Medical ethics in troubled times

This blog post is based on a conversation between Andrew Papanikitas, Senior Clinical Researcher at the University of Oxford Department of Primary Care Health Sciences and the #MotivationBuddies, a virtual discussion group hosted by Graham Combe and chaired by Professor Tony Sedgwick. Book to join #MotivationBuddies and #CoffeeBuddies on Tuesdays and Thursdays at 2.30 pm BST (GMT+1 hr) at Eventbrite.

In discussions about ethical and moral issues, the world is full of opposing viewpoints, never more so than in the midst of the coronavirus pandemic and the aftermath of the George Floyd killing.

The best and most fruitful discussions are based around respectful disagreement, which seeks to understand why someone thinks how they do and prioritises logic and facts over opinion in the response. Building a consensus framework for medical ethics, particularly in troubled times, needs this kind of reasoned respectful disagreement.

Medical ethics isn't always about consensus though. It can be about a single voice speaking up against the status quo.  The issues and skills learned and discussed in medical ethics are not just relevant in healthcare they are widely applicable anywhere.
 
Ethics: the personal perspective
Our personal ethics can be driven by our goals, beliefs and values, and by the conditions in which we find ourselves, and all of these can influence communication and clinical practice.

• Goals – can be wide-ranging, from helping people through healthcare, through a job well-done, to money and status. The importance of these can vary throughout our careers, and the urge to reach them can distort our approaches, for example by falsifying data.
• Beliefs – we all have different sets of beliefs, depending on how we were brought up, what religious or spiritual beliefs we do (or don't) have, or where our politics lie on a broad spectrum. These can change how we interpret data, or the conclusions we reach.
• Values – we have different ways of assigning good and doing right, whether it's about maximising happiness, recognising intrinsic worth, or providing choice.
• Conditions – are we hungry, angry, late or tired (HALT)? Are we rich or poor, junior or senior?

Ethics: Coming to consensus
When people understand why they are doing something, and are supplied with principles, structures and processes, they are more likely to comply. Medical ethics frameworks, created through discussion and consensus, should therefore include:

• Guidelines for behaviour (principles)
• Established forms of knowledge and patterns of behaviour (structures)
• How things are done (processes)

The framework should be applicable to healthcare professionals across the range of professions and agencies, but it should consider different people and perspectives. If guidelines are created for individual groups, care needs to be taken where the sets of people cross over, for example the two sets of guidelines for midwives and obstetricians working with pregnant individuals, or the many different guidelines for the range of healthcare professionals working with older people in care homes.
 
Ethics, empathy and connection
Feelings of compassion (the desire to alleviate suffering) are important for healthcare professionals. In order to cope, and to be able to make decisions, it is important to mix in logic and reason, but this can result in healthcare professionals taking too big a step back, and healthcare becoming too dehumanised. Empathy (feeling what others feel), can play an important role by allowing healthcare professionals to: develop a two-way relationship with patients; gain insight into their condition and mindset; step into their shoes; respect their dignity; and base their care on the understanding gained.

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