There is no RIGHT way to do the WRONG thing

CC 18 – Valid Consent

CC 19 – Legal Framework

EM Curriculum: (click to view)

Background

Medical ethics is defined as the system of moral values that applies values and judgements to the practise of medicine. It revolves around four key principles: autonomy, beneficence, non-maleficence and justice.

Ethics does not decide what is right and what is wrong, and nor are its principles carved in stone. Principles and guidance must be applied to specific clinical scenarios and have to be tailored to the patient’s and clinicians involved. 

Ethical practice involves a systematic approach to decision making and actions, considering the interests of all affected by the decision.

Medical ethics is often complicated by the duties the doctor holds to their patient, relatives or society as a whole. Unfortunately, these duties can conflict with each other in specific circumstances and in these circumstances one must assess the duties that must be discharged and how best these can be discharged. 

With medical ethics there is not always a right answer, and there are usually multiple facets of the problem that must be considered. Rather than aiming for best answer for one party involved in a conflict, it is usually preferable to aim for the best compromise between all parties.


LEARNING OUTCOMES FROM COMPLETING THE TASKS

  • Know and be able to recall the four pillars of medical ethics.

  • Be aware of the likely ethical scenarios that arise in the emergency department, and what GMC guidance is available for these scenarios.

  • Be aware of the likely scenarios regarding patient confidentiality that may arise in the emergency department and what GMC guidance is available for these scenarios.

  • Understand the principles and the implications of the Mental Capacity Act within the emergency department.

LEARNING OUTCOME FROM FACE-TO-FACE TEACHING

  • Undertaken further discussion with a senior A+E clinician regarding medical ethics and confidentiality within the emergency department.

  • Applied your knowledge of the GMC guidance and pillars of medical ethics to a number of these scenarios to achieve acceptable outcomes.


TASKS

Complete the following before the face to face session:

TASK 1: CONSENT AND CONFIDENTIALITY

Duration: 30 mins

Produced as part of Project MELON the Ministry of Ethics Website aims to bring learning about Medical Ethics and Law up-to-date, with interactive MCQs, case videos, and discussions with other students and professors/lecturers from across the country. For this task you should read the entry on Consent & Confidentiality. As ever you may wish to take some extra time to look at some more of their content.

Task 2: Mental Capacity Act (2005)

Duration: 8 mins

This short podcast covers the Mental Capacity Act (2005), it applies some of it to patients with dementia but also covers some of the basic principles as well.

TASK 3: VIRTUAL PATIENT

Duration: 45 mins

This website was produced by St. Georges and is provides more ED based scenarios. The modules tend to be more text heavy but are challenging and very informative. There is also a little less information about the theory behind the ethical issues raised. However, if you have not been involved in many ethical situations in the ED this is certainly worth browsing.

Task 4: Ethics of Rationing in Critical Care

Duration: 25 mins

This podcast discusses some of the ethics behind the rationing of critical care. It discuss principles of triage and utilitiy of the individual you are trying to save. Listen out for the question at the end discussing the ventilation of those with motor neurone disease. The original file is hosted here

Task 5: Good Medical Practice in action

Duration: 30 mins

There are several scenarios here, each aimed at working through some of the GMCs guidance. For our purposes please complete those relevant to the ED:

  1. Marlena

  2. Dr Walker

  3. Dr MacDonald

  4. Lesley

They are all relatively short, but give a chance to explore different options and approaches to the scenarios.

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#EM3 Content

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EMERGENCY PROTOCOLS

You should familiarise yourself with relevant Local Guidelines, but for East Midlands Trainees we are aiming to host these on the website shortly (although this may password protected).

In the meantime please review your local guidelines relevant to consent and confidentiality.


CASE DISCUSSION

We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.

Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.

Part of the face-to-face teaching will be spent discussing the case(s) below:

For each of the following conditions what are the requirements by law for informing the DVLA and refraining from driving?

Additional Resources

BMJ – Common Dilemmas:

A short article from the BMJ Website, covering some common ethical dilemmas that can occur including:

  • Can I prescribe antibiotics for myself

  • What to do if the patient asks you for a drink

  • And several more...

DRIVING AND ILLNESS:

BMA E-LEARNING (SUBSCRIPTION REQUIRED):

BMA: Ethics A to Z

A Series of links on a variety of ethical topics - it is worth spending some time looking at these.

Best Case Ever Podcast:

No .23 The Effect of Medical Insurance on ED Care. This short podcast from Canada discusses the American healthcare system and how the way it is financed affects the delivery of care in their emergency departments.

Whilst not directly related to us it does highlight some ethical considerations and offers a stark reminder that the NHS and free at the point of access care is something to be proud of.

JPAC:

The Joint UK Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee (JPAC) have produced this page which summarises the standpoint of Jehovah's Witness regarding blood transfusion.

ILLUSIONS OF AUTONOMY:

A blog post about DNAR decisions and why attempts should always be made to discuss with families. Also touches on how this is reflected in the law.

This post is a transcript of a discussion between a consultant and the son of a patient who was not contacted when a DNAR decision was made.

DNUK:


COURSE FEEDBACK

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: