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------=_NextPart_01C863F8.0D1AD280 Content-Location: file:///C:/D175B0D3/medicalethics_files/master05.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C863F8.0D1AD280 Content-Location: file:///C:/D175B0D3/medicalethics_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C863F8.0D1AD280 Content-Location: file:///C:/D175B0D3/medicalethics_files/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Medical Ethics
Medical Ethics
Sarah Kelt
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Disclaimer
`= 58;“I’m not an ethicist bu= t I do ethics”
`= 58;= 3;
`= 58;= 3;
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quoted-printable Content-Type: text/html; charset="us-ascii" Medical Ethics
Beginnings and endings
►Ethical dilemmas cluster = at the beginning= and end of life ► My experience is end of life ►I won’t co= ver abortion, fertility treatment,  = premature babies= etc
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Ethical theories I know nothin= g = ab= out
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Metaphysics =
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Teleology
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Kantian ethics&#= 13;
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Deontology <= /span>
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Utilitarianism
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Ethics I know a little about
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►4 principles of = modern bioethics
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Beauchamp and Childress 1979
<= span style=3D'visibility:hidden'>►= 3;
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Autonomy
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Justice
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Benificence =
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Non-maleficence<= /span>
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Autonomy
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Paramount
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Being self-governing
►Able to exercise= free will in making a personal decision
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►A right to withh= old consent
<= span class=3DBB style=3D'position:absolute;left:-4.09%;top:.22em'>►Applicable to an= yone who has capacity
------=_NextPart_01C863F8.0D1AD280 Content-Location: file:///C:/D175B0D3/medicalethics_files/slide0007.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Medical Ethics
Beneficence
►Literally being charitable or doing good
►Performing care = so as to maximise patient wellbeing
<= span class=3DBB style=3D'position:absolute;left:-4.35%;top:.22em'>►Exercising clini= cal judgement
►Going beyond the minimum standards required
------=_NextPart_01C863F8.0D1AD280 Content-Location: file:///C:/D175B0D3/medicalethics_files/slide0008.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Medical Ethics
Non-malificence
<= span class=3DBB style=3D'position:absolute;left:-6.62%;top:.22em'>►Doing no harm= 3;
►Avoidance of put= ting a person at risk of avoidable harm ►A 1st step towards beneficence = ►Defined under th= e Hippocratic oath=
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------=_NextPart_01C863F8.0D1AD280 Content-Location: file:///C:/D175B0D3/medicalethics_files/slide0009.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Medical Ethics
Justice
►No single definition
►Usually distribu= tive justice when applied to medical ethics
►Fairness
►Equity
<= span class=3DBB style=3D'position:absolute;left:-5.98%;top:.22em'>►Method of righti= ng wrongs
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file:///C:/D175B0D3/medicalethics_files/slide0010.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Medical Ethics
Limitations
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Very simplistic&= #13;
<= span class=3DBB style=3D'position:absolute;left:-4.19%;top:.22em'>►Autonomy trumps = the other principles
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Role of justice&= #13;
►No coherent appr= oach to resolving conflicting principles
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Other factors
<= span class=3DHBB style=3D'position:absolute;left:-8.96%;top:.22em'>►Patient expectations
►Family expectations
<= span class=3DHBB style=3D'position:absolute;left:-8.96%;top:.22em'>►Genuine uncertainty
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Wishes of patien= t
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Wishes of family=
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Cultural values&= #13;
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Religious values=
<= span style=3D'visibility:hidden'>►
►Preferences of <= /span>professionals= 3;►Power balance wi= thin the healthcare team
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Trust policies&#= 13;
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Financial issues=
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Legal issues = ;
<= span style=3D'visibility:hidden'>►
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       You= are a doctor in a hospice
►Ken 45-year-old has always lived with mum = Barbara. He is d= ying of mouth cancer. He wants to eat but when he does he chokes. The nurse asks y= ou to sedate Ken as Barbara can’t bear to see him choking.
►
►Will you give him sedation?
►What will you say to the nurse and Barbara?
=
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charset="us-ascii" Medical Ethics
Dilemmas and topical issues
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Mental capacity act
►Replaced best pr= actice and common law ►Adults who may be = unable to make a= decision
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Decision specifi= c
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Time specific= 3;
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Assessment
►Presumption of <= /span>capacity ►Support to make = decisions
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Unwise decisions=
<= span class=3DHBB style=3D'position:absolute;left:-9.3%;top:.22em'>►Best interests&#= 13;
<= span class=3DHBB style=3D'position:absolute;left:-7.96%;top:.22em'>►Least restrictive option
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Terms
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►LPA <= /span>
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Court appointed deputy
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Court of protection
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►Public Guardian&= #13;
<= span class=3DBB style=3D'position:absolute;left:-4.26%;top:.22em'>►IMCA
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Advance decision to refuse = tr= eatment
►Validity
§Has to be made when competent
►Applicability
§Have anticipated the situation
§And the implications of the decision
►If relating to withdrawing or withholding life sustaining treatment
§In writing, signed, witnessed
§Express “even if life is at risk”
<= span style=3D'mso-special-format:bullet;color:#A3C145;mso-color-index:6;positio= n: absolute;left:-4.26%;font-family:Arial;font-size:80%'>►= 3;
<= span style=3D'mso-special-format:bullet;color:#A3C145;mso-color-index:6;positio= n: absolute;left:-4.26%;font-family:Arial;font-size:80%'>►
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     You are a young doctor in A&E
►Mary 80-year-old lady admitted to hospital = this morning wit= h a stroke. She has collapsed and her heart has stopped. The nurse tells you = Mary told a student nurse she didn’t want CPR if she collapsed.&= #13;
►
►Will you resuscitate her?
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Euthanasia/PAS/slow euthanasia
►Euthanasia
§Active – an intentional act
§Passive – due to an omission
§Voluntary
§Involuntary - ?killing
►PAS – Carr= ied out by patient with help of another
►Slow euthanasia – sometimes used for terminal sedation
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Joan
►94-year-old with advanced lung cancer. All treatment has fa= iled. She is admitted to the hospice as her family can’t man= age to look after her at home. She isn’t able to wake up <= span style=3D'position:absolute;top:52.5%;left:8.05%;width:92.13%;height:7.5%'>= or speak but she= is very distressed and agitated. You feel she is dying and start he= r on sedatives to = settle her agitation. She dies the next day – peacefully.
=
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What happened next
►Joan’s dau= ghters say “She was fine before she came in. The sedative you gave killed her. <= /span>Why didn’t= you give her a drip when she couldn’t drink?”
►Did you kill her=
&= sect;Morally?
&= sect;Legally?
►Should you have = given her a drip?
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Doctrine of double effect
►Th= omas Aquinas and Dr Adams
►An action having good and bad consequences is defensible if:
§The nature of the act is good&= #13;
§The intention is for the good effect
§Th= e good effect outweighs the bad and the situation is gr= ave enough to risk yielding to the bad effect
§The good effect does not depen= d on the bad effect
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Dr Adams
►British GP and suspected serial killer. Edith Alice Morrell was paralysed by a stroke. She was given a cocktail of morphine, diamorphine (her= oin) and barbiturates to treat cerebral irritation and help her sleep= . <= span style=3D'font-family:Tahoma;mso-ascii-font-family:Tahoma'>He arranged her cremation on the day of her death, stating on the form her had no pecuniary intere= st. He received a Rolls Royce, silver cutlery and a lamp.
=
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Question
►
►
►
►
<= span style=3D'mso-special-format:nobullet;display:none;color:#A3C145;mso-color-= index: 6;font-family:Arial;font-size:80%'>►The doctrine of double effect became = well known through this case.
►
►Does it apply?
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