Medical Ethics Part 2: The General Medical Council

The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its responsibility is to protect, promote and maintain the health and safety of the public. In 2013, the GMC published a guidance for ‘Good Medical Practise’, which is the core ethical guidance for doctors. This includes explanations or rules to follow during complex ethical situations during medical practise.  Every 5 years, all NHS staff, including licensed doctors, must demonstrate that they continue to meet the principles set out in Good Medical Practise, known as revalidation. 

 

Medical Ethics becomes an extremely challenging subject when there is conflict between different principles without clear outlines for a decision to be made. It’s important that the pillars of medical ethics have equal moral weight and value so that an appropriate decision can be taken. For example, a patient denies a certain treatment on religious grounds and a nurse decides to provide it anyways. The nurse may have saved the patient, but they have taken away the patient’s autonomy.

 

 

Organ Donation Example: 

A liver from a compatible donor is available to two patients who are both at the same risk of dying. The patient histories are: 

• A 19 year old female with autoimmune hepatitis.
• A 52 year old man, ex-heavy drinker with cirrhosis.

Argument: Although one may think that the man has inflicted the liver damage upon himself, the ideology of justice would make us consider both patients with fairness and equality. For the man, there may be a greater a chance of relapse into alcoholism, which would in turn cause damage to the transplanted liver. Equally, there is also a chance that the teenager may take up heavy drinking later in life. For the man, the excess alcohol consumption may have resulted in thinning of the blood, which may be more likely to complicate the operation, increasing the risk for infection. Additionally, the woman is younger and, provided the procedure is effective for both patients, she is more likely to live a longer life. Equally, the woman suffers from an autoimmune disease. These diseases often manifest themselves alongside other conditions. This could mean that the 19 year old would require prolonged treatment, increasing the cost for the NHS. Overall, I would give the 19 year old the kidney (BUT THERE IS NO RIGHT ANSWER!) 

 

 

Consequentialism

 

The ethical ideology that the morality of an action depends purely on its consequences. For example, a patient with a terminal illness is not likely to survive and, before an operation, they ask the anaesthetist: “Will I be ok?”. Consequentialism supports the idea that lying in this circumstance is acceptable, even though lying itself is not a moral action. 

 

 

Deontology (Duty-Based Ethics)

 

The ideology that states that the correct course of action is solely dependent on your duties and obligations. Thus, the morality of an action is based on the action itself, not its consequences. This is the opposite of consequentialism. A deontological approach to the scenario above would be to tell the truth, no matter the consequences. 

 

 

Utilitarianism  

 

The ideology that supports that the best action is that which brings the largest increase in utility, considering both the individual, and the wider society. For example, with a sum of money, you could fund one patient's expensive treatment, or the treatment for five patients with a common, easily treated, disease. Utilitarian ethics dictates that treating five patients is morally superior as a greater overall benefit is achieved. 

 

 

Competence and Confidentiality 

 

Competence is a legal term referring to an individuals ability or capacity to undertake a given medical procedure, also given the legal or natural qualifications required. It is important for one to recognise their level of competence. 

 

Example 1 — A medical student gets asked by the senior doctor to take blood from a patient. This is not something the student has practised on a patient before. The pressure to accept is high, and the student has successfully taken blood from a prop arm before. However, the risk of harm to the patient outweighs any potential good you could do by taking the blood without having sufficient training. 

 

Example 2 — Medical competence is applicable to all doctors. Therefore, another example may be a junior doctor being asked to lead an orthopaedic surgery that they have learned about, but have never performed before. 

 

The current understaffing situation in the NHS means that competency is often broken in situations where more qualified individuals are not available. This can put patients’ lives in danger. In ‘This Is Going To Hurt’, Adam Kay describes having to perform his first breech caesarean section unauthorised and without sufficient legal qualifications to do so. 

 
Confidentiality is the state of keeping patient information secret. However, confidentiality is not absolute, making it a complex ethical debate. The GMC (General Medical Council) states certain guidelines for handling patient information in the Data Protection Act of 2018. 

This states that confidentiality can be broken: 

• For education purposes, when the patient information is essential for the training. Usually, patient information can be anonymised before being used. 
• When the information has to be provided to a third party, such as the patient’s employer, or an insurance company. 
• When a patient has a serious communicable disease, such as HIV or tuberculosis, and there is a risk that others could be harmed from it.
• Reporting a patients’ fitness to drive to the DVLA. Although it is the patient’s duty to report this, their doctor also has this responsibility. 
• Reporting gunshot or knife wounds to the police, as well reporting illegal actions that may put others in danger. For example, if a bus driver on his day off is brought into hospital to get their stomach pumped after excessive alcohol consumption.  

Additionally, patient information can be disclosed if not doing so would could put the patient, or children and young people at risk, such as in the case of possible abuse or neglect of children.  Do not ask for consent if you have already decided to disclose the information in the public interest. Tell the patient that this information has been shared, unless doing so may put anyone else at risk. 

 

Patient information may be shared between professionals when it is in the patient’s best interest. In these scenarios, it is important that a doctor does not disclose patient information that they have found out through professional interactions. In many hospitals, it is likely that a patients data and care is monitored by an array of health professionals over time. Some hospitals provide brochures outlining the likely range of people who will need to access the patient’s health records and who may be involved in the care. However, sometimes it may not be practical for individual patients to know exactly who is involved in every aspect of their care at all times. Patient confidentiality is protected under the state law. A breach of confidentiality is the act of sharing information to a third party without consent. 

 

 

Organ Donation

 

Every year, hundreds of patients in the UK die before they were able to receive a transplant. From spring 2020, England is changing from an opt-in to an opt-out system in the hope to increase organ donations. 

 

A problem with the current opt-in system is that many potential donors either don’t register or unaware that they have the option to. Changing to an opt-out system is also important, because the number of brain-dead donors is decreasing, partly thanks to increased road-safety. Patients experiencing circulatory death are often rendered unavailable for donations as the organs are starved of blood. 

 

The new opt-in system, which is already employed by some European countries such as Spain, means that all over 18s in England will be considered for organ donation when they die, unless they had recorded a decision not to donate. This excludes people who lack the mental capacity to have registered their decisions since the instalment of the new laws. 

 

 

Abortion 

 

Abortion is the process of ending a human pregnancy so that it doesn’t culminate in the birth of a baby. Under the 1967 Abortion Act, an abortion is legal in England, Wales and Scotland up to 24 weeks of the pregnancy. It may also be legally carried out after 24 weeks when the pregnant woman’s life is at risk, or when the baby is at risk of being born with serious physical or mental injury. 

 

In Northern Ireland abortion is illegal and considered murder, unless the woman’s life is at risk or if continuing with the pregnancy could cause serious physical or mental health effects to the woman. Additionally, rape, incest or fatal foetal abnormalities are not grounds for a legal abortion in Northern Ireland.

 

The pregnancy is ended either by taking medications (within 10 weeks of gestation), or by having a minor surgical procedure, which involves general or local anaesthetic.

 

Pro-Abortion: 

• Most legal abortions take place within the first 3 months of pregnancy, at which time the foetus cannot exist independent outside the mother’s womb, so therefore cannot be regarded as a living organism. Thus, abortion cannot be regarded murder. 
• Fertilised eggs generated by IVF are often thrown away or destroyed and this is not considered murder. 
• In the case of rape or incest, forcing a woman to have the child is likely to be more psychologically damaging to her than having an abortion. 
• Aborting may be necessary to safe the woman’s life in certain cases, thus this option should be taken when necessary. 

 

Pro-Life: 

• Some people believe that human life begins at the point of conception, making abortion murder. 
• Instead of carrying out abortion and taking an innocent life, the child could be adopted by parents who are unable to conceive. In the case of rape or incest, the unborn child is innocent and should not be punished for this crime with an abortion.
• The abortion often leads to a great deal of psychological distress for the woman.   

 Legal age of consent to sexual activity in the UK is 16

 

 

Dealing with minors. 

 

The GMC has set out particular laws involving the treatment of children and young people under the age of 18. These are outlined below:

• You can provide medical treatment to a child or young person with their consent if they are competent to give it, or with the consent of a parent or the court. You can provide emergency treatment without consent if the child’s life is at risk, or when dealing in the best interest of the patient. 
• A person over 16 can be presumed to have the capacity to consent and a young person under 16 may have the capacity to consent, depending on their level of maturity and ability to understand what is involved. 
• There are complex laws on whether parents can override a children’s decision to refuse treatment. A doctor should seek legal advice if they think that it is in the best interest of a competent young person who refuses treatment.  
• To assess the best interest of the patient you should consider their religious and cultural believes and values, as well as social, psychological and emotional benefits. 

When parents of a child under 18 want to access their medical files, the doctor must ask for the children’s consent when they children are considered able to consent. When the child/young person refuses the disclosure of information, confidentiality may be broken when:

• There is an overriding public interest;
• Acting in the best interest of a child/young person who does not have the maturity or understanding to make a decision about disclosure; or when
• Disclosure is required by law.

A doctor can provide you contraceptive medicine, and STI and abortion treatment without parental knowledge or consent to young people under 16 when: 

• The young person understands all aspects of the treatment and implications; 
• The person is likely to have unprotected sex if contraception is not provided; 
• Their physical or mental health is likely to suffer unless they receive advice or treatment; 
• It is in the best interest of the young person that they receive treatment or advice without parental knowledge or consent.