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Life at Work
Jennifer Trueland

For doctors facing ethical conundrums at work, the answers often require extensive research to unearth. In response, the BMA ethics department has repackaged its core guidance into a digital version, which can be accessed and searched in seconds.

At 925 pages long, weighing 1.5kg and costing more than £100 in hardback, Medical Ethics Today – the BMA’s Handbook of Ethics and Law has always been a big beast.

However, now its core elements have been distilled into a new online version, which is instantly accessible, easily searchable, with content which can be constantly updated to consider the latest guidance or changes in law.

According to Julian Sheather, specialist adviser (ethics and human rights) with the BMA, it was time to move the core guidance online.

‘Previously we brought out a new edition of Medical Ethics Today every five to 10 years but the books became extremely large and, with things being so fast-moving in the field, it was difficult to keep them up to date.

SHEATHER: Books were becoming very large

‘We decided to replace the book with an online version of our core ethical guidance, which covers those areas where doctors most routinely encounter ethical questions and dilemmas in their practice.’

It covers real-world issues based on actual problems identified by doctors, he says, and provides a framework for making ethical decisions. ‘For example, someone might want to know how long to keep medical records, or what if the police want access to medical records – they might be asking “can I provide them?” or “what would I need to take into consideration?”.

‘There are a lot of questions doctors ask where there is a straightforward legal answer. But there are also areas where the law is silent, or it says you can do this, but you need to make a judgement or a decision. Even if there’s a legal answer, and that can be helpful, it can still leave a lot up to professional judgement. It’s in these areas where ethical advice is necessary.’

Practical solution

The guidance contains a flowchart of how to approach ethical questions, he adds, including what to take into consideration when coming to a decision. It is also completely up to date with GMC guidance and policy – and will be updated when this changes.

‘This is the first time we’ve brought out a very navigable, searchable core set of guidance. I think it will be extremely helpful for medical students and practising doctors because it’s all in one place, it’s practically orientated, it’s designed specifically for doctors – and it’s highly practical.

'It’s focused on the sorts of things doctors will confront day in, day out – things such as confidentiality and data protection that we in the BMA ethics department get questions about all the time. That’s front and centre of this new guidance.’

Empowered users

Jan Wise, chair of the BMA medical ethics committee, says the guidance is invaluable for all doctors, but perhaps especially for those starting out in their careers. In his experience as an educator, medical students find ethics ‘phenomenally interesting’, and already find it incredibly useful to access guidance with real examples, rooted in actual practice. Putting it online – and easily searchable – will make it even more so.

Jan Wise
WISE: ‘We want people to be able to work things out for themselves’

‘When you’ve been in the field for two or three or even more decades and you’ve dealt with problems thousands of times, it’s a well-trodden path. But to someone who’s coming to the forest for the first time, the path isn’t clear.

'We want people to be able to work things out for themselves, and that’s where the BMA’s ethics guidance can be invaluable. It’s not doing it for them, it’s helping them to find the way for themselves to navigate so that they can do it again, and again, and again.

‘It’s easy for people like me who have been around for a long time to pontificate and say it’s obvious – well if it was that obvious you wouldn’t need the contents of a book that’s 1.5kg.’

Different people need parts of the guidance at different points in their careers, he adds. ‘I’m not terribly familiar with the ins and outs of the bits which apply to children because I treat adults,’ adds Dr Wise, who is a psychiatrist.

‘But it’s written in such a way that it’s accessible or understandable to those who might not be experts in a particular area, so that when they need it, the map is there – the guidance to keep them safe.’

The core ethics guidance falls under six main headings

These are:

  • How to approach an ethical question
  • The doctor-patient relationship
  • Consent and refusal by adults with decision-making capacity
  • Mental capacity
  • Children and young people.

Toolkits for doctors

New and revised toolkits were published on the BMA website on 31 January covering topics which are UK-wide and specific to the devolved nations. These toolkits form the individual components of  the new core guidance. 

All have been updated to refer to new GMC guidance that came into effect on 30 January. The toolkits are:

  • How to approach an ethical question
  • Doctor-patient relationship
  • Confidentiality
  • Consent
  • Children and young people.

There will also be new versions of toolkits on capacity and incapacity, covering the situation in different nations of the UK. These are:

  • England and Wales: Mental Capacity Act
  • Northern Ireland: Mental Capacity in Northern Ireland
  • Scotland: adults with incapacity Scotland.