11 CURRENT ISSUES IN MEDICINE
confidential. In cases where there is a serious risk to the patient or others, disclosures may be justified even where patients have been asked to agree to a disclosure, but have withheld consent.
Two examples which can be used are: 1) In the case of notifiable diseases (where it is required by law to report details to the authorities). These include tuberculosis, cholera and tetanus. 2) Where a patient is infected with a serious infectious disease (e.g., HIV/AIDS) for which they refuse to take treatment or for which there is no treatment, and state their intention to continue to engage in behaviour which risks passing the disease to others.
Exercise G
In their groups students should now present their research findings on examples of ethical conflict. Remind them that the task was to come up with examples of situations where doctors make decisions with patients in either a treatment or research context, where there is a conflict between two or more of the main ethical principles in medicine. They also had to try to think about whether the conflicting ethical principles can be successfully resolved in the situation.
There are many possible examples which students can come up with and students should be encouraged to be clear on which (main) ethical principles are in conflict in the examples they have chosen. The following are some examples which can be used to start the exercise, or alternatively if students have difficulty in coming up with their own examples.
The example of a Jehovah’s Witness who refuses a blood transfusion, which has been outlined in Lesson 11.1. (patient autonomy vs beneficence)
The example of 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 find them annoying. Does the patient’s right to autonomy override the doctor’s responsibility for the well- being of their patient?
A woman 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 (beneficence)?
An example of a dilemma in research might be between the principles of beneficence and malfeasance when weighing up potential volunteers for a clinical trial. On the one hand the need to make up the numbers so the trial is successful is for the greater good. On the other hand there is the need to consider the individual patient’s safety.
201 Closure
Ask students to imagine they have qualified as doctors and have been awarded a grant to carry out research on a medical topic of interest to them. Ask them to think about the following in relation to the topic they choose.
The benefits that their research would provide: to patients, to society, to themselves.
Any possible risks associated with the research: to patients, to themselves, to others.
Organize students in small groups to discuss the topics and feed back to the class.
Encourage students to use the seminar language as practised in this unit and earlier. In addition, students can, of course, make use of the information in Lesson 11.4. They should mention at least two of the four principles of patient autonomy, non-malfeasance, beneficence and justice in their examples.
Choose a number of examples for further discussion by groups, in terms of whether the conflicting 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. This conclusion should be presented to the rest of the class, together with supporting evidence from students’ own research.
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