Assessing Ethics in Assessing Ethics in CbDsCbDs

Hasna BegumHasna Begum

Workshop Format

o Small groups: Fact-Finding Exerciseo How do people do it at the moment?

o Examples of good practice.

o What do people find difficult?

o Ethics theory – Frameworks, Values, Assessment

o Group work: case discussions - how to incorporate into practice

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RCGP Rationale for Ethics

o Professional Codes of Conduct – incorporates some ethical principleso Minimum standardso Limits of accepted professional behaviour

o Application and interpretation to specific cases or situations

o Identify ethical issues in practiceo Evaluate moral justification for different

courses of actionso Make appropriate and justifiable decisions

HealthProfessional

Professional Professional Codes of Codes of ConductConduct

Professional Professional Codes of Codes of ConductConduct

Decision-Decision-makingmaking

Decision-Decision-makingmaking

Case Specifics

Personal Values

Wider Societal Values

Evidence

The Clinical Encounter

• Each healthcare encounter is informed by • Facts:

• history, examination findings, investigation results

• evidence of effectiveness of treatment options.

• Values of ALL those involved in the encounter • Moral, cultural and aesthetic values• Often implicit rather than explicitly articulated

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Clinical Ethics and Values Based

Practice• GPs must:

• Understand the ethical and legal framework within which they practise

• Identify ethical issues that arise in day-to-day practice

• Recognise the relevant values of all those involved

• Demonstrate the moral reasoning on which their decisions are based

Four Principles

• Beauchamp and Childress (1970s)• Respect for autonomy• Beneficence • Non maleficence• Justice

• All of equal importance

• Codes of conduct generally in keeping with these principles

In the GMC context

GMC guidance Respect for Autonomy

Beneficence

Non-malefice

nce

Justice

Duty of confidence

✔ ✔

Public interest Disclosures

✔ ✔

Informed consent ✔ ✔Safeguarding ✔Mental capacity ✔ ✔Providing good clinical care

✔ ✔ ✔

Access to medical care

✔ ✔ ✔ ✔

Conduct of colleagues

✔

Values

• What do we mean by this?

• A value is a standard – typically shared by others in a given community – for judging the goodness or badness of some thing or some action.

• Values have moral implications.

• Separate from preferences.

Moral Theory

Deontology• “The science of duty”

• The morality of an action is intrinsic to the action itself rather than the consequences

• Most societies rely somewhat on these kinds of moral rules

Utilitarianism• “The greatest happiness

of the greatest number”

• People should act in a way that brings about the best overall outcome

• The goodness of any outcome depends on the amount of happiness realised

Jim and the Tribespeople

• Jim is an anthropologist, and one day, deep in the Amazon, he comes across a tribe. The chief is about to execute a group of ten people from his tribe, who were chosen at random. The chief hails Jim and says, “You are a guest amongst us and in order to honour you, I will allow you to save nine of these ten people. All you have to do is pick one for execution and the other nine will go free. If you do not choose one, then all ten will die.”

• If you were Jim, what would you do?

Trainer’s task

• In the discussion you need to elicit from your trainee: 1.Their understanding of the ethical

dimensions to the case2.The relevance of professional codes of

conduct (if appropriate)3.The values of the individuals involved

(themselves included)4.How all of the above impacted on their

decision making

Eliciting the Information

Assessing the Information

• Competence Framework

• Competence No. 11: Maintaining an ethical approach to practice – practising ethically with integrity and a respect for diversity

• Bloom’s taxonomy: knowledge, skills, attitudes

NFD Competent Excellent

KnowledgeWhat your trainee knows

Recognises that people are different. Observes professional codes of practice.

Identifies ethical conflicts in clinical practice.

Anticipates and avoids situations where personal and professional interests might be brought into conflict.

SkillsWhat your trainee does

Treats patients, colleagues and others equitably and with respect for their beliefs, preferences, dignity and rights.

Discusses ethical conflicts in clinical practice. Takes action to address prejudice, oppression and unfair discrimination within the self, other individuals and within systems.

Actively promotes equality of opportunity for patients to access health care and for individuals to achieve their potential.

AttitudeWhat your trainee thinks and feels

Does not discriminate against people because of their differences. Shows awareness of own values, attitudes and ethics and how these might influence professional behaviour.

Recognises prejudice, oppression and unfair discrimination within the self, other individuals and within systems.

Values diversity by harnessing differences between people for the benefit of practice and patients alike.