Medical ethics concerns how doctor should approach decision making and apply reasoning to support their decisions. Doctors must weigh up the benefit and disadvantages of their decision considering or the relevant considerations. Doctors must consider how they apply principles of medical ethics in their conversations and interactions with patients and staff. Below we have outlined 5 areas of ethics which inform the practice of doctors:
Justice refers to how fairly people are treated and encompasses protecting the rights of individuals. Doctors have a moral responsibility to ensure that there is an element of fairness in all their medical decisions. This may relate to how doctors ensure equitable distribution of scarce resources between individuals. Increasingly the demand for healthcare resource is outstripping the supply that the NHS can provide. The remit of healthcare is growing with increasing medicalisation. With new technological advances and changes in the ways we practice medicine patient involvement in their healthcare is constantly changing. Patients are increasingly aware of, and expecting, the most recent and effective treatments. Moreover, challenges such as an ageing population increase demand. With a limited budget and staff shortages there is not a direct correlation between increasing demand for healthcare and resource availability. Doctors must not only determine which resources/ patients to prioritise but also which services to ration. Using and applying theories of distributive justice doctors can ensure that when resources are allocated there is no form of discrimination. As part of their decision making doctors must ensure they abide with discrimination laws. Below is a list of relevant factors when thinking about how to just allocate scarce resources:
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Approach | Meaning | How to apply when allocating individuals resources | How to apply when making service commission decisions |
Consequentialism | Seek the most benefit for the least harm/cost | Consider how the individual may contribute the society, do they have dependables? | Prioritise services which benefit the most people. |
Equality and Egalitarianism | Distribute benefits equally | To treat everyone equally nobody would receive the organ | Equally split funds between services. |
Aristolean | Treat equals equally and unequal unequally. | Use relevant criteria such as a person’s health behaviour and lifestyle to determine when to treat people differently. | Ensure you do not discriminate against services which benefit patients based on their protected characteristics. |
Ethical and professional practice is influenced by moral, legal and human rights. There is a societal expectation that healthcare workers treat patients respectfully. In order to preserve the dignity of patient’s doctors must respect patient confidentiality. Doctors have a duty to keep promises to patients and respect their privacy. Outcomes are more positive where doctors follow their ethical obligations, maintaining a patients confidence increases trust in the doctor patient relationship, increasing patient’s engagement with their health. Doctors have a legal obligation to act ethically under the Human Rights Act and Law of equity. There are certain situations in which doctors can break confidentiality but there are strict protocols of how doctors should approach these situations.
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Autonomy is a cornerstone of medical law; doctors must respect decisions made by competent adult patient. The ethical issue of patient rights influences medical practice. Patients are entitled to make independent decisions about their healthcare without coercion or undue influence from medical professionals. Decision making within medicine should consult the preferences and needs of the patient. Doctors must ensure that patients consent or can refuse treatment. In order for a patient to agree to a treatment or form of investigation they must have adequate information about the topic, their decision must be voluntary and the patient must have capacity. Consent is important to prevent patients from negating a patient’s autonomy. In addition, patients have the right to control their private information as this is linked to self-determination. Medical schools highlight the importance of confidentiality to their students
Doctors should act with integrity aiming to do bring about good through their behaviour and actions. Doctors will frequently discuss the benefits and harms of medical interventions with their patients. These benefits will be specific to each individual and are open to interpretation. Doctors must cooperate with their multidisciplinary team to ensure that their actions are justified where the benefits exceed the risk and harms. Doctors should strive to improve the heath and wellbeing of all NHS users.
Avoiding harm is an exhortation of medicine. Patients have the right to safe, effective, high quality care. By avoiding harm and showing a commitment to the quality of care we deliver medics gain trust and respect for society. In order to avoid patient harm doctors must have an excellent emotional intelligence and self-awareness. They must use their emotional intelligence and effectively communicate with their patients, their families and carers and staff.
