12 FYi • Ethics


MEDICAL ETHICS I


Dr John Dudgeon off ers a quick, practical tool for the busy doctor


N my experience, when ethics comes up in conversation, many doctors develop a pained or puzzled look. But in working with patients, helping my trainees or answering complaints at the offi ce of the Scottish Public Services Ombudsman, I am increasingly aware of ethics being a part of most of the decisions that doctors make. No doubt it can create feelings of uncertainty but I hope my back-of-an-envelope


explanation will make ethics less something to be unsure about and more of a useful tool to help work our way through the increasing challenges of modern medicine. I should make it clear from the start that I am no expert – but maybe this leaves me well placed to present this simple and practical guide. Ethics is nothing more than a system of principles or values which can help us in decision-making. It is not necessarily about discovering what is right. In medicine there are often contrasting views that have their own legitimate morality (morality = a personal, intuitive sense of what is right or wrong). This is when ethics is required. When used to decide these issues, ethics has to justify the path taken.


Theory in practice For me, one thing that causes uncertainty around medical ethics is the language used. It is arguably over-complex but it can be simplifi ed. There are also multiple ethical theories, thought out by great minds. The kudos


due to those responsible is not to be ignored but if we try to remember them all we would never, in my opinion, put medical ethics into practical use.


Some of the better known theories are:


• Consequentialism – Often called utilitarianism, this suggests we should select the right choice of action as determined by the manner of doing good which leads to the greatest happiness for the greatest number, where happiness equals benefi t or good. Traditionally, Jeremy Bentham is associated with utilitarianism but there are many modern forms like preference utilitarianism.


• Deontology –This is a duty-based school of ethics which advises that some actions are intrinsically wrong in themselves, regardless of their foreseeable outcomes. Classically associated with Kant, he stressed that every person must be treated as an end in him or herself rather than as a means to an end.


• Other types –Further approaches exist like liberal individualism and communitarianism, all of which have importance to specifi c areas of medicine, but I would suggest forgetting all of the above and thinking instead about the Four Principles.


MADE EASY


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