Ethics

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					Ethics in an Hour (or less)


        Richard de Ferrars
  GP Faculty Frimley Park Hospital
           Ethics in an Hour
•   What is/ are Ethics?
•   Are ethics & morals the same?
•   Ethics – where can I get some?
•   Theory into practice – some “rules”
•   Case discussions
          What is/ are Ethics?

• What does the term
  and concept of
  “ethics” mean to you?
  – Knowing what is right?

  – Doing what is right?
          What is/ are Ethics?
• A set of moral principles

• The philosophical study of moral values and rules

• The study of right and wrong in conduct

• The branch of philosophy concerned with evaluating
  human action

• A system or code of morals of a particular religion,
  group, or profession.
              What are Ethics?

• Ethics vs Morals?

    Ethics - What is right or wrong based on reason

            Ethics = thinking

    Morals - Right or wrong behaviour based on social custom.

            Morals = behaviour = action
 But Where Can I Get Some?
• Medical ethics is primarily a field of applied
  ethics, the study of moral values and
  judgments as they apply to medicine.

• What determines your own “individual” ethics?
  – Own moral values
  – Cultural norms
  – Professional duties
 But Where Can I Get Some?
• Medical ethics is primarily a field of applied
  ethics, the study of moral values and
  judgments as they apply to medicine.

• What determines your own “individual” ethics?
  – Own moral values      • Evil people?
                          • Upbringing
  – Cultural norms
                          • Peer group
  – Professional duties
 But Where Can I Get Some?
• Medical ethics is primarily a field of applied
  ethics, the study of moral values and
  judgments as they apply to medicine.

• What determines your own “individual” ethics?
  – Own moral values
  – Cultural norms      • Compare with UK 20(0) years ago
                        • Compare with another country
  – Professional duties
                        • Compare war and peace
 But Where Can I Get Some?
• Medical ethics is primarily a field of applied
  ethics, the study of moral values and
  judgments as they apply to medicine.

• What determines your own “individual” ethics?
  – Own moral values
  – Cultural norms
  – Professional duties
 Medical Professional Values

Hippocratic Oath

• Modern version used
  in many countries
  including some UK
  graduates
                          Hippocratic Oath
• I swear by Apollo, the healer, Asclepius, Hygieia, and Panacea, and I take to witness all the gods,
  all the goddesses, to keep according to my ability and my judgment, the following Oath and
  agreement:
• To consider dear to me, as my parents, him who taught me this art; to live in common with him
  and, if necessary, to share my goods with him; To look upon his children as my own brothers, to
  teach them this art.
• I will prescribe regimens for the good of my patients according to my ability and my judgment and
  never do harm to anyone.
• I will not give a lethal drug to anyone if I am asked, nor will I advise such a plan; and similarly I
  will not give a woman a pessary to cause an abortion.
• But I will preserve the purity of my life and my arts.
• I will not cut for stone, even for patients in whom the disease is manifest; I will leave this
  operation to be performed by practitioners, specialists in this art.
• In every house where I come I will enter only for the good of my patients, keeping myself far from
  all intentional ill-doing and all seduction and especially from the pleasures of love with women or
  with men, be they free or slaves.
• All that may come to my knowledge in the exercise of my profession or in daily commerce with
  men, which ought not to be spread abroad, I will keep secret and will never reveal.
• If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in
  all times; but if I swerve from it or violate it, may the reverse be my lot.
  Medical Professional Values
Where do we find the
statement of our current
professional values?


GMC –
Good Medical Practice
 The duties of a Doctor registered with the
         General Medical Council
Patients must be able to trust doctors with their lives
and health. To justify that trust you must show respect
for human life and you must:
• Make the care of your patient your first concern

• Protect and promote the health of patients and the public
• Provide a good standard of practice and care
   – Keep your professional knowledge and skills up to date
   – Recognise and work within the limits of your competence
   – Work with colleagues in the ways that best serve patients' interests
The duties of a Doctor registered with the
        General Medical Council
• Treat patients as individuals and respect their dignity
   – Treat patients politely and considerately
   – Respect patients' right to confidentiality

• Work in partnership with patients
   – Listen to patients and respond to their concerns and preferences
   – Give patients the information they want or need in a way they
     can understand
   – Respect patients' right to reach decisions with you about their
     treatment and care
   – Support patients in caring for themselves to improve and
     maintain their health
The duties of a Doctor registered with the
        General Medical Council
• Be honest and open and act with integrity
   – Act without delay if you have good reason to believe that you or a
     colleague may be putting patients at risk
   – Never discriminate unfairly against patients or colleagues

   – Not abuse patients' trust in you or public's trust in the profession   .
• You are personally accountable for your professional
  practice and must always be prepared to justify your
  decisions and actions.
 But Where Can I Get Some?
• Medical ethics is primarily a field of applied
  ethics, the study of moral values and judgments
  as they apply to medicine.

• What determines your own “individual” ethics?
  – Own moral values
  – Cultural norms
  – Professional duties

• Within this room, we have a lot in common but
  we are not clones....
Theory into Practice
                 Problem Constructs
      Ethics (Thinking)   - What is right or wrong based on reason
      Morals (Action)     - What is considered right or wrong behaviour
                            based on social custom.

• Ethical Principles behind thinking:       • Moral Theories behind actions:
   – Autonomy                                     – Virtue
   – Beneficence                                  – Duty
   – Non-malificence                              – Utility
   – Justice                                      – Rights

• Consider the effect on:
   Self        Your organisation    Profession        NHS
   Patient     Family/ Carers       Community         Country
Established Ethical Principles
1. Autonomy      - free from coercion, with capacity,
                  informed decision

2. Beneficence   - benefits for the patient

3. Maleficence   - potential harm to patient

4. Justice       - justifiable in resource terms not
                  legal sense

Aide-memoire “A BMJ”
      Moral Theories Behind Actions

• Virtue    Professional obligations (“Hippocratic Oath”)

• Duty      What would society expect us to do?

• Utility   On balance, the majority benefit although some do not
            (eg immunisation, risk of a procedure)

• Rights    Is our action in accordance with the person’s rights?
            Have rights of others been taken into account?
        Framework for Discussion
Case Analysis:
• 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
• Analyse the case with reference to moral theories
• Acknowledge other approaches and state preferred
  approach with explanation
 Case Analysis:
 •     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
 •     Analyse the case with reference to moral theories
 •     Acknowledge other approaches and state preferred approach with explanation



 Ethical Principles                                        Moral Theories
 Autonomy     - free from coercion, with capacity,         Virtue    Professional obligations
                  informed decision                        Duty      What would society expect us to do?
 Beneficence - benefits for the patient                    Utility   On balance, the majority benefit
 Maleficence - potential harm to patient                             although some do not (eg immunisation)
 Justice      - justifiable in resource terms not          Rights    Is our action in accordance with that
                    legal sense                                      person’s rights?
                                                                     Have rights of others been taken into
                                                                     account?
Consider the effect on:
     Self          Your organisation              Profession            NHS
     Patient       Family/ Carers                 Community             Country
The End

				
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posted:9/23/2011
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