Medical Ethics in Action Conference Report
On Saturday 28th February, 2105, the University of Leeds Student Clinical Ethics Forum (SCEF) hosted its’ first student conference, entitled “Medical Ethics in Action” at Leeds University Union. The aim of the conference was to increase awareness of and interest in the application of ethical concepts to clinical practice by medical students, specifically in relation to their future careers. The conference was well attended by students from across all 5 years of the course, all of whom were extremely enthusiastic.
Guest Speakers
The morning programme consisted of lectures given by three guest speakers: Dr Michael Farrall, FY1 at Pinderfields Hospital; Mr Abeezar Sarela, Consultant Surgeon at Leeds Teaching Hospitals Trust; and Dr Andrew Stanners, Consultant Geriatrician at Pinderfields Hospital.
Ethical Issues at Work – Dr Farrall
Dr Farrall presented an interesting outline of the ethical challenges he faces working as a junior doctor. He gave examples of two recent clinical cases, and discussed the actions he took in each scenario, including the ethical thought process behind his decisions. These cases covered DNACPR decisions and the rights of a patient to refuse treatment, after determining their capacity. Dr Farrall highlighted to participants the importance of sound ethical knowledge for a career in Medicine, due to the frequent occurrence of challenging situations. He described how ethics is part of everyday practice, and not only impacts on the decisions doctors make, but also the way they work. Specifically he discussed the importance of self-care and taking time to rest when working long hours. His lecture was very well received by participants, who were actively encouraged to consider how ethics will be entwined in their future clinical practice.
Autonomy and Informed Consent – Mr Sarela
Mr Sarela gave an overview of the process of consent in healthcare, and the role of health care professionals in shared decision making. He described the transition in healthcare from paternalism to partnership with patients, and explained to participants the difference between single-agent informed decision making – whereby either the doctor acts as the sole paternalistic decision maker, or the patient is the sole decision maker, whilst the doctor acts only as a provider of technical information – and shared decision making, whereby both the patient and the doctor bring their values and opinions into decision making to reach a conclusion together. He argued in favour of shared decision making, and the need for doctors to provide recommendations to patients regarding a course of action. His discussion was extremely thought provoking, and gave participants the opportunity to consider how to approach discussing treatment options with patients in their future practice.
Medical Ethics in My Career – Dr Stanners
Dr Stanners opened his lecture by presenting a timeline of his medical career to date, throughout which he highlighted the key ethical moments he had encountered.He discussed how his appreciation for the ethical intricacies of working as a doctor have developed throughout his career, such that as he has become more experienced, he finds he recognises ethical challenges far more readily. He encouraged participants to take an active interest in ethics from the early stages of their career, arguing that doing so would stand them in good stead for the future. He went on to give several specific cases of ethical challenges he has faced, including whistleblowing, and gave participants the opportunity to consider how they would respond to these situations. Dr Stanners highlighted the importance of recognising such scenarios, and reflecting upon them in order to further individual knowledge and understanding of medical ethics. He finished by congratulating participants on their current engagement with SCEF and provided advice on how they could further their involvement with medical ethics, such as intercalation, post-graduate courses, and attending ethics committees at work.
During the lunch break, participants and speakers were given time to network and share ideas. Emily Lindsay, a 3rd year medical student, presented a poster on a case seen on clinical placement, and a discussion of the impact of sedation on a patient’s capacity to consent, which stimulated much interesting discussion. SCEF are grateful for her submission.
Workshops
After lunch, participants were offered the choice of four workshops, run in two parallel sessions. Each of these workshops aimed to delve deeper into ethical issues in clinical practice, and provided a platform for students to engage in discussion in a non-intimidating environment. A summary of each of the workshops is found below.
Social Media Debate
Workshop 1, facilitated by 4th year students Cordelia Newbury and Amber Garnish, was a debate on the topic of the use of social media by medical students and whether this is a platform for unprofessional behaviour. Participants discussed examples of Facebook status’ from public pages, a parody video filmed by medics which went viral, and an example of a real-life case where some members of staff were temporarily suspended after uploading unprofessional photographs to Facebook. Participants were then split into two teams to debate the motion: “Being a medical student/doctor means that there are restrictions on the way that you are allowed to use social media.” They were provided with the BMA guidance on social media, “Using social media: practical and ethical guidance for doctors and medical students” to support their arguments. Those in favour of the motion argued there are several factors which ought to restrict the use of social media, in particular: trust, professionalism, patient expectations, potential damages to the doctor-patient relationship, and individual moral responsibility. Those against the motion argued that being open on social media supports the importance of honesty and candour, also that using social media makes doctors more relatable/approachable, thereby improving the doctor-patient relationship. They also argued students ought not to be doing anything that needs to be hidden; if they are then it is the behaviour that is the problem, not the use of social media. Lastly they argued that medics’ individual liberty ought to allow them to do as they please on social media, and compared this to people in other respected professions, such as teachers.
Everyone engaged fully in this workshop and there was excellent exchange of arguments between the two sides; the overall quality of content for a group of medical students who are no experts in medical ethics or debating was very impressive. The group seemed to enjoy debating as a way of learning and utilising this ethical knowledge, and said it was a worthwhile and fun workshop to have attended. Furthermore, participants stated the session had made them reconsider their use of social media or the use of it by their colleagues.
Newsflash
Workshop 2, entitled “Newsflash” facilitated by Dr Stanners, aimed to bring to light the impact of the media – both good and bad – on how the public perceive health and the healthcare system. Participants were encouraged to think about the doctor-patient relationship and whether mass media helped or hindered it. The first task involved looking at healthcare-related articles selected from a variety of national newspapers. In small groups, participant assessed the articles for the balance between fact and sensationalism, and considered how a layperson would interpret the article and how as healthcare professionals they could adapt their practice/interaction with patients in light of it. Once each group had done this for their article, they gave feedback to the whole group. Although this was originally allocated a 15-minute time-slot in the plan of the workshop, the participants were keen to feedback and discuss and lasted the 50 minutes of the workshop instead. The subsequent parts of the workshop gave examples – for further discussion – of how the media, including television and the internet, played a part in making patients feel better informed and better able to challenge their clinicians as well as allowing educational messages to reach huge audiences – much greater numbers than would ever be possible solely via face-to-face interactions. Participants were introduced to the NHS twitter and website campaign ‘Behind the Headlines’, demonstrating that the health service is already aware on the power of the media and the need to harness its potential while ensuring patients receive accurate information. The final part of the workshop was designed to examine the nature of high-profile cases and whether media coverage affected the treatment of those involved. The example of Aysha King was chosen as a case study and a basis for further discussion. Overall the workshop was a success, with participants expressing that it was enjoyable and that they had benefitted from the opportunity to look at and discuss some of the ethical issues surrounding Medicine and the media with some of their peers.
Junior Doctors
Workshop 3 was entitled “Junior Doctors”, and was facilitated by University of Leeds lecturer Georgia Testa and final year medical student Adam Brown. The session involved watching several clips from the popular BBC television series Junior Doctors, which aired three years ago. Each clip was watched in turn and was followed by a discussion of the ethical issues raised. The first clip was about a doctor who needed to do a rectal exam but had never done one before. She stated how she would rather exude confidence and not tell the patient this was her first time than unsettle the patient by admitting she had never done it before. This provided good discussion on the area of consent.The second clip showed a junior doctor taking blood from a patient who had mental health issues. He approached the patient and told her that he was going to do a blood test, however when she declined consenthe proceeded regardless. This sparked discussion about how his practice could have been improved and also how much information is required by patients in order to give valid consent to different procedures. It also raised the question of how and when to assess capacity.The third clip featured a junior doctor trying to persuade an elderly woman at the end of life to drink more fluids as she was very dehydrated. The patient at first refused but with a little encouragement agreed to increase her oral intake. Dr Stanners was in the workshop, and as a geriatrician was able to offer his opinion on what he would do in this situation. Thankfully, he said scenarios where elderly patients refuse to drink anything at all are rare. The final clip showed a junior doctor visiting a deceased patient in order to complete a cremation form for the first time. It was mentioned that junior doctors get £70 for doing this as it is classed as beyond their normal duties. The doctor expressed his discomfort at being paid extra to do this task. The group shared their ideas about whether it is ethical for doctors to "profit from death" and whether completing cremation forms should be part of their everyday duties.
The workshop was very well received. All of the clips provoked healthy discussion which could have continued for longer. The workshop helped participants to realise how often 'ethics' crops up in everyday practice and provided examples of the ethical challenges they will face when they become junior doctors.
Quality Decision Making and Informed Consent
Following from his lecture in the morning, Mr Sarela facilitated an extremely insightful discussion on the quality of decision making by patients, particularly in relation to how the information provided by health care professionals impacts on the decision made. This included a discussion of how much information is necessary in order for patients to make informed decisions, and how framing information can influence the decision made. Participants were provided with an information pack containing three examples of information regarding Inguinal Hernia Repair, all presented in contrasting ways, which facilitated discussion of whether it is possible for doctors to disclose information in a neutral way. Mr Sarela challenged participants to consider whether doctors ought to make recommendations to patients regarding treatment choices, or ought to simply provide information as a technician. The workshop was thought provoking and participants enjoyed delving deeper into the concept of informed consent and the power doctors have to influence decision making.
Summary
Feedback from the conference was extremely positive, with all participants in agreement that they would attend similar events in the future; overall the conference was deemed a great success. In particular, the conference provided the opportunity for students to improve their ethical reasoning skills in relation to their future practice by providing clinical context, and highlighting to students how ethics is woven into every aspect of their daily practice. SCEF are extremely grateful to all three speakers, and to Georgia Testa for their input into the day, and to both the Institute of Medical Ethics and The Leeds for Life Foundation for supporting them with this project. SCEF plan to continue promoting engagement with medical ethics through regular meetings, and look forward to planning their 2nd conference next year.