Medical Ethics
Content :
1. Four principles 2. Capacity 3. Consent 4. PARQ 5. Confidentiality 6. Human rights 7. Dignity 8. Four virtues 9. Consequentialism/Consequentialist 10. Utilitarianism 11. Deontology
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THE FOUR PRINCIPLES OF MEDICAL APPROACH
Autonomy : The patient has the right to make decisions, the doctor has to respect the decision making capabilities of the autonomous person
Beneficence : The act of always doing what is right for the patients, remove anything that may cause harm to the patient
Non-Maleficence : The act of doing no harm, avoiding unnecessary harm to the patients.
Justice : Actions have to be compatible with the rights of the individual (Human rights), all patients must get the treatment that is owed to them and patients with similar conditions should be treated equally – fairness in treatment
Capacity : It’s an essential factor, in order for the patient to have Autonomy. Basically, they need to be able to make decisions. Also, it is a fundamental requirement to give consent. (NO CAPACITY = NO AUTONOMY)
In order to ensure that we can take Consent (permission to do something) from a patient, Competence, Voluntariness (do not force the patients, they do it at their own will) and Information giving (doctor gives the patient all the needed information) have to apply.
More about Capacity…
The patients need to understand and know the information that is given to them by the doctors and retain it. They also need to be able to analyse the given information and weigh the pros and cons of it. After that, they are required to communicate with their doctor about their decision.
Only adults have capacity, example in the UK, you are considered an adult form 16 years of age and up, so a 16year old individual in the UK has capacity. However, they cannot refuse life-threatening treatment till they are 18.
A patient who has capacity (in this case, a mentally competent adult), has the right to self-determination, meaning, they have the right to make free decisions regarding themselves, they can also withhold or give consent and they also have the right to any information that concerns them.
We said before, that when a patient has Capacity, they also have Consent. And when a patient has Consent, they are also entitled to Confidentiality. Meaning that the doctor is not allowed to share information about the patient.
However, there are some cases, where the doctor can breach Confidentiality. When is that? That can happen when we have the consent of the patient, for the patient's best interest (for example, when there is a case of a suicidal patient, confidentiality must be breached in order to achieve the best possible outcome regarding the patient→help) and for the public's best interest (when a patient is on the verge of hurting someone, confidentiality must be breached in order to save the community as well as the patient)
Let's look at some examples:
Do the following patients have capacity?
A patient with intellectual disabilities
A patient with dementia
A patient with acute alcohol intoxication
The only time a patient is assumed to lack capacity, is when they are unconscious. (unable to express their will)
In this case, since we can't ask the patient for consent, we have to rely on a legally entitled representative (etc relatives). That is a proxy decision maker. That does not apply however if the patient has previously expressed their denial on giving consent on a specific matter.
Now, let's take a look at informed consent.
It is associated with Competence, Voluntariness and Information (look at section regarding when consent applies)
It has to do with the patient's acceptance of treatment, having the option to choose between other possible treatment options and even refuse the treatment.
Except from informed consent, we also have two other types of consent, which are Explicit Consent and Implied Consent.
Explicit consent is given when a patient actively agrees to use or disclose their information.
Implied consent has to do with circumstances when it would be reasonable to infer that the patient agrees to the use of the information, even though this has not been directly expressed.
Neglecting to take consent is unethical. It is a breach of the patient's rights, disrespect to their autonomy and the patient is not being treated with dignity. It can also be described as an unprofessional behaviour since it does not follow the legal and professional guidelines.
What does PARQ stand for?
Procedure -> discussion with the patient about the outcome of the procedure, the benefits and the possible side effects of it, other alternatives and what would happen if no treatment was used. The possible side effects and risks need to be presented in a way that patients can understand, identify the adverse outcomes and the potential outcomes of taking no action.
Alternatives
Risks and Benefits
Questions
…………………………………..…………………………………………….
Sometimes, even if they have full capacity and consent, patients prefer to give away their right to make decisions to the physician or third party. The reason either being the complexity of the situation-being scared to make a decision, they are too confident in the physician's judgement or because of their cultural ideologies.
About confidentiality...
Physicians hold back medical information when the disclosure of them might potentially cause serious physical, psychological or emotional harm to the patient.
Human Rights
People have rights regarding life, being free from inhuman or degrading treatment, privacy of family life, freedom of expression and being free from discriminatory practices.
Dignity in care
Dignity: respect, privacy, autonomy, self-worth
Principals of Dignity: it is about treating people as individuals, it is not about physical care, it is about equal power relationships
When is human dignity at risk?
In sickness
Towards death
In childhood and elderly
In prison
People with disabilities
Lack of capacity
What is a patient entitled to?
The doctor treats the patient, and the patient is a person, who entitled to enjoy all human rights, respect, recognition => human dignity. To sum it up into one word, it would be Beneficence (doing good to the patient)
Virtue Ethics
THE FOUR VIRTUES
Prudence -› right reason leads to the right action (i.e. the patient is going through a lot the doctors need to find the best treatment possible that fits best for the patient)
Justice -> all patients should be treated, patients with similar conditions should be treated equally
Fortitude -> moral courage** leads to a reasonable act (remaining calm in chaos etc)
Temperance -> Decisions made free from self interest
*when you have HIGH courage, you are reckless
*when you have LOW courage, you are a coward
IDEALLY, we have to be in-between, that's the concept of the 'Golden Mean'
Consequentialism
Implies that the right action, leads to the best consequences
Consequentialist
Someone who will find the best way to proceed in ethical dilemmas and get the best outcome
Utilitarianism
Determines right from wrong by focusing on the outcomes. It also claims that the most ethical action leads to the best outcome for most people. People should maximise human welfare, wellbeing and health.
Deontology
Concerned with the nature of action. Has to do with rules, law and action.
Content :
1. Four principles 2. Capacity 3. Consent 4. PARQ 5. Confidentiality 6. Human rights 7. Dignity 8. Four virtues 9. Consequentialism/Consequentialist 10. Utilitarianism 11. Deontology
…………………………………………………………………………………
THE FOUR PRINCIPLES OF MEDICAL APPROACH
Autonomy : The patient has the right to make decisions, the doctor has to respect the decision making capabilities of the autonomous person
Beneficence : The act of always doing what is right for the patients, remove anything that may cause harm to the patient
Non-Maleficence : The act of doing no harm, avoiding unnecessary harm to the patients.
Justice : Actions have to be compatible with the rights of the individual (Human rights), all patients must get the treatment that is owed to them and patients with similar conditions should be treated equally – fairness in treatment
Capacity : It’s an essential factor, in order for the patient to have Autonomy. Basically, they need to be able to make decisions. Also, it is a fundamental requirement to give consent. (NO CAPACITY = NO AUTONOMY)
In order to ensure that we can take Consent (permission to do something) from a patient, Competence, Voluntariness (do not force the patients, they do it at their own will) and Information giving (doctor gives the patient all the needed information) have to apply.
More about Capacity…
The patients need to understand and know the information that is given to them by the doctors and retain it. They also need to be able to analyse the given information and weigh the pros and cons of it. After that, they are required to communicate with their doctor about their decision.
Only adults have capacity, example in the UK, you are considered an adult form 16 years of age and up, so a 16year old individual in the UK has capacity. However, they cannot refuse life-threatening treatment till they are 18.
A patient who has capacity (in this case, a mentally competent adult), has the right to self-determination, meaning, they have the right to make free decisions regarding themselves, they can also withhold or give consent and they also have the right to any information that concerns them.
We said before, that when a patient has Capacity, they also have Consent. And when a patient has Consent, they are also entitled to Confidentiality. Meaning that the doctor is not allowed to share information about the patient.
However, there are some cases, where the doctor can breach Confidentiality. When is that? That can happen when we have the consent of the patient, for the patient's best interest (for example, when there is a case of a suicidal patient, confidentiality must be breached in order to achieve the best possible outcome regarding the patient→help) and for the public's best interest (when a patient is on the verge of hurting someone, confidentiality must be breached in order to save the community as well as the patient)
Let's look at some examples:
Do the following patients have capacity?
A patient with intellectual disabilities
A patient with dementia
A patient with acute alcohol intoxication
The only time a patient is assumed to lack capacity, is when they are unconscious. (unable to express their will)
In this case, since we can't ask the patient for consent, we have to rely on a legally entitled representative (etc relatives). That is a proxy decision maker. That does not apply however if the patient has previously expressed their denial on giving consent on a specific matter.
Now, let's take a look at informed consent.
It is associated with Competence, Voluntariness and Information (look at section regarding when consent applies)
It has to do with the patient's acceptance of treatment, having the option to choose between other possible treatment options and even refuse the treatment.
Except from informed consent, we also have two other types of consent, which are Explicit Consent and Implied Consent.
Explicit consent is given when a patient actively agrees to use or disclose their information.
Implied consent has to do with circumstances when it would be reasonable to infer that the patient agrees to the use of the information, even though this has not been directly expressed.
Neglecting to take consent is unethical. It is a breach of the patient's rights, disrespect to their autonomy and the patient is not being treated with dignity. It can also be described as an unprofessional behaviour since it does not follow the legal and professional guidelines.
What does PARQ stand for?
Procedure -> discussion with the patient about the outcome of the procedure, the benefits and the possible side effects of it, other alternatives and what would happen if no treatment was used. The possible side effects and risks need to be presented in a way that patients can understand, identify the adverse outcomes and the potential outcomes of taking no action.
Alternatives
Risks and Benefits
Questions
…………………………………..…………………………………………….
Sometimes, even if they have full capacity and consent, patients prefer to give away their right to make decisions to the physician or third party. The reason either being the complexity of the situation-being scared to make a decision, they are too confident in the physician's judgement or because of their cultural ideologies.
About confidentiality...
Physicians hold back medical information when the disclosure of them might potentially cause serious physical, psychological or emotional harm to the patient.
Human Rights
People have rights regarding life, being free from inhuman or degrading treatment, privacy of family life, freedom of expression and being free from discriminatory practices.
Dignity in care
Dignity: respect, privacy, autonomy, self-worth
Principals of Dignity: it is about treating people as individuals, it is not about physical care, it is about equal power relationships
When is human dignity at risk?
In sickness
Towards death
In childhood and elderly
In prison
People with disabilities
Lack of capacity
What is a patient entitled to?
The doctor treats the patient, and the patient is a person, who entitled to enjoy all human rights, respect, recognition => human dignity. To sum it up into one word, it would be Beneficence (doing good to the patient)
Virtue Ethics
THE FOUR VIRTUES
Prudence -› right reason leads to the right action (i.e. the patient is going through a lot the doctors need to find the best treatment possible that fits best for the patient)
Justice -> all patients should be treated, patients with similar conditions should be treated equally
Fortitude -> moral courage** leads to a reasonable act (remaining calm in chaos etc)
Temperance -> Decisions made free from self interest
*when you have HIGH courage, you are reckless
*when you have LOW courage, you are a coward
IDEALLY, we have to be in-between, that's the concept of the 'Golden Mean'
Consequentialism
Implies that the right action, leads to the best consequences
Consequentialist
Someone who will find the best way to proceed in ethical dilemmas and get the best outcome
Utilitarianism
Determines right from wrong by focusing on the outcomes. It also claims that the most ethical action leads to the best outcome for most people. People should maximise human welfare, wellbeing and health.
Deontology
Concerned with the nature of action. Has to do with rules, law and action.
