Ethics in Health Care

You are on night shift, running two operating theatres. A recidivist 
drunken driver is in one, having his arm reimplanted. In quick succession, 
you have five more candidates for theatre: three women for emergency 
caesareans, a 22-year-old stabbing victim you have reason to believe is a 
drug-dealer, and a nun in her seventies whose chances of survival also 
depend on how long she has to wait for surgery. 

You have a rationing dilemma: who among the newcomers goes to surgery 
first, or at all, tonight? 

Not all can. Do you have to go through with the long process, already under 
way, of the arm reimplantion in the first theatre? 

How might ethics guide you here? 

Is there any agreed, simple ethical formula you can tap into to get the 
right answer? 
No. 
Do you then have to give up on ethics? 
No. 
So, which criteria for allocating the theatres and staff should you go 
for? -- and in consultation with the other staff? -- and with the 
candidates? 

> How should the criteria be chosen and weighted? 
> What of the chances of success, and to what degree, for each person with 
and without surgery? 
> What about life expectation, and quality of life? 
> Should age be a criterion at all, if not why not, and if so why, and to 
what degree? 
> How much are babies worth as against adults? 
> Is your view of the 'social worth' of the candidates to count? 

If so, how much? 

To what extent should you follow a queuing principle, according to which, 
other things being equal, it is first come, first served?- but other things 
are not equal. And so on..... 

You make your decisions.... It is a long night.

The outcome in due course: three healthy new babies, five healthy adults 
and one dead adult. Looking back on that night later on, how can you 
reasonably justify the choices you made? 

This is the sort of dilemma - though not all are so starkly immediate - 
that a participant might bring to the Ethics in Health Care Course at the 
University of Oxford's Centre for Professional Development. 

This course is a freestanding module at the Master's level, as well as 
being an accredited unit on the University's MSc in Evidence-Based Heath 
Care. It aims to help participants analyse and assess arguments within the 
ethics of health care; to argue effectively, taking the strongest counter-
arguments into account; to apply some main ethical concepts and theories to 
selected moral dilemmas; to appraise some main current frameworks for 
discussion of health-care ethics; and to articulate their own moral values. 

The syllabus covers aspects of ethical theory and relates them to health-
care and to specific topics within that, such as consent, autonomy, 
resource allocation, and issues at the beginning and end of life. Student-
led seminars, and the course assignment itself, analyse ethical dilemmas 
participants have met in their own professional experience. Resources are 
discussed, such as the UK Clinical Ethics Network. 

Donald Hill, of Ethox, University of Oxford, is course tutor. Visiting 
lecturers are Dr. Helen Aveyard, of Oxford Brookes University, and Prof. 
Tony Hope, Prof. Michael Parker and Dr. Anne Slowther, all of Ethox. 

The taught part of the next course is over five full days in Oxford on 22 
and 29 September and 6,11 and 13 October 2005. Those wishing to may 
complete a piece of assessed work over the following 7 weeks and earn 
academic credit which may be counted towards a Postgraduate Qualification. 

For more information or to register contact 
Phoebe Chen
Tel: +44 (0)1865 286947 Fax: +44 (0)1865 286934
[log in to unmask] www.conted.ox.ac.uk/health