Page 22 - Community Living Magazine 34-2

ethics

How Covid-19 exposed a deep medical ethics problem

In the first of a two-part series, Simon Jarrett considers how There is no other reference to learning
and why ethical practice within healthcare always poses a disability in this entire book. An ethical
problem for people with learning disabilities guidance vacuum of this sort leaves
doctors in a position where they make
their own decisions based on their
instincts, beliefs or unconscious biases.
edical ethics are, at heart, Their only specific reference to disability The absence of specific ethical guidance
simple. The duty of a doctor is to (note 60) states: “You must consider and about learning disability, a general paucity
Mtry to prevent death, make respond to the needs of disabled patients of guidance about disability as a whole and
people who are ill better, treat patients and make reasonable adjustments … so a poor track record of safe healthcare for
well and do no harm. they can receive care to meet their needs.” people with learning disabilities all came
British doctors are legally bound by an They note these are not just physical to a head in the early days of the
ethical code devised by their professional adjustments but also relate to a person’s coronavirus pandemic health crisis in 2020.
regulator, the General Medical Council communication and other needs. From
(GMC), in which the basic commands of here, doctors are then referred to a rather
“do good” and “cause no harm” loom large. vague section (25b) of the guidelines, NHS guidance implied a young
It all appears straightforward. Yet we which states: “If patients are put at risk
know that complex medical issues often because of inadequate resources… you person with no pre-existing
arise, and what constitutes “good” and should put it right if possible.” conditions would get priority
what constitutes “harm” can be Ethical training for doctors in relation to for treatment over a young
contentious areas. The area of medical learning disability is also lacking, although
ethics applied to people with learning battling parents whose sons died person with such a problem
disabilities is no exception. prematurely in NHS care are working
Readers of this magazine will know incredibly hard to change this.
there have been a series of tragedies A leading 2020 textbook used in UK Who is first in line for care?
involving people with learning disabilities medical schools, Medical Ethics and Law: News items showed exhausted Italian and
in the UK health system. At heart, most of a Curriculum for the 21st Century, Spanish doctors having to make heart-
these have arisen not from systemic contains only one reference of any breaking decisions about who should
organisational problems, accidents or significance to learning disability in its receive treatment and who not as
incompetence but from ethical failings. 357 pages. coronavirus surged through their countries.
The list is long and includes preventable This refers to the impact of cognitive If two people required critical care, and
deaths arising from inappropriate impairment on decision-making capacity there was only one ventilator, who should
treatment, “do not resuscitate” notices and states “most healthy people without live and who should be left to die?
routinely applied to young patients with learning disability have the capacity to As the virus entered the UK and
learning disabilities, neglect on wards and make decisions about their own threatened to overwhelm the NHS, the
harmful use of medication. healthcare and to understand the main medical profession prepared itself
We can add to these a series of recent points at issue” (page 103). for the horrendous task of making
and current abuse scandals in assessment The assumption appears to be that similar decisions.
and treatment units (provided by the NHS healthy people with a learning disability The NHS stated that, in cases of excess
or by private or charitable bodies) and do not have the capacity to make demand, critical life-saving treatment
decades of neglect and abuse of people decisions about or understand their would be prioritised for those most likely
with learning disabilities in long-stay own healthcare. to survive. This involved a cluster of factors
hospitals managed by the NHS after its including age and pre-existing conditions.
formation in 1948 through to the 1990s. It implied that, in the event of a
However much of a boon the universal, treatment decision having to be made, a
free-to-use NHS has been for the young person with no pre-existing health
population as a whole, for those with conditions would be given priority over a
learning disabilities it has too often been young person with such a problem.
an ethical disaster zone. This was enough to cause concern
Why is this so, and why have many among people with disabilities as a whole
people with learning disabilities not been and for people with learning disabilities in
subject to the simple dictum that doctors particular, given the chequered history of
should seek to do them good and strive to the NHS in its treatment of disabled people.
do them no harm? Disability Rights UK issued a statement
in April signed by hundreds of disability
Silent about learning disability organisations and their allies, including
The GMC’s current Good Medical Practice many learning disability bodies. The
guidelines, published in 2013, are reticent concern was that the simple fact of being
regarding disability as a whole, and silent The British Medical Association says disability is designated disabled would be sufficient
about learning disability altogether. not a consideration in decisions about treatment grounds for withholding treatment,

22 Vol 34 No 2 | Winter 2021 Community Living www.cl-initiatives.co.uk