Assessing Ethics in CbDs

1. Assessing Ethics in CbDs • Hasna Begum

2. Workshop Format • Small groups: Fact-Finding Exercise • How do people do it at the moment? • Examples of good practice. • What do people find difficult? • Ethics theory – Frameworks, Values, Assessment • Group work: case discussions - how to incorporate into practice 2

3. RCGP Rationale for Ethics • Professional Codes of Conduct – incorporates some ethical principles • Minimum standards • Limits of accepted professional behaviour • Application and interpretation to specific cases or situations • Identify ethical issues in practice • Evaluate moral justification for different courses of actions • Make appropriate and justifiable decisions

4. Health Professional Wider Societal Values Professional Codes of Conduct Case Specifics Decision-making Personal Values Evidence

5. The Clinical Encounter • Each healthcare encounter is informed by • Facts: • history, examination findings, investigation results • evidence of effectiveness of treatment options. • Values of ALL those involved in the encounter • Moral, cultural and aesthetic values • Often implicit rather than explicitly articulated 5

6. Clinical Ethics and Values Based Practice • GPs must: • Understand the ethical and legal framework within which they practise • Identify ethical issues that arise in day-to-day practice • Recognise the relevant values of all those involved • Demonstrate the moral reasoning on which their decisions are based

7. Four Principles • Beauchamp and Childress (1970s) • Respect for autonomy • Beneficence • Non maleficence • Justice • All of equal importance • Codes of conduct generally in keeping with these principles

8. In the GMC context

9. Values • What do we mean by this? • A value is a standard – typically shared by others in a given community – for judging the goodness or badness of some thing or some action. • Values have moral implications. • Separate from preferences.

10. Moral Theory Deontology Utilitarianism “The greatest happiness of the greatest number” People should act in a way that brings about the best overall outcome The goodness of any outcome depends on the amount of happiness realised • “The science of duty” • The morality of an action is intrinsic to the action itself rather than the consequences • Most societies rely somewhat on these kinds of moral rules

11. Jim and the Tribespeople • Jim is an anthropologist, and one day, deep in the Amazon, he comes across a tribe. The chief is about to execute a group of ten people from his tribe, who were chosen at random. The chief hails Jim and says, “You are a guest amongst us and in order to honour you, I will allow you to save nine of these ten people. All you have to do is pick one for execution and the other nine will go free. If you do not choose one, then all ten will die.” • If you were Jim, what would you do?

12. Trainer’s task • In the discussion you need to elicit from your trainee: • Their understanding of the ethical dimensions to the case • The relevance of professional codes of conduct (if appropriate) • The values of the individuals involved (themselves included) • How all of the above impacted on their decision making

13. Eliciting the Information

14. Assessing the Information • Competence Framework • Competence No. 11: Maintaining an ethical approach to practice – practising ethically with integrity and a respect for diversity • Bloom’s taxonomy: knowledge, skills, attitudes