Ethics support for GPs: what should it look like?
Monika Clark-GrillCorrespondence to: Dr Monika Clark-Grill, Department of Primary Health Care and General Practice, Wellington, University of Otago, 45 Melville Street, Dunedin 9016, New Zealand. Email: monika.clark-grill@otago.ac.nz
Journal of Primary Health Care 8(1) 75-81 https://doi.org/10.1071/HC14999
Published: 31 March 2016
Journal Compilation © Royal New Zealand College of General Practitioners 2016.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Ethics support services for hospital clinicians have become increasingly common globally but not as yet in New Zealand. However, an initiative to change this is gathering momentum. Its slogan ‘Clinical ethics is everyone’s business’ indicates that the aim is to encompass all of health care, not just the hospital sector. General Practitioners (GPs) deal with ethical issues on a daily basis. These issues are often quite different from ethical issues in hospitals. To make future ethics support relevant for primary care, local GPs were interviewed to find out how they might envisage ethics support services that could be useful to them.
METHODS: A focus group interview with six GPs and semi-structured individual interviews with three GPs were conducted. Questions included how they made decisions on ethical issues at present, what they perceived as obstacles to ethical reflection and decision-making, and what support might be helpful.
FINDINGS: Three areas of ethics support were considered potentially useful: Formal ethics education during GP training, access to an ethicist for assistance with analysing an ethical issue, and professional guidance with structured ethics conversations in peer groups.
CONCLUSION: The complex nature of general practice requires GPs to be well educated and supported for handling ethical issues. The findings from this study could serve as input to the development of ethics support services.
KEYWORDS: General practice; primary care; ethics; support; education
References
[1] Callahan D.[2] Kleinman A. Writing at the margin. Discourse between anthropology and medicine.
[3] Papanikitas A. Ethics of the ordinary: a meeting run by the Royal Society of Medicine with the Royal College of General Practitioners London J Prim Care 2011; 4 70–72.
[4] Papanikitas A, Toon P. Primary care ethics: a body of literature and a community of scholars? J R Soc Med 2011; 104 94–96.
| 21357971PubMed |
[5] Rogers WA. A systematic review of empirical research into ethics in general practice BJGP 1997; 47 733–737.
| 1:STN:280:DyaK1c7otVSmsA%3D%3D&md5=a766019971790a5efef7e5816d6cf762CAS | 9519523PubMed |
[6] Doyal L, Doyal L, Sokol D. General practitioners face ethico-legal problems too! Postgrad Med J 2009; 8 393–394.
[7] Sturman NJ, Parker M, van Driel ML. The informal curriculum: General practitioner perceptions of ethics in clinical practice Aust Fam Physician 2012; 41 981–984.
| 23210125PubMed |
[8] Papanikitas A. Ethicality and confidentiality: Is there an inverse-care issue in general practice ethics? Clin Ethics 2011; 6 186–90.
| Ethicality and confidentiality: Is there an inverse-care issue in general practice ethics?Crossref | GoogleScholarGoogle Scholar |
[9] Armstrong D. Clinical autonomy, individual and collective: the problem of changing doctors’ behaviour Soc Sci Med 2002; 55 1771–1777.
| 12383461PubMed |
[10] Berney L, Kelly M, Doyal L, Feder G, Griffiths C, Rees Jones I. Ethical principles and the rationing of health care: a qualitative study on general practice Br J Gen Pract 2005; 55 620–625.
| 16105371PubMed |
[11] Førde R, Aasland OG. Moral distress among Norwegian doctors. J Med Ethics 2008; 34 521–525.
| 18591286PubMed |
[12] Martin R. Rethinking primary health care ethics: ethics in contemporary primary health care in the United Kingdom Prim Health Care Res Dev 2004; 5 317–328.
[13] Braunack-Mayer AJ. What makes a problem an ethical problem? An empirical perspective on the nature of ethical problems in general practice J Med Ethics 2001; 27 98–103.
| What makes a problem an ethical problem? An empirical perspective on the nature of ethical problems in general practiceCrossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3itVKqsQ%3D%3D&md5=102b2064d6fc28c15aee0a26ae22ba18CAS | 11314166PubMed |
[14] Gardner J, Papanikitas A, Owens J, Engward H. Emerging themes in the everyday ethics of primary care: a report from an interdisciplinary workshop Clin Ethics 2011; 6 211–214.
[15] Mintzker Y, Rogers W. General practice ethics: text messages and boundaries in the GP–patient relationship: AFP 2015; 44 593–595.
[16] Rogers WA, Braunack-Mayer AJ. Practical ethics for general practice.
[17] Slowther A. Ethics case consultation in primary care: Contextual challenges for clinical ethicists Camb. Q Healthc Ethics 2009; 18 397–405.
| Ethics case consultation in primary care: Contextual challenges for clinical ethicistsCrossref | GoogleScholarGoogle Scholar | 19715626PubMed |
[18] Fox E, Myers S, Pearlman RA. Ethics Consultation in United States Hospitals: A National Survey Am J Bioeth 2007; 7 13–25.
| Ethics Consultation in United States Hospitals: A National SurveyCrossref | GoogleScholarGoogle Scholar | 17366184PubMed |
[19] Slowther A. Embedding clinical ethics in a health care system: The experience of the UK clinical ethics network Bioethics Forum 2008; 1 40–4.
[20] Macdonald A, Worthington R.
[21] Macdonald, A. http://www.rcw.org.nz/uploaded/file/downloads/Clinical_ethics_almacdonald.pdf; accessed 12.11.2015
[22] Byrne M. Hermeneutics as a methodology for textual analysis AORN J 2001; 73 968–70.
| Hermeneutics as a methodology for textual analysisCrossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M3ptlylsw%3D%3D&md5=15d632bee0f524a0e933cafa14d69444CAS | 11378953PubMed |
[23] Ezzy, D.
[24] Beauchamp TL, Childress JF. Principles of Biomedical Ethics. (7th edition).