Balancing Ethical Considerations in Health and Social Care

Exploring the Importance of Ethics in Health and Social Care

Introduction

Ethics is a system of moral principles that influence how people make decisions and lead their lives. It is concerned with what is good for individuals and society and is often known as moral philosophy. The term “ethics” is derived from the Greek word “ethos”, which can mean custom, habit, character or disposition (BBC).

In the context of health and social care, ethics refers to the principles, frameworks, standards and values that guide the behaviour and decision-making of professionals in their respective fields. It includes patient autonomy, confidentiality, informed consent and the duty to prevent harm. These ethical guidelines ensure care is beneficial, accessible, fair and delivered in a compassionate, respectful, dignified and person-centred way.

Balancing ethical considerations is crucial for providing high-quality care, as it respects patients’ rights and dignity, ensures care is effective and morally sound and adopts a holistic approach. It is also important for patient safety, fairness and trust while helping healthcare professionals and institutions maintain integrity and credibility.

The key ethical principles that guide healthcare professionals are autonomy, beneficence, non-maleficence and justice. Balancing these ethical principles helps create a healthcare environment where patients feel respected, cared for and confident in the decisions made about their health.

This comprehensive guide explores the complex and crucial topic of balancing ethical considerations in health and social care. It offers practical insights, examples and strategies to help healthcare professionals navigate ethical challenges in their practice.

Ethical Considerations

Understanding Ethical Principles in Health and Social Care

The ethical principles of autonomy, beneficence, non-maleficence, and justice, outlined by Beauchamp and Childress, are fundamental to health and social care and are the cornerstone of ethical practice and law.

Autonomy

In the context of ethics and health and social care, autonomy refers to healthcare professionals respecting the rights of individuals to make their own decisions regarding their care and treatment (British Medical Association). It is significant, as it:

  • Aligns with legal and ethical standards, helping healthcare providers maintain professional integrity.
  • Ensures that patients can make informed choices about their treatments, understanding the risks and benefits involved.
  • Enables care and treatment plans to be tailored to individual needs and preferences, thus enhancing the overall quality of care.
  • Empowers patients by giving them control over their own healthcare decisions
  • Fosters trust between patients and healthcare professionals.

Some examples of respecting patient autonomy include:

  • Informed consent – patients are given all relevant information about their diagnosis, care and treatment options and the potential risks and benefits to enable them to make informed decisions.
  • Respect for choices – healthcare professionals respect patients’ preferences, values and choices even if they disagree with them, e.g. if they refuse to have recommended treatments.
  • Capacity – patients document their preferences for future care and treatment if they lose mental capacity and cannot communicate them, and healthcare professionals respect their wishes.

Healthcare professionals may face many challenges while maintaining autonomy, especially where patients are vulnerable, lack the mental capacity to make informed decisions or refuse life-sustaining treatment. They may also have to navigate other issues, such as communication barriers, cultural differences, power imbalances and resource limitations.

Beneficence

Another core ethical principle in healthcare is beneficence. It emphasises the duty that healthcare professionals have to ‘do good’ and act in the best interests of their patients. It goes beyond avoiding harm (non-maleficence) and expects healthcare professionals to prevent harm and actively promote patients’ well-being.

Healthcare professionals can apply beneficence in practice by:

  • Considering what actions will most benefit the patient while considering their needs, condition, personal circumstances and preferences.
  • Providing holistic care by looking at the patient as a whole and considering emotional, social and psychological factors, not just focusing on their condition when making treatment decisions.
  • Balancing the benefits of the decision or treatment against the risks and costs while ensuring it is proportionate to the patient’s needs.

The Medic Portal details how to apply this principle here.

Balancing beneficence with other ethical principles, such as autonomy, is crucial in healthcare ethical decision-making. It can be challenging, as they can often clash, e.g. what is in the patient’s best interests may go against their wishes, beliefs or preferences, or they cannot make decisions themselves due to a lack of capacity.

Healthcare professionals could balance ethical principles in the following ways:

  • Informed consent – ensure patients are fully informed about their treatment options, including the benefits and risks, thus enabling them to make autonomous decisions while meeting the beneficence duty.
  • Shared decision-making – collaborate with patients to make shared decisions, as it respects their autonomy and ensures the decision-making process includes their preferences and wishes.
  • Understand and respect patients’ values, beliefs, and preferences – it may identify any conflicts between the principles and help to find a compromise.
  • Ethical deliberation – use ethical frameworks or seek guidance from colleagues and ethical committees, especially in complex cases.

Non-Maleficence

Non-maleficence is a cornerstone of healthcare ethics that places a duty on healthcare professionals to avoid causing harm to patients. This principle is often summarised by the Latin phrase “primum non nocere,” which means “first, do no harm (Medical School Expert).

Some examples of non-maleficence in healthcare settings include:

  • Avoiding unnecessary treatments, e.g. not giving patients non-essential medications or surgeries, due to potential side effects and risks.
  • Withholding harmful treatments, e.g. consider different options where treatments may cause harm rather than benefit. For example, doctors may choose palliative care options instead of aggressive chemotherapy for a terminally ill patient.
  • Managing medications, e.g. ensuring patients receive the correct dosage to avoid adverse effects.
  • Informed consent, e.g. providing patients with all necessary information about the risks and benefits of a procedure, thus allowing them to make informed decisions.

Conflicts between non-maleficence (avoiding harm) and beneficence (promoting well-being) can occur in healthcare and create ethical dilemmas. Healthcare professionals can navigate and address these dilemmas by:

  • Following established ethical guidelines and professional codes of conduct.
  • Using the best available evidence to inform decisions.
  • Engaging in ethical discussions with healthcare teams, including ethicists.
  • Involving patients in decision-making to help balance these principles.
  • Regularly review and monitor the outcomes of interventions.

Justice

Another fundamental principle in healthcare is justice, which is about fairness and equality, i.e.:

  • Ensuring all patients have fair and equitable access to care and resources.
  • Treating patients in similar circumstances similarly and not unfairly discriminating against anyone.
  • Distributing resources, benefits, risks and costs fairly.

Justice and fairness in healthcare resource allocation means all individuals should get equitable access to medical services, regardless of their background. Resources should also be distributed to maximise health benefits across the population while minimising inequalities.

Ensuring equitable access to care is fraught with challenges, including:

  • Resource limitations, e.g. limited facilities and budget constraints – can lead to unequal distribution of services.
  • Social inequalities, e.g. socioeconomic status, education and ethnicity – can affect access due to barriers, such as a lack of health literacy and transportation.
  • Cultural and language barriers, e.g. differences in language and cultural understanding – can lead to miscommunication, mistrust and an unwillingness to use services.
  • Healthcare systems, e.g. staff shortages, inefficiencies and bureaucracy – can delay care and create disparities in access.

Strategies for promoting justice in health and social care include targeted funding, policy reform, workforce development and community engagement to create a more equitable healthcare system. Resources should also be used effectively and distributed based on need, and the allocation process should be open and transparent with clear criteria and rationale for decisions.

Common Ethical Dilemmas in Health and Social Care

Healthcare professionals often face ethical dilemmas where two or more ethical principles conflict and must make complex choices that can compromise other principles. Some common ethical dilemmas in health and social care include end-of-life care, confidentiality and privacy, informed consent and resource allocation.

End-of-Life Care

The goal of end-of-life care is to prevent pain, meet patients’ needs, wishes and preferences and promote their quality of life and well-being. However, healthcare professionals can face many challenges, ethical considerations and dilemmas in end-of-life care decision-making, such as:

  • Balancing honesty with sensitivity – ensuring patients and families understand the prognosis and options available.
  • Deciding when to continue or withdraw treatment, especially when the benefits and burdens match closely.
  • Providing adequate pain relief while avoiding over-sedation, thus impacting quality of life.
  • Balancing cultural preferences and legal and ethical frameworks, e.g. some religious beliefs do not permit certain procedures and treatments.
  • Ensuring autonomy and informed consent where patients have a lack of mental capacity.

Balancing patient autonomy with family wishes and professional guidelines can be challenging for healthcare professionals. However, they can overcome this by:

  • Following professional guidelines that support patient autonomy and provide a framework to work to ensure care is patient-centred and respects the dignity of the dying person.
  • Encouraging patients to document their wishes to maintain their autonomy and respect their preferences if they lose capacity, e.g. advance care planning.
  • Involving families in care and treatment preferences and helping them to understand and accept their loved one’s decisions.

Balancing these aspects requires sensitivity and a commitment to ethical principles. Healthcare professionals must navigate these waters carefully to respect patients’ wishes while supporting their families and adhering to professional standards.

Advance directives and palliative care are crucial in ethical decision-making in end-of-life care.

Advance directives

These are legal documents recognised under the Mental Capacity Act 2005.

  • They allow individuals to outline their care and treatment preferences if they cannot communicate their decisions in the future.
  • They respect patient autonomy by fulfilling their healthcare preferences and wishes, even where they cannot communicate their decisions.
  • They provide clear guidance and a framework for healthcare professionals and families, thus reducing uncertainty and potential conflicts.

Palliative care

  • It aims to improve the quality of life for patients through a holistic approach, which addresses their physical, emotional, social and spiritual needs and aligns with their values and preferences. It helps to ensure care and treatments are person-centred.
  • It emphasises beneficence (doing good) and non-maleficence (avoiding harm) by prioritising comfort and quality of life over aggressive treatments.
  • It facilitates open communication between patients, families, and healthcare professionals, thus helping to align treatment plans with patients’ values and goals.

Combining advance directives with palliative care enhances ethical decision-making. It ensures patients and their families are better informed, and decisions are guided by the patient’s documented wishes and current needs. It also helps healthcare professionals navigate complex ethical dilemmas when there are clear directives and palliative care principles.

Further information

Confidentiality and Privacy

Patient confidentiality and privacy are crucial in healthcare settings for several reasons:

  • Building trust – it enables patients to feel comfortable that their information will be kept confidential by healthcare professionals.
  • Legal compliance – it is a legal requirement under the Data Protection Act 2018 and UK GDPR.
  • Quality of care – it encourages patients to be open and honest about their health, thus helping in accurate and effective diagnoses and treatments.
  • Core ethical duty – it is the cornerstone of healthcare and is a core ethical duty that professionals must follow. It also reflects a commitment to patient privacy, dignity, safety and welfare.

There may be instances where healthcare professionals need to decide whether to share information with family members or other professionals, which can create ethical dilemmas, such as:

  • Balancing patient confidentiality with the need to share information for patient safety and effective care
  • Obtaining consent to share information where a patient lacks the mental capacity to consent.
  • Conflict between respecting the patient’s wishes and the family’s right to know when a patient does not want to share information with their family.
  • Disclosing patient information without consent for public protection, e.g. infectious disease outbreaks or safeguarding vulnerable individuals.

There are various legal requirements and guidelines for managing patient data and upholding patients’ confidentiality and privacy, such as:

  • Professional standards and guidelines – various professional bodies and regulators require healthcare professionals to manage patient data safely and responsibly. For example, the GMC has a confidentiality professional standard.
  • UK GDPR and Data Protection Act 2018 – provide a framework for lawful information sharing, emphasising the need to protect individuals’ data while allowing necessary sharing to prevent harm. NHS Digital has further information here.
  • The Common Law Duty of Confidentiality (CLDC) – requires patient information to be kept confidential unless there is a legal requirement, court order, overriding public interest, or explicit/implied consent to disclose it.
  • The Caldicott Principles – eight principles to ensure people’s information is kept confidential and used appropriately in health and social care services. The National Data Guardian has further information here.

CPD Online College has a guide on confidentiality in care here.

Informed consent involves several key ethical considerations to ensure patients can make well-informed decisions about their healthcare, for example:

  • Autonomy – patients’ right to make decisions about their healthcare must be respected, even if they refuse treatment.
  • Communication – patients should be given all necessary information they understand, considering language barriers, literacy levels, or sensory impairments, thus allowing them to make an informed choice.
  • Voluntariness – patients must give their consent freely without any form of coercion or undue influence from healthcare professionals, family or friends.
  • Informed decision – patients must have all relevant information about the proposed treatment, including potential benefits, risks, and alternatives. It also includes what might happen if they do not have the treatment.
  • Capacity – patients must have the mental capacity to understand the information provided and make decisions based on it. If they lack capacity, healthcare professionals must act in their best interests, often involving discussions with family or legal representatives.
  • Documentation –  the consent process should be properly documented, including the information provided and the patient’s decision.
  • Ongoing process – informed consent is not a one-time event but an ongoing process. Patients should be kept informed, and their consent reaffirmed, especially if there are significant changes in their treatment plan.

Ensuring patients fully understand the risks and benefits of treatments involves several ethical challenges, for example:

  • Obtaining informed consent can be difficult when relaying complex information, and patients have limited health literacy.
  • There may be communication barriers, e.g. language differences, cultural factors, learning disabilities/difficulties and varying levels of understanding, which can affect communication and comprehension.
  • Vulnerable patients, e.g. elderly or those with impairments, may have difficulties in understanding their treatment options.
  • Patients may have personal beliefs or preferences that conflict with medical advice.

There may also be additional ethical challenges in obtaining consent from minors or individuals with cognitive impairments, which requires special considerations, such as:

Under 16

  • Children deemed “Gillick competent” can consent to their own treatment.
  • It means they have enough intelligence, competence and understanding to consent.
  • If children are not deemed competent, someone with parental responsibility, e.g. a parent or legal guardian, must consent.
  • The NSPCC has further information on Gillick competence here.

Aged 16-17

  • Young people are presumed to have the capacity to consent to their own medical treatment, similar to adults.
  • Their consent is generally respected unless significant evidence suggests they lack the capacity.
  • The NHS has further information here.

Individuals with cognitive impairments

  • Health professionals must assess individuals with cognitive impairments and their capacity to consent.
  • Decisions must be in the best interests of those lacking the capacity to consent.
  • Healthcare professionals should consult with family members or friends to understand the individual’s preferences and make decisions.
  • In cases of disagreement or uncertainty about the best course of action, the Court of Protection can be involved in making decisions.
  • The Mental Capacity Act 2005 provides the legal framework for making decisions for those who lack capacity.

The NHS has further information on consent here.

Resource Allocation

Healthcare resources are often limited in various settings. Therefore, distributing those limited, such as organ transplants and ICU beds, presents several ethical challenges. Healthcare professionals must ensure all patients have fair access while balancing varying needs, avoiding discrimination and prioritising patients during crises, such as the COVID-19 pandemic.

Triage systems and prioritisation play a crucial role in ethical decision-making within healthcare, especially during times of resource scarcity. They prioritise patients most likely to benefit from treatment and provide clear and consistent guidelines to assist in making difficult decisions and treating patients equitably. They also ensure resources are allocated fairly and efficiently, thus aiming to maximise overall benefit while maintaining equity and public trust.

Resource allocation can significantly impact health disparities, leading to unequal health outcomes across different populations. Therefore, it is vital to address this through targeted policies and equitable distribution of resources to ensure all populations have access to the necessary health and social care services. Improving health literacy is also crucial to enable all patients to understand their options and make autonomous decisions.

Understanding Ethical Principles in Health and Social Care

Ethical Decision-Making Models and Frameworks

Various models and frameworks guide ethical decision-making in healthcare and help navigate complex ethical dilemmas.

The Four-Quadrant Approach

The four-quadrant approach integrates the four principles (autonomy, beneficence, non-maleficence and justice). It divides ethical considerations into four quadrants – medical indications, patient preferences, quality of life and contextual features.

Healthcare professionals can use this model to analyse and resolve ethical dilemmas by working through the four quadrants and asking various questions.

Medical indications – focuses on the medical facts of the case, including diagnosis, treatment options, and prognoses.

  • What is the patient’s diagnosis?
  • What are the treatment options?
  • What are the likely outcomes (goals) of each option (prognoses)?
  • What are the medical benefits and risks of the proposed treatments?
  • Are proposed treatments curative, palliative or preventive?

Patient preferences – considers the patient’s wishes and autonomy.

  • Does the patient have the mental capacity to make decisions?
  • What are the patient’s preferences regarding treatment, if they have the capacity to make decisions?
  • If the patient lacks capacity, what is in their best interests and what is known about their wishes?
  • Are there any advance directives or previously expressed wishes that should guide the decision?

Quality of life – evaluates how the proposed treatments will affect the current and future of the patient’s quality of life from their perspective.

  • How will the proposed treatment improve, maintain, or diminish their quality of life?
  • What are the potential benefits and burdens of the treatment?
  • What does the patient consider a good quality of life? How do they value different aspects of their life and health?

Contextual features – looks at the broader context of the case, including social, legal, and economic factors.

  • Are there any social, cultural, or religious factors that should be considered in the decision-making process?
  • What are the legal implications of the decision?
  • Are there any economic factors that might influence the decision?
  • Are there any resource limitations?

This framework can help healthcare professionals consider all relevant aspects of a case, thus leading to more balanced and ethical decision-making.

Some examples of applying the four-quadrant approach in practice include:

  • Clinical ethical committees when systematically analysing and resolving ethical issues in patient care.
  • Acute care settings when making decisions on complex cases, e.g. a patient refusing life-saving treatment, making decisions about end-of-life care or keeping a patient on life support.
  • Mental health services address ethical issues related to patient autonomy, consent, and the balance between beneficence and non-maleficence. For example, where a patient is a risk to themselves and others.
  • General practice navigates ethical dilemmas in everyday practice, e.g. sharing patient information, addressing cultural or religious considerations and managing chronic illnesses.

Further information

The Ethical Decision-Making Process

Making ethical decisions in health and social care involves several key steps to ensure that decisions are fair and made thoughtfully and responsibly. Healthcare professionals should:

  • Identify the ethical issue or dilemma and clearly define it, as it helps to lay the foundation for the whole decision-making process.
  • Gather all relevant information, including medical facts, patient preferences, legal considerations, and any other essential data.
  • Evaluate available options and consider possible courses of action while considering each option’s benefits and risks and the four ethical principles.
  • Make a decision based on evaluation of options, ethical and legal principles and professional guidelines. The patient (if possible), their family and other healthcare professionals should be involved, and it should be a collaborative decision.
  • Implement the decision, inform everyone involved and ensure they understand the chosen course of action.
  • Reflect on the decision, the outcome and the decision-making process after implementation to learn and improve future ethical decision-making.

Gathering relevant information, considering all stakeholders, and reflecting on ethical principles is vital for the following reasons:

  • Gathering all relevant information creates a complete picture of the situation and is crucial for making informed decisions. It also highlights potential ethical dilemmas and the consequences of various choices.
  • Considering all stakeholders makes decision-making inclusive and balanced when all stakeholders (patients, families, healthcare professionals and policymakers) are involved and diverse perspectives are considered.
  • Reflecting on ethical principles provides a framework for evaluating options and making decisions that respect the rights and dignity of all involved. When healthcare professionals reflect on these principles, it ensures that decisions align with both professional standards and personal moral values.

Here are some examples of case studies demonstrating the ethical decision-making process:

Balancing Competing Ethical Principles

Resolving conflicts between ethical principles, such as autonomy and beneficence, can be challenging, but there are several strategies that can help healthcare professionals effectively navigate these dilemmas:

  • Use established ethical frameworks, models and guidelines, such as the four principles of biomedical ethics, the four quadrant approach and standards relevant to specific professions.
  • Engage in reflective practice to consider own values and biases and how these might impact decision-making. Also, reflect on past cases with similar conflicts and consider the implications of prioritising one principle over another.
  • Maintain open, clear, honest and transparent communication with all stakeholders involved in decision-making, as it can help build trust and credibility.
  • Balance the principles and consider the costs, risks and benefits. Try to find a middle ground to respect both principles, e.g. providing detailed information and obtaining informed consent can uphold autonomy while ensuring the patient receives beneficial care.
  • Personalise care and treatment plans to meet patient’s specific needs and preferences, as this respects their autonomy and the beneficence principle.
  • Seek support when faced with complex dilemmas. Support networks may include colleagues, supervisors, ethical committees, professional bodies, etc. They may provide valuable insights and additional support.
  • Undertake regular training and continuous professional development on ethical issues and conflict resolution to help handle conflicts effectively.

By employing these strategies, healthcare professionals can navigate the complex interplay between ethical principles and resolve and balance ethical dilemmas thoughtfully.

Multidisciplinary collaboration is vital when balancing competing ethical principles. Healthcare professionals from various backgrounds and specialities can bring diverse expertise and perspectives, thus enhancing decision-making and leading to a more holistic approach to patient care. It also helps to reduce the risk of errors due to a lack of information and miscommunication and can improve efficiency.

Healthcare professionals should also seek input from ethics committees where necessary, as they can provide valuable guidance on complex healthcare and ethical issues and make patient care and treatment decisions while considering ethical principles. They also help protect patients’ rights and autonomy and can also mediate and resolve conflicts between stakeholders if they occur.

We have real-world examples and case studies of balancing competing ethical considerations in care here.

Ethical Decision-Making Models and Frameworks

The Role of Professional Codes of Ethics

Healthcare professionals should understand professional codes of ethics relevant to their field and adhere to ethical guidelines in practice.

Understanding Professional Codes of Ethics

Professional codes of ethics help professionals maintain integrity, accountability and trust in their respective fields. They are vital frameworks that guide various profession’s behaviour and decision-making processes. Some examples include (this list is not exhaustive):

  • The Health and Care Professions Council (HCPC) – the Standards of Conduct, Performance and Ethics, an ethical framework within which registrants must work.
  • Nursing and Midwifery Council (NMC) – the Code contains professional standards of practice and behaviour for nurses, midwives and nursing associates.
  • General Medical Council (GMC) – Professional Standards for doctors set out the principles of good medical practice and describe the values, knowledge, skills and behaviours expected of all doctors. The British Medical Association also has advice and guidance here.
  • The British Association of Social Workers (BASW) – the Code of Ethics states the values and ethical principles on which the profession is based.

These codes guide ethical behaviour and decision-making in practice, as they provide a framework to follow and help them make informed decisions that align with ethical and professional expectations. They also ensure healthcare professionals:

  • Maintain high standards.
  • Practice effectively.
  • Promote professionalism and trust.
  • Prioritise patient safety.
  • Navigate ethical dilemmas professionally.

Continuous professional development (CPD) has a crucial role in maintaining ethical standards, and it is mandatory in healthcare to meet regulatory requirements. Respective professional bodies require those working in their fields to undertake regular CPD to maintain their licenses and registration. It is also important as it:

  • Keeps knowledge and skills up-to-date and enables healthcare professionals to stay informed about the latest legal and ethical guidelines.
  • Enhances knowledge and skills and increases competence, thus leading to better quality care and improved patient outcomes.
  • Helps navigate complex ethical issues and make decisions that are in the best interest of patients.
  • Demonstrates a commitment to the profession and ethical practice, thus fostering a culture of continuous improvement and ethical practice.

Adhering to Ethical Guidelines in Practice

Ethical guidelines help professionals to act ethically and maintain public trust in their respective fields. Understanding and following professional ethical guidelines in healthcare and social care is crucial for several reasons:

  • It safeguards patients, as ethical guidelines ensure that healthcare professionals act in the best interests of their patients, avoid harm and promote their well-being.
  • It fosters trust when healthcare professionals demonstrate ethical behaviour, and patients are more likely to engage in their care and treatment, thus improving their health outcomes.
  • It protects healthcare professionals from legal issues by ensuring their actions comply with the law and reduces the risk of mistakes, misunderstandings and malpractice claims.
  • It allows healthcare professionals to keep up-to-date with the latest practices, undertake continuous professional development and deliver high-quality and consistent care.

Failing to adhere to professional guidelines can lead to ethical breaches, which can have significant consequences for patients, healthcare professionals and organisations. These consequences can include:

  • Harm to patients – ethical breaches can lead to medical errors and confidentiality violations, which can lead to physical, emotional and psychological harm to patients.
  • Loss of trust – compromising ethical standards can undermine trust between healthcare professionals and patients, which is fundamental in providing effective care.
  • Legal action – healthcare professionals and providers can face criminal and civil legal action in serious cases, which can cause reputational and career damage.
  • Professional discipline – ethical breaches can lead to disciplinary action from their professional bodies, which can lead to suspension or revocation of their license or registration to practice.
  • Operational impact – ethical breaches can disrupt healthcare operations, thus leading to increased scrutiny and reduced services.

Another vital aspect of adhering to ethical guidelines is accountability. It ensures healthcare professionals take responsibility for their actions – essential for maintaining high standards of care and upholding ethical standards. It creates an environment where errors are acknowledged and addressed constructively, thus enhancing patient trust, safety and quality of care.

Here are some case examples of ethical challenges and how professional codes provide guidance:

Case example – a patient arrives at A&E unconscious and requires immediate surgery, but there is no time to obtain informed consent.

  • Guidance from professional codes – the General Medical Council (GMC) advises that doctors act in patients’ best interests in emergencies when they cannot obtain consent. It includes considering what the patient would have wanted and consulting with family members if possible.

Case example – during the COVID-19 pandemic, healthcare providers had to decide how to allocate limited ventilators.

  • Guidance from professional codes – the British Medical Association (BMA) provided ethical guidance, emphasising principles such as fairness, minimising harm, and transparency. They helped healthcare professionals make difficult and ethically justifiable decisions about resource allocation. Macmillan Cancer Support also has information about some ethical challenges associated with the COVID-19 pandemic here.

Case example – a patient with a communicable disease refuses to inform their close contacts, posing a public health risk.

  • Guidance from professional codes – the Nursing and Midwifery Council (NMC) Code advises nurses to maintain patient confidentiality but also allows for breaches in cases where there is a significant risk to public health. It helps navigate the ethical dilemma of protecting individual privacy while ensuring public safety.
The Role of Professional Codes of Ethics

Ethical Considerations in Emerging Healthcare Trends

Several ethical considerations arise with emerging healthcare trends, such as technological advancements, global health issues and cultural sensitivity.

Technological Advancements

Technology is advancing rapidly in many sectors. In healthcare, artificial intelligence (AI) is improving diagnoses, wearable devices are helping to monitor patients’ health and detect early issues, and telemedicine is enabling patients to receive medical advice and treatment without needing to visit a healthcare setting (the Health Foundation) (the King’s Fund).

With this rise of new technologies and increasing advancements in healthcare comes different ethical challenges, such as (this list is not exhaustive):

  • Data privacy and security – patients’ data must be protected, kept private and secure and confidentiality upheld. There are concerns regarding how this can be achieved when collecting, storing and sharing data and the potential for data breaches and misuse of personal information when using technology. Breaches can lead to harm and a loss of patient trust.
  • Informed consent – is an essential aspect of autonomy. Technology can make it difficult to obtain informed consent from patients, explain how their data will be used and shared, and the limitations and risks associated with these systems. Patients may find it difficult to fully understand what they are consenting to.
  • Bias and fairness – AI systems and algorithms may introduce biases or perpetuate existing ones if they are not carefully designed or monitored, potentially leading to unfair treatment, diagnostic errors and unequal outcomes. The Nuffield Council on Bioethics has further information on this here.
  • Equitable access – while technology can improve access to healthcare, it can increase the risk of widening the digital divide and exacerbate health disparities, especially for marginalised communities. Some people may lack digital literacy skills or access to these technologies.

In addition to the above, there are also the following ethical implications associated with digital health records and data sharing:

  • Data ownership – there is an ongoing debate regarding who owns the data. Is it the patient, healthcare provider, institution or the system collecting and storing the data?
  • Ethical data use – patients’ data should be used ethically and in a way that improves their healthcare outcomes without exploitation. There are ethical considerations regarding sharing their data for research, development or commercial purposes.

These considerations highlight the need to balance innovation and the benefits of emerging healthcare technologies with patient safety, privacy concerns, and other ethical considerations. New technologies and treatments require rigorous testing and evaluation to ensure their safety and effectiveness, and ethical principles must be maintained to ensure technology is implemented in ways that are ethical and beneficial to all.

Global Health Issues

According to the British Medical Association (BMA):

“Global health refers to issues that transcend national boundaries and governments. Global health trends increasingly impact on the UK health service, affecting doctors, patients, resources – like medicines and instruments – and the social determinants of health.”

The impact of global health trends can create disparities, which are significant differences in healthcare access and health outcomes across various populations and regions. For example, the COVID-19 pandemic highlighted the inadequacies of all health systems and intensified health disparities between and within countries (World Health Organisation). These disparities are often more pronounced in resource-limited settings, where infrastructure, funding and workforce are insufficient to meet the population’s needs.

Addressing global health disparities and providing care in resource-limited settings involves several key ethical considerations, such as:

Equity and justice

  • Ensuring care, treatments and resources are fairly distributed, even when limited.
  • Prioritising the needs of the most disadvantaged groups to benefit them and reduce health inequalities.

Respect for individuals and communities

  • Respecting the autonomy, dignity and rights of individuals.
  • Understanding and respecting cultural, social and economic contexts.
  • Involving individuals and communities in decision-making processes and ensuring informed consent.
  • Tailoring interventions to meet specific needs, values and preferences of individuals and communities.

Sustainability

  • Focusing on building sustainable healthcare systems that can continue to function effectively after withdrawing external support.
  • It may involve:
  • Training local healthcare workers.
  • Developing and investing in local infrastructure.
  • Ensuring care and treatments are deliverable in the long term.

Transparency and accountability

  • Maintaining transparency regarding goals, decision-making processes and outcomes.
  • Being accountable to local communities and international stakeholders to:
  • Foster trust and collaborate effectively.
  • Ensure the effective use of resources.
  • Ensure the decisions and actions are in the best interest of communities.
  • Ensuring patients in resource-limited settings have the same informed consent and rights as others.
  • Respecting patients’ rights to make their own decisions about their healthcare, even though it may conflict with public health goals
  • Providing clear, understandable information about treatment options and respecting patients’ decisions.

International collaboration, e.g. with governments, organisations and communities, and ethical guidelines are crucial in global health initiatives. Collaboration promotes resource sharing between countries and community involvement, thus leading to more appropriate, accepted and effective interventions. Ethical guidelines ensure fair and equitable partnerships that can be mutually beneficial and non-exploitative and aid in maintaining globally high standards.

Balancing local and global ethical obligations in healthcare can be challenging. There may be:

  • Conflicting priorities – immediate needs of patients locally can often overshadow global responsibilities, especially where resources are limited.
  • Conflicting ethical principles – there may be situations where local and global ethical principles conflict, e.g. prioritising local patients over international aid during a pandemic.
  • Conflicting regulations and ethical frameworks – different countries have varying laws, standards and ethical frameworks, thus making it difficult to navigate. It can create conflicts and complicate global health efforts.
  • Conflicting geopolitical and cultural boundaries – there may be ethical dilemmas, such as power imbalances and different health priorities, due to varying geopolitical and cultural boundaries between and within countries.

These challenges require healthcare professionals to navigate complex ethical landscapes, balancing immediate local needs with broader global health goals.

Further information

Cultural Sensitivity

Cultural competence involves developing the skills and knowledge necessary to interact with people from different cultural backgrounds. It is also about respecting one’s own and their cultural identity and biases. It is crucial in ethical decision-making, as it helps healthcare professionals effectively understand and appreciate patients’ cultural backgrounds, differences and perspectives. It also:

  • Ensures respectful and inclusive decision-making that respects patients’ needs and values and helps prevent biases and misunderstandings.
  • Builds trust, as patients are more likely to openly and honestly communicate with professionals who are respectful of their cultural values and beliefs.
  • Helps provide more person-centred care and treatments that meet patients’ needs, thus leading to improved health outcomes.
  • Assists healthcare professionals in balancing ethical considerations with cultural respect and helps navigate ethical dilemmas.

Addressing ethical dilemmas arising from cultural differences in healthcare practices can be challenging and create complex situations for patients and healthcare professionals. Language differences can create communication barriers, and cultural and religious dietary restrictions can impact patient care. Some cultures may also not permit certain types of care and treatments, which can conflict with what is in the patient’s best interests.

Cultural competence helps healthcare professionals navigate ethical dilemmas and provide equitable care. They must provide culturally sensitive care while maintaining ethical standards, and here are some strategies they can adopt:

  • Undertake cultural sensitivity training and continuous education to enhance their understanding of various cultural backgrounds, beliefs, and practices, and to appreciate cultural nuances and avoid biases.
  • Comply with legal standards and ethical guidelines, such as the Equality Act 2010, to promote equality and avoid discrimination. The Care Quality Commission details how culturally appropriate care is relevant to adult social care regulations here.
  • Use ethical decision-making frameworks to help navigate ethical dilemmas. They allow for an objective approach to ethical decision-making and consider the cultural context of the patient while adhering to professional ethical standards.
  • Develop and follow inclusive policies and practices that promote cultural sensitivity, e.g. inclusive hiring practices and cultural competence training for staff. It provides a welcoming healthcare environment that is respectful of all cultural backgrounds.
  • Create and follow personalised care plans that respect cultural needs, preferences and practices, such as religious and dietary.
  • Use culturally appropriate communication strategies, including interpreters and culturally appropriate educational materials, and adapt them where necessary to increase patients’ understanding and make them feel valued and respected.
  • Build relationships and engage with diverse communities to help understand their diverse needs and collaborate to identify solutions that respect cultural differences.
Ethical Considerations in Emerging Healthcare Trends

Conclusion

Balancing ethical considerations in health and social care is challenging but necessary for healthcare professionals. It helps them comply with ethical and legal requirements and ensures that patient autonomy is respected and they make decisions in the best interest of patients. Overall, it is crucial for effective and morally sound care and treatment, thus promoting patient well-being and health outcomes.

Healthcare professionals should understand the four ethical principles, autonomy, beneficence, non-maleficence and justice, as they lay the foundation for ethical decision-making. These principles, along with various models, frameworks, professional codes and guidelines, help navigate ethical dilemmas in health and social care.

Continuous ethical reflection and professional development are vital in health and social care, especially with emerging healthcare trends, such as technological advancements, global health issues and cultural sensitivity. It helps healthcare professionals keep up-to-date with the latest ethical and legal best practices and enhances their ethical decision-making capabilities.

Healthcare professionals should engage in ethics training and seek guidance when faced with ethical dilemmas, as breaches can have serious consequences for all involved. It will help reduce the risk of mistakes and breaches and identify the best course of action for the situation. Making decisions in the best interest of patients should be at the forefront when balancing ethical considerations.

Some resources for further reading and ethics education include:

There are also several books, journals and YouTube videos on healthcare ethics.

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