1. MEDICAL ETHICS Prof. Gerard Garbutt Visiting Prof. Clinical Exercise Science University of Huddersfield GP ST2 Pennine Training Scheme

2. What are ethics? • Derived from the Greek word ethos • custom, habit, character or disposition. • Ethics covers the following dilemmas: • how to live a good life • our rights and responsibilities • the language of right and wrong • moral decisions - what is good and bad? http://www.bbc.co.uk/ethics/introduction/intro_1.shtml

3. Medical Ethics http://www.merriam-webster.com/dictionary/ethics

4. Four Bioethical Principles • Autonomy - respect individual ability to make decisions about health and future. • Beneficence - actions intended to benefit • Non-maleficence - intent not to harm • Justice fair to the wider community in terms of the consequences http://priory.com/ethics.htm

5. Ethical Approaches • God-based ethics • Supernaturalism • Only source of moral rules is God. • Virtue ethics • Moral character • The way individuals live their lives • Situation ethics • Ethical decisions should be made according to the unique situation • No moral rules or rights • each case is unique and deserves a unique solution. http://www.bbc.co.uk/ethics/introduction/intro_1.shtml

6. Ethical Approaches • Consequentialism • “the greatest good for the greatest number of people” • Bad acts could be good if the consequences are good • Utilitarianism • Deontology • Non-consequentialism • Actions not consequences. • "the principle of the thing" • Some acts are right or wrong in themselves. http://www.bbc.co.uk/ethics/introduction/intro_1.shtml

7. Why is it relevant to us? • Deontological ethics or deontology • (from Greek, deon, "obligation, duty") • Adherence to a rule or rules. http://en.wikipedia.org/wiki/Deontology

8. Why is it relevant to us? • GMC (2006): Good Medical Practice • Duties of Doctors • Clearly prescribed behaviour • GMC states what we as Doctors 'must' do as ‘an overriding duty’. • The GMC instruct that you ‘must’ as a Doctor, ‘make the care of your patient your first concern’. http://www.gmc-uk.org/guidance/good_medical_practice.asp

10. GMC Judgement • “Irresponsible”, “misleading” and “dishonest” • Honesty • Unnecessary and invasive tests on children • Least harm • Breached fundamental principles of research medicine • Probity • Callous disregard” for the suffering of children by taking blood samples • Consent • Failed to declare a conflict of interest • Honesty • GMC • To protect patients and is in the wider public interest, including the maintenance of public trust and confidence in the [medical] profession http://www.gmc-uk.org/Wakefield_SPM_and_SANCTION.pdf_32595267.pdf

11. Medicine should be taught on the wards • Ethical decisions in clinical medicine are cannot be recreated in a classroom • Repeated, realistic exposure is the key to good ethical training. BMJ 2010;340:c1992

12. Consent • "consented" on the morning of the operation and have little idea of what awaits them. • Confidentiality • Patient dies from a ruptured cerebral aneurysm during intercourse with mistress. • Distraught wife asks the medical team what happened. BMJ 2010;340:c2489

14. End of life decisions • DNAR orders • QoL • Futility • Meaning of best interests • Sports medicine • Tension between clinical best interests and overall best interests BMJ 2010;340:c2489

16. Organisational ethics • locums • rotas • continuity of care • targets • patient safety. • Whistleblowing • reporting their concerns about an underperforming colleague • "The care of my patient is my first concern" BMJ 2010;340:c2489

17. Increasing availability of life sustaining treatments • Genetic advances • Organ transplantation BMJ 2010;340:c2489

21. For 2/52!! • Bring one ‘ethics’ case with you • 29th June • References • Good Medical Practice – GMC 2006 • D. Sokol. BMJ 2010;340:c1992 • D. Sokol. BMJ 2010;340:c2489