by Crispin Best
I was recently one of several Nelson Croomers who took part in a meeting to discuss a new medical ethics and law course that we are just starting to develop. Stories of incompetent or downright naughty doctors still always manage to cause a stir, so I was really looking forward to learning more about what rules and strictures doctors are really encouraged to follow.
After the initial stages of the meeting, we got to the meat of the issue: the prospective content of the course.
"What do we want to cover?" we asked. And there was plenty!
Before too long, various terms were being thrown around at lightning speed:
"We have to cover non-maleficence!"
"Don't forget autonomy."
"And beneficence."
At this point, in spite of the terminology being bandied about, I think I was just about managing to keep up with proceedings. Then the Latin started,
"Well, yes, voluntus aegroti suprema lex," said one of the subject experts.
"Hear, hear!" I replied. Or I might have if I'd had any idea what he had just said, (sadly my Latin is confined mostly to football club mottos.) I rather wearily felt like medical ethics was going to be the cause of more headaches than it was going to help cure.
Medical ethics obviously is an issue that gets people going, and I was starting to understand why people are so fascinated by it. It's (literally) a life and death issue, and doing the right thing doesn’t always seem obvious. What's more, in spite of the emotions that are surely involved, if you're not careful it all has a tendency to sound so cold.
I think a few of the client contingent started to sense a certain amount of uncertainty on some of our parts. One of their party, a lady who specialises in seminars for newly qualified doctors, explained:
"Well. It's actually very simple. There's a technique that we use in our sessions to help people remember the basics. We call it 'The Kindergarten Rules'."
This got me interested. She carried on:
"For example, when talking about the dos and don'ts of confidentiality, which is one of the key principles of medical ethics, we just tell them all to remember: "Don't tell tales". That’s how to stay safe."
So maybe confidentiality is as simple as that, but surely that can't be said for all the key principles?
Well. It turns out you can do this with pretty much all of them. Patient autonomy becomes "Don't boss people around". Dignity becomes "Show respect". Justice (referring to the equal distribution of care) becomes "Always share". Non-maleficence becomes "Don't hurt people". Beneficience becomes, rather sweetly, "Try to help people".
The doctors were laughing, and so were we. It was as simple as that. Just by looking at the principles from a slightly different viewpoint, the rules immediately came to life in a way that couldn’t be failed to be understood by everyone.
And there we had it. Although there will always be situations which demand interpretation, in general the responsibility of the doctor is basically to follow a set of rules that they were all probably brought up with anyway. The whole content of this course, which minutes ago had seemed so hard to grasp, had been boiled down, brilliantly, to a list of seven-or-so key points that could have come straight from the wall of a nursery school.
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