11.4 Extending skills
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Extract 1 Majed
The lecturer we listened to last week introduced a number of interesting issues. I’d like to build on what she said about patient consent to treatment by looking at some legal cases. As well as the issue of informed patient consent, which is relevant, we can also look at a very different issue – which is whether legal decisions are in line with medical ethics. Cases I have identified include one in which a patient’s legs were removed in order to save his life. The patient went to court because he felt that he would not have consented to have his legs removed under any circumstances. The doctor argued that the ethical (and legal) obligation was to save the patient’s life before anything else. There is also a case of a doctor who removed a woman’s womb in which he discovered a cancer while he was operating for something else. These and other similar cases raise very interesting questions about how the autonomy of the patient is protected. Does anybody have any opinions or anything they would like to add?
Extract 2 Evie
Thanks, Majed. I don’t have anything to add – does anybody else? No. OK, following on from what Majed has said, I’d like to look at how ethical dilemmas can arise in obtaining consent in relation to research, focusing on the conflict between the benefits and the risks to people participating in experiments. I’ve looked at the websites of companies who recruit volunteers for trials, and one of the reasons they give for taking part is that it helps provide drugs to tackle the diseases of the future. It is true that without trials there wouldn’t be new drugs, but I don’t think that is the main reason most people actually take part. Most of the websites focus on the money volunteers can make and how easy it is. In my opinion, it is very difficult to reconcile two principles which both seem ethically important: firstly, paying people to take part, and secondly, expecting them to give informed consent which is not influenced in any way. I’m going to expand the topic by looking at whether regulation in the UK and other countries means that more trials are taking place in countries in Asia and Africa.
Extract 3 Jack
That’s a very good point you’re making about the effect of regulation on drug trials, Evie. To expand on that, I want to look at what exactly these regulations require the companies running tests to do, comparing how they work in a number of different countries. This should allow me to compare
the benefits of extensive testing with the difficulty it presents in terms of getting new drugs onto the market. I’m going to expand on this by looking at examples of drugs which have been tested extensively, have gone onto the market and then been withdrawn because they are unsafe. This could show whether or not the level of regulation is high enough to protect patients.
Extract 4 Leila
Thank you, Jack. That sounds like a very interesting topic. But I’d like to add something. As well as looking at how to balance patient safety against the need for new drugs, we can also look at a very different issue. This is the issue of the extent to which we can use patient data to carry out research on specific conditions, without needing to gain the patient’s consent every time we use the data. For example, at the moment, if data is gathered on a patient in the course of treatment, it cannot be used for research purposes unless the patient authorizes it. Gaining that authorization can be a long and time-consuming process. By carrying out research using this data, it could be possible to come up with new ways of treating the condition which would benefit not only the patient but others as well. So I’d also like to look at how to balance the patient’s right to confidentiality against the wider public interest.
E Set for individual work or pairwork discussion.
Point out to students that these phrases were used at the beginning of each extract in Exercise D.
See if students can complete the phrases before they listen.
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Play the extracts so that students can check and confi rm their answers.
You could also ask students to check the transcripts on pages 154–155 of the Course Book.
SKILLS BANK 11.3 Linking to a previous point
Elicit ideas on what the phrases are used for, and feed back visually with the class to create the table below. You could also direct students to Skills Bank 11.3, which contains a list of three phrases that add a new point to a previous contribution.
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