Consequences
Another area that requires ethico-legal imagination is the foreseeable consequences of clinical practice. While our intentions are antecedent (consciously orienting our practices towards an anticipated end), consequences are the ensuing events that are temporally linked to our earlier actions through causation. In order to act ethically, we must also consider the potential sequelae of what we do. While it is necessary that our intentions meet criteria of acceptability, the protest that we did not deliberately intend the untoward outcome caused by our actions may not be legally or ethically enough.
The concept of non-maleficence resonates with this. The distinction between non-maleficence and the concept of beneficence is important, as it may not be immediately obvious to students that the principle of acting in patients’ best interests requires the further standard of also not harming patients. (Again, rather than ‘non-malevolence’, it is a matter of doing rather than wishing.) The weighing of likely benefit relative to associated risk has been a cornerstone principle of ethical practice in medicine since antiquity, implicit in the Hippocratic tradition and entering modern discourse in the later formulation of ‘primum non nocere’ (‘first, do no harm’).
Society
All professions form a triangle of political partnerships in conjunction with the other two vertices represented by society and the state. However, the exchange of benefits between these partners is contingent and can be endangered. In particular, according to Salter (2001), ‘public trust in the medical profession is the key to the political arrangement between medicine, society and the state’. Trust in the medical profession operates at two levels: in ethical practice as performed by individual doctors when treating their patients, and in the governance of doctors as performed by regulatory bodies (Dowie & Martin, 2009).
Both aspects of trust relate to another ‘S’ under this heading, which is professional standards as defined by medical councils, specialty colleges, and learned societies. Consonant with this, a further ‘S’ in the ethico-legal curriculum is the safety of patients. Box 15 lists patient safety themes for medical school curricula identified by World Health Organization (2009).
BOX 15 World Health Organization patient safety topics
1. What is patient safety? 2. What are human factors and why are they important to patient safety? 3. Understanding systems and the impact of complexity on patient care 4. Being an effective team player 5. Understanding and learning from errors 6. Understanding and managing clinical risk 7. Introduction to quality improvement methods 8. Engaging with patients and carers 9. Minimizing infection through infection control 10. Patient safety and invasive procedures 11. Improving medication safety
Public trust in the medical profession is the key to the political arrangement between medicine, society and the state.
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Guide 53: Ethics and Law in the Medical Curriculum
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