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The right treatment — distinguishing technical and ethical dimensions

May 1995
(MA thesis in
Health Care Ethics)
by Stuart Donnan

The summary is shown opposite; the full document will be added later.

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website updated on 18 September 2016

The thesis begins with the axiom that student health professionals, medical students in particular, are pressured by many circumstances - including their perceived ignorance and the context in which they learn - to focus on facts, that is, on technical dimensions of health and health problems.

Since the concept of the right treatment manifestly includes, at least to some extent, ethical or moral dimensions, the thesis next addresses possible definitions of ethical or moral which would be useful in a learning context.

Out of this arises a redefinition of the original problem which could be seen as the conflict, both in learning about and in practising health care, between facts and values.

Further consideration is then given to the meaning of value and values, and the document Core Values for the Medical Profession in the 21st Century is analysed.

In this discussion it is noted that relatively little attention is given to conflicts and dilemmas at any level above or beyond an individual patient, and how they might be addressed.

It is then suggested that values might be seen to be of more importance and salience than sometimes is the case, if attention in teaching and learning was addressed to interpersonal dimensions of health care including communication skills, and to the management and care of people rather than of illnesses.

A vital aspect is the need for awareness of value dimensions; they can clearly not be addressed or leamt about if they are not perceived.

It is also suggested that everyday decisions and problems are an important focus for learning rather than just spectacular and hard cases, since most clinical encounters and therefore overall the majority of ethical or value aspects of health care arise in rather routine circumstances.

The new problem-based curriculum at Manchester Medical School is analysed in some detail, to see how values are or might be addressed.

The main problem seems to be that dilemmas at a resource or group or community level rarely arise in problem-based learning unless a different sort of problem from the customary individual patient is presented.

In summary it is proposed that what student health professionals need to leam about is values rather than ethics, specifically how to determine and weigh up the various value dimensions of health care problems ranging from societal to professional to individual values (of both the carer and the client) and also how to balance process issues and outcome issues.

That there is no right answer - that is, no right treatment as determined by the professionals alone - is seen as a prompt to learning to discern both all the relevant values and also the relevant decision-makers.