Utilitarian versus Kantian ethics

Shuli Levy is a locum consultant geriatrician at the Hammersmith hospital, London, running liaison geriatrics and MDT support teams for tertiary specialist services. She has recently taken over as head of the BGS Ethics and Law special interest group. 

kant_461965I recently gave a talk to doctors and medical students in my department, about the difference in Utilitarian versus Kantian ethics and the implications for our practice as generalists and as geriatricians. It surprised me that no one, apart from one medical student, had heard the terms before. Not for the first time, I reflected on how so much of our daily work as geriatricians involves complex ethical and legal decisions but so little time is devoted to exploring and understanding them. We may use our precious CPD time to learn more about endocrinology in older people or novel approaches to the mitral valve, but rarely encounter patients for whom this is relevant in clinical practice. In contrast, ethical questions, and the statutory duties they engender, arise on every medicine for the elderly ward round, on most acute takes, daily in the community and in every MDM. These issues are difficult and complex, they are subject to varied interpretation and application and they evolve, sometimes on a case by case basis (such as the gradual hammering out of the Deprivation of Liberty Safeguard laws). Moreover (and this may be a London thing), it’s not that easy to find geriatrician orientated Ethics and Law training and updates.

As the new chair of the BGS Ethics and Law special interest group, I’d like to try to change that.   I have had the privilege of organising our upcoming one day conference, which opens the BGS Spring 2017 Meeting in Newcastle next April. Together with the group’s new secretary, Prem Fade, I have tried to identify topics that are relevant and stimulating, then match them with speakers who are expert and engaging.

Our opening session is on transitions at the end of life. Professor Edwina Brown, a nephrologist, and principal investigator on the Frail Elderly Patients on Dialysis (FEPOD) study will talk about withdrawing renal replacement therapy. Dr James Beattie, the cardiologist who wrote the BHF guidelines on ICD deactivation at the end of life will take us through this topic, and then Professor Robert Song, professor of theology at Durham University, who has published widely in the field of bioethics, will talk about religion at the end of life.

The second session focusses on recent legal developments relevant to our speciality. Baroness Ilora Finlay, professor of palliative care at Cardiff University will give an update on deprivation of liberty safeguards (following the much anticipated 2016 law commission update) and the mental capacity act. Dr Zac Etheridge, co-author of the 2015 BMJ review that examined DNAR discussions will introduce the topic of changes to DNA-CPR. Then in the final talk of the session, Dr Zoe Fritz, Wellcome fellow in bioethics and a Cambridge based physician, who created the widely used ReSPECT document, will talk about the development and implementation of this tool.

In the afternoon, we will hear from Professor Hans vanDelden, professor of medical ethics at Utrecht university in Amsterdam and a nursing home physician, whose research interests include end of life ethics and moral problems in caring for the elderly. His talk will examine the experience of assisted dying in the Netherlands, the moral, legal and ethical challenges that arise and consider how our profession should respond if assisted dying is made legal in the United Kingdom.

Finally, Professor Des O’Neill, who holds the chair in medical gerontology at Trinity College, Dublin, will end the day with a reflective look back and a contemplative look forward at medical ethics over the span of his career.

The day will be chaired by Eileen Burns, our incoming president, David Oliver, our past president and RCP clinical vice chair and Stephen Louw from the Newcastle ethics committee.

All that’s missing from this venerable line up is you, the delegates. Come along, bring your questions, comments, opinions and experiences. Engage with our speakers, stimulate and inform the debate and then take the discussions back to your teams in hospitals and in the community.

Finally, I know there are lots of you out there with expertise, qualifications and pursuits in this area that dwarf my own.  There are many others of you who are interested and enthusiastic and would like to know and debate more.  Please join our SIG – it’s free – and get involved with our activities and shaping our future (email Jo Gough: ScientificOfficer@bgs.org.uk). If you’re already a member, please keep your details up to date on the BGS website so we can continue to contact you.  If you would like to share something with me or have any suggestions for the SIG, please be in touch, as some already have: shuli.levy@imperial.nhs.uk.

And see you in Newcastle in April 2017!

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