Accreditation practice pointer: ethical dilemmas

C2.1 E Our clinical team considers ethical dilemmas.

RACGP Standards for general practice

Clinicians are often faced with perplexing ethical dilemmas. Such dilemmas might take the form of:

• patient–practitioner relationships (familial relationships, friendships, romantic relationships)

• professional differences

• patients giving gifts to the practitioner

• bioethical dilemmas (eg when a patient has an: unwanted pregnancy and wishes to discuss termination; or a terminal illness, and wishes to discuss euthanasia)

• reporting to the state’s driver licensing authority that a patient is unfit to drive.

Practices must have a process for documenting ethical dilemmas that have been considered, and the outcome or solution. Discussions about an ethical dilemma with a medical defence organisation must be documented in a medico-legal file, separate from the patient’s health record.

When GPs face an ethical dilemma, the practitioner could inform the patient that they see an ethical dilemma for themselves, and refer them to another practitioner.

General practices can support clinicians managing ethical dilemmas through the following actions:

• develop a policy or procedure that explains how the clinical team must manage ethical dilemmas

• provide clinicians with ongoing training about dealing with ethical dilemmas

• discuss ethical dilemmas at clinical team meetings

• provide a buddy or mentoring system in which ethical dilemmas can be discussed

• use a clinical intranet or group email to pose common ethical dilemmas and solutions for the clinical team to consider and discuss

• display a notice in the waiting room listing ethical dilemmas that practitioners sometimes encounter, and how they generally deal with them (eg referring the patient to another practitioner or clinic, politely refusing all offers of gifts).