1 / 24

Medical ethics

Medical ethics. Dr D Grace MD. FFARCSI. Dip.ICM. Dept of Anaesthesia & Critical Care Medicine Altnagelvin Area Hospital. 1. Aims. Consider medical ethics & clinical practice Outline and define ethical principles Outline practicalities & challenging issues arising in medical practice. 2.

eaton-hebert
Download Presentation

Medical ethics

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Medical ethics Dr D Grace MD. FFARCSI. Dip.ICM. Dept of Anaesthesia & Critical Care Medicine Altnagelvin Area Hospital 1

  2. Aims • Consider medical ethics & clinical practice • Outline and define ethical principles • Outline practicalities & challenging issues arising in medical practice 2

  3. Ethics • A branch of moral philosophy & the theoretical study of practical morality • Medical ethics - value judgements applied in a professional context • Ordinary morality 3

  4. Principles of medical ethics • Autonomy • Beneficence • Non-maleficence • Justice, equity, utility 4

  5. Autonomy • The capacity to think, decide and act freely and independently on the basis of such thought & decision Linked to autonomy are issues pertaining to: • Consent • Competence • Advance directives 5

  6. Consent - principles • “Every adult has an inviolable right to determine what is done to his or her body” Lord Donaldson • Required for examination, treatment, care • Verbal, written, implied, presumed • Given voluntarily • Informed / valid if the quality & clarity of information given is adequate and appropriate 6

  7. Competence • > 16 years competence presumed unless evidence to the contrary • Adults may be competent to make some decisions but not competent to make others • Mental disorder / impairment does not of itself imply incompetence • Implies that one can understand, retain, evaluate and choose freely 7

  8. Advanced statements • Autonomy (expression of) • Facilitate communication • A useful guide to wishes • Facilitate a good death • Uptake limited • Impact limited • Potential for disagreement • Wording crucial • Circumstances unanticipated 8

  9. Beneficence / non-maleficence • The promotion of what is best for the patient - do good • Objective professional assessment v autonomous choice by patient - paternalism v autonomy • Non-maleficence - do no harm • Sanctity of life - quality > duration • Futility - inappropriate provision of life-prolonging therapies when there is no expectation of survival 9

  10. Justice • Healthcare resources are finite • One strives for fair distribution • Futility is very costly • Funds are rationed / treatment options are restricted • Advocates and rationers - medical profession, patient groups, government 10

  11. Utility • The maximizing of outcomes / preferences • Tension exists between utility & equality • Concentrate resources? • Utility implies making service & provision choices • Requires measurement and research 11

  12. Challenging scenarios • Right to treatment • Ordinary v extraordinary measures • Futility & treatment limitation • End of life issues and care • Commissions and omissions • Do not attempt resuscitation • Death & organ donation • Research 12

  13. Should all patients be treated? • Natural claim to care / natural duty & professional duty • Statutory “right” to care (consultation, advice, treatment) • Right to be received, respected, heard, advised, treated appropriately if available • Responsibility for the treatment chosen rests with the clinician • When consulted Courts authorize but do not order care 13

  14. Ordinary / extraordinary treatment • Treatments with a reasonable probability of benefit with minimal burden • Actions may involve pain + distress • Proportionate v disproportionate measures • Duty to provide proportionate care 14

  15. End of life (E.O.L.) considerations in ICU • ICU aims to restore patients to well-being or to a functional existence • Medical intervention may prolong life / postpone death • E.O.L. issues including symptom palliation arise 15

  16. Futility + withdrawal • Balance likelihood of survival to discharge against risks & burdens of therapy • Institute/continue/escalate/limit/withdraw treatment - all ethically equivalent • Communication is paramount • Ensure dignity, rights, comfort, wishes (of patient or proxy) • G.M.C., B.M.A., professional bodies provide guidelines & standards 16

  17. Omissions, commissions & double effect • Inability to benefit • Withholding & withdrawing differ from killing • Intent v foresight / double effect: palliation & cardiorespiratory depression - relieve burden + allow to die • Physician-assisted suicide / active euthanasia – illegal 17

  18. D.N.A.R. / P.N.D.(do not attempt resuscitation – permit natural death) • Cardiorespiratory arrest may -> cardiopulmonary resuscitation (C.P.R.) • C.P.R. success is circumstance-dependent • Consent (for C.P.R.) is invariably assumed when unknown • Communication re E.O.L. care absolutely essential • Patient’s wishes & preferences determined • Multi-disciplinary input to decision invaluable • Treatment status / wishes recorded + reviewed 18

  19. Death and B.S.D. (brain stem death) • Death = the irreversible loss of the capacity to breathe and the capacity for consciousness - occurs when the brain stem ceases to function • Brain stem - the critical part of the critical organ • Traditional cardiorespiratory death v B.S.D. • Brain stem or “beating heart” death 19

  20. Organ donation • Demand rising, supply falling • Beating-heart (B.S.D.) & non-beating heart • Life-saving & life-enhancing • Requires consent/assent – patient or N.O.K. (next of kin) • Advance statement - register as potential donor - http://www.organdonation.nhs.uk • Presumed consent / opt out largely irrelevant as N.O.K.’s wishes actually paramount 20

  21. Medical research • An imperative – today’s research is tomorrow’s medicine • Requires funding & regulation • Potential conflict b/n public & personal interests? • Nuremberg code (1946) • Declaration of Helsinki (1964/2000) – concern for the interests of the subject must prevail over the interest of science & society. 21

  22. Research guidelines • Respect autonomy of potential participants thus rigorous consenting: (i) research (ii) not contrary to subject’s interests (iii) outcome unpredictable (iv) freedom to withdraw • Risk of harm - quantifiable, identifiable? Ideally risk < minimal! • Research of quality and of value • Justice 23

  23. Summary • Ethical concepts, definitions & context outlined • Autonomy, beneficence & non-maleficence, equity justice & utility - the pillars of medical ethics • Consent + associated difficulties considered • Futility, commission, omission & double effect discussed • Special circumstances – D.N.A.R. - P.N.D. / death & organ donation 23

More Related