Medical ethics has had an increasingly high profile in recent years, although most attention has focused on secondary or tertiary care. However, many of the ethical issues facing health professionals in hospitals also confront those working in primary care.
Withdrawal of treatment, genetic counselling and issues around informed consent are problems for GPs as well as hospital doctors. Some argue that there may be other ethical issues that are more likely to occur in primary than in secondary care.1,2
The development of primary care groups (PCGs) and primary care trusts (PCTs) offers challenges and opportunities for improving ethical standards in primary care. PCGs, and even more so PCTs, will be responsible for allocating resources and for ensuring equity in the delivery of healthcare across their community.
To do this they will need to develop transparent decision-making frameworks that are informed by good evidence of clinical effectiveness and cost-effectiveness, and by clearly articulated values of distributive justice.
As health authorities have discovered, ihis is not an easy task; however, PCGs and PCTs may be able to capitalise on their closer proximity to both practitioners and the community they serve to develop processes for allocating resources that are clinically and ethically sound.
In their clinical governance role, PCGs and PCTs will be responsible for ensuring that high quality healthcare is delivered to the population they serve. Increasingly, this is acknowledged to include high standards of ethical as well as clinical practice.
If PCGs and PCTs are to ensure high ethical standards in patient care and provide support and advice to healthcare professionals on these issues, they need to identify the ethical issues that cause concern for primary care practitioners and how these are currently dealt with by individual practitioners or within the primary care team.
Ethical standards in clinical care are beginning to be addressed by acute and community NHS trusts, both within and outside the clinical governance framework.
A recent study highlighted the emergence of clinical ethics committees and clinical ethics groups as a means of identifying ethical issues in a trust and of providing a forum for debate and advice to support clinicians with ethical dilemmas relating to patient care.3
There is a danger that we could simply import the ethical dilemmas and the structures developed for dealing with them directly from secondary to primary care. PCGs and PCTs are in a position to develop models of ethics support appropriate to primary care as part of their development.
The above discussion provides the background for a study that I am commencing, supported by a National Primary Care Researcher Development Award. The study will use qualitative research methods to explore the ethical issues currently facing health professionals working in primary care, and the processes that could be used to support them and to facilitate high quality, ethical decision making.
Preliminary pilot work suggests that issues of equity, confidentiality and conflict of interest raise difficult questions for practitioners and managers in primary care. The findings of the study should provide information that is specifically relevant to primary care and can be used to inform the development of models to support high quality, ethical practice in primary care.
- Fetters MD, Brody H. The epidemiology of bioethics. J Clin Ethics 1999;10:107-15.
- Doyal L. Ethico-legal dilemmas within general practice. In: Dowrick C, Frith L (Eds). General Practice and Ethics. London: Routledge, 1999.
- Slowther A, Bunch C, Woolnough B, Hope T. Clinical ethics support services in the UK: a review of the current position and likely development. J Med Ethics 2001; 27(Suppl I): i2-8.