Aims

What is (medical) ethics?

Principles of medical ethics (American Medical Assoiation)

Duties of a Doctor (GMC)

 

Recent ethical issues

Medical errors

Medical ethics: four principles plus attention to scope

R Gillon BMJ 1994;309:184 (16 July)

The "four principles plus scope" approach provides a simple, accessible, and culturally neutral approach to thinking about ethical issues in health care. The approach, developed in the United States, is based on four common, basic prima facie moral commitments -

  1. respect for autonomy (deliberated self rule)
  2. beneficence
  3. non-maleficence
  4. justice

plus concern for their scope of application.

It offers a common, basic moral analytical framework and a common, basic moral language. Although they do not provide ordered rules, these principles can help doctors and other health care workers to make decisions when reflecting on moral issues that arise at work.

What are the implications of respect for autonomy in health care?

Beneficence and non-maleficence

Justice

…basic precept is equality - but people can be treated unjustly even if treated equally

Personal decision making

Whose decision is it?

Scope

Health care professionals and their organisations all profess a commitment to help their patients and clients, and to do so with minimal harm. This commitment is underwritten by the societies in which they practise, both informally and through legal rules and regulations that define the health care professionals' duties of care.

Lords publish report on assisted dying bill

A House of Lords Committee today published its report on a Bill seeking to legalise assistance with suicide and voluntary euthanasia for terminally-ill people who are mentally competent and suffering unbearably.

There is insufficient time remaining for the Bill to be considered adequately in this session of Parliament, so the Committee has presented a thorough and balanced report on the subject of assisted suicide and voluntary euthanasia based on wide-ranging evidence. The Committee heard from more than 140 witnesses in four countries, considered over 60 formal written submissions and received over 14,000 letters and e-mails.

The Committee recommends that its report should be debated early in the next Parliamentary session and that, if a new bill is introduced along similar lines, a Committee of the whole House should examine it. The Committee identified a number of key issues which, it hopes, those who draft any future bill will address. These include:

  • The need for any future bill to distinguish clearly between assisted suicide and voluntary euthanasia in order to give the House the opportunity to consider them separately and to decide, if it should favour a change in the law, whether it would be appropriate to legalise only one or both of them.
  • The need for qualifying conditions for assisted suicide or voluntary euthanasia to be set which reflect the realities of clinical practice as regards the prognosis of terminal illness and which define a patient’s suffering in as objective a manner as possible – eg ‘unrelievable’ rather than ‘unbearable’ suffering.

 

The Chairman of the Committee, Lord Mackay of Clashfern said:

“Ending or helping to end someone’s life, albeit with their consent, is an awesome issue, and opinion within the Committee has been divided. We have explored the underlying ethical principles involved and the practical implications of any change in the law on intentional killing and assistance with suicide. And we have looked at the experience of other countries where legislation of this nature is in force.”

“Our Report is intended to inform future debate and to improve public understanding of this complex and emotive subject.”

Report on assisted dying bill

"Right to die"

BMJ 2005;330:799 (9 April), doi:10.1136/bmj.330.7495.799

The moral basis of the right to die is the right to good quality life

Ethics

Microsoft Word document Ethics

Ethics

Clinical ethics