Ethical Issues

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CONTENTS Click on the up arrow to return here

1) INTRODUCTION

2) DEFINITIONS

3) ETHICAL THEORY

4) ETHICAL DECISION MAKING

5) NEGLIGENCE

6) CONSENT IN COMPETENT ADULTS

7) CONSENT IN CHILDREN

8) CONSENT IN INCOMPETENT ADULTS

9) CONSENT CONCERNING UNUSUAL IDEAS

10) ADVANCE DIRECTIVES

11) CONFIDENTIALITY

12) CONFIDENTIALITY AUDIT

13) EUTHANASIA

14) ABORTION

15) BIOTECHNOLOGY

16) SUGGESTED READING

ONE – INTRODUCTION (Registrar)

The importance of Ethical thinking in General Practice is becoming more and more apparent. It should not be thought that Ethics merely relates to the “Life and Death” issues in our Professional life – Abortion, Contraception, Euthanasia and the like. Ethical issues affect some part of almost every consultation, even if the ethical issue is something more mundane like obtaining adequate consent for an examination or respecting a patient’s dignity. Indeed, it could be argued that the Consultation skills that we foster so assiduously are actually Ethical skills – and that we need to know the patient’s “Ideas, Concerns and Expectations” in order to respect his Autonomy as well as in order to improve the outcome of the Consultation. In the 1998/99 academic year, I was appointed the deanery’s Medical Ethics fellow with a bursary from the MDU. I developed an approach to the teaching of GP ethics based on two half day sessions, which I presented in each VTS scheme in the deanery. The first session involved a consideration of Ethical theory. However, the more useful session was the second one where each Registrar presented an “Ethical case history” to the Registrar Group. The Case History summarised an Ethical problem that had concerned the Registrar, and in each case was followed by discussion. As promised I now present background to some of these Ethical case histories, some of which was developed in the discussion, but some which wasn’t for reasons of time. In fact the issues that most concerned Registrars seemed to be repeated time after time–

Negligence – what do we have to do to avoid being negligent? Confidentiality - and when we can break it?
Consent - and how do we manage when the patient is not able to give consent? Children – can we treat them ethically in the same way as adults? Abortion – are there circumstances when this is the right option? Euthanasia – is this the same as respecting a patient’s wish to not be treated?

This booklet consists of Introductory chapters concerned with Ethical theory, Ethics literature and Ethical decision making. Subsequent Chapters are each divided into 4 sections, as shown below:

• GP Background
• Ethical issues
• Legal and GMC issues
• Case Histories to consider
ONE – INTRODUCTION (Trainer)

The importance of Ethical thinking in General Practice is becoming more and more apparent. It should not be thought that Ethics merely relates to the “Life and Death” issues in our Professional life – Abortion, Contraception, Euthanasia and the like. Ethical issues affect some part of almost every consultation, even if the ethical issue is something more mundane like obtaining adequate consent for an examination or respecting a patient’s dignity. Indeed, it could be argued that the Consultation skills that we foster so assiduously are actually Ethical skills – and that we need to know the patient’s “Ideas, Concerns and Expectations” in order to respect his Autonomy as well as in order to improve the outcome of the Consultation. In the 1998/99 academic year, I was appointed the deanery’s Medical Ethics fellow with a bursary from the MDU. I developed an approach to the teaching of GP ethics based on two half day sessions, which I presented in each VTS scheme in the deanery. The first session involved a...
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