Transcript≤2.24 Extract 1
MAJED: I’d like to start by explaining why I would like to focus on legal cases relating to patient consent to treatment. 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 had legs 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. It sounds like fascinating stuff. 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 would 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 is that taking part in trials 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 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 have an ethical balance between paying people to take part and 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 seems like a very good point Evie is making about the effect of regulation on drug trials. To carry on from this point, 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 and the difficulty it presents in terms of getting new drugs onto the market. I’m going to expand on the topic by looking at examples of drugs which have been tested
200
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. As well as looking how to balance patient safety and 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 to sum up, we can say that I will be looking at the balance of the patient’s right to confidentiality against the wider public interest.
Exercise F
1/2/3 Set for pairwork. Tell students to study the Patient Protection Authority web page (B) on page 91 of the Course Book. Feed back with the whole class.
4 Set for small group discussion. Feed back with the whole class.
Answers Possible answers:
1 That legally and ethically patients have a right for the information provided during treatment or research to be kept confidential and used only for the purpose for which it was provided.
2 Data can be released with the patient’s consent, without the patient’s consent when it is in the public interest, or released accidentally.
3 When transferring data to another department, institution or organization. When disposing of personal data. By including too much information when creating statistical data sets, by users accessing data for a use other than intended, unauthorized access by having the record system hacked.
4 There are various possible answers and it is impossible to cover them all. The key when evaluating students’ answers is that there needs to be a clear case of the benefits to an individual or to society of the disclosure outweighing the public and the patient’s interest in keeping the information
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