Medical Ethics Today The BMA s Handbook of Ethics and Law 2nd Edition by Bma Ethics Department ISBN 978-0727917447 0727917447
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ISBN 10: 0727917447
ISBN 13: 978-0727917447
Author: Bma Ethics Department
Doctors and medical students confront increasingly complicated ethical dilemmas. To respond effectively they need skills in ethical reasoning and an understanding of the law and professional guidance. This book helps them achieve these things. It provides practical advice and guidance that draws upon the large volume of enquiries received by the BMAs Medical Ethics Department.
Although rooted in moral theory and legal practice, the book is designed both to provide practical advice for doctors day to day working lives and to stimulate debate on broader areas of public policy.
Table of contents:
Bridging the gap between theory and practice: the BMA’s approach to medical ethics
The BMA and medical ethics
What is medical ethics?
The transition from “traditional” to “analytical” medical ethics
Medical ethics and human rights
Practical approaches to medical ethics
Approaching an ethical issue or dilemma
The relationship between ethics and law
The General Medical Council
Philosophical approaches to medical ethics
Bridging the gap between theory and practice
The approach taken in this book
1 The doctor-patient relationship
Themes for discussion
General principles
Changing expectations of the doctor-patient relationship
Types of relationships in modern medicine
Choice and duty
The search for balance
The importance of communication
Trust and reciprocity
Recognising responsibilities and boundaries
The doctor-patient relationship of the future
2 Consent and refusal: competent adults
The nature and purpose of consent
General principles
Standards and good practice guidance
The process of seeking consent
The scope of consent
Pressures on consent
Refusal of treatment
Are there limits to an individual’s consent?
From the everyday to the extreme
3 Treatment without consent: incapacitated adults and compulsory treatment
Consent and the alternatives
General principles
When can treatment be given to adults who lack capacity?
What constitutes capacity?
Assessing capacity
Factors affecting capacity and how to enhance capacity
Best interests and benefiting patients
Involving people close to the patient
The role of people close to the patient
Advance statements
Treatment safeguards and procedures
Physical restraints and other measures of control
Treatment in hospital
Compulsion – mental health
Compulsion – public health
Proposals for law reform
4 Consent and refusal: children and young people
Combining respect for autonomy with best interests
Has human rights changed things for children?
Scope of this chapter
General principles
Emergencies
Consent for examination and treatment
Consent from competent young people
Refusal by competent young people
Decision making by people with parental responsibility
The courts
Providing treatment against a child’s wishes
Cultural practices
Withdrawing or withholding life prolonging treatment
Conjoined twins
Child protection
5 Confidentiality
The ethos of confidentiality
General principles
What is confidential?
Regulation
Consent for disclosure of information
Disclosures necessary to provide effective health care
Disclosure for purposes associated with providing health care
Uses of health information for purposes not associated with providing health care
Disclosures in the public interest
Examples of disclosures in the public interest
A confidential service that shares information
6 Health records
Records and record keeping
General principles
Record keeping
Recordings
Databases
Ownership
Security
Transmission
Transfer of GP records
Retention of records
Disposal
Private records
Access to health records
Access to medical reports
7 Contraception, abortion, and birth
The nature of reproductive ethics
General principles
Autonomy, rights, and duties
Contraception
Sterilisation
Abortion
Prenatal diagnosis
Pregnancy
Childbirth
Reproductive ethics: a continuing dilemma
8 Assisted reproduction
New reproductive technologies, new dilemmas?
General principles
Public debate and regulation
Access to treatment
Consent to the storage and use of gametes and embryos
Use of donated gametes or embryos
Preimplantation genetic diagnosis
Gender selection
Surrogacy
Seeking treatment in other countries
Time to review the law?
9 Genetics
Responding to the “genetic revolution”
General principles
Does genetics raise different ethical issues?
Genetic testing of those with a family history of genetic disease
Consent for genetic testing
Confidentiality within families
Diagnostic testing
Carrier testing
Predictive testing
Incidental findings
Population genetic screening
Genetic tests supplied direct to the public
Controversial uses of genetic information
Regulation of genetics in the UK
Other developments
Preparing for the “genetic revolution”
10 Caring for patients at the end of life
Breaking the taboo
General principles
Decisions to withhold or withdraw life prolonging treatment
Helping patients to prepare for a “good death”
Palliative care
Communication
Maintaining control
Good quality care
Caring for specific groups
Training and support
11 Euthanasia and physician assisted suicide
End of life: what are the issues?
General principles
Definitions and distinctions
BMA policy and the views of UK doctors
Moral, legal, and pragmatic arguments
Practical issues for doctors in the UK
Medical tourism
Views of the public
The future?
12 Responsibilities after a patient’s death
Scope of this chapter
General principles
Terminology
Changing expectations
Implementing good practice
The ethics of consent and authorisation
Organ and tissue transplantation
Advance consent in other situations
Issues of confidentiality
Common practical queries
Areas needing further debate
13 Prescribing and administering medication
The challenges and dilemmas
General principles
Responsibility for prescribing
Providing information to patients about medication
Pressure from patients
Pressure from employers
Clinical freedom and resources
Clinical freedom and official guidance
Clinical freedom and NICE
Conflicts of interest in prescribing matters
Shared prescribing
Prescribing for children
Self prescribing and prescribing for family members
Prescribing for addicts
Prescribing at a distance
Drug administration
Reporting adverse drug reactions
Pharmacogenetics
14 Research and innovative treatment
Range of issues discussed
General principles
Research governance
Why dilemmas arise in research and innovative treatment
Implementing ethical guidance in research and innovative treatment
Specialised areas of research
Fraud and misconduct in research and innovative treatment
Monitoring of research and innovative treatment
Support structures
15 Emergency care
General principles
Promoting patient autonomy
Determining patients’ best interests
Recognition of the skills of all members of the team
Samaritan acts
Duties to families
Confidentiality and privacy
Privacy and witnessed resuscitation
General issues in immediate and prehospital care
16 Doctors with dual obligations
When do dual obligations arise?
General principles
Providing reports for third parties
Medical reports for insurance
Expert witnesses
Refereeing firearms licences
Doctors examining asylum seekers
Pre-employment reports and testing
Occupational health physicians
Doctors in the armed forces
Sports doctors
Media doctors
Doctors with business interests
17 Doctors working in custodial settings
Duties in custodial settings
General principles
General issues of consent, confidentiality, and choice
Practical problems common to various detention settings
Health care in prisons
Young offenders’ facilities
Detention centres for asylum seekers
Police surgeons
18 Education and training
The ethical practice of medicine
General principles
Medical education: the changing landscape
The teaching of medical ethics and law
Ethical issues raised in teaching medical students
Particular dilemmas of medical students
The teaching of ethics and the ethics of teaching
19 Multidisciplinary teams and relationships with colleagues
Good clinical care
General principles
Working in multidisciplinary teams
Working with others in primary care
Working with others in hospitals
Interaction between NHS and private treatment
Advertising medical services
20 Public health dimensions of medical practice
Ethics and public health medicine
General principles
The use of health information
Public health interventions
Developing policies and commissioning services
Managing public health risks
Looking towards the future
21 Reducing risk, clinical error, and poor performance
Reducing error and managing risk
General principles
Causes and categories of risk
Retrospective overview
Assessing the scope of the problem
Recognising and addressing signs of problems
Dealing with the consequences of poor performance
A changing culture
Addressing doctors’ health problems
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