2003 Aberdeen Spring Meeting

Held as a parallel session at the main BGS Spring Meeting in Aberdeen, the meeting of the BGS Medical Ethics Special Interest Group (SIG) began with a thought provoking presentation by Prof Fulford (Consultant Psychiatrist, University of Oxford and Professor of Philosopy at Warwick University, on value based medicine. He explained that it is his view that all people involved in healthcare, including the patient and their carers, bring to the situation very different sets of values. Increasingly in medicine, we are having our roles defined by the government or managerial objectives, and our ethics coded by law. Prof Fulford outlined two types of values:

• Outcome values which are shared values and targets against which one measures one’s decision making; and
• Process values which are the differing values which do legitimately influence the situation, but may result in conflict.

Prof Fulford went further to examine how these values can influence decision making, saying that there are 10 principles of value based medicine1, namely:

• All decisions stand on their own 2 feet, values and facts.
• We notice values when they conflict whereas shared values disappear.
• Scientific progress has opened up choices which brings a greater diversity of values into health care
• Information regarding the patient’s perspective on the situation is the ‘first call’ on the decision making process
• Conflicts are resolved by supporting a balance of different perspectives rather than a rule prescribing the ‘right’ outcome.
• Raise awareness of different values using careful language.
• Use resources available to improve knowledge of everyone’s values
• Use ethical reasoning to explore different values.
• Take on board others views and inter-actions.
• Decisions ultimately should be made by the users and providers at the coal face.

1(Abbreviated from Fulford: The principles of value-based medicine published in Radden J, Ed, Companion to the Philosophy of Psychiatry, OUP).

The audience were then invited to use these principles in exploring the ethical dilemmas raised in a clinical case presented by Steven Louw, Consultant Geriatrician, Freeman Hospital, Newcastle upon Tyne. The case described complex issues involving a PVS patient and their future needs.

There followed a fruitful, interesting and at times, heated discussion as the issues were debated.
An interesting observation was how practical we are as geriatricians, immediately focusing on the practicalities of future care provision and further rehabilitation potential, rather than the ethically challenging decisions. The audience were extremely engaged and numerous hands were still raised at the end of the session.

Anybody interested in joining the group please e.mail kleball@hotmail.com or b.j.liddle@sheffield.ac.uk

Jane Liddle
Medical Ethics SIG Secretary