Medical Ethics

Front 1

A person who "looks at benefits and harms to individualand society; look at the consequences" is said to be what?

Back 1

A Utilitarianist - i.e they base decisions based on what will have the best outcome for the individual AND society

ie. Thinks about the greater good for the greatest number of people

Front 2

What is Deontology?

Back 2

Deontology is the ethical principle which judges an action purely based on the rules surrounding that subject.

Front 3

List 2 good points of Deontology and 2 bad points?

Back 3

Good Points:

Gives you absolute certainty (clear line between ok and not ok

It defines the behaviours and actions that are inhibited.

Bad Points:

Doesn’tconsider the consequences of the action just says whether the action is good orbad.

Sometimesto do the right thing the consequences are not good.

Front 4

What is consequentialism?

Back 4

Consequentialism is the ethical principle which takes the consequences of an action into account.

The morality of an action all depends on the outcome.

Front 5

Name 3 good points of utilitarianism?

Back 5

The good points of utilitarianism are:

It is flexible - can adapt to the particular decision of the circumstance

It is measurable and decisions can be made based on real stats

Front 6

What is moral realism?

Back 6

Moral realism is the belief that there are objective moral facts. Realists believe that moral claims can only either be true or false - no grey area.

Front 7

What is moral Irrealism?

Back 7

Moral irrealism holds that there are no moral facts that can be objectively true.

Front 8

What ethical belief is 'Ethical naturalism' a derivative from?

Back 8

Moral naturalism is a derivative of Moral Realism.

Front 9

What is moral relativism?

Back 9

Moral relativism is the option that Moral codes differ from one culture to another - it implies that no single moral code can have universal Validity.

Front 10

What are the 5 anthropological evolutionary moral domains ?

Back 10

Harm/Care

Fairness/reciprocity

Ingroup/Loyalty

Authority/Respect

Purity/Sanctity

Front 11

When approaching a moral situation what are the two forms of cognition that are used to deal with it?

Back 11

Two forms of cognition in moral situations:

Moral Reasoning

Moral Intuition

Front 12

What does the term autonomy mean?

Back 12

Autonomy - the condition or quality of being autonomous and independent

ie. a persons right to self govern. Promote right of self determination

Front 13

What does the term Non-maifanence mean?

Back 13

The ethical principle of doing no harm or inflicting as little harm as possible.

i.e. Do no harm

Front 14

What does the term beneficence mean?

Back 14

The state of being kind, charitable or beneficial.

i.e To do good

Front 15

What does the term Justice refer to in terms of the 4 ethical principles of health care?

Back 15

Justice = Fairness vs equity, individual vs population

Front 16

What are the 4 ethical principles of health care?

Back 16

Autonomy

Non-malifinence

Benificence

Justice

Front 17

Do you give iv fluids to an elderlycancer patient who is too drowsy to drink?

*use 4 ethical principles to help decision making*

Back 17

Respect for autonomy - ask the family what the patient would have wanted, look for information in wills. Treat delirium so that she can make the decision herself.

Non-malifinence - What are the harms of giving/not giving fluids?

Beneficence - What are the benefits of giving/not giving fluids?

Justice - What are the costs to keep patient alive? Is it fair to focus money on a futile cause?

Front 18

Example formative question:

Houseand his team find themselves having to choose between two diagnoses andtreatments for their patient. Withparticular reference to the principles of beneficence and non-maleficenceconsider what would need to be considered when choosing between the treatments.

– Do autonomy and justice impact on the decision?

Back 18

–Autonomy

•Competentpatient can make an informed choice between offered treatments

•Competentpatient can refuse all treatments even if this refusal results in their death

•Thepatient lied about her risk – this could be interpreted as treatment refusal,but when incompetent probably not sufficient to be considered an advancedrefusal of treatment.

-Justice

•Perhapsminimal importance in this scenario

•Highcost of treatments and care need to be justifiable in the context of a rationedhealth service and the needs of the wider population

Front 19

Whenthe patient lapses into unconsciousness House gets consent for his proposedtreatment from her husband. How doesthis scenario differ from what should happen in the UK?

Considerwho can consent to a treatment

Back 19

Acompetent patient can consent to/ choose between offered treatments

Acompetent patient cannot demand a treatment that is not offered (Thoughthey can demand a second opinion)

Front 20

Howdoes this differ between a patient with or without capacity?

Back 20

Whenthe patient is incompetent

–Familymembers/ next of kin have no decision making rights or responsibilities

–Unless theyhave been legally appointed as a proxy decision maker (e.g. welfare power ofattorney)

–Aproxy decision maker can consent to offered treatments but cannot demandtreatments that are not offered

–Ifthere is no proxy decision maker the clinician takes responsibility to makedecisions based on the patient’s ‘best interests’

–Theclinician should try to maximise the patient’s autonomy by

»Followingany valid advanced directive

»Elicitingfrom family/ friends what they believe the patient would have wanted

Front 21

Which legislation is applicable?

Back 21

–Relevantlegislation includes

•Adultswith Incapacity Act Scotland

•MentalCapacity Act

•MentalHealth Act

Front 22

Atone point House makes a comment about one of his patient’s breasts and makes aninappropriate referral to his colleague, Dr Wilson.

Inanother scene House reveals that he has accessed the medical test results ofone of his colleagues without her consent.

TheGMC document ‘Good Medical Practice’ describes the principles and valuesappropriate for doctors in the UK.

–Whichof these principles and values has House failed to demonstrate through thebehaviour described above? –(8marks)

Back 22

–Housefails to

•Makethe care of his patient his first concern

•Workwith colleagues in ways that best serve the patient’s interests

•Treatpatients politely and considerately

•Respectpatients’ right to confidentiality

•Respectpatients’ right to reach decisions with him

•Behonest, open and act with integrity

•Neverdiscriminate unfairly against patients or colleagues

•Notbully or harass colleagues

•Neverabuse his patients’ trust in him or the public’s trust in the profession

Front 23

IsHouse a consequentialist or a deontologist? Justify your answer.

Defineconsequentialism and deontology

Back 23

–Deontology

•Focuson actions/ duties/ obligations. Cannotuse outcome to judge moral worth of an action. Not using people as a means to an end etc.

–Consequentialism

•Focuson outcomes e.g. happiness/ reduced suffering/ promotion of choice. Moral worth of an action depends on theoutcome.

In this house is a Consequentialist:

Endsjustify the means, prepared to break confidentiality/ ignore consent to reachhis preferred outcome (although it seems that he has no interest in maximisinghappiness!)

Front 24

List 5 things that a a patient must meet to be detained under the mental health act against their will.

Back 24

MUST MEET ALL:

Mental disorder

Treatment is available

Impaired decision making ability

Risk to self or others

Necessity