Practical Ethics for General Practice

by Rogers, Wendy A; Braunack-Mayer, Annette

• ISBN13: 9780199235520
• ISBN10: 019923552X
• Edition: 2nd
• Format: Paperback
• Copyright: 2009-02-15
• Publisher: Oxford University Press

Summary

General practice provides the first point of contact to medical care for patients across the world. GPs have obligations to patients in their care, to the government for responsible use of resources, and to communities for the standard of health services provided. Ethics is at the heart of health services, dealing with fundamental questions about what ought to be valued, and why. The two disciplines inevitably impact upon each other, and this book brings them together to focus on practical ethics for general practitioners. In this update of a successful first edition, the authors aim to: help GPs appreciate the ethically significant nature of general practice, drawing attention to the ethical complexity of apparently mundane and everyday experience; present a thoughtful and thought-provoking account of the moral foundations of general practice, exploring how moral concepts such as trust, beneficence, respect for autonomy, and fairness take on unique meanings in the general practice setting; and to discuss some specific ethical issues in detail, offering solutions that are practical as well as ethically sound. The focus is on practice throughout, ensuring through real cases and discussions with practitioners that the book is not abstract and esoteric in its discussion of philosophical principles, but that it is applicable in the real world of the doctor's surgery. The authors guide their readers through basic approaches to ethical reasoning and use of a practical ethics analysis framework suitable for use in all ethical dilemmas in medicine. Themes covered include the authors' research-based account of trust and the doctor-patient relationship, acting in the patient's best interests, confidentiality, making decisions with patients, beginning and end of life issues, treating children and adolescents, and role conflicts in general practice.

Author Biography

Wendy Rogers leads the teaching of ethics, law and professionalism in the medical program at Flinders University. In 2007, she received a national Carrick award for her teaching in this area. Her current research projects include gender equity in health research, the ethics of influenza pandemic planning, and issues raised by biological donations. Wendy was a founding director of the Ethics Centre of South Australia, served as the Co-coordinator of the International Network on Feminist Approaches to Bioethics from 2006-8 and serves on the editorial boards of journals including Bioethics, International Journal of Feminist Approaches to Bioethics, Health Expectations and BMC Biomedical Ethics. She is a member of the Medical Board of South Australia, and is a regular commentator in the media on a range of bioethical issues.
Annette Braunack-Mayer teaches medical and public health ethics and qualitative research methods at the University of Adelaide. Her current research projects include the ethics of influenza pandemic planning, consent and privacy in public health research, and community involvement in decision-making about clinical and public health practice. She is also a Consultant Ethicist to Adelaide Health Technology Assessment and the Australia and New Zealand Horizon Scanning Network. With Wendy, Annette was a founding director of the Ethics Centre of South Australia, and she currently chairs the Centre's Board of Management.

Table of Contents

Foreword to the second edition	p. v
Foreword to the first edition	p. vii
Preface	p. ix
List of abbreviations	p. xv
Introduction	p. xvii
The GPs and their practices	p. xviii
References	p. xxi
General practice and ethics	p. 1
Introduction	p. 1
The GP-patient relationship	p. 2
Ethical complexities in general practice	p. 5
Conclusion	p. 8
References	p. 8
Ethical reasoning and general practice	p. 9
Introduction	p. 9
The role of ethical deliberation in general practice	p. 9
Ethical theory	p. 10
A framework for analysing ethical problems	p. 14
Using the framework: Dr Morrow and Lisa	p. 17
Conclusion	p. 22
References	p. 22
Further reading	p. 23
Trust and the doctor-patient relationship	p. 25
Introduction	p. 25
What is the doctor-patient relationship?	p. 26
The importance of the relationship to general practice	p. 27
The importance of trust	p. 29
Trust in the doctor-patient relationship	p. 30
The benefits of trust	p. 32
Trust, paternalism and consumerist relationships	p. 35
Fostering patient trust	p. 36
Trusting wisely	p. 36
Conclusion	p. 37
References	p. 38
Difficult relationships with patients	p. 41
Introduction	p. 41
The balance between intimacy and professionalism	p. 41
Gifts from patients	p. 43
Sexual boundary violations	p. 45
Needy or dependent patients	p. 48
Patients and their relatives	p. 49
Collusive relationships	p. 50
Conclusion	p. 50
References	p. 51
Confidentiality in general practice	p. 53
Introduction	p. 53
What is confidentiality?	p. 55
Why is confidentiality important?	p. 56
Cases in which maintaining confidentiality can be a problem	p. 58
Conclusion	p. 66
References	p. 66
Further guidance on confidentiality	p. 67
Beneficence or does the doctor know best?	p. 69
Introduction	p. 69
The principle of beneficence	p. 70
Acting in the patient's best interests	p. 71
Beneficence and paternalism	p. 73
Medicine and paternalism	p. 76
What is the medical good? The role of evidence-based medicine	p. 79
The limits of beneficence	p. 81
Preventive healthcare	p. 86
Conclusion	p. 90
References	p. 90
Justice and resource allocation in general practice	p. 93
What is resource allocation and why does it matter?	p. 95
How are resources allocated in healthcare systems?	p. 96
How can we allocate resources fairly?	p. 99
Material principles of justice	p. 101
Conclusion	p. 111
References	p. 112
Making decisions: patient autonomy in general practice	p. 113
Introduction	p. 113
What is autonomy and why is it important?	p. 114
Autonomy in practice	p. 115
Informed consent	p. 116
Limits on autonomy and difficult cases	p. 126
Conclusion	p. 132
References	p. 132
Ethical issues at the beginning of life	p. 135
Introduction	p. 135
Contraception	p. 135
Abortion	p. 138
Reproductive technologies	p. 141
In pregnancy	p. 145
Labour and delivery	p. 149
Conclusion	p. 151
References	p. 151
Ethical issues in the care of children	p. 153
Introduction	p. 153
Why do children raise particular ethical issues?	p. 154
Requests for circumcision	p. 155
Immunization	p. 157
Complimentary and alternative treatments	p. 158
Obesity	p. 159
Non-accidental injuries	p. 161
Adolescent consent and confidentiality	p. 163
Conclusion	p. 166
References	p. 166
Ethical issues at the end of life	p. 169
Introduction	p. 169
Ethical responses to requests for assistance in dying	p. 171
What is euthanasia?	p. 174
The doctrine of double effect	p. 178
Physician-assisted suicide	p. 179
Practical aspects	p. 180
Advance directives	p. 183
Legalizing euthanasia and assisted suicide	p. 184
Conclusion	p. 186
References	p. 187
Role conflicts in general practice	p. 189
Introduction	p. 189
Conflicts of interest in general practice	p. 189
Why should we be concerned about conflicts of interest?	p. 193
Some specific examples	p. 194
Evaluating conflicts of interest	p. 201
Dealing with conflicts of interest	p. 206
Conclusion	p. 209
References	p. 209
On being a good doctor: virtues in general practice	p. 211
Introduction	p. 211
What is different about a virtues approach in general practice?	p. 211
What is virtue ethics?	p. 213
Compassion	p. 214
Medical vices	p. 217
Why do we need a focus on virtue in medicine?	p. 218
Conclusion: what is a good GP?	p. 220
References	p. 222
Index	p. 225
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