Medical Ethics VTS 24/09/08. Curriculum statement 3.3 Curriculum statement 3.4.

Medical EthicsMedical Ethics

VTS 24/09/08VTS 24/09/08

Curriculum statement Curriculum statement 3.33.3

Curriculum statement Curriculum statement 3.43.4

Timothy McVeighTimothy McVeigh

Timothy Timothy McVeigh.docMcVeigh.doc

Should doctors have to Should doctors have to swear an oath when they swear an oath when they

qualify?qualify?

The Hippocratic Oath.docThe Hippocratic Oath.doc

Modern Hippocratic Modern Hippocratic Oath.docOath.doc

AMA Oath.docAMA Oath.doc

What is meant by What is meant by Ethics?Ethics?

What is meant by What is meant by morality?morality?

What is meant by What is meant by Ethics?Ethics?

• Ethics – the philosophical Ethics – the philosophical study of moralitystudy of morality

• Morality – a system applying Morality – a system applying to all rational persons, to all rational persons, governing behaviour that governing behaviour that affects others, having the affects others, having the lessening of harm as its goallessening of harm as its goal

Example from practice - 1Example from practice - 1

• Microalbuminuria testing in Microalbuminuria testing in diabetesdiabetes


• Microalbuminuria testing in Microalbuminuria testing in diabetesdiabetes• Does this test benefit some patients? Does this test benefit some patients? • If so, who? If so, who? • Is it about QOF points?Is it about QOF points?• Could it cause injury?Could it cause injury?• Is such a process respectful of Is such a process respectful of

patients’ views?patients’ views?• It is expensive and if we use much It is expensive and if we use much

resource doing this is there a knock-resource doing this is there a knock-on effect on other services? Is this on effect on other services? Is this fair? Do others suffer if we use “too fair? Do others suffer if we use “too much” for a few patients?much” for a few patients?


• ImmunisationImmunisation


• ImmunisationImmunisation

• Is this process beneficial? If so, to Is this process beneficial? If so, to whom?whom?

• Individual benefit vs. herd-immunity. Individual benefit vs. herd-immunity. • Do we know who is going to benefit?Do we know who is going to benefit?• What about if GPs get paid for What about if GPs get paid for

immunisations?immunisations?• Could it cause injury?Could it cause injury?• If some might suffer from it, is it still If some might suffer from it, is it still

right to proceed with it on grounds of right to proceed with it on grounds of benefit for the majority?benefit for the majority?


• Patient empowermentPatient empowerment


• Patient empowermentPatient empowerment• Is choice about treatment options always a Is choice about treatment options always a

good thing?good thing?• Information-giving may be good for the Information-giving may be good for the

doctor-patient relationship but is it a good doctor-patient relationship but is it a good basis for making treatment decisions? (DXT, basis for making treatment decisions? (DXT, chemo)chemo)

• ““What would you do, doc?”What would you do, doc?”• There may be an illusion of choice where There may be an illusion of choice where

there is no real choicethere is no real choice• What about Choose and Book? If it is based What about Choose and Book? If it is based

on historical referral patterns, is there on historical referral patterns, is there really choice?really choice?

Example from practice – 4Example from practice – 4

• Why don’t we just give Why don’t we just give patients prescriptions if they patients prescriptions if they ask for something?ask for something?


• Why don’t we just give Why don’t we just give patients prescriptions if they patients prescriptions if they ask for something?ask for something?• E.g. antibiotics, tranquillisers?E.g. antibiotics, tranquillisers?• This might be beneficial and patient-centredThis might be beneficial and patient-centred• Is patient choice more important than Is patient choice more important than

avoiding iatrogenesis or medicalisation? Or avoiding iatrogenesis or medicalisation? Or less?less?

• In any case, how likely is iatrogenesis with In any case, how likely is iatrogenesis with such simple, widely used treatments?such simple, widely used treatments?

• Is it fair - to other patients? To colleagues?Is it fair - to other patients? To colleagues?• Does doctor/nurse-practitioner know best?Does doctor/nurse-practitioner know best?

The First PrincipleThe First Principle

• Do goodDo good

• This is BENEFICENCEThis is BENEFICENCE

• Such aspects as cure / palliation / Such aspects as cure / palliation / comfort / empathy / compassion / comfort / empathy / compassion / treating patients with dignitytreating patients with dignity

• Such concepts are well understood by Such concepts are well understood by medical and nursing staffmedical and nursing staff


• Cholesterol monitoring in the Cholesterol monitoring in the elderlyelderly


• Cholesterol monitoring in the Cholesterol monitoring in the elderly elderly

•How old is elderly?How old is elderly?• Is this process beneficent? If so, Is this process beneficent? If so,

to whom?to whom?•What is the evidence for benefit?What is the evidence for benefit?• Is it about QOF points?Is it about QOF points?•Could it cause injury?Could it cause injury?• Is such a process respectful of Is such a process respectful of

patient views?patient views?


• SpirometrySpirometry


• SpirometrySpirometry

• Is this process beneficent? Is this process beneficent? • Do we know who is going to benefit? Do we know who is going to benefit? • Is it about QOF points?Is it about QOF points?• Could it cause injury?Could it cause injury?• It uses up a lot of time. Do others It uses up a lot of time. Do others

suffer if we use “too much” for a few suffer if we use “too much” for a few patients?patients?


• Termination of pregnancyTermination of pregnancy


• Termination of pregnancyTermination of pregnancy•What is the purpose in discussing What is the purpose in discussing different numbers of weeks of time different numbers of weeks of time where abortion is permissible? where abortion is permissible?

•Is there a moral difference between Is there a moral difference between abortion at 20 weeks and at 24?abortion at 20 weeks and at 24?

•Whose rights need to be considered Whose rights need to be considered – just the mother’s? The unborn – just the mother’s? The unborn child’s?child’s?

•How much guidance do the clauses How much guidance do the clauses of the Abortion Act(s) offer?of the Abortion Act(s) offer?

The Second PrincipleThe Second Principle

• Do no harmDo no harm

• This is NON-MALEFICENCEThis is NON-MALEFICENCE

• Not injuring patients by what we doNot injuring patients by what we do

• Non-iatrogenesisNon-iatrogenesis

• Well understood but sometimes Well understood but sometimes happens inadvertentlyhappens inadvertently

The Hippocratic Oath does notThe Hippocratic Oath does not contain the contain the words “First, do no harm”, (nor was it words “First, do no harm”, (nor was it actually written by Hippocrates, according to actually written by Hippocrates, according to many sources). It expresses a similar idea, many sources). It expresses a similar idea, but does not use these words. but does not use these words.

Hippocrates probably did originate the Hippocrates probably did originate the phrase, but did so in hisphrase, but did so in his Epidemics, Epidemics, Bk. I, Bk. I, Sect. XI. One translation reads: "Declare the Sect. XI. One translation reads: "Declare the past, diagnose the present, foretell the past, diagnose the present, foretell the future; practice these acts. As to diseases, future; practice these acts. As to diseases, make a habit of two things — to help, or at make a habit of two things — to help, or at least to do no harm.“least to do no harm.“

The Greek "First, do no harm" becomes The Greek "First, do no harm" becomes "Primum non nocere" in Latin. A translation "Primum non nocere" in Latin. A translation of the original perhaps, but some sources of the original perhaps, but some sources attribute "Primum non nocere" to the Roman attribute "Primum non nocere" to the Roman physician, Galen.physician, Galen.


• Should the cost of Should the cost of prescriptions be an issue?prescriptions be an issue?


• Should the cost of Should the cost of prescriptions be an issue?prescriptions be an issue?• How much should the PCT/DoH tell us what How much should the PCT/DoH tell us what

to prescribe? E.g. lansoprazole vs. to prescribe? E.g. lansoprazole vs. omeprazoleomeprazole

• Is generic prescribing always right? What Is generic prescribing always right? What about when patients feel branded about when patients feel branded medication is “better”?medication is “better”?

• Should we prescribe Calpol, cough mixtures, Should we prescribe Calpol, cough mixtures, etc?etc?

• What about “setting precedents”?What about “setting precedents”?• What about top-up payments for What about top-up payments for

“expensive” drugs?“expensive” drugs?


• Fertility treatmentFertility treatment


• Fertility treatmentFertility treatment• Is it right to choose the sex of a child Is it right to choose the sex of a child

produced by fertility treatment? Always? produced by fertility treatment? Always? Ever? Never?Ever? Never?

• What about selective abortion?What about selective abortion?• Cloning – what about for stem cell research Cloning – what about for stem cell research

or for treatment of an afflicted child?or for treatment of an afflicted child?• How many embryos can be “sacrificed” for How many embryos can be “sacrificed” for

the purposes of research? 9 to 1? 99 to 1? the purposes of research? 9 to 1? 99 to 1? 999 to 1?999 to 1?

• Should egg and sperm donors be Should egg and sperm donors be anonymous?anonymous?

Explanatory Notes to Human Tissue Act Explanatory Notes to Human Tissue Act 2004.doc2004.doc


• Ethical employment practiceEthical employment practice


• Ethical employment practiceEthical employment practice

• Hiring and firing – are non-Hiring and firing – are non-discriminatory policies and discriminatory policies and procedures in place?procedures in place?

• Issues of confidentiality for staffIssues of confidentiality for staff• What should be put in a reference?What should be put in a reference?• How much weight and value should How much weight and value should

be given to the views of non-clinical be given to the views of non-clinical staff in running a practice?staff in running a practice?

• How much should staff be paid? And How much should staff be paid? And doctors?doctors?

The Third PrincipleThe Third Principle

• Act fairlyAct fairly

• This is (distributive) JUSTICEThis is (distributive) JUSTICE

• Such aspects as treating equals Such aspects as treating equals equally / if people are non-equal they equally / if people are non-equal they should be treated in proportion to should be treated in proportion to their degree of inequality (? e.g. those their degree of inequality (? e.g. those in custody, relatives) / ethical in custody, relatives) / ethical rationing – should those who are rationing – should those who are deprived have more?deprived have more?

• A more difficult principleA more difficult principle


• Is it ever right to break Is it ever right to break confidentiality?confidentiality?


• Is it ever right to break Is it ever right to break confidentiality?confidentiality?• Who has a “right” to know your medical Who has a “right” to know your medical

history?history?• At what point does “need to know” override At what point does “need to know” override

“need for confidentiality”? “need for confidentiality”? • HIV in a partner? Open TB in a family HIV in a partner? Open TB in a family

member?member?• Suspected murder? Driving while fitting? Suspected murder? Driving while fitting?

Driving whilst under the influence of drugs? Driving whilst under the influence of drugs? If someone has “gone missing”? Who might If someone has “gone missing”? Who might you speak to – police, family, concerned you speak to – police, family, concerned neighbours?neighbours?

• Court may give an order to release medical Court may give an order to release medical records in some circumstancesrecords in some circumstances


• Should doctors always tell Should doctors always tell patients their diagnosis?patients their diagnosis?


• Should doctors always tell Should doctors always tell patients their diagnosis?patients their diagnosis?• What about uncertainty in diagnosis? What about uncertainty in diagnosis?

Is it right to make patients share Is it right to make patients share this?this?

• Is it ever right to suppress diagnoses Is it ever right to suppress diagnoses – what about stigmatising diagnoses, – what about stigmatising diagnoses, e.g. MS, dementia, HIV, psychiatric e.g. MS, dementia, HIV, psychiatric diagnoses? diagnoses?

• What if relatives ask doctors not to What if relatives ask doctors not to disclose diagnoses to patients?disclose diagnoses to patients?


• EuthanasiaEuthanasia


• EuthanasiaEuthanasia• What about withdrawing feeding tubes What about withdrawing feeding tubes

when someone is in a persistent when someone is in a persistent vegetative state?vegetative state?

• Who could make such a decision? Who Who could make such a decision? Who should?should?

• What role should relatives have in these What role should relatives have in these matters?matters?

• What about Living Wills?What about Living Wills?• Do we all “have a responsibility” not to Do we all “have a responsibility” not to

be a burden on society under certain be a burden on society under certain circumstances?circumstances?


• Should mentally disabled Should mentally disabled babies be prevented from babies be prevented from growing/maturing?growing/maturing?


• Should mentally disabled Should mentally disabled children be prevented from children be prevented from maturing?maturing?

• Has no awarenessHas no awareness• Life should be as comfortable as Life should be as comfortable as

possiblepossible• No sexual development – no periodsNo sexual development – no periods• Perhaps remain light enough to be Perhaps remain light enough to be

treated like a babytreated like a baby• Quality of life issuesQuality of life issues• But….?But….?

The Fourth PrincipleThe Fourth Principle

• Allow people to determine their own Allow people to determine their own futuresfutures

• This is AUTONOMYThis is AUTONOMY

• Such aspects as honesty / telling the Such aspects as honesty / telling the truth / informed consent / decision truth / informed consent / decision sharing / maximising the ability of sharing / maximising the ability of patients to make choicespatients to make choices

• CONFIDENTIALITY comes under this CONFIDENTIALITY comes under this principleprinciple

A further aspectA further aspect

• There is another aspect to this and There is another aspect to this and that is SCOPEthat is SCOPE

• To whom do we owe these duties?To whom do we owe these duties?

• Who are the interested parties?Who are the interested parties?

• Individuals or patients as a group? The Individuals or patients as a group? The Practice? The NHS? Society? Practice? The NHS? Society? Government?Government?


• Ethical researchEthical research


• Ethical researchEthical research

• Blood tests without specific consentBlood tests without specific consent• Blinding patients / consentBlinding patients / consent• Taking tissueTaking tissue• Keeping tissueKeeping tissue• Human Tissue Act 2004Human Tissue Act 2004


• Practice-based commissioningPractice-based commissioning


• Practice-based commissioningPractice-based commissioning• Whose interest does this serve?Whose interest does this serve?• Is allocation of funds based on historical Is allocation of funds based on historical

referral patterns a fair way to do it? Should referral patterns a fair way to do it? Should some practices/patients/areas of some practices/patients/areas of deprivation have more?deprivation have more?

• Who decides on the amount? Should one Who decides on the amount? Should one practice which “saves” support others who practice which “saves” support others who “overspend”? “overspend”?

• What about the time used in such a What about the time used in such a process?process?

• Whose responsibility is it if overspends Whose responsibility is it if overspends occur? The practice’s? The patients’? The occur? The practice’s? The patients’? The PCT’s? The NHS’s? The Government’s?PCT’s? The NHS’s? The Government’s?

• What if PBC destabilises or damages What if PBC destabilises or damages secondary care providers’ services?secondary care providers’ services?


• Do violent patients lose their Do violent patients lose their right to confidentiality?right to confidentiality?


• Do violent patients lose their Do violent patients lose their right to confidentiality?right to confidentiality?• They may have to go somewhere “special” – They may have to go somewhere “special” –

different – for treatment; they may be in different – for treatment; they may be in custodycustody

• They may have injured one of your They may have injured one of your colleagues and you may want or be asked to colleagues and you may want or be asked to report something to the policereport something to the police

• GMC advice is that information may be GMC advice is that information may be shared without consent where the public shared without consent where the public interests outweigh the benefits of keeping interests outweigh the benefits of keeping the information confidential - but may need the information confidential - but may need a court decisiona court decision


• Having health provisionHaving health provision


• Having health provisionHaving health provision

““Great physicians and nurses, skilled, caring and Great physicians and nurses, skilled, caring and unparalleled in their training, intervened in my life unparalleled in their training, intervened in my life and and probably saved it. I was lucky but other probably saved it. I was lucky but other Americans are Americans are not. It is time to speak again and not. It is time to speak again and stand again for the ideal stand again for the ideal that in the richest nation that in the richest nation ever on this planet, it is wrong ever on this planet, it is wrong for 41 million for 41 million Americans, most of them in working Americans, most of them in working families, to families, to worry at night and wake up in the morning worry at night and wake up in the morning without without the basic protection of health insurance.” the basic protection of health insurance.”

Senator John KerrySenator John Kerry

The “Four Principles” of The “Four Principles” of medical medical

ethics are:ethics are:

• Do goodDo good

• Do no harmDo no harm

• Act fairlyAct fairly

• Allow people to determine their Allow people to determine their own futuresown futures

Moral frameworkMoral framework

• The model of the Four Principles was The model of the Four Principles was suggested by the American ethicists suggested by the American ethicists Beauchamp and ChildressBeauchamp and Childress

• Popularised in UK by Ranaan GillonPopularised in UK by Ranaan Gillon

• A moral framework such as this can help to A moral framework such as this can help to give consistency in decision makinggive consistency in decision making

• It is claimed that “Any ethical problem can be It is claimed that “Any ethical problem can be solved by considering these four principles” solved by considering these four principles”

• But…But…

Critique of this modelCritique of this model

• It is not a coherent ethical theoryIt is not a coherent ethical theory

• Rather it is a mish-mash of ideasRather it is a mish-mash of ideas

• What about when there is conflict? What about when there is conflict?

• How do these ideas fit with underlying How do these ideas fit with underlying ethical theories?ethical theories?

Ethical theoryEthical theory

• The problem is that there is no single The problem is that there is no single agreed underlying ethical theoryagreed underlying ethical theory

• The task of Ethics is to try to arrive at The task of Ethics is to try to arrive at some conclusions without reference to some conclusions without reference to religious ideas or gut instinctreligious ideas or gut instinct

• There are two main ways of thinking There are two main ways of thinking about the rightness or wrongness of an about the rightness or wrongness of an action – Consequentialism and action – Consequentialism and Deontology Deontology

ConsequentialismConsequentialism

• This holds that the only thing that matters is This holds that the only thing that matters is the consequences of an actionthe consequences of an action

• Best known example of this type of idea is Best known example of this type of idea is UTILITARIANISM which proposes that the UTILITARIANISM which proposes that the morally correct course of action is that which morally correct course of action is that which results in the greatest good for the greatest results in the greatest good for the greatest number of those affected by the action number of those affected by the action

• These ideas were developed and set down by These ideas were developed and set down by the English philosophers Jeremy Bentham – the English philosophers Jeremy Bentham – “An Introduction to the Principles of Morals “An Introduction to the Principles of Morals and Legislation” (1789) – and John Stuart Mill and Legislation” (1789) – and John Stuart Mill – “Utilitarianism” (1861)– “Utilitarianism” (1861)

Good things about Good things about UtilitarianismUtilitarianism

• ““The central insight of Utilitarianism, The central insight of Utilitarianism, that one ought to promote happiness that one ought to promote happiness and prevent unhappiness whenever and prevent unhappiness whenever possible, seems undeniable”possible, seems undeniable”

• Provides support for democracy as the Provides support for democracy as the way to ensure that the interests of way to ensure that the interests of government coincide with the general government coincide with the general interestinterest

• Socially beneficial e.g. in 19Socially beneficial e.g. in 19thth century - century - anti-slavery movement, promotion of anti-slavery movement, promotion of women’s rights and spread of suffragewomen’s rights and spread of suffrage

Bad things about UtilitarianismBad things about Utilitarianism

• Disregards the distribution of benefits and Disregards the distribution of benefits and burdens on individualsburdens on individuals

• Can we correctly work out what the Can we correctly work out what the consequences of an action are? consequences of an action are?

• How can the sum of the benefits of actions be How can the sum of the benefits of actions be calculated?calculated?

• Difficult to compare alternativesDifficult to compare alternatives

• Is more to morality than simply Is more to morality than simply consequences?consequences?

Bad things about UtilitarianismBad things about Utilitarianism

• Might sometimes justify killing – killing Hitler Might sometimes justify killing – killing Hitler as a child could have saved millions of livesas a child could have saved millions of lives

• Deciding how to use limited resources – water, Deciding how to use limited resources – water, food, oxygen – in critical conditions - choosing food, oxygen – in critical conditions - choosing one Siamese twin to survive after separation one Siamese twin to survive after separation surgery instead of neithersurgery instead of neither

• Triage and rejection of critically injured Triage and rejection of critically injured patients after terrorist atrocitiespatients after terrorist atrocities

• If there are problems with Utiltarianism under If there are problems with Utiltarianism under these conditions, is there a general problem?these conditions, is there a general problem?

DeontologyDeontology

• These sorts of ethical theories regard These sorts of ethical theories regard obligation as deriving from reason or as obligation as deriving from reason or as residing primarily in certain specific residing primarily in certain specific rules of conduct rather than in the rules of conduct rather than in the maximisation of some goodmaximisation of some good

• Concepts like duty, moral obligation, Concepts like duty, moral obligation, moral commitment, what you should moral commitment, what you should and should not doand should not do

Good things about DeontologyGood things about Deontology

• Usually some sort of coherent systemUsually some sort of coherent system

• Might give a set of answers to a range Might give a set of answers to a range of problemsof problems

• Chimes with what individuals feel about Chimes with what individuals feel about thingsthings

• Fits with ideas of rules, laws, Fits with ideas of rules, laws, commandmentscommandments

33 ¶ Thou shalt have no other gods before me. ¶ Thou shalt have no other gods before me.44 ¶ Thou shalt not make unto thee any graven image, or any likeness ¶ Thou shalt not make unto thee any graven image, or any likeness of any thingof any thing that that isis in heaven above, or that in heaven above, or that isis in the earth beneath, or that in the earth beneath, or that isis in the water under in the water under the earth:the earth:55 thou shalt not bow down thyself to them, nor serve them for I the LORD thy God thou shalt not bow down thyself to them, nor serve them for I the LORD thy God amam a jealous God, visiting the iniquity of the fathers upon the children unto the third a jealous God, visiting the iniquity of the fathers upon the children unto the third and fourth and fourth generationgeneration of them that hate me; of them that hate me;66 and showing mercy unto thousands of them that love me, and keep my and showing mercy unto thousands of them that love me, and keep my commandments. commandments. 77 ¶ Thou shalt not take the name of the LORD thy God in vain for the LORD will not ¶ Thou shalt not take the name of the LORD thy God in vain for the LORD will not hold him guiltless that taketh his name in vain.hold him guiltless that taketh his name in vain.88 ¶ Remember the sabbath day, to keep it holy. ¶ Remember the sabbath day, to keep it holy. 99 Six days shalt thou labor, and do all thy work: Six days shalt thou labor, and do all thy work:1010 but the seventh day but the seventh day isis the sabbath of the LORD thy God: the sabbath of the LORD thy God: in itin it thou shalt not do thou shalt not do any work, thou, nor thy son, nor thy daughter, thy manservant, nor thy maidservant, any work, thou, nor thy son, nor thy daughter, thy manservant, nor thy maidservant, nor thy cattle, nor thy stranger that nor thy cattle, nor thy stranger that isis within thy gates: within thy gates:1111 for for inin six days the LORD made heaven and earth, the sea, and all that in them six days the LORD made heaven and earth, the sea, and all that in them is,is, and rested the seventh day: wherefore the LORD blessed the sabbath day, and and rested the seventh day: wherefore the LORD blessed the sabbath day, and hallowed it. hallowed it. 1212 ¶ Honor thy father and thy mother that thy days may be long upon the land ¶ Honor thy father and thy mother that thy days may be long upon the land which the LORD thy God giveth thee. which the LORD thy God giveth thee. 1313 ¶ Thou shalt not kill. ¶ Thou shalt not kill. 1414 ¶ Thou shalt not commit adultery. ¶ Thou shalt not commit adultery. 1515 ¶ Thou shalt not steal. ¶ Thou shalt not steal. 1616 ¶ Thou shalt not bear false witness against thy neighbor. ¶ Thou shalt not bear false witness against thy neighbor. 1717 ¶ Thou shalt not covet thy neighbor's house, thou shalt not covet thy neighbor's ¶ Thou shalt not covet thy neighbor's house, thou shalt not covet thy neighbor's wife, nor his manservant, nor his maidservant, nor his ox, nor his ass, nor any thing wife, nor his manservant, nor his maidservant, nor his ox, nor his ass, nor any thing that that isis thy neighbor's. thy neighbor's.

Code of Hammurabi - Code of Hammurabi - laws from the sixth laws from the sixth king of the Amorite Dynasty of Old Babylon king of the Amorite Dynasty of Old Babylon c. 1760 BC – contains medical aspectsc. 1760 BC – contains medical aspects

Code of Code of Hammurabi.docHammurabi.doc

““The essence of Buddhism is very simple: The essence of Buddhism is very simple: it is finding ways to transform oneself. It it is finding ways to transform oneself. It could be summed up as 'learning to do could be summed up as 'learning to do good; ceasing to do evil; purifying the good; ceasing to do evil; purifying the heart' (as the Dhammapada says)”.heart' (as the Dhammapada says)”.

Bad things about DeontologyBad things about Deontology

• Deontology depends on a variety of ideas -Deontology depends on a variety of ideas -• The fundamental principles of right and The fundamental principles of right and

wrong are authoritative by virtue of being wrong are authoritative by virtue of being self-evident truthsself-evident truths

• There are axiomatic or intuitive ideas of There are axiomatic or intuitive ideas of rightness or wrongnessrightness or wrongness

• (Some consider that) moral principles are (Some consider that) moral principles are based on God-given laws for humanitybased on God-given laws for humanity

• But.. But.. • Not all accept appeals on such “absolute” Not all accept appeals on such “absolute”

grounds grounds • It is easy to say if something is “square” It is easy to say if something is “square”

but is it similar when something is but is it similar when something is described as “right”?described as “right”?

Conclusions and implicationsConclusions and implications

• Things are not always as Things are not always as straightforward as they may seemstraightforward as they may seem

• There are ethical aspects to many There are ethical aspects to many medical situationsmedical situations

• If the problem is an ethical one, If the problem is an ethical one, try to generate lots of options – try to generate lots of options – rule nothing outrule nothing out

• Assess the advantages and Assess the advantages and disadvantages of each solution disadvantages of each solution using the four principlesusing the four principles

• Consider consequential and Consider consequential and deontological theorydeontological theory

Conclusions and implicationsConclusions and implications

• There may be legal precedentsThere may be legal precedents• There are sources of help and There are sources of help and

advice – colleagues, GMC, advice – colleagues, GMC, medical defence companies, medical defence companies, RCNRCN

• Impart decisions to patients in Impart decisions to patients in an ethical wayan ethical way

• Record everythingRecord everything

Medical Ethics VTS 24/09/08. Curriculum statement 3.3 Curriculum statement 3.4.

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Transcript of Medical Ethics VTS 24/09/08. Curriculum statement 3.3 Curriculum statement 3.4.