The Clinical Reasoning Series - Should we always give patients the treatments they want? Ethical reasoning with Prof. Clare Delany

Welcome to another episode of The Words Matter Podcast.

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Following on my previous episodes in the series with Bjørn Hofmann (here and here) where we spoke about the ethics of disease and the moral obligations that flowed from being given a disease label - on this episode we are going to speak more explicitly about clinicians' thinking directed towards ethical problems and the resulting moral judgments they should endeavour to make and the processes which delivers them to those judgments.

And so today I’m speaking with Professor Clare Delany. Clare is a Professor in Clinical Education at the University of Melbourne, Department of Medical Education, and a Clinical Ethicist at the Royal Children’s Hospital Children’s Bioethics Centre and Peter MacCallum Cancer Centre in Melbourne. She also chairs the University of Melbourne Central Human Research Ethics Committee. Clare’s health professional background is in physiotherapy.

For the past 15 years, Clare’s research and professional work has focused on a combination of clinical education and clinical ethics. Her research interests include applied health ethics, paediatric bioethics, clinical reasoning, and critical reflection and she has authored more than 100 publications in peer-reviewed journals covering these areas of applied clinical ethics and clinical education.

Clare has co-edited the books ‘Learning and Teaching in Clinical Contexts: A Practical Guide’ and ‘When Doctors and Parents Disagree: Ethics, Paediatrics and the Zone of Parental Discretion.’

So on this episode we speak about:

• What ethics is in the context of healthcare practice including the ethical principles of autonomy, non-maleficence, beneficence and justice
• About the interaction and occasional tension between evidence-based practice and ethics-based practice and how ethics can help settle clashes between research evidence, patient values and clinician judgement and experience.
• What ethical reasoning is and the processes involved In making moral judgements.
• How it feels to identify an ethical problem which is often intuitive or as Clare describes an ‘ikiness’.
• Ethical reasoning when the consequences or stakes are high.
• Communicating risk to patients prior to treatment.
• Some case examples including patients requesting seemingly ineffective treatments or treatments which the clinician may feel is potentially harmful or not in the patients best interest.
• How the ethical principles should apply to all healthcare settings, whether public or private but in reality there are differences on how these principles are interpreted and applied in these respective settings.
• And finally we speak about how ethical reasoning motivates us to be aware of our own assumptions and of the assumptions and values of others which enriches our clinical work and also the therapeutic bond with our patients.

So, this was such a wonderful conversation with Clare. She beautifully highlighted the foundational nature yet often prickliness of the ethical dilemmas we all face in practice and shares some extremely useful reasoning strategies to identify, manage and resolve the inevitable ethical moments in our clinical practice.

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