12 June 2019
Indicator C2.1▶︎E Our clinical team considers ethical dilemmas.
What is an ethical dilemma?
When there is a need to choose from among two or more morally acceptable options or between equally unacceptable courses of action, when one choice prevents selection of the other an ethical dilemma occurs. An ethical issue may give rise to an ethical dilemma.
Some examples of ethical issues that providers may face in general practice are:
- Conscientious objections by providers to types of care such as termination of pregnancy or voluntary assisted dying
- Issues with determining competency for treatments or other decisions in minors, patients with dementia, or those with severe mental health issues
- Refusal of treatment or requests for an inappropriate treatment or investigations
- Vaccine refusal
- Requests to treat your own family members or staff members
Who is in my ‘clinical team’ for the purposes of accreditation?
Ethical dilemmas may be an issue for anyone, but for accreditation we are talking about the context of patient care. In these cases, it is the clinical team who will be faced with ethical dilemmas.
For the purposes of accreditation, the RACGP defines the clinical team as “all members of the practice team who have health qualifications that qualify them to perform clinical functions”. In most general practices this will be the GP and nurse(s). In other larger practices this may also include co-located allied health or mental health providers.
The RACGP states that accreditation agencies will determine whether a practitioner is part of the clinical team based on whether the practitioner:
- has access to the medical records system
- is included on the website and practice team information (for example: brochures, practice directory)
- attends practice team meetings
Further information is available in a factsheet on the RACGP website.
How can my practice manage ethical dilemmas?
As a provider, when an ethical issue arises that causes an ethical dilemma you must document in the patient notes the issues, the discussion and the outcome or solution. It is important to record these discussions in case they need to be referred to at a later stage. You may also wish to seek advice from your medical indemnity insurer if you are unsure.
As a practice there are a number of ways that you can manage ethical dilemmas. You could:
- create a culture of open discussion and collaboration around ethical dilemmas, especially encouraging younger/less experienced team members to feel comfortable seeking support from more experienced members of the team
- develop a policy or procedure that explains how the clinical team should manage ethical dilemmas
- discuss ethical dilemmas at clinical team meetings and/or in more informal settings
- provide a buddy or mentoring system in which ethical dilemmas can be discussed
- use a clinical intranet or group email to pose common ethical dilemmas and solutions for the clinical team to consider and discuss
Where can I get more information?
- The Medical Board of Australia has a useful document outlining the code of conduct for doctors in Australia
- Your medical indemnity insurer will be able to provide advice on specific issues