Clinical Ethics & Values-based practice

The provision of health care is guided by a framework of legal and ethical principles that are reflected in professional codes of practice.
Ethical decision-making and behaviour in clinical practice requires the application and interpretation of these principles within a specific context, taking into account the perspectives and values of all involved.
General practitioners need to be able to justify their decisions with reference to both the clinical evidence and the moral and other values that inform those decisions.
The knowledge and skills acquired are applicable across the whole curriculum and should be incorporated into all aspects of clinical, managerial and research practice.

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Learning Outcomes

All general practitioners should be able to:

Recognise the ethical dimension of every healthcare encounter
Understand the nature of values and how they impact on healthcare
Identify the values that patients, families and members of the healthcare team bring to a specific healthcare decision
Demonstrate moral reasoning skills in the process of choosing an appropriate course of action or resolving conflicting values
Demonstrate the knowledge skills and attitudes for effective communication in eliciting and understanding the values of patients, negotiating an acceptable course of action and justifying that course of action
Demonstrate knowledge of the professional ethical guidelines and legal framework within which healthcare decisions should be made
Recognise their personal values and how these influence their decision-making.

Primary Care Management

Primary care management

By the end of the GP training the specialty registrar (GP) should demonstrate:
Awareness of the range of values that may influence a patient’s behaviour or decision- making in relation to his or her illness
How to integrate knowledge of patients’ values with the relevant scientific evidence and clinical experience to achieve the best outcome for the patient
Ability to recognise the ethical issues raised by public health programmes and develop appropriate approaches to their implementation.

Person-centred Care

Person-centred care

By the end of GP training the specialty registrar (GP) should demonstrate:
Skills to achieve meaningful consent by a patient to a plan of management by seeing the patient as a unique person in a unique context
Skills to balance conflicting duties to individual patients who are members of the same family
Ability to apply the ethical guidance on consent and confidentiality to the particular context of primary care
Awareness of the research evidence on patient values that are likely to influence a given healthcare situation
Understanding of the importance of continuity of care and long-term relationships with patients and their families in identifying and understanding the values that influence a patient's approach to health care.

Problem-solving

Specific problem-solving skills

At the end of GP training the specialty registrar should demonstrate:

The skills to analyse the effect of different values on specific decisions by patients, families and health professionals
Ability to draw on frameworks of moral reasoning to think through the issues and resolve conflicts of values.

Comprehensive Approach

A comprehensive approach

At the end of GP training the specialty registrar should demonstrate:

Understanding that patients’ views and perspectives may change through the course of a chronic disease
Understanding that co-morbidity or disease progression may affect decision-making capacity
That they can recognise and respond to a patient entering a terminal stage of illness, and the values that are important in managing this
Ability to identify potential ethical difficulties and develop proactive strategies to prevent or reduce the likelihood of conflict arising for themselves and for patients.

Community Orientation

Community orientation

At the end of GP training the specialty registrar should be able to demonstrate:
Understanding of the different conceptions of distributive justice that are used in resource allocation debates
Recognition of the range of values that influence choices about healthcare provision
Awareness of the obligation to use public resources in a prudent manner to benefit the whole community
Ability to give morally relevant reasons for decisions that balance individual patient needs with the needs of the wider community.

Holistic Approach

A holistic approach

At the end of GP training the specialty registrar should be able to demonstrate:
Understanding of the complexity of values that influence patients’ attitude to their illness and their health care
Ability to identify and involve appropriate resources and skills in other disciplines and other agencies to respond to the patient’s individual needs and concerns
Understanding that respect for patient autonomy is in essence a holistic approach. To enable a patient to make choices about how he or she wishes to live his or her life, a GP must explore what is important to the patient overall and not restrict information- sharing to clinical data.

Context

Contextual aspects

At the end of GP training the specialty registrar should be able to demonstrate:
Understanding of the local community and culture
How the values and beliefs prevalent in the local culture impact on patient care
Understanding of how the social context of primary care frames the identification and resolution of ethical issues by general practitioners
The ability to apply the results of research appropriately to the needs of individual patients and their families.

Attitude

Attitudinal aspects

At the end of GP training the specialty registrar should be able to demonstrate:
Awareness of his or her own capabilities and values
Understanding that his or her attitudes/feelings/values are important determinants of how he or she practices
Ability to clarify and justify his or her personal ethics
Awareness of the interaction of work and private life, and the ethical tensions that this can create.

Science

Scientific aspects

At the end of GP training the specialty registrar should be able to demonstrate:

Understanding of the ethical principles that underpin the conduct of medical research
Awareness of the process for gaining ethics approval for research conducted in primary care.