This chapter briefly explains ethical theories, principles and issues of relevance in health and social care including some recent trends in contemporary policy and practice with ethical implications. The first section, ‘What is “ethics”?’, separates ethics from morality. The question ‘What is “ethics”?’ leads to an examination of distinctions between normative and non–normative ethics, virtue ethics, ethics and law. In ‘Applied and professional ethics’, examples of ethical challenges are identified highlighting issues common to health and social care. Finally, the changing nature of professional roles and relationships, the role of protocols in relation to professional autonomy, lack of trust,...

Historically, research has been tainted by incidents of unethical conduct in which vulnerable individuals were harmed. This chapter reviews events that have led to the development of codes of conduct and guidance, together with requirements to conduct ethical reviews of research involving human subjects. An overarching aim of ethical review is to protect the rights, health and well–being of research participants, utilising an approach that is sensitive to diversity, cultural values and the social and cultural context in which research is conducted. Ethical principles of respect for autonomy, beneficence, non–maleficence and justice are examined and applied to the...

Research and Development (R&D) in health and social care is dependent on funding from government or charitable sources, public confidence and concrete support. Therefore it is essential that R&D be conducted according to regulations that are both stringent and transparent. In the UK, R&D, carried out by organisations and individuals, is subject to theResearch governance framework for health and social care(DH, 2005). This framework, which is overseen by the relevant government department, aims to enhance the promotion and quality of R&D and to ensure a sustainable research culture. Research governance compliance criteria include the need for independent scientific...

The ethical aspects of everyday work in primary health care in the UK are discussed in this chapter. In this context, four main ethical concepts of beneficence, non–maleficence, autonomy and justice, described in Chapter Two, are reviewed within the context of primary health care. Issues such as the conflicting responsibilities for primary health professionals in their duty of care to an individual and to the greater community are discussed. The implications of evidence–based clinical care and the concept of clinical equipoise are considered, as well as issues of competence and consent. The uncertain and complex world of primary...

This chapter describes examples of the values and ethical codes that aim to inform and govern practice in the overlapping domains of social care and social work in the UK. The provenance of these codes is considered. The history and nature of three broad streams of values that influence social care and social work are then described: ‘traditional’, ‘emancipatory’ and ‘governance’ values. The twin discussions of provenance and different value streams are used to argue that the codes manifest political and organisational dimensions as well as professional ones. The chapter then turns to a further dimension, interorganisational, and to a...

Ethics and interprofessional care are briefly defined to clarify a fourfold pathway for analysis.Beneficence:for whose good and who benefits from working together for health and social care?Confidentiality:how far can trust and private information be upheld for service users, across the differing administrative and professional boundaries?Accountability:to what extent can interprofessional work be held accountable to audit and regulation, to the rules of professional bodies, to management targets as well as to service users?Collaborative governance:as governance increasingly cuts across the public, private and voluntary sectors, how far can partnership working promote user involvement? One...

The ethical case for involving service users in service planning and delivery, and in research and evaluation, has been made on several grounds. One important set of reasons is that such involvement is ethical, as well as effective. In this chapter the ethical case for service user involvement is reviewed as well as how this involvement operates at various levels. Whether a consumerist or a more democratic or empowering approach is taken as the framework for such involvement, there are increasing principle–based justifications for user involvement.

Developments in health and social care in the UK, outlined inThe NHS...

This chapter examines the ethical and legal repercussions of human rights legislation. The current and future potential impact on health and social care of the enshrining of the European Convention for the Protection of Human Rights and Fundamental Freedoms into British law is explored by situating the analysis within the international perspective on human rights and the work of the World Health Organisation. An ethical critique of individual rights such as the right to the highest attainable standard of health, rights to life, liberty and privacy and the right not to be subjected to degrading or inhuman treatment, among others,...

The concept of collaborative multidisciplinary teamwork is conceived as an important catalyst and site for social and cultural transformation in the provision of health and welfare services. In increasingly diversified and pluralist health care systems, redrawing the parameters of professional practice promised opportunities for new forms of thought and action that would achieve optimal treatment outcomes and improve the experience of care for patients. Driven in part by demands for greater efficiency and effectiveness, the movement towards multidisciplinary teamwork has taken on greater urgency as an instrument by which all health care providers can be rendered more fully productive both...

Management is essentially a practical discipline that is concerned with resolving problems and making decisions about the use of resources. The common perception is that of a concern with questions of getting things done in line with the government policy of the day. However, this is only part of the story. In the increasingly complex world of health and social care, management is also concerned with questions of value and judgement. In the real world managers have to deal with conflicting demands from communities, patients/clients and a range of organisations in the local health and social care system. Contemporary management...

Like people, institutions are social structures that embody history, values, purposes, power and relationships. In the US (United States), health care contexts are defined by the health care seeker’s ability to pay for services through insurance payers and by payers making services available through health care providers. Some services are provided by public funds. However, there are many people who are not eligible for any of these programmes who join the ranks of the more than 43 million in the US without insurance (IOM, 2001; Skocpol and Keenan 2005). Although unemployed people are especially vulnerable to being uninsured, many live...

In recent years, following the implementation of the community care reforms of the 1990s, there has been an increased emphasis on charging for social care. This chapter aims to provide a brief overview concerning charging for the care of vulnerable adults, encompassing deliberation of some of the historical antecedents, together with an exploration of systems of rationing. This is followed by an examination of current practice in this area, together with issues and dilemmas raised by such practice. Further exploration, through research findings, is tied to an examination of the ethical principles involved, notably justice and equity, as well as...

New discoveries in genetics, when combined with developments in assisted reproduction, have raised some important and highly contentious issues. How should the right to found a family be interpreted and to what extent is reproductive choice a private matter or a matter for public regulation? Should the protections associated with adoption be extended to assisted reproduction using donated gametes? Do individuals have a right to knowledge of their genetic identity or origins if available? Are children losing something valuable, perhaps indeed a basic human right, if those origins necessarily deprive them of a genetic link to their carers or of...

In this chapter, two cases involving children are used to illustrate problems and challenges in contemporary childcare practice. These cases also serve to highlight how, in focusing on individual circumstances, attention can be drawn away from broader ethical questions that may be relevant to the treatment of children. A similar tendency to overlook this broader perspective is noted from an overview of recent childcare reforms set out inEvery child matters(DfES, 2003a). A historical and conceptual analysis of childcare discourse charts the interaction between ideas about children’s relationships, interests and rights, concluding that the concept of ‘children’s rights’ challenges...

Complex disabilities, usually of a neurological cause, result in a combination of physical, cognitive and behavioural disorders. The disabilities not only affect the individual but also the family and to some extent society. The impact of these disabilities creates a range of ethical dilemmas in the areas of confidentiality; decision making for those who lack mental capacity; advance statements; decisions about withholding or withdrawing treatment; and involvement of people with disabilities in teaching and publications. All of these factors have an impact on professional and informal carers, while creating a challenge for statutory bodies in their responsibilities towards people with...

In 1998, the Department of Health (DH, 1998a) issued a White Paper on the future of mental health services. EntitledMental health: Safe, sound and supportive, this document was the first in a series of official publications to outline fundamental reforms of health and social care for people with mental health problems (see, for example, DH, 1999a, 2001a). Subsequent measures included the introduction of national targets for adult mental health services, a new National Institute for Mental Health in England (NIMHE), additional investment and attempts to reform mental health legislation (the 1983 Mental Health Act; see DH, 1998b, 2001b, 2001c)....

There are two main areas where ethical issues arise for older people in health and social care. The first relates to services and the second to research. This chapter will start with general issues, such as general and demographic factors, in order to examine the ethical case for and against treating older people differently from other age groups. Are there groups, such as those with dementia, who should receive different attention? On services, ethical issues such as those relating to age discrimination and changing views on autonomy will be examined. On research, ethical procedures (including consent, confidentiality and the role...

Public support for laws that allow medical practitioners to end life by active measures has risen in recent years, but the medical profession in the UK has been reluctant to endorse this development. The obvious benefits to a few people who experience extremes of suffering towards the end of life need to be balanced against the interests of those who might feel pressurised to opt for death in a society where euthanasia becomes an acceptable and well–known solution to the problems of old age. Additionally, the effect on practitioners (usually doctors) who are called on to administer lethal treatments...

This conclusion offers a summary of interrelated themes and ethical challenges that have emerged across chapters. Review of the content has identified five broad, emergent themes, the first of which explores ethical decision making utilising principles, models, professional codes and dialogue ethics in collaborative working across organisational boundaries and systems. A second theme, user—professional relationships and roles in the context of decision making, is focused on therapeutic relationships and virtuous practice, best interests, refusing treatment and end of life decisions, equity, resources and provider, professional and user relationships. A third theme, vulnerable people, summarises the challenges that can arise...