Values-based medicine

-
Consideration for individual values, particularly those
of the patient, can be difficult within the context of
modern health care, where complex and conflicting
values are often in play. This is particularly so when a
patient’s values seem to be at odds with evidence-based
practice or widely shared ethical principles, or when a
health professional’s personal values may affect the care
provided.
Values-based practice, a framework developed originally
in the domain of mental health, maintains that
values are pervasive and powerful influences in healthcare
decisions and research, and that their impact is
often underestimated. It suggests that our current
approaches lead us to ignore some important manifestations
of values at both the general level, as relevant in
legal, policy and research contexts, as well as at the individual
level, as relevant in clinical practice. All students
and trainees are continually exposed to areas of ethical
difficulty throughout their training; the important thing
is to try to be aware of them. Fulford (2004) calls this the
‘squeaky wheel principle’ of values-based medicine.
This metaphor means that we tend to notice values only
when they are diverse or in conflict. Learners may have
difficulty doing this on their own. Discussion with
others is essential to bring out a proper range of
responses to ethical problems or value conflicts and
to challenge individual views.
Values-based practice expands on the ideas that may
be regarded as value-laden. It suggests that one of the
reasons for overlooking values is that they are presumed
to be shared when not obviously in conflict. Fulford and
others (Fulford 2004, Fulford et al 2002) have suggested
that since primary care is an area of significant diversity
of values, values-based practice may have particular relevance
there.

Commentaires

Enregistrer un commentaire

Posts les plus consultés de ce blog

Medical negligence

-
Doctors may sometimes fall foul of the criminal law (this is discussed in relevant sections over the next four chapters) but the majority of cases against doctors are heard in the civil courts. Civil law cases involving doctors are usually actions in medical negligence. There are some basic components of a medical negligence action. A duty of care: it must be shown that the defendant (that is the person or authority accused of negligence) owed the claimant (that is the injured party or the person accusing the defendant of negligence) a duty of care: • The duty of care of a GP crystallizes when the patient registers with that GP and then consults with the GP on the occasion in question. • The duty of care of a hospital doctor crystallizes when the patient is formally accepted into hospital. English law does not oblige doctors to give emergency treatment outside of the above situations except when: • a patient presents to an A&E department • when a GP is requested ...
Lire la suite

ETHICAL THEORIES

-
Ethical theories attempt to provide an over-arching theoretical framework for addressing the problem of how human beings should behave with one another in the world. There are three key theories which have historically dominated medical ethics teaching: Utilitarianism, Deontology and Virtue Ethics. More recent frameworks attempt to reconcile different theories and values. The widely taught four principles of biomedical ethics attributed to Beauchamp and Childress is one such attempt. ‘Values-Based Practice’ or ‘Values in Medicine’ has recently gained prominence in psychiatry and general practice, and is taught on some undergraduate medical degrees (these theories are considered below).
Lire la suite

DUTIES FOR MEDICAL STUDENTS

-
The GMC also sets out duties for medical students. Medical students have legal restrictions on the clinical work they can do, but must be aware that they are often doing things that a qualified doctor might do (such as ‘taking a history’) and that their activities will affect patients. Patients may see students as knowledgeable, and may consider them to have the same responsibilities and duties as a doctor. Students must be aware that their behaviour outside the clinical environment, including in their personal lives, may have an impact on their fitness to practise (professional boundaries are discussed later in this chapter). Therefore: • students have a duty to make sure that patients know that they are students and not doctors. For example: should medical undergraduates introduce themselves as medical students or as student doctors? The title ‘Student doctor’ could mislead a patient that the person seeing them is medically qualified • students have a duty to beha...
Lire la suite