumptions being made or to be made * Analyse the case with reference to * ethical principles * consequences * Professional codes / virtuous healthcare practitioner * the law * Acknowledge justifiable ethical solutions and those that are not justifiable * State preferred approach with explanation

Question 33

What steps do ethical analysis compromise?

Answer 33

1. Determine whether the issue at hand is an ethical one. 2. Consult authoritative sources (medical association codes of ethics and policies, respected colleagues etc). 3. Consider alternative solutions in light of the principles/duties/values/likely consequences 4. Discuss your proposed solution with those whom it will affect. 5. Make your decision and act on it, with sensitivity to others affected. 6. Evaluate your decision.

Question 34

What is the clinical ethics committee?

Answer 34

- Multidisciplinary and independent groups - Membership includes; = Different health professionals (majority members); Members of hospital management/administration; Legal member; Medical ethics academic; Religious representatives; Lay members - aim to provide support for decision-making on ethical issues arising from several aspects of patient care. = provide discussion and/or advice about complex or controversial cases = not take over responsibility for a clinical decision; this responsibility remains with the doctor/the clinical team

Question 35

What is the function of clinical ethics committees?

Answer 35

Their primary functions are -case consultation Urgent and non-urgent cases -ethics education -policy development and review interpretation of national guidelines

Question 36

What are the frequent issues for consultation with CEC?

Answer 36

* Withholding to withdrawing life sustaining treatment * consent and capacity * refusal of treatment and restraint issues * pandemic response