11
Answers Phrase
1. I’d like to build on what she said about …
2. … following on from what Majed has said, …
3. T at’s a very good point you’re making about …
4. To expand on that, I want to look at …
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1. 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.
2. 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.
3. That’s a very good point you’re making about the effect of regulation on drug trials, Evie.
4. 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.
5. 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.
F
In their groups, students should now present their research fi ndings on examples of ethical confl ict. Remind them that the task was to come up with examples of situations where doctors make decisions with patients in either a treatment or a research context and where there is a confl ict between two or more of the main ethical principles in medicine. Students also had to try to think about whether the confl icting ethical principles could be successfully resolved in the situation.
T ere are many possible examples students might have researched. Try to make sure students are clear about which (main) ethical principles are in confl ict in the examples they have chosen. T e following are some examples which can be used to start the exercise if students have had diffi culty in coming up with their own cases.
• A patient who is a Jehovah’s Witness and who refuses a blood transfusion – a scenario which has been outlined in Lesson 11.1. Does their right to autonomy outweigh the medical obligation of benefi cence?
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11.4 Extending skills
Used for
adding a new point to a previous contribution
adding a new point to a previous contribution
confi rming a contribution was useful
adding a new point to a previous contribution
5. … I’d like to add something. adding a new point to a previous contribution
• An elderly patient who is prone to falling out of bed but who does not wish to have side rails put on their bed because they fi nd them annoying. Does the patient’s right to autonomy override the doctor’s responsibility for the well-being of their patient?
• A woman who is in intensive care in a critical state following a car crash. All her children have been killed in the crash. She becomes conscious and wants to know how her children are doing. Is her right to know the truth (principle of justice) greater than the doctor’s responsibility to spare her unnecessary distress at a critical time (benefi cence)?
• A research dilemma between the principles of benefi cence and nonmalefi cence when weighing up potential volunteers for a clinical trial. On the one hand, there is a need to achieve a certain number of participants so that the trial is successful, for the greater good. On the other hand, there is a need to consider each individual patient’s safety.
Encourage students to use the seminar language practised in this unit and previous units. In addition, students can, of course, make use of the information in Lesson 11.4. T ey should mention at least two of the four principles of patient autonomy, nonmalefi cence, benefi cence and justice in their examples.
Choose a number of examples for further discussion by groups, focusing on whether the confl icting ethical principles can be successfully resolved in the situation. As a group, students should try to come to an overall conclusion about whether this is possible. T is conclusion should be presented to the rest of the class, together with supporting evidence from students’ own research.
Closure
Ask students to imagine they have qualifi ed as doctors and have been awarded a grant to carry out research on a medical topic of interest to them. Ask them to choose a topic and to think about the following in relation to it:
• the benefi ts that their research would provide: to patients, to society and to themselves
• any possible risks associated with the research: to patients, to themselves and to others
Organize students in small groups to discuss the topics and then feed back to the class.
11.4_Closure Students can use the PDF provided to record their ideas.
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