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MEDICAL ETHICS

MEDICAL ETHICS. Prof. Gerard Garbutt Visiting Prof. Clinical Exercise Science University of Huddersfield GP ST2 Pennine Training Scheme. What are ethics?. Derived from the Greek word ethos custom, habit, character or disposition. Ethics covers the following dilemmas:

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MEDICAL ETHICS

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  1. MEDICAL ETHICS Prof. Gerard Garbutt Visiting Prof. Clinical Exercise Science University of Huddersfield GP ST2 Pennine Training Scheme

  2. What are ethics? • Derived from the Greek word ethos • custom, habit, character or disposition. • Ethics covers the following dilemmas: • how to live a good life • our rights and responsibilities • the language of right and wrong • moral decisions - what is good and bad? http://www.bbc.co.uk/ethics/introduction/intro_1.shtml

  3. Medical Ethics http://www.merriam-webster.com/dictionary/ethics

  4. Four Bioethical Principles • Autonomy - respect individual ability to make decisions about health and future. • Beneficence - actions intended to benefit • Non-maleficence - intent not to harm • Justice fair to the wider community in terms of the consequences http://priory.com/ethics.htm

  5. Ethical Approaches • God-based ethics • Supernaturalism • Only source of moral rules is God. • Virtue ethics • Moral character • The way individuals live their lives • Situation ethics • Ethical decisions should be made according to the unique situation • No moral rules or rights • each case is unique and deserves a unique solution. http://www.bbc.co.uk/ethics/introduction/intro_1.shtml

  6. Ethical Approaches • Consequentialism • “the greatest good for the greatest number of people” • Bad acts could be good if the consequences are good • Utilitarianism • Deontology • Non-consequentialism • Actions not consequences. • "the principle of the thing" • Some acts are right or wrong in themselves. http://www.bbc.co.uk/ethics/introduction/intro_1.shtml

  7. Why is it relevant to us? • Deontological ethics or deontology • (from Greek, deon, "obligation, duty") • Adherence to a rule or rules. http://en.wikipedia.org/wiki/Deontology

  8. Why is it relevant to us? • GMC (2006): Good Medical Practice • Duties of Doctors • Clearly prescribed behaviour • GMC states what we as Doctors 'must' do as ‘an overriding duty’. • The GMC instruct that you ‘must’ as a Doctor, ‘make the care of your patient your first concern’. http://www.gmc-uk.org/guidance/good_medical_practice.asp

  9. GMC Judgement • “Irresponsible”, “misleading” and “dishonest” • Honesty • Unnecessary and invasive tests on children • Least harm • Breached fundamental principles of research medicine • Probity • Callous disregard” for the suffering of children by taking blood samples • Consent • Failed to declare a conflict of interest • Honesty • GMC • To protect patients and is in the wider public interest, including the maintenance of public trust and confidence in the [medical] profession http://www.gmc-uk.org/Wakefield_SPM_and_SANCTION.pdf_32595267.pdf

  10. Medicine should be taught on the wards • Ethical decisions in clinical medicine are cannot be recreated in a classroom • Repeated, realistic exposure is the key to good ethical training. BMJ 2010;340:c1992

  11. Consent • "consented" on the morning of the operation and have little idea of what awaits them. • Confidentiality • Patient dies from a ruptured cerebral aneurysm during intercourse with mistress. • Distraught wife asks the medical team what happened. BMJ 2010;340:c2489

  12. End of life decisions • DNAR orders • QoL • Futility • Meaning of best interests • Sports medicine • Tension between clinical best interests and overall best interests BMJ 2010;340:c2489

  13. Organisational ethics • locums • rotas • continuity of care • targets • patient safety. • Whistleblowing • reporting their concerns about an underperforming colleague • "The care of my patient is my first concern" BMJ 2010;340:c2489

  14. Increasing availability of life sustaining treatments • Genetic advances • Organ transplantation BMJ 2010;340:c2489

  15. For 2/52!! • Bring one ‘ethics’ case with you • 29th June • References • Good Medical Practice – GMC 2006 • D. Sokol. BMJ 2010;340:c1992 • D. Sokol. BMJ 2010;340:c2489

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