Autonomy and informed consent Student groups considered the following scenario: You are a doctor working in a busy practice in London, UK. One of your patients is a fifteen year old girl who has come to see you to ask advice about contraception and sexually transmitted diseases. She explains that she has a regular boyfriend with whom she is now having sexual intercourse. At age fifteen in the UK she is considered a minor.

Case scenario – students were asked to consider: 1 ) What are the major ethical dilemmas? 2) Consequences: what are the consequences of any given course of action? Consider both benefits and harms 3) Duties and Obligations: what are the duties of the clinician? Is this a case of conflict of duties? To whom does the clinician owe these duties? If so how best can this dilemma be resolved? 4) Consider the categorical imperatives. Is this a case of respect for autonomy and informed consent? If so are there sufficient grounds to ignore her wishes? 5) Application of principles. How might the four key ethical principles of ethical clinical practice be applied?

Case scenario – students: worked in groups of 5 students discussing each case produced their discussions on flip charts These were then presented and discussed by the entire class Sample worksheets are presented in the following slides

Case-based facilitated learning Through facilitated learning the students were encouraged to apply a systematic analysis to each case scenario and to consider case-sensitive factors leading to different conclusions about possible best courses of action. At the end of the presentations the general approach adopted in the UK was discussed. Students are also encouraged to consider not only which course of action might be best but also how such action should be implemented in the best interest of the patient. Students learn to consider the patient specific factors rather than to seek a ‘one rule fits all’ solution Students become more confident in dealing with uncertainty in ethical discussion

A group of students taking the course in December 2007