Medical Ethics: From 1 Different Sources
the standards of conduct required of medical professionals and also the academic study of ethical issues arising from the practice of medicine. From the *Hippocratic oath onwards, standards are designed to reassure that professionals subscribing to them will act in the *best interests of, and will avoid harming, their patients. Today they lay greater emphasis on patient *autonomy, while the contemporary study of medical ethics is concerned with a great variety of complex societal and social issues related to medical practice and research. Medical ethics is now taught in all medical schools in the UK as an essential part of a professional training, and the wider field of *bioethics is becoming a recognized academic specialty. See also clinical ethics; feminist ethics; public health ethics; publication ethics; virtue ethics.
Guidance on good medical practice from the website of the General Medical Council
A detailed review and evaluation of selected clinical records by qualified professional personnel for the purpose of evaluating the quality of medical care.... medical audit
A committee that can have a number of roles in relation to ethics. For example, it may develop policy relative to the use and limitation of treatment; serve as a resource for individuals and their families regarding options for terminal illness; or assess research projects with respect to the appropriate application of ethical principles.... ethics committee
Within most cultures, care of the sick is seen as entailing special duties, codi?ed as a set of moral standards governing professional practice. Although these duties have been stated and interpreted in di?ering ways, a common factor is the awareness of an imbalance of power between doctor and patient and an acknowledgement of the vulnerability of the sick person. A function of medical ethics is to counteract this inevitable power imbalance by encouraging doctors to act in the best interests of their patients, refrain from taking advantage of those in their care, and use their skills in a manner which preserves the honour of their profession. It has always been accepted, however, that doctors cannot use their knowledge indiscriminately to ful?l patients’ wishes. The deliberate ending of life, for example, even at a patient’s request, has usually been seen as alien to the shared values inherent in medical ethics. It is, however, symptomatic of changing concepts of ethics and of the growing power of patient choice that legal challenges have been mounted in several countries to the prohibition of EUTHANASIA. Thus ethics can be seen as regulating individual doctor-patient relationships, integrating doctors within a moral community of their professional peers and re?ecting societal demands for change.
Medical ethics are embedded in cultural values which evolve. Acceptance of abortion within well-de?ned legal parameters in some jurisdictions is an example of how society in?uences the way in which perceptions about ethical obligations change. Because they are often linked to the moral views predominating in society, medical ethics cannot be seen as embodying uniform standards independent of cultural context. Some countries which permit capital punishment or female genital mutilation (FGM – see CIRCUMCISION), for example, expect doctors to carry out such procedures. Some doctors would argue that their ethical obligation to minimise pain and suffering obliges them to comply, whereas others would deem their ethical obligations to be the complete opposite. The medical community attempts to address such variations by establish-ing globally applicable ethical principles through debate within bodies such as the World Medical Association (WMA) or World Psychiatric Association (WPA). Norm-setting bodies increasingly re?ect accepted concepts of human rights and patient rights within professional ethical codes.
Practical changes within society may affect the perceived balance of power within the doctor-patient relationship, and therefore have an impact on ethics. In developed societies, for example, patients are increasingly well informed about treatment options: media such as the Internet provide them with access to specialised knowledge. Social measures such as a well-established complaints system, procedures for legal redress, and guarantees of rights such as those set out in the NHS’s Patient’s Charter appear to reduce the perceived imbalance in the relationship. Law as well as ethics emphasises the importance of informed patient consent and the often legally binding nature of informed patient refusal of treatment. Ethics re?ect the changing relationship by emphasising skills such as e?ective communication and generation of mutual trust within a doctor-patient partnership.
A widely known modern code is the WMA’s International Code of Medical Ethics which seeks to provide a modern restatement of the Hippocratic principles.
Traditionally, ethical codes have sought to establish absolutist positions. The WMA code, for example, imposes an apparently absolute duty of con?dentiality which extends beyond the patient’s death. Increasingly, however, ethics are perceived as a tool for making morally appropriate decisions in a sphere where there is rarely one ‘right’ answer. Many factors – such as current emphasis on autonomy and the individual values of patients; awareness of social and cultural diversity; and the phenomenal advance of new technology which has blurred some moral distinctions about what constitutes a ‘person’ – have contributed to the perception that ethical dilemmas have to be resolved on a case-by-case basis.
An approach adopted by American ethicists has been moral analysis of cases using four fundamental principles: autonomy, bene?cence, non-male?cence and justice. The ‘four principles’ provide a useful framework within which ethical dilemmas can be teased out, but they are criticised for their apparent simplicity in the face of complex problems and for the fact that the moral imperatives implicit in each principle often con?ict with some or all of the other three. As with any other approach to problem-solving, the ‘four principles’ require interpretation. Enduring ethical precepts such as the obligation to bene?t patients and avoid harm (bene?cence and non-male?cence) may be differently interpreted in cases where prolongation of life is contrary to a patient’s wishes or where sentience has been irrevocably lost. In such cases, treatment may be seen as constituting a ‘harm’ rather than a ‘bene?t’.
The importance accorded to ethics in daily practice has undergone considerable development in the latter half of the 20th century. From being seen mainly as a set of values passed on from experienced practitioners to their students at the bedside, medical ethics have increasingly become the domain of lawyers, academic philosophers and professional ethicists, although the role of experienced practitioners is still considered central. In the UK, law and medical ethics increasingly interact. Judges resolve cases on the basis of established medical ethical guidance, and new ethical guidance draws in turn on common-law judgements in individual cases. The rapid increase in specialised journals, conferences and postgraduate courses focused on ethics is testimony to the ever-increasing emphasis accorded to this area of study. Multidisciplinary practice has stimulated the growth of the new discipline of ‘health-care ethics’ which seeks to provide uniformity across long-established professional boundaries. The trend is to set common standards for a range of health professionals and others who may have a duty of care, such as hospital chaplains and ancillary workers. Since a primary function of ethics is to ?nd reasonable answers in situations where di?erent interests or priorities con?ict, managers and health-care purchasers are increasingly seen as potential partners in the e?ort to establish a common approach. Widely accepted ethical values are increasingly applied to the previously unacknowledged dilemmas of rationing scarce resources.
In modern debate about ethics, two important trends can be identi?ed. As a result of the increasingly high pro?le accorded to applied ethics, there is a trend for professions not previously subject to widely agreed standards of behaviour to adopt codes of ethical practice. Business ethics or the ethics of management are comparatively new. At the same time, there is some debate about whether professionals, such as doctors, traditionally subject to special ethical duties, should be seen as simply doing a job for payment like any other worker. As some doctors perceive their power and prestige eroded by health-care managers deciding on how and when to ration care and pressure for patients to exercise autonomy about treatment decisions, it is sometimes argued that realistic limits must be set on medical obligations. A logical implication of patient choice and rejection of medical paternalism would appear to be a concomitant reduction in the freedom of doctors to carry out their own ethical obligations. The concept of conscientious objection, incorporated to some extent in law (e.g. in relation to abortion) ensures that doctors are not obliged to act contrary to their own personal or professional values.... ethics
A file kept for each patient, maintained by the hospital (medical practitioners also maintain medical records in their own practices), which documents the patient’s problems, diagnostic procedures, treatment and outcome. Related documents, such as written consent for surgery and other procedures, are also included in the record. In addition to facts about a patient’s illness, medical records nearly always contain other information such as clinical, demographic, sociocultural, sociological, economic, administrative and behavioural data. The record may be on paper or computerized.... medical record
Under the strict legal de?nition, negligence must involve proving a clearly established duty of care which has been breached in a way that has resulted in injury or harm to the recipient of care. There does not need to be any malicious intention. Whether or not a particular injury can be attributed to medical negligence, or must simply be accepted as a reasonable risk of the particular treatment, depends upon an assessment of whether the doctor has fallen below the standard expected of practitioners in the particular specialty. A defence to such a claim is that a respected body of practitioners would have acted in the same way (even though the majority might not) and in doing so would have acted logically.... medical negligence
A statutory body in the United Kingdom that promotes the balanced development of medical and related biological research and aims to advance knowledge that will lead to improved health care. It employs its own research sta? in more than 40 research establishments. These include the National Institute for Medical Research, the Laboratory of Molecular Biology, and the Clinical Sciences Centre. Grants are provided so that individual scientists can do research which complements the research activities of hospitals and universities. There are several medical charities and foundations – for example, the Imperial Cancer Research Fund, the British Heart Foundation, the Nu?eld Laboratories and the Wellcome Trust which fund and foster medical research.... medical research council
See LIVING WILL.... advance statements about medical treatment
A complete system of theory and practices that has evolved independently of, and often prior to, the conventional biological approach. Many are traditional systems of medicine that are practised by individual cultures throughout the world. Traditional Oriental medicine and Ayurveda, India’s traditional system of medicine, are two examples.... alternative medical system
The basic evaluative principles which (should) guide “good” care. Principles typically refer to respect for, and the dignity of, human beings. Basic dimensions are “autonomy” (respect for self determination), “well-being” (respect for happiness, health and mental integrity) and “social justice” (justifiable distribution of scarce goods and services). More specifically, ethics of care refer to ethical standards developed for the care professions which are designed to implement ethical principles in the practice of care provision.... ethics (of care)
Guidelines for doctors on the provision of good medical care laid down by the GENERAL MEDICAL COUNCIL (GMC).... good medical practice
Equipment, such as hospital beds, wheelchairs and prosthetics, provided by an agency and used at home.... home medical equipment
An executive agency of the Department of Health in the UK. Set up in 1994, it is responsible for regulating and advising on the sale or use of any product, other than a medicine, used in the health-care environment for the diagnosis, prevention, monitoring or treatment of illness or disease. Equipment ranges from pacemakers (see CARDIAC PACEMAKER) to prostheses (see PROSTHESIS), and from syringes to magnetic resonance imaging (see (MRI).... medical devices agency
Treatment that is usually considered unable to produce the desired benefit either because it cannot achieve its physiological aim or because the burdens of the treatment are considered to outweigh the benefits for the particular individual. There are necessary value judgements involved in coming to an assessment of futility. These judgements must consider the individual’s, or proxy’s, assessment of worthwhile outcome. They should also take into account the medical practitioner or other provider’s perception of intent in treatment. They may also take into account community and institutional standards, which in turn may have used physiological or functional outcome measures.... futile medical treatment
These are UK bodies that provide doctors with advice and, where appropriate, ?nancial support in defending claims for medical negligence in their clinical practice. They also advise doctors on all legal aspects of their work, including patients’ complaints, and provide representation for members called to account by the GENERAL MEDICAL COUNCIL (GMC) or other regulatory body. The sharp rise in claims for medical negligence in the NHS in the 1980s persuaded the UK Health Departments to introduce a risk-pooling system called the Clinical Negligence Scheme for Trusts, and the defence societies liaise with this scheme when advising their doctor members on responding to claims of negligence (see MEDICAL LITIGATION; MEDICAL NEGLIGENCE).... medical defence organisations
An error or omission in the medical care provided to an individual. Medical errors can occur in diagnosis, treatment, preventive monitoring or in the failure of a piece of medical equipment or another component of the medical system. Often, but not always, medical errors result in adverse events such as injury or death. See also “malpractice”; and “incidence monitoring and reporting”.... medical error
See INFORMATION TECHNOLOGY IN MEDICINE.... medical informatics
See ONCOLOGY.... medical oncology
See “futile medical treatment”; “advanced directive”.... withholding / withdrawing medical treatment
See ETHICS.... world medical association
Quarterly publication of the National Herbalists Association of Australia. Australian medicinal plants, Government reports, case studies, books, plant abstracts. For subscription details and complimentary copy of the Journal contact: NHAA, PO Box 65, Kingsgrove NSW 2208, Australia. Tel: +61(02) 502 2938. Annual subscription (Aus) $40 (overseas applicants include $15 for air mail, otherwise sent by sea mail). ... australian journal of medical herbalism
This term is used to de?ne the process of learning and knowledge-acquisition in the study of medicine. It also encompasses the expertise required to develop education and training for students and learners in all aspects of medical health care. Studies for undergraduate students, postgraduate students and individual health-care practitioners, from the initial stages to the ongoing development of a career in medicine or associated health ?elds, are also included in medical education. The word ‘pedagogy’ is sometimes applied to this process.
A range of research investigations has developed within medical education. These apply to course monitoring, audit, development and validation, assessment methodologies and the application of educationally appropriate principles at undergraduate and postgraduate levels. Research is undertaken by medical educationalists whose backgrounds include teaching, social sciences and medicine and related health-care specialties, and who will hold a medical or general educational diploma, degree or other appropriate postgraduate quali?cation.
Development and validation for all courses are an important part of continuing accreditation processes. The relatively conservative courses at both undergraduate and postgraduate levels, including diplomas and postgraduate quali?cations awarded by the specialist medical royal colleges (responsible for standards of specialist education) and universities, have undergone a range of reassessment and rede?nition driven by the changing needs of the individual practitioner in the last decade. The stimuli to change aspects of medical training have come from the government through the former Chief Medical O?cer, Sir Kenneth Calman, and the introduction of new approaches to specialist training (the Calman programme), from the GENERAL MEDICAL COUNCIL (GMC) and its document Tomorrow’s Doctors, as well as from the profession itself through the activities of the British Medical Association and the medical royal colleges. The evolving expectations of the public in their perception of the requirements of a doctor, and changes in education of other groups of health professionals, have also led to pressures for changes.
Consequently, many new departments and units devoted to medical education within university medical schools, royal colleges and elsewhere within higher education have been established. These developments have built upon practice developed elsewhere in the world, particularly in North America, Australia and some European countries. Undergraduate education has seen application of new educational methods, including Problem-Based Learning (PBL) in Liverpool, Glasgow and Manchester; clinical and communications skills teaching; early patient contact; and the extensive adoption of Internet (World Wide Web) support and Computer-Aided Learning (CAL). In postgraduate education – driven by European directives and practices, changes in specialist training and the needs of community medicine – new courses have developed around the membership and fellowship examinations for the royal colleges. Examples of these changes driven by medical education expertise include the STEP course for the Royal College of Surgeons of England, and distance-learning courses for diplomas in primary care and rheumatology, as well as examples of good practice as adopted by the Royal College of General Practitioners.
Continuing Professional Development (CPD) and Continuing Medical Education (CME) are also important aspects of medical education now being developed in the United Kingdom, and are evolving to meet the needs of individuals at all stages of their careers.
Bodies closely involved in medical educational developments and their review include the General Medical Council, SCOPME (the Standing Committee on Postgraduate Medical Education), all the medical royal colleges and medical schools, and the British Medical Association through its Board of Medical Education. The National Health Service (NHS) is also involved in education and is a key to facilitation of CPD/CME as the major employer of doctors within the United Kingdom.
Several learned societies embrace medical education at all levels. These include ASME (the Association for the Study of Medical Education), MADEN (the Medical and Dental Education Network) and AMEE (the Association for Medical Education in Europe). Specialist journals are devoted to research reports relating to medical educational developments
(e.g. Academic Medicine, Health Care Education, Medical Education). The more general medical journals (e.g. British Medical Journal, New England Journal of Medicine, The Lancet, Annals of the Royal College of Surgeons) also carry articles on educational matters. Finally, the World Wide Web (WWW) is a valuable source of information relating to courses and course development and other aspects of modern medical education.
The UK government, which controls the number of students entering medical training, has recently increased the quota to take account of increasing demands for trained sta? from the NHS. More than 5,700 students – 3,300 women and 2,400 men – are now entering UK medical schools annually with nearly 28,600 at medical school in any one year, and an attrition rate of about 8–10 per cent. This loss may in part be due to the changes in university-funding arrangements. Students now pay all or part of their tuition fees, and this can result in medical graduates owing several thousand pounds when they qualify at the end of their ?ve-year basic quali?cation course. Doctors wishing to specialise need to do up to ?ve years (sometimes more) of salaried ‘hands-on’ training in house or registrar (intern) posts.
Though it may be a commonly held belief that most students enter medicine for humanitarian reasons rather than for the ?nancial rewards of a successful medical career, in developed nations the prospect of status and rewards is probably one incentive. However, the cost to students of medical education along with the widespread publicity in Britain about an under-resourced, seriously overstretched health service, with sta? working long hours and dealing with a rising number of disgruntled patients, may be affecting recruitment, since the number of applicants for medical school has dropped in the past year or so. Although there is still competition for places, planners need to bear this falling trend in mind.
Another factor to be considered for the future is the nature of the medical curriculum. In Britain and western Europe, the age structure of a probably declining population will become top-heavy with senior citizens. In the ?nancial interests of the countries affected, and in the personal interests of an ageing population, it would seem sensible to raise the pro?le of preventive medicine – traditionally rather a Cinderella subject – in medical education, thus enabling people to live healthier as well as longer lives. While learning about treatments is essential, the increasing specialisation and subspecialisation of medicine in order to provide expensive, high-technology care to a population, many of whom are suffering from preventable illnesses originating in part from self-indulgent lifestyles, seems insupportable economically, unsatisfactory for patients awaiting treatment, and not necessarily professionally ful?lling for health-care sta?. To change the mix of medical education would be a di?cult long-term task but should be worthwhile for providers and recipients of medical care.... medical education
Legal guidance sought by the sufferer when making claims against a doctor or health authority is available from: Action for Victims of Medical Accidents (AVMA), Bank Chambers, 1 London Road, Forest Hill, London SE23 3TP. ... medical accidents
Est. 1864. The oldest and only body of professional medical herbalists, now known as phytotherapists, in Europe. Membership by examination after completion of course of training. A stipulated period of clinical practice must be completed before the final examination is taken.
Members are directly involved with patient-care, carrying full responsibility for their recommendations, prescribing medication suitable to the individual biological requirements of each patient. Their role includes patient-counselling, health education and research.
Official recognition of the Institute, indicating its growing importance in the field of medicine came with the historic Grant of Arms by Her Majesty’s College of Heralds. Members regard this as evidence that the Royal Charter of King Henry VIII still stands and that there is no monopoly in healing the sick. See: HENRY VIII, HERBALISTS’ CHARTER.
The Institute played a major role in winning vital concessions for the survival of the herbalist in the passage through Parliament of the Medicine’s Bill. See: MEDICINE’S ACT, 1968.
In connection with the NIMH degree courses in herbal medicine are available at a London University, and Exeter University.
The Institute provides professional indemnity cover for its members, and is engaged in a series of clinical trials to evaluate traditional remedies.
All members are required to adhere to a strict professional Code of Ethics and are entitled to carry after their names the letters of qualification: MNIMH or FNIMH.
Members have a key role in preventative medicine and health promotion in their contribution to improvement of the nation’s health.
Address: 56 Longbrook Street, Exeter EX4 6AH, from which a list of members is obtainable. ... national institute of medical herbalists
(AMA) a professional organization for US physicians. Its purposes include dissemination of scientific information through journals, a weekly newspaper, and a website; representation of the profession to Congress and state legislatures; keeping members informed of pending health and medical legislation; evaluating prescription and non-prescription drugs; and cooperating with other organizations in setting standards for hospitals and medical schools. The AMA maintains a comprehensive directory of licensed physicians in the US.... american medical association
(BMA) a professional body for doctors and also an independent trade union dedicated to protecting individual members and the collective interests of doctors. It has a complex structure that allows representation both by geographical area of work and through various committees, including the General Practice Committee (GPC), Central Consultants and Specialists Committee, Junior Doctors Committee, and the Medical Students Committee.... british medical association
(CMO) the most senior medical adviser to the UK government, who is responsible for providing expert advice on health issues (including health-related emergencies). The CMO is responsible to the Secretary of State for Health and acts as leader of profession for Directors of Public Health. There are separate CMOs appointed to advise the devolved governments in Scotland, Wales, and Northern Ireland.... chief medical officer
consideration of the moral issues attendant upon, and questions arising from, clinical practice, as distinct from research. In North America, it is common for hospitals to employ a clinical ethicist or provide a formal clinical ethics consultation service. In the UK, clinical *ethics committees are increasingly common in the NHS.... clinical ethics
see community health.... clinical medical officer
an approach that is critical of the prevailing focus and methods of *medical ethics. In particular, it is argued that contemporary bioethics has replicated oppressive social structures, privilege, and power relationships at the expense of the marginalized. Moral problems are seen as determined from the social context in which they arise and narrative, care, and *empowerment are usually integral to feminist analyses of ethical dilemmas.... feminist ethics
an approach to moral problems acknowledging that ethical analysis is frequently culture-specific and geographically limited. The international and worldwide experience of health care is the subject of study and there is commonly close attention to inequities in health and health-care provision, with frequent emphasis on *human rights, *justice, and *equality.... global ethics
see HEMS.... helicopter-based emergency medical services
approaches to moral questions based on the thought of the German philosopher Immanuel Kant (1724–1804). These seek to discover what is morally right by asking what basic rules all rational people (see autonomy) could adopt for themselves and then act on as an *imperative matter of *duty, regardless of their personal desires or of the possible consequences (see deontology; consequentialism). The Kantian tradition has been influential in medical ethics, especially in its insistence that every human life must be treated as an end in itself and not simply as a means.... kantian ethics
(LMC) a group of representatives of the general practitioners working in a defined geographical area. There are separate LMCs for each area, and the members speak on behalf of the local practitioners by whom they are elected. Similar arrangements and responsibilities apply for dentists, pharmacists, and optometrists practising in the NHS outside hospitals.... local medical committee
adj. 1. of or relating to medicine, the diagnosis, treatment and prevention of disease. 2. of or relating to conditions that require the attention of a physician rather than a surgeon. For example, a medical ward of a hospital accommodates patients with such conditions.... medical
a certificate stating a doctor’s diagnosis of a patient’s medical condition, disability, or fitness to work (see statement of fitness for work). It is known informally as a ‘fit note’ (formerly a ‘sick note’). See Appendix 8.... medical certificate
see local medical committee.... medical committee
(MET) a team, usually consisting of a group of physicians, anaesthetists, and senior nurses, that can be summoned urgently to attend to patients with deteriorating medical conditions. The aim is to prevent further deterioration and to decide if enhanced levels of care are appropriate (e.g. on the high-dependency or intensive care units). The team will also assume the role of the *cardiac-arrest team.... medical emergency team
1. a health service worker who is not a registered medical practitioner (often in the armed forces) working in association with a doctor to undertake minor treatments and preliminary assessments. In poorer countries, particularly in rural areas where qualified resources are short (e.g. China), agricultural workers receive limited training in health care and continue in a dual role as barefoot doctors; elsewhere, limited training concentrates more on environmental issues: the workers so trained are known as sanitarians. 2. in the USA, a person – licensed or unlicensed, certified or uncertified – who provides administrative and/or clinical assistance in a physician’s office or other health-care facility. Administrative duties typically include filling out insurance forms, billing, and bookkeeping, while clinical duties may include taking medical histories, preparing patients to be examined, and preparing blood and urine specimens.... medical assistant
the study or practice of the legal aspects of medicine. See forensic medicine.... medical jurisprudence
travelling internationally to undergo surgery or otherwise be treated for an illness or condition. This may be done to save money, to avoid having to wait for treatment, or to receive a treatment not available in the home country.... medical tourism
an approach to ethical problems and practice that involves listening to and interpreting people’s stories rather than applying principles or rules to particular situations. This context-specific empathetic approach to patient and professional life stories is often contrasted with the universalizing rationalist approach of *Kantian ethics. Narrative ethics has an obvious relevance to the doctor–patient relationship and mirrors the clinical context in which moral choices are made.... narrative ethics
the ethics of population (as opposed to individual) health, including issues related to epidemiology, disease prevention, health promotion, *justice, and *equality. Public health ethics is commonly concerned with the tensions between individual *autonomy and *communitarianism and/or *utilitarianism.... public health ethics
see ethics committee.... research ethics committee
theories that emphasize the ethical importance of the virtues (e.g., honesty or courage), true happiness, and practical wisdom (compare consequentialism; deontology). In medical ethics, the traits of a ‘good doctor’ provide the moral compass by which to assess professional practice.... virtue ethics
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