Challenging questions and ethical obligations: the ethics of everyday practice > 21 January 2015

Oyin Alabi


The incorporation of ethics into medical education is essential. Ethical considerations play a vital role in clinical decision-making and in order for patients’ best interests to be paramount, clinicians must develop the necessary skills to come to both reasoned and justifiable decisions. The ways in which these skills are taught in medical school can vary, one way being classroom teachings on ethical concepts and philosophical theories. Another by observing and discussing real life situations and applying ethical decision making tools to generate guidance on how to proceed when faced with ethical challenges.

In this presentation, I describe Miss D who attended a Genitourinary Medicine Clinic with vaginal discharge and pain whilst urinating. Miss D was later found to have gonorrhoea. Her sexual health history revealed one occasion in the last three months of unprotected sexual intercourse with Mr X. The nurse treating the patient explained the importance of notifying Mr X that he had been exposed to a sexually transmitted infection so that he too could be tested and treated. Miss D explicitly expressed that she did not want him to be contacted. This left the nurse with the ethical dilemma of whether she should go against Miss D’s wishes and break her confidentiality. I subsequently go on to analyse the scenario using a common decision-making tool, the ‘four principles plus scope’.

Applying the tool reveals that the principle of autonomy has restrictions, otherwise we would be morally required to respect any request from a patient no matter the consequences (1). In my scenario, it was limited by the principle of non-maleficence in terms of the harm Mr X could experience from an untreated gonorrhoea infection. It was further highlighted that beneficence in regards to Miss D would include upholding her confidentiality. However, it was shown that this must be balanced against the benefit of treating Mr X and the harm caused by not treating Mr X and his possible future sexual partners, who arguably fall within the scope of application. With the identification of conflicting principles and competing interests, the potential harms of non-disclosure were weighed against the potential harms of disclosing without consent. It was decided that the principle of non-maleficence in regards to Mr X/his future partners carried the most weight, since gonorrhoea is a serious infection and its complications are both great and avoidable. This decision was then supported by professional guidelines such as those by the General medical council and the British Association for Sexual Health and HIV Partner Notification statement (2, 3).

The presentation concludes that learning ethics via ethical decision making tools proves to be a useful and thought provoking experience, but highlights that their application may be a lengthy process. Thus using the tools may not always be practical in an acute setting. Nevertheless, it is critical for clinicians to develop these reasoning skills so that they make ethical decisions, as well as explain and justify their decisions to their patients and peers in order to create and sustain healthy doctor-patient relationships.



Oyin Alabi is a 4th year medical student at Lancaster University. Next June she will be sitting her final medical school exams and will then go to North Carolina to do her medical elective in Plastic surgery. After she has completed her current year of study, she is planning on taking a year out of medicine, to do an intercalated degree in healthcare ethics and law. Oyin has completed student selected components on topical areas such as euthanasia, saviour siblings and zenotransplantation. She has also been part of many societies whilst at Medical school and has held many roles of responsibility including being president of the charity Medsin, the academic and welfare officer for Medsoc and the vice captain of her college netball team.


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