Sunday, 24 January 2010

Ethics, how to think it all through

Medical students are (hopefully) taught to think logically and in a systematic way. This is useful, consider chest pain and its causes. Thinking in the way described above allows us to break down the problem - Is it a cardiovascular, respiratory or musculoskeletal cause?

This also applies to ethics. Potential medics are often faced with an "ethics" question at interview. A classic is whether or not Patient A or Patient B should get a liver transplant. The decision is made more complicated for the student when the interviewer drops into conversation that patient A is an alcoholic and has been for the last five years. Then student then says patient B should get the transplant. The other interviewer then chirps in and says patient B is unlikely to survive the operation due to a previous illnesses.

Thankfully ethical decision making is made a little easier when students are taught the four ethical principles. These were thought out to help ethical decision making in a more secular world. They are as followed

1)Autonomy - Patients should be allowed to make there own decisions
2) Non-maleficience - Doc should do no harm
3)Beneficience - Do whats best for the patients
4) Justice - How does your decision impact on the wider world? (a very rough definition)

At an ethics OSCE station i was given the following senario

A patient was diagnosed by his GP as having a viral cold. The patients was worried about an upcoming exam and wanted antibiotics (his friend had told him he should be on antibiotics). The GP reassured the patient that it was probably due to a virus, would hopefully disappear within a few days and antibiotics would be useless. Despite protests from the patient his GP refused to prescribe any antibiotics

I was asked "Using the ethical principles explain why the GP did not respect the patients right to autonomy"


  1. The obvious one is that 4.) Justice - unnecessary prescription of antibiotics affects the whole population.

    And similarly, 2/3.) unnecessary prescription of anti-biotics could prove detrimental to that particular patient as well.

    Finally, doesn't 1.)'s autonomy rely on *informed* consent - it could be argued that the patient is ill-informed regarding their decision.

  2. Heya

    Thats pretty much it, you just make sure you discuss all four in turn and then make a conclusion.

    You are right, what you would say is that you would like to further discuss with the patient your reasons and try and find out why he thinks there necesarry, i.e. ask exactly what his friend says to

    Hope your exams went ok