Dales GPEC
Medical Ethics
www.bradfordvts.co.uk
29.11.01 Bruce Davies 1
Dales GPEC
Frameworks
• Variety of them exist.
• Will present three.
29/11/01 Bruce Davies 2
Dales GPEC
Tavistock Principles
• Rights.
– People have a right to health and health care.
• Balance.
– Care of individual patients is central, but the
health of populations is also our concern.
• Comprehensiveness.
– In addition to treating illness, we have an
obligation to ease suffering, minimise disability,
prevent disease, and promote health.
29/11/01 Bruce Davies 3
Dales GPEC
Tavistock Principles
• Cooperation.
– Health care succeeds only if we
cooperate with those we serve, each
other, and those in other sectors.
• Improvement.
– Improving health care is a serious and
continuing responsibility.
29/11/01 Bruce Davies 4
Dales GPEC
Tavistock Principles
• Safety.
– Do no harm.
• Openness.
– Being open, honest, and
trustworthy is vital in health care.
29/11/01 Bruce Davies 5
Dales GPEC
Justice in Health Care
• Health.
– Health systems should pursue
health as their primary goal.
• Access.
– Health systems should provide care
primarily according to need rather
than ability to pay.
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Dales GPEC
Justice in Health Care
• Accountability.
– Consumers, providers, and
healthcare institutions must take
responsibility for health and
healthcare resources with which
they are entrusted .
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Dales GPEC
Justice in Health Care
• Choice.
– Consumers must have the real ability to
choose their healthcare systems, providers,
and treatments in order to seek the best
value in health care for themselves.
• Education.
– Education of consumers, providers, and
institutions regarding value and quality in
health care is necessary for responsible and
informed health choices.
29/11/01 Bruce Davies 8
Dales GPEC
MDU
Beneficence
Non-maleficence
Justice
Autonomy
29/11/01 Bruce Davies 9
Dales GPEC
Tavistock Principles
• Rights.
• Balance.
• Comprehensiveness.
• Cooperation.
• Improvement.
• Safety.
• Openness.
29/11/01 Bruce Davies 10
Dales GPEC
Case to Discuss
A doctor working in an NHS trust
thinks it wrong that his patients will
be denied a new treatment for
cancer (the hospital formulary
committee had decided that it
should not be prescribed). Should he
contact the local media? Should the
trust punish him if he does?
29/11/01 Bruce Davies 11
Dales GPEC Case to Discuss
A health maintenance organisation in the
United States considers investing in
improvements in its system for caring for
patients with AIDS.The vice president for
marketing warns that such improvements
may lead to selective enrolment of
unprofitable membersnamely, those with
HIV infection. Is the organisation ethically
bound to improve its HIV care, even if that
may reduce its financial viability?
29/11/01 Bruce Davies 12
Dales GPEC
Case to Discuss
Managers of a health provider discover
that one of their nurses is infected with
HIV but has told nobody. Should they
release the nurse's name to the media?
Should they notify all those who may have
been treated by the nurse even though the
chances of anybody being infected are
vanishingly small?
29/11/01 Bruce Davies 13
Dales GPEC
Case to Discuss
A infertility specialist writes to
ask if a patient of his can select
the gender of a child because he
has a patient who want a girl to
balance their family.
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