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Postgraduate Medical Ethics Education
Primary care ethics is a field of study that has recently found new life, with calls to establish the relevance of ethical discussion in general practice, to gather a body of literature and to carve out an intellectual space for primary care on the academic landscape of bioethics. In this report, we reflect on the key strands of the 4th primary care ethics conference held at the Royal Society of Medicine, on a theme of ethics education and lifelong learning: first, to produce insights that have relevance for policy and practice; and second, to illustrate the idea that not only is ethics relevant in primary care, but primary care is relevant in medical ethics. Core themes included the advantages and disadvantages of prescriptive ways of doing ethics in education, ethical reflection and potential risk to professional status, the need to deal with societal change and to take on board the insights gained from empirical work, whether this is about different kinds of fatherhood, or work on the causes of moral distress in healthcare workers.
Professionalism is a key component of good general practice, and self-awareness is a key component of professionalism. Being self-aware means understanding your own fitness to practice as a GP. It is a critical skill for ePortfolio reflections and appraisals, as it is a critical skill for good practice. In this article I will offer an approach to professional self-awareness through a set of four questions: What are my goals? What are my beliefs? What are my values? and What is my condition?
GPs in the UK have been involved in commissioning healthcare for years; well before the Health and Social Care Act of 2012. In this article, we discuss the ethics of commissioning and resource allocation as an essential skill for all GPs. Limitations in resources for healthcare, need and expectations result in difficult decisions, which need to be visibly coherent and consistent for public trust in GPs is to be well-founded.
This short paper is the annotated version of a three minute 'elevator pitch' which was presented at the NIHR collaboration for leadership in applied health research and care (CLAHRC) Oxford stakeholder symposium on 11 th December 2014 at St Anne's College Oxford Translational approaches to medical research aim to improve links between science and application. Recently there have been calls for translational ethics in the context of medicine. In the first instance I suggest that a translational approach is an argument in itself for a distinct ethics of primary care. Most patient encounters take place primary care in the UK. Whilst Primary care is subject to many of the same concerns as hospital or experimental medicine, many consultation, research, business and commissioning decisions in primary care are as if not more complicated by ethical legal and social issues.
An ethically problematic clinical case is used to illustrate the potential importance of understanding clinical ethics in an interdisciplinary context. Whilst much has been written on ethics education for multidisciplinary and interdisciplinary teams, we argue that it is important that both healthcare professions and healthcare teams are able to look outside their own disciplinary ethos and sometimes outside their formal teams when considering the ramifications of an ethical issue. A complex (fictional but based on the authors’ pooled experiences) case involving the delivery of a new-born from a mother with HIV is used to illustrate this, because multiple clinical teams will be involved at different times and in parallel with one another.
We comment on a paper published in the same issue of the London Journal of Primary Care. We applaud Bow's engagement with the ethical issues in a previous LJPC paper but argue that further work is needed to establish the everyday moral concerns of health care workers in primary care. We also suggest that the ethical distinction between advice and medication and devices may be artificial if both have an effect on a patient.
In advance of a medical conference on the duty of candour for medical ethics educators, this paper discusses the duty of candour as a significant development in the culture of medicine. Those who teach medical ethics need to assess its implications for their own practice. It is also a duty that needs to be critically examined in light of both patients’ interests and clinical work environments if it is to be practical and not meaningless rhetoric. Two examples of ways in which that critical examination might take place are outlined.
In this paper I discuss the ways in which the conference stream ethics and values manifested at the 2015 RCGP Annual Conference in Glasgow, and the ways in which it is planned for the 2016 RCGP Annual Conference in Harrogate. The 2015 RCGP had plenaries, oral presentations, breakout symposia, a debate, and a poster stream. I briefly discuss each in turn before offering a manifesto (a public statement of aims and proposed policy) for ethics and values at healthcare conferences. It is my hope that others will critique this, flesh it out further and even consider how ethics and values relate to conferences for healthcare workers of various specialities. A conference provides opportunities for ethics and values discussion that are potentially distinctive from any other kind of forum. Because conferences offer the potential for knowledge and attitudes to be revisited and revised, issues can be ‘unsettled’ in a way that permits different perspectives to be more fully discussed.