Medical Ethics and Law Introduction

1. Medical Ethics and LawIntroduction Dr Gordon Linklater

2. Medical Ethics and Law system

5. Morality and Ethics

6. Two traditions: 1. Duties, “right” & “wrong” actions, absolute values 2. Look at benefits and harms to individual and society; look at the consequences.

7. Two traditions: 1. Duties, “right” & “wrong” actions, absolute values DEONTOLOGY 2. Look at benefits and harms to individual and society; look at the consequences. UTILITARIANISM (a type of consequentialism)

9. Hippocratic tradition • “as to diseases, make a habit of two things – to help and not to harm.” • “I will never give a poison to anyone to cause death, not even if asked.”

10. Hippocratic tradition • “into whatever houses I enter, I will enter to help the sick, and I will abstain from all intentional injustice and harm, especially from abusing the bodies of man or woman, bond or free.”

11. Kant • Immanuel Kant (1724 – 1804) • Categorical Imperative • Act only in such a way that you would be happy for it to become an universal law • Treat people as ends in themselves, never just means

12. Religion • e.g. the ‘sanctity’ of human life

13. http://www.gmc-uk.org/guidance/good_medical_practice.asp

15. Doctors are powerful • We get to look at you naked • We can cut you open • We might tell you that you are going to die • We can decide what is in your best interests

16. Doctors are trusted • Trust to tell the truth % • Doctor 92 • Teacher 88 • Professor 80 • Judge 80 • Journalist 22 • Politician 13 MORI poll 2009

17. Deontology • Good points • Gives you some certainty • Duty not to kill • Defines behaviours • Duty of care

18. Deontology • Bad points

19. Consequentialism • The moral worth of an action is determined by its outcome

20. Utilitarianism • Jeremy Bentham (1748 – 1832) • The greatest good for the greatest number (maximising pleasure/ happiness and minimising pain/ unhappiness)

21. Utilitarianism • Classic • Judges the consequences of a particular act • Rule • Judges the consequences of particular rules • Preference • Maximising choice rather than pleasure

22. Utilitarianism • Good points • Flexible • Can adapt to the particular circumstances of a decision • Avoids need for a belief system • Measurable • Do you want a nice doctor or an effective doctor?

23. Utilitarianism • Bad points

25. Ethics and clinical decisions • Duties • 4 Principles • Ethics grid

26. Duties

28. Having watched a caesarean section whilst on my medical elective in Kwa-Zulu Natal I thought, ‘that looks fun – I’ll have a go on the next patient’

30. A young woman comes to your surgery very distressed. She tells you she had unprotected intercourse last night whilst drunk. She does not want to get pregnant. She asks if there is anything that can be done…

32. 4 Principles • Respect for Autonomy • Non-maleficence • Beneficence • Justice

33. 4 Principles • Respect for Autonomy • Promote the right to self determination • Non-maleficence • Beneficence • Justice

34. 4 Principles • Respect for Autonomy • Non-maleficence • The avoidance of harm • Beneficence • Justice

35. 4 Principles • Respect for Autonomy • Non-maleficence • Beneficence • To do good • Justice

36. 4 Principles • Respect for Autonomy • Non-maleficence • Beneficence • Justice • Fairness/ equality • Individual vs population

37. Which chemotherapy? • Mr Jones has non small cell lung cancer

38. Autonomy Chemo C • Non-maleficence Chemo A • Beneficence Chemo C • Justice Chemo B

39. Justice • you cannot use chemo C • Non-maleficence • you must not use chemo B • Beneficence • chemo A is better than nothing • Autonomy • Patient can chose either chemo A or nothing

41. Should we use data from medical ‘research’ carried out in the concentration camps of Nazi Germany? • Specifically research into the effects of hypothermia on the human body

46. A synthesis of ethics and the current UK law • Duty of care, right to life, sanctity of life • If in doubt, doctors have a duty of care to save life and preserve function • Euthanasia and physician assisted suicide are illegal • Doctors must not intend to hasten death, but may in certain circumstances administer treatment that will hasten death (Doctrine of Double Effect) • Not keeping alive versus killing (usually not considered equivalent) • Autonomy, justice • Patient autonomy allows the refusal of any treatment, even if refusing the treatment will result in their certain death • Patients cannot demand a treatment that a doctor does not consider indicated (but they can get a second opinion) • Also remember that healthcare is rationed. Treatment may be indicated but not affordable • Family members cannot make medical decisions for patients (unless they have been legally appointed proxy decision maker)