Summary

The aim of this publication is to show the importance of ethics in health and social care. The emphasis in both arenas of care is significant as, up to now, ethical issues have tended to focus on either health or social care separately. This chapter begins by briefly setting out definitions of ethics, followed by providing a policy overview to illustrate the increasing impact of ethics overall that has led to ever more media coverage. Summaries of the chosen topic areas are then set out where three key arenas have been assembled for discussion. The main themes selected are ethics: research and provision in health and social care together with service users’ perspectives; followed by law, management and ethics in health and social care; with the final section on ethics: from the start of life to the end. Each chapter also sets out to identify the contemporary challenges presented for health and social care provision.

Ethics defined

Ethics is derived from the Greek ‘ethos’, meaning a person's character, nature or disposition. Ethics, as relating to morals, pertains to the distinction between right and wrong or good and evil in relation to actions, volitions or the character of responsible beings. Ethical theories can cover consequentialism (assessing principles in doing good, removing harm and preventing harm) as well as virtue ethics and deontology (acting according to morally obligatory principles or duties).

Ethical principles are concerned with aspects such as: autonomy, beneficence, non-maleficence and justice; corporate, research and collaborative governance; truth telling; confidentiality; consent and accountability, the themes of which are discussed and applied across this publication. In particular, Louise Terry provides an overview of ethical principles and contemporary challenges in Chapter Two.

Each chapter addresses selected ethical principles applied to a theme in health and social care. For example, the chapter on interprofessional care (Chapter Seven) considers the issues of beneficence, confidentiality, accountability and collaborative governance in relation to interprofessional, interagency and partnership working. The purpose of this publication is to demonstrate the increasing impact of ethics on a range of themes and arenas in health and social care. The authors’ chapters are summarised at the end of this introduction to provide an overview of the publication as a whole.

Summary

This conclusion offers a summary of interrelated themes and ethical challenges that have emerged across chapters. Review of the content has identified five broad, emergent themes, the first of which explores ethical decision making utilising principles, models, professional codes and dialogue ethics in collaborative working across organisational boundaries and systems. A second theme, user–professional relationships and roles in the context of decision making, is focused on therapeutic relationships and virtuous practice, best interests, refusing treatment and end of life decisions, equity, resources and provider, professional and user relationships. A third theme, vulnerable people, summarises the challenges that can arise in charging vulnerable older adults for their care, vulnerability to loss of personhood, protecting the claims and entitlements of future people, child protection and protecting rights and welfare in research participation.

The theme of service users summarises the case for ethical involvement of users in health and social care and explores the benefits of services working together in relation to user involvement and outcomes. The exercise of choice, equity in access, balancing liberty and public safety and challenging ageism and discrimination are also explored from a user perspective. A final theme of governance and accountability links new forms of collaborative governance and their ethical justification, summarising current conflicts and challenges for governance frameworks in general and, more specifically, in relation to research. Our intention in writing this conclusion is to offer the reader both a summary and integrated synthesis of key themes and challenges; these themes are not intended to be comprehensive and there is much more in the chapter content that will repay exhaustive scrutiny by the reader.

Ethical decision making

Principles

Health and social care professionals can apply diverse theories (deontology, consequentialism, virtue ethics), rights, principles (autonomy, beneficence, non-maleficence, justice, fidelity, confidentiality), models and frameworks to inform decision making on ethical issues; legal precedents and professional codes of conduct are also relevant. All of the chapters in this text make reference to one or more of these approaches. In Chapter Two, Louise Terry reviews the application of ethical principles, for example autonomy, beneficence, non-maleficence and justice (Beauchamp and Childress, 2001), in a range of decision-making situations familiar to health professionals. However, in resolving ethical dilemmas, the point is made that sometimes principles can be in conflict and it is then necessary to determine which take priority.

Summary

Historically, research has been tainted by incidents of unethical conduct in which vulnerable individuals were harmed. This chapter reviews events that have led to the development of codes of conduct and guidance, together with requirements to conduct ethical reviews of research involving human subjects. An overarching aim of ethical review is to protect the rights, health and well-being of research participants, utilising an approach that is sensitive to diversity, cultural values and the social and cultural context in which research is conducted. Ethical principles of respect for autonomy, beneficence, non-maleficence and justice are examined and applied to the research context as a basis for decision making. Characteristics of vulnerable groups and special considerations that can apply to their participation in research are considered. Recent developments in the arena of research governance frameworks, intended to provide accountability for the moral acceptability, scientific quality and safety of research, are also briefly reviewed.

Introduction

Research can be defined as a process of systematic enquiry involving human subjects past, present or future. In considering the moral imperative for research, few would argue with the benefits that have accrued from improvements in prophylactic, diagnostic and therapeutic procedures, the eradication of some diseases, together with improvements in quality and duration of life. The World Medical Association Declaration of Helsinki principles encapsulate key ethical principles of respect for autonomy, beneficence, non-maleficence and justice relating to medical research involving human subjects, emphasising that research is subject to ethical standards that promote respect for participants, protect their health and promote their rights:

In the conduct of research, it is vital that any foreseeable risks to the participant, whether physical, psychological or social, are removed, human dignity maintained and rights respected.