Ethical Questions?

[fatcat]

No it is not harder than non-maleficence et beneficence. At the end of the day these are the principles at stake. However what is hard is to determine whether prolonging treatment will benefit the patient or not. In most cases when there is a douobt the safe approach is to continue treatment.

Hi wiseman, I’m afraid I have to disagree. Whether you consider withdrawing or administering treatment, it is not always as simple as considering beneficence and nonmaleficence. Take the example where a doctor administers increasing doses of diamorphine to ease the unbearable, chronic pain of a terminally ill patient. Since the pain is so bad, the dose of diamorphine required to ease the pain is so high that it causes the patient to die through respiratory failure (an effect that was likely foreseen the doctor). This is the double effect doctrine, where a bad effect (the death) is masked by a good (the pain relief). But now if we analyse the situation, by sticking strictly to those ethical principles, it is difficult to see how can you apply beneficence (the provision of benefit) or nonmaleficence (doing no harm) properly to this particular case.

The patient dies as a result of treatment, which throws nonmaleficence aside. What about beneficence? The patient does not benefit from pain relief because he dies as a result of the high doses of medication that would have been necessary to alleviate the pain. Where is the provision of benefit? You might say that the patient has benefited by being put out of his misery, but this is not so; the patient is dead so technically there is no beneficiary, and so, like nonmaleficence the principle of beneficence fails.

So would withdrawing/withholding treatment be thought of as preferable? The gut feeling for most people would probably be no, after all the patient is in such pain and you are doing nothing about it. But, applying the ethical principles again, by not giving pain reflief, yes, you are still contravening the principle of beneficence, but technically you might actually be upholding the principle of non-maleficence; you are not actively taking steps to harm the patient. So in this case, by sticking to the principles as best we can, the outcome is counterintuitive.

So I personally don't think these ethical principles are solid enough to stick by without further thought.

[ryanm]

i was asked 2 ethicals at 1st interview

parent (let baby die) vs doctors (treat baby) in treatment of a down syndrome baby

q's were - wot are most important considerations in making the decision 2 treat or not. wot my views were in opposing parents

also

my view on abortion of cleft lip and palate babies, how i would feel as a parent of one

[malone]

Hey everyone i just wanted a little insight on the Good Samaritan Act. I don't think there is one effective in the UK but i just wanted to make sure. Anyone out there who knows anything about this?

cheers

[M Clayton]

Although no such provision exists within UK law, there has never been a case where a patient (or their family) has successfully sued somebody that had stopped to render aid at the scene of an accident. Judges have very short shrift for such cases and, to date, each and every case has been thrown out of court.

As long as you do things to the level of your training (or, if you're a lay person, what an average person would do under the circumstances) you should be fairly safe from litigation.

And, it might be worth noting, the GMC requires all doctors and medical students to render what aid they can if they come across somebody requiring medical assistance. Both the MPS and MDU provide "good samaritan cover" which will protect you if you act to help someone in need of medical assistance.

[caster]

Your religion may influence your view, but your views may not influence your actions.

Obviously your views are going to influence your actions... If you hold an ethical view, that is going to influence how you act - part of the reason for asking about your ethical views is to see whether you can think, and therefore act, in an ethical way - if you say "well, I think it would be ethically wrong to do xxxxx, but I would do it anyway, despite believing it to be wrong", they are probably going to be quite worried.... after all, what is the point in thinking about ethics if you are not going to then act in what you believe to be an ethical way?

As for people having a religious objection to abortion or euthanasia, I don't really see why this is a problem. In the same way, people may hold a "non-religious" objection to abortion or euthanasia, or people may hold "religious" objections to other issues. If you said (for example) "I would not kill a patient who was suffering because I believe that it is not the place of a human to decide when other humans should die", there is nothing wrong with this, even though this might be a "religious view" - you have expressed an ethical view and provided a logical arguement explaining this view. Obviously, if you just said something like "I would not kill a patient who was suffering because I am a <religious group>", this might not go down so well because you have not really explained what it is about euthanasia that you (and, presumably, other members of your religious group) object to - but in the same way, if you said "I would not kill this patient because I am an atheist" it would also not go down particularly well, again because you have not explained what it is about your atheism that means you object to euthanasia. So long as you provide some kind of a justification of why you hold your views, to show that you have thought about the issue (or can think about the issue), then there is no reason to not express your personal views whether they have a religious or secular basis to them.

[malone]

this interview question has been buggin' me for a while. i have an idea how to answer it but would like to hear other peoples views on the matter. If you were a doctor and a patient who was underage came into your surgery asking for contraceptives what's the correct/legal course of action?

thanks

oh...if this topic has already been discussed somewhere a helpful link to that page would be gratefully appreciated

[Daedalus]

this interview question has been buggin' me for a while. i have an idea how to answer it but would like to hear other peoples views on the matter. If you were a doctor and a patient who was underage came into your surgery asking for contraceptives what's the correct/legal course of action?

thanks

oh...if this topic has already been discussed somewhere a helpful link to that page would be gratefully appreciated

This is quite a complicated point, but as we covering this a few weeks ago I'll have a go:
1. It is permissible for a doctor to provide contraceptive medication to a minor, including a minor under the age of 15 if appropriate conditions are met, even if the parent/guardian has not given permission:
- a. The minor has been encouraged strongly to inform her parents/guadian
- b. The minor will indulge in sexual activity irrespective
- c. The minor has the capacity to understand what is involved in sexual intercourse and pregnancy and also understands the issues surrounding contraception
- d. The minor is 'at risk' if contraception is not provided
(The details may be found
2. Although a sexually active underage girl is involved in illegal activity, unless the girl is under the age of 13, it is not usually regards as so serious as to warrant a doctor breaching confidentiality by informing police/authorities
3. There is a balance between providing confidentiality to the minor, encouraging minors to trust their GP/doctors, and enforcing the law. Medical practise tends to err towards preserving confidentiality and meeting health needs, rather than law enforcement. The law does not usually require doctors to report breaches, and gives medical practitioners fairly wide scope to judgement. Doctors working in the area of sexual health (e.g. at Gento-Urinary Medicine (GUM) Clinics) tend to be very pro-confidentiality, while hospital doctors (e.g. gynaecologists) tend to be less so, with GPs somewhere in the middle, although this is making very broad generalisations.

Have a look for the phrase 'Gillick Competence' in the web. The case of Mary Gillick against a doctor/health authority who provided contraception to her daughter without her knowledge has set the basic standard for this situation.

[malone]

Thanks for the info Daedalus.