Canterbury Christ Church University Associateship Programme

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Canterbury Christ Church University
Associateship Programme

• Issues in Medical Ethics
• Dr Alison Smith
• Centre for Health and Social Care Research

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Four Principles of Medical Ethics

• Respect every persons desire for autonomy, for
  self determination.
• Inflict no harm or evil on others
  (nonmaleficence)
• Act in the best interests of others (beneficence)
• Ensure that healthcare is distributed in a fair
  and equitable way (justice)
• Beauchamp Childress (2001)

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Consensus Morality

• one ought not to harm other people physically or
  psychologically (non-maleficence)
• give positive help to people wherever necessary
  (benevolence, beneficence and compassion)
• treat people fairly or equally before the law
  (justice)
• produce the best possible consequences (or the
  greatest happiness) for the majority (utility)
• Downie Calman (1987)

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Professional Codes of Ethics

• Doctors
• Hippocratic oath
• Nurses
• Code of Conduct
• Social Workers AHPs

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A good action (Aquinas)

• good motivation
• a good thing to do
• appropriate circumstances

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Ethical Issues at the Beginning of Life 1

• Infertility
• Technology at the start of life
• Designer babies

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Ethical Issues at the Beginning of Life 2

• Pregnancy
• Abortion
• Time limit currently 24 weeks
• difficult situations/dilemmas

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Ethical Issues at the Beginning of Life 3

• Dilemmas of neonatal care
• technology
• expectations of medical science

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Activity 1
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End of life ethical issues

• Life is a sexually transmitted degenerative
  condition with a mortality of 100
• Its not that Im afraid of death, its just that
  I dont want to be there when it happens

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Virginia Ironside, Independent 19 Sept 2006

• Death like grandchildren is one of the
  extraordinary and exciting perks of old age.
  Over 60 its time to get acquainted with it. No
  use dreading it or being frightened by it.
  People are always wringing their hands when
  friends die, but frankly, what did they expect?
  That theyd live forever?

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Joan Bakewell Guardian 19 Aug 2005

• That urge to stay young will eventually, with
  good fortune, transmute into a benign acceptance
  that life cant go on for ever. Thats the most
  we can hope for. The prospect of dying frightens
  some.(but) I favour the more sentimental Walter
  Savage Landor I fought with none for none was
  worth my strife/Nature I loved and next to nature
  art/ I warmed my hands before the fire of life/
  It sinks and I am ready to depart. - Not just
  yet though. The embers are still glowing.

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End of life ethical issues

• We hide death as if it were shameful and dirty.
  We see in it only horror, meaninglessness,
  useless struggle and suffering, an intolerable
  scandal, whereas it is our lifes culmination,
  its crowning moment and what gives it both sense
  and worth.
• It is nevertheless and immense mystery, a great
  question mark that we carry at our very marrow
• Marie de Hennezel (1997)

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Principles of a good death

• to know when death is coming and to understand
  what can be expected
• to be able to retain control of what happens
• to be afforded dignity and privacy
• to have control over pain relief and other
  symptom control
• to have choice and control over where death
  occurs
• to have access to information and expertise of
  whatever kind is necessary

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Principles of a good death cont.

• to have access to any spiritual or emotional
  support required
• to have access to hospice care in any location
• to have control over who is present and who
  shares the end
• to be able to issue advance directives which
  ensures wishes are respected
• to have time to say goodbye, and control over
  other aspects of timing
• to be able to leave when it is time to go and not
  to have life prolonged pointlessly
• Age Concern (1999)

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Quality end of life care - a dynamic process

• freedom from pain
• at peace with God
• presence of family
• mentally aware
• treatment choices followed
• finances in order
• feel life was meaningful
• resolve conflicts
• die at home AMA (2000)

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Palliative care

• The right to die well
• Symptom Control
• The concept of total pain
• Control
• Dependence / independence
• Role of health professionals
• Advocacy and respect for the vulnerable

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Julia Neuberger 2008

• Dont treat my death as meaningless
• The medical profession must adopt a duty to allow
  people a good death, where they can be pain-free
  and in some control over how and where they die,
  and who they want to be there.
• Teach children about dying and make it visible
  the best GPs are truly remarkable people and we
  should use them as community teachers as well,
  especially to children

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Activity 2
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Conclusion

• Issues in Medical Ethics
• no easy answers