With chapters revolving around practical issues and real-world contexts, this Handbook offers much-needed insights into the ethics of primary healthcare. An international set of contributors from a broad range of areas in ethics and practice address a challenging array of topics. These range from the issues arising in primary care interactions, to working with different sources of vulnerability among patients, from contexts connected with teaching and learning, to issues in relation to justice and resources. The book is both interdisciplinary and inter-professional, including not just ‘standard’ philosophical clinical ethics but also approaches using the humanities, clinical empirical research, management theory and much else besides.
This practical handbook will be an invaluable resource for anyone who is seeking a better appreciation and understanding of the ethics ‘in’, ‘of’ and ‘for’ primary healthcare. That includes clinicians and commissioners, but also policymakers and academics concerned with primary care ethics. Readers are encouraged to explore and critique the ideas discussed in the 44 chapters; whether or not readers agree with all the authors’ views, this volume aims to inform, educate and, in many cases, inspire.
Chapter 4 of this book is freely available as a downloadable Open Access PDF under a Creative Commons Attribution-Non Commercial-No Derivatives 3.0 license. https://s3-us-west-2.amazonaws.com/tandfbis/rt-files/docs/Open+Access+Chapters/9781498769679_oachapter4.pdf
Table of Contents
Education. The consultation. Justice and resource allocation. Ethics and the vulnerable patient.
Dr Andrew Papanikitas qualified as a general practitioner in 2008. His PhD in medical education was awarded in June 2014 and is entitled, "From the classroom to the clinic: ethics education and general practice." Dr Papanikitas is part of an informal network of academics, educators, and clinicians with an interest in the study of ethics in, of, and for primary healthcare. He welcomes conversations on this topic, especially via the 'Primary Care Ethics' LinkedIn Group which is has an international and influential membership.
Dr Papanikitas is also Director of the Society of Apothercaries Course in Ethics and Philosophy of Healthcare. He has taught medical ethics and law as well as inter-professional and clinical communication skills at King's College London (KCL). He has co-led a postgraduate medical ethics course at KCL and an online Bioethics course at the University of Oxford. Dr Papanikitas holds degrees the History of Medicine, and Medical Law & Ethics, as well as postgraduate diplomas in history, philosophy and child health. Most recently he was awarded a diploma in teaching and learning in higher education by the University of Oxford, and has become a Senior fellow of the Higher Education Academy.
He is one of the founding members of the Royal Society of Medicine Student Members' Group and has served on the Trainees Section and is currently also on the council the GP and Primary Healthcare Section. He was President of the RSM Open Section from 2012-15.
Dr Spicer is Head of Primary Care Education and Development at Health Education England - South London, and a GP in Croydon, South London. In 2017 he marked 40 years of clinical practice in the UK National Health Service and overseas.
Having previously been a Senior Lecturer at St George's University of London for 10 years, he now has particular interests in the medical humanities and the nature of personal responsibility in health.
Over the last 15 years he has written widely on primary care, clinical ethics and associated educational issues. He is an editor for the London Journal of Primary Care and a Board member of the London Arts in Health Forum.
This enterprising collection spans the breadth of primary care in multiple ways. Contributions from general practitioners, philosophers, nurses, physiotherapists, dentists, health economists, educationalists, patients and others reflect the rich variety that makes up primary care. Authors do not shy away from the messy complexity of primary care. Instead, they embrace the uncertainty inherent in the day-to-day reality of primary care. Numerous stakeholder perspectives are used to identify and analyse ethical issues, using a diversity of frameworks and models. The theoretical perspectives represented in the book (ranging from Hippocrates to post-modernism) mirror the eclecticism of primary care itself. Practical advice sits alongside heartfelt accounts of issues that challenge practitioners.
The book is helpfully organised into four sections, on the primary care interaction, vulnerable patients, teaching and learning, and justice and resources. The section on teaching and learning is particularly valuable, with its strong focus on reflective practice and the practical challenges of combining service delivery with educational goals. The section on the primary care encounter is wide-ranging, including discursive explorations of important concepts as well as discussion of the specific features of primary care that warrant its own ethical analysis. Case studies provide tantalising glimpses into the consultation, thereby showcasing the richness of the primary care environment. Chapters in the section on justice and resources do not shy away from political topics such as funding models and workforce issues.
The Handbook focuses on general practice as delivered within the National Health Service, which may limit its appeal to other members of the primary care team. However, there is something here for everyone, whether the reader is looking for guidance on duties in primary care, a framework for analysing a difficult consultation, insights into the voice of the patient, or an understanding of the economics of primary care. Throughout there is a welcome focus on ‘ethics of the ordinary’ or ‘everyday ethics’, reflecting the ethical nuances of the millions of interactions that occur each day in primary care.
Wendy Rogers, Professor of Clinical Ethics, Macquarie University