In the study of medicine, our focus is often on the science of clinical diagnosis. Figuring out the meaning of various constellations of symptoms and signs; defining the differential diagnosis; learning which investigations will pin down the diagnosis and deciding what treatment options might be appropriate. But a clinical management plan will not be successful unless the ethical aspects involved in the consultation have also been addressed.
What do we mean by 'medical ethics'?
Medical ethics is all about values. It defines which values are morally important and explores relationships and conflicts between values in health care. Ethics defines what we, as health care professionals, ought to do and the reasons why we ought to do it.
This essentially translates into everything that we do as doctors. This includes mechanics of the doctor-patient relationship, communication skills, professionalism, obtaining consent, confidentiality, working with children, patients with psychiatric disorders or patients at the end of life, the law as it applies to medicine...the list goes on.
There are ethical dimensions to all of our consultations with patients. Often the ethical aspects occur at a subconscious level during an interaction with a patient, and it's only when there's some kind of conflict - a conflict of values - that the underlying ethical issues reach our awareness as a problematic ethical dilemma.
Consider the case of Mrs A, who was advised by her GP to use a short course of steroids and antibiotics to treat an episode of bronchitis. Mrs A had not been prescribed steroids before and, unknown to the doctor, believed from reading about steroids in the newspaper that they had dangerous side effects. She was also reluctant to pay for two prescriptions.
Diagnosing Mrs A's bronchitis and defining the correct treatment for this (steroids and antibiotics) will not necessarily help Mrs A unless:
- she trusts the doctor
- she understands and agrees with the treatment options
- the management plan fits with her health beliefs
- the treatment is available and accessible to her.
These are the ethical dimensions to the consultation. They may not be immediately obvious to the doctor, but it's essential to be aware of, to actively address, and to be able to reconcile the ethical dimensions within the clinical decision-making process.
Remember, ethics informs clinical decision-making.
Why is learning about ethics important?
Medical care is becoming increasingly complex, with new and often costly technologies and treatments being made available. Society's expectations of medicine are high, as are patient expectations of care. NHS resources are increasingly stretched and the need to manage their time often puts pressure on doctors.
Doctors are also expected to take on new roles as managers and leaders, and to be able to make decisions on all these conflicting aspects of practice. The complexities of modern clinical care can lead to quite challenging ethical situations, with even the most experienced of doctors finding the ethical dimensions of clinical practice difficult to manage.
For all these reasons, as a student doctor you must have a good grounding in medical ethics and in the skills of ethical reasoning. This should include the development of the attitudes and behaviour consistent with the professional practice of medicine, as well as communication skills that will help you identify and negotiate around conflicting values.