Inside general practice ethics: guidelines ‘and’ ‘of’ or ‘for’ good clinical practice

Abstract

The RCGP conference, like other annual healthcare conferences offers a protected space for reflection on ethical aspects of practice. This paper presents a summary and discussion of a fringe session led by the RCGP Committee On Medical Ethics at the 2017 RCGP annual conference in Liverpool. Well thought-out rules offer a potential solution to the burden of responsibility for making every single decision from first principles. But guidelines can be difficult to follow, too numerous to know, may conflict with each-other and may not be appropriate in all circumstances. Delegates at this meeting discussed barriers to good guideline development and implementation, perceptions of medicolegal risk in non-adherence, aspects of benefit, harm and justice in guideline use and ethical guidelines. Delegates found it easier in the meeting to critique clinical rather than ethical guidelines. There was broad agreement that understanding how to practice in relation to guidelines represented a learning need in general practice education.

Availability and perceived usefulness of guidelines and protocols for subcutaneous hydration in palliative care settings

“…In situations in which the available evidence is inconclusive, as in cases of uncertainty or ethical doubts, the guidelines not only are a solid way to standardise clinical practice but also can be an important basis for individualised attention and decision‐making if they are applied according to the clinical judgement of the professionals and the wishes of the patients (Papanikitas & Lunan, ).…”

“Wrongful conception” ruling against UK general practitioner

“…However, although the Toombes judgment is surprising given the bar on wrongful birth cases and general sentiments upholding the sanctity of life in English law, it is likely to have limited application in routine practice. The notion that doctors should know and follow evidence based guidelines is already accepted and complicated only by the sheer number of guidelines available and their potential to contradict one another 8. Furthermore, documentation has improved substantially in the past 20 years, largely as a result of electronic health records.…”