Medical Ethics, Law and Communication at a Glance

Patrick Davey, Anna Rathmell, Michael Dunn, Charles Foster, Helen Salisbury

• Publisher: Wiley-Blackwell
• Year: 2016
• ISBN:
  9781119266167
• Edition: 1
• Topic: Medicine
• Subtopic: Internal Medicine & Diagnosis

Medical Ethics, Law and Communication at a Glance presents a succinct overview of these key areas of the medical curriculum.

This new title aims to provide a concise summary of the three core, interlinked topics essential to resolving ethical dilemmas in medicine and avoiding medico-legal action.

Divided into two sections; the first examines the ethical and legal principles underpinning each medical topic; while the second focuses on communication skills and the importance of good communication.

Medical Ethics, Law and Communication at a Glance offers an accessible introduction to the fundamentals of good medical practice, and will provide indispensable support for undergraduate medical students and nurses, as well as newly qualified healthcare professionals.

Part 1 Medical ethics and law

Chapters

1. 1 What is medical ethics?
2. 2 Ethical theories and principles
3. 3 Ethical reasoning
4. 4 What is medical law?
5. 5 The English legal system
6. 6 Relationship between ethics, law and professionalism
7. 7 Ethical decisions in practice
8. 8 Negligence
9. 9 Battery and assault
10. 10 Confidentiality
11. 11 Consent
12. 12 Reproduction
13. 13 Termination of pregnancy
14. 14 Organ donation and transplantation
15. 15 Mental health
16. 16 Safeguarding children and adults
17. 17 Public health
18. 18 Allocation of resources
19. 19 Clinical genetics
20. 20 Human research
21. 21 Care of older adults
22. 22 End of life care
23. 23 Health management
24. 24 Primary care

1 What is medical ethics?

Introduction

Medical ethics is a discipline concerned with the systematic analysis of values in healthcare.

But this definition only gets us so far. We need to be clear about what healthcare values are, what it means to systematically analyse these values, and what it means to do so in the varied policy and practice contexts in which healthcare takes place. The first issue relates to the content of medical ethics, the second to its methods and the third to its scope. Each of these issues will be considered in turn.

The content of medical ethics

Medical ethics is founded on the idea that there are discrete ethical values specific to healthcare. Put another way, practitioners working in health owe something to those whom they care for precisely because they are involved in healthcare provision, and such provision is importantly different from other professions and the general obligations that human beings owe to each other. The justification for this special set of ethical values is usually articulated by observing that one’s health is fundamental, in some sense, to one’s life plan. Because being healthy is a prerequisite to pursuing other valuable goals, having access to healthcare, being able to make decisions about the care one receives, and being treated well within the healthcare relationship, is morally significant.

Much work in medical ethics is concerned with specifying the correct ethical values that underpin good healthcare. This project is one that is necessarily sensitive to moral theory, and that most commonly takes the form of identifying so-called ‘mid-level principles’ that seek to reflect and combine different theoretical considerations to provide a coherent, and ethically justifiable, roadmap for good practice (see Chapter 2).

Once ethical principles for healthcare have been determined, the medical ethics project broadens out. One other activity is to attend carefully to how these abstract principles ought to be applied to specific healthcare decision-making settings in diverse parts of the world. The challenge of translating ethical values into practice is no small feat. The varied social, cultural, and economic differences that are characteristic of different healthcare institutions means that careful analytic work needs to be undertaken to know precisely what it means to do good for a patient, here.

Another activity that medical ethicists attend carefully to is the common situation in which it is evident that value conflicts arise between competing principles, and therefore where there is genuine uncertainty about what a healthcare practitioner or policy-maker ought to do. Such conflicts can take different forms. On the one hand, they might be akin to a traditional moral dilemma, where there are good ethical reasons for pursuing two different and mutually exclusive courses of action. What ought to be done, for example, when a teenage patient refuses a straightforward and life-saving blood transfusion on the basis that such a procedure would go against the religious beliefs that they hold dear? On the other hand, the conflicts might be less fundamental in nature, perhaps where a doctor is clear about what ought to be done, but is unable to act as they ought due to practical constraints, such as institutional rules or cultural expectations in her workplace. Addressing conflicts of this kind raises questions about the role of medical ethics in advocating for policy or practice changes, and also shifts the locus of analysis onto issues such as ‘moral distress’ that can arise when practitioners are prevented from acting as they ought.

The methods of medical ethics

Medical ethics is a broad church. Those contributing to medical ethics use a variety of methodological approaches, including both ethical analytic and empirical methods.

Methods of ethical analysis are deployed in order to develop arguments that aim to settle these conflicts – to determine what ought to be done in a situation of ethical uncertainty. Justification and argument are the methodological characteristics of this normative enterprise. A defence to the claim that ‘Doctors ought to do X’ depends on providing a justification, based on the reasons in support of this argument, against the reasons supporting the claim that ‘Doctors ought not to do X’ or ‘Doctors ought to do Y’. The extent to which a claim counts as a satisfactory answer to the question ‘What ought a doctor to do here?’ is judged in light of the standards of reasoning that apply to arguments generally. Thus, while rational argumentation of this form is generally seen to be philosophical in nature, it is in fact closely related to other analytic approaches, including the scientific method. Further information about ethical reasoning is provided in Chapter 3.

Empirical methods, on the other hand, are used primarily to describe how value conflicts arise within healthcare practice. Empirical methods can also be used to contribute to ethical argumentation by specifying evidence that can give substance to the reasons in favour, or against, a particular claim. If we think, for example, that a particular course of action is justified only if it would be widely accepted by the public, we need evidence that shows us whether the public would indeed accept that course of action. Finally, medical ethicists might draw on empirical methods to evaluate the impact of an ethical claim. If, for example, a research ethics committee is introduced in a healthcare setting to ensure that patients’ well-being is safeguarded when these patients are recruited to a clinical trial, we need to be able to show that the intervention does indeed safeguard well-being. If not, there is no ethical justification for introducing the committee on the basis of this argument.

The scope of medical ethics

As well as being an academic pursuit, medical ethics is also practised ‘on the ground’ in healthcare settings. Ethicists provide ethical guidance by the bedside, in the hospital boardroom, or as part of committees working in health settings. These ethics support functions are described in Chapter 7. In addition to recommending a specific course of practice, arguments within medical ethics might also focus on the regulations or laws that govern healthcare practice.

Similarly, the boundaries of what counts as a medical ethics issue is also open to dispute. Medical ethics might be differentiated from healthcare ethics, where the former is more narrowly focused on the moral duties of doctors, while the latter broadens its analytic lens to other professionals and to non-medical settings such as social and community-based care services. Equally, the boundaries between medical ethics and bioethics are difficult to ascertain, with the latter orientated more towards biotechnological issues than the professional world of healthcare. In common parlance, these different terms are used interchangeably, and little hangs on where the boundaries are drawn.

2 Ethical theories and principles

Introduction

Consider the relatively common scenario in a district general hospital late one evening: an elderly patient who collapsed at home with a large intra-cerebral bleed is now intubated and ventilated in the emergency department. Prior to intubation the patient is deeply unconscious, with a Glasgow Coma Score of three. His case has already been discussed with the neurosurgeons who feel that the transfer to the regional neurosurgical centre for further management is not appropriate because the predicted outcome are universally poor (Figure 2.1).

What is the next course of action? He could be admitted to the intensive care unit (ICU) for further assessment and review the following morning on withholding of sedation. Or should you consider a planned withdrawal of treatment that evening with his extubation and subsequent transfer to a medical ward for palliation? Does the knowledge that he is on the organ donation register make a difference? Will the situation change if this is the last empty bed in the ICU? Now consider your responses when it transpires that the patient is 96, not 69 as first thought. Are the wishes of the patient known to the clinical team? The family have been called and will not arrive this evening. How important is their input into the decisions that are required during the evening?

Ethical reasoning is critical to resolve ethical issues such as this one. However, if such reasoning is going to be able to guide clinicians’ actions in ways that are justifiable, ethical theories and principles must be incorporated into this process. This chapter will provide the background to the main ethical theories, the ethical principles that are derived from those theories and that are relevant to contemporary medical ethics.

Three different ethical theories dominate the landscape of medical ethics. These function to determine how particular decisions or actions can be judged to be right or wrong in ethical terms. It is from these three theories that four ethical principles have been derived. The principles are well established in modern medicine. The method behind their applicat...

Table of contents

• Cover
• Inside Cover
• Title Page
• Copyright
• Editors
• Contributors
• Preface
• Part 1 Medical ethics and law
• Part 2 Communication
• Index
• Eula