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12MEDICOETHICAL NEW DOCTOR | VOLUME 6 | ISSUE 1 | 2013 | UNITED KINGDOM www.mps.org.ukInformativeDOCTORPaternalisticmanaged to fracture his pelvis. ECT wasnew at that time, and medical opinionwas divided on whether a relaxantanaesthetic should be used. 5In the subsequent legal action,the court was invited to decide betweenthe two competing medical schoolsof thought – relaxant or no relaxant.The court said it was not competent todecide on a medical issue. The judgein that case said that: “A doctor is notguilty of negligence if he has acted inaccordance with a practice accepted asproper by a responsible body of medicalmen skilled in that particular art.”This has been tweaked a bit overthe years, but the ‘Bolam test’ or‘Bolam standard’, also called the ‘PeerProfessional Acceptance’ or ‘Reasonabledoctor’ test, remains the yardstick.Hippocrates wrote that doctorsshould: “Continue with diligence to keepabreast of advances in medicine.”In 1711 Alexander Pope cautioned usto: “Be not the first by whom the neware tried, nor yet the last to laythe old aside.” Neither ethics nor thelaw requires us to be the best doctor inthe world, but we do need to attain andmaintain that level of skill in what we dothat would attract peer support.Shared decision making“Doctor’sorders”Passive PATIENT ActiveREFERENCES1. Schloendorff v Society of New York Hospital (1914)2. NHSLA, Risk Management Handbook (2012)3. Gillick v West Norfolk and Wisbech Area Health Authority (1985)4. Donoghue v Stevenson (1932)5. Bolam v Friern Hospital Management Committee (1957)SharedDecisionMaking“Patient’schoice”JusticeThere are three elements to Justice:■■■Distributive justice – fair distributionof limited healthcare resources■■ ■Rights-based justice – respect forpeople’s rights, such as prohibitionof discrimination■■■Legal justice – respect for the law.On an individual patient level,there are some obvious elements to‘Justice’– for example, not discriminatingagainst patients on the basis of theircolour, race, religion, etc; but can werefuse to perform cardiac surgery ona patient because they smoke? Is thatdiscrimination – punishing the patientfor not stopping – or a fair medicaljudgment based on their increased riskof complications at and after surgery?More broadly, we do our best tomaintain a focus on the patient infront of us, but we are aware of theneed to balance that patient’s rightsand needs against the need for anequitable allocation of healthcare fundsand resources. Who decides whatis ‘equitable’? The ethical principle ofJustice imposes a moral obligation todecide fairly between competing claims.Dr Nisselle is a senior consultantat MPS Educational Services.He can be contacted atpaul.nisselle@mps.org.ukLOOKING FOR EVIDENCE FORYOUR ePORTFOLIO?MPS is committed to education andtraining. As well as helping you providethe best care for your patients, we wantto support your development. That iswhy we have developed two onlinelearning modules on the topics coveredin this article, so that you can downloada certificate of completion as evidenceof your learning for your ePortfolio.What to do next….■■Once you’ve read this article, simplygo to www.mps.org.uk/e-portfoliowhere you can register for theE-learning platform■■You’ll need your membership detailsto register and log on■■Once logged on, you will be able toaccess the modules highlighted onthe home page■■You can complete the modules at atime that suits you■■Download your certificate ofcompletion and any supporting notes■■Other modules on a wide rangeof subjects can also be accessedthrough the E-learning platformTo learn more visit MPS’s website■■Access the MPS library offactsheets, this includes detailedinformation on the law aroundconsent and confidentiality –www.medicalprotection.org/uk/factsheets■■Visit the handbooks and bookletssection, to read more aboutconsent and the ethical mazethat is modern medicine – www.medicalprotection.org/uk/adviceand-publications/booklets-andhandbooks.