Ethics 1: truth telling
Duty of candour:
This is the duty of being honest and straightforward in attitude and speech.
The moral tension between beneficence and respect for autonomy: The principle of nonmaleficence is translated from ‘first, do no harm’ (Hippocratic oath) and what intends to say that if you can not do any good without causing harm then do not do it at all. The principle of beneficence is understood as the first principle of morality and follows closely to nonmaleficence. Its meaning is to do good for the patient. It does however depend on what one defines good as. The difference between beneficence and nomaleficence can be see in the following example: A doctor places a venflon into the patients are so that drugs can be delivered to the patient intravenously. This can be seen as beneficence because you are doing good for the patient. However, there is also nonmaleficence because you are hurting the patient in the process. In this cases beneficence trumps nonmaleficence. The principle of autonomy is that an adult with a capacity to decide has a full and perfect right what is done to their body.
Beneficence vs. autonomy:
An example of such would be a patient has been diagnosed with cancer and the doctor informs the patient of chemotherapy and its benefits. The doctor recommends it to the patient as he will live a year longer than without it. The patient however decides not to have chemotherapy. In this case it is the interpretation of beneficence from the doctor (i.e. take chemo) versus the patients autonomy (his right to decline chemo) and the principle issue is the quality of life. Beneficence versus autonomy has an important role in truth telling and it is our duty to tell the patient everything that is relevant.
Utilitarianism/ Consequentialism v. deontological arguments:
Utilitarianism ⋄ an action should lead to the greatest amount of happiness in the majority of people. Consequentialism ⋄ an action should be judged right or wrong on the basis of their outcomes (the ends justify the means) Utilitarianism is the simplest form of consequentialism. Deontological arguments ⋄ deontology suggests that decisions should be made by considering one’s duties and other’s rights. Consequentialism vs. deontological arguments ⋄ people have rights and this should be respected. They have the right to be told the truth. It may be so that with-holding information may benefit the patient, e.g. not-telling a patient they are chronically depressed (so that do not commit suicide) but they also have the right to know their condition.
The ‘scruples’ criterion:
Scruples is an uneasy feeling arising from conscience or principles that tender to hinder action.
J.S. Mills ‘the bridge is out’
From the book On liberty. It suggests that people should not be forced into the things. E.g. if there is a poison then it should be sold freely but properly labelled or if there is a unstable bridge and a man wants to cross then he should be informed of it, but it is entirely up to him whether he should cross it. It is a principle on non-coercion. Information should not be coerced on patients. They have a right to refuse information, without it affecting the validity of their decision. The man may want to cross the bridge to find his wife but by you telling him it may affect his decision. The bolam test ⋄ the doctor is not negligent if they act in accordance with a practice accepted at the time as proper by a responsible body of medical opinion. It imposes a duty of care, but leaves it to reasonable judgement of medical professionals to determine what is acceptable. They have to decide what the acceptable amount of information to the patient is. For example reporting a very rare risk to the patient may not be advisable but reporting a major risk is advisable.
The prudent patient test ⋄ if there is a significant risk which would affect the judgement of a reasonable patient then in the...