Safety and Ethics in Healthcare: A Guide to Getting it Right

As more and more people survive into old age, the burden of caring for them becomes greater and greater. Although it is now possible to alleviate many of the afflictions that beset mankind, no society can afford to pay for all the healthcare that is now available or technically possible. People working in healthcare increasingly have to do more with less. Rationing takes many forms, mostly covert, and the less privileged in most societies end up struggling to get their proper share of the available healthcare resources. All too often, those in the front-line have to deal with the consequences of this 'rationing by default': healthcare professionals find themselves rushed off their feet simply doing the basic tasks and completing all the paperwork; placing frail, sick people in ever lengthening queues, sometimes asking them to wait for hours in the middle of the night under uncomfortable and even unsafe conditions; and, worst of all, working under conditions they would rather avoid in which the safety margin for those they are caring for has been greatly diminished. We are all aware that under these conditions the chance of making a mistake which can seriously harm or even lead to the death of a patient is greatly increased. But what can be done about this? How can you be sure that you are doing the right thing when faced with having to practise an uncertain science on vulnerable patients in a complex system under ever-changing conditions? At what point could you cross the invisible line from reasonable to irresponsible or unethical behaviour by tolerating conditions or tacitly accepting practices which may be regarded as unacceptable, even though you may have little immediate control over them? This book is a guide to getting it right for healthcare professionals. It is about doing the right thing, in the right way, at the right time, for the right people. These are the dimensions of quality in healthcare, and although some are in conflict (equitable access and efficiency, for example), adherence to ethical practice and professional behaviour will help lead healthcare practitioners through the minefield of responsibilities and priorities. Real-life situations are integral to the book, with over 500 clinical examples referred to within the text.

Bill Runciman is Professor of Anaesthesia and Intensive Care at the Adelaide University and Head of the Department of Anaesthesia and Intensive Care at the Royal Adelaide Hospital. He founded the Australian Patient Safety Foundation in 1988, and is the current President. He has been a member of task forces which produced world patient safety standards for both Anaesthesia and Intensive Care. He was Chairman of the Safety and Quality of Practice Committee of the World Federation of Societies of Anaesthesiologists from 1992 to 2000. He has been a member of the Australian Council for Safety and Quality in Healthcare and of the Australian Health Information Council, and is joint co-ordinator of groups developing research tools and an International Patient Safety Classification for the World Alliance for Patient Safety of the World Health Organization. Alan Merry is Professor of Anaesthesiology at the University of Auckland. He chairs the Quality and Safety Committee of the World Federation of Societies of Anaesthesiologists. He is a Councillor of the Australian and New Zealand College of Anaesthetists, chairs the College's Quality and Safety Committee, and has chaired its New Zealand National Committee. He co-chaired the New Zealand Medical Law Reform Group and has been president of the Auckland Medico-Legal Society. He is co-author of the books Errors, Medicine and the Law (with Alexander McCall Smith; Cambridge University Press, 2001) and Essential Perioperative Transoesophageal Echocardiography (with David Sidebotham and Malcolm Legget; Butterworth-Heinemann, 2003). Merrilyn Walton is an Associate Professor in the Faculty of Medicine at the University of Sydney. She chairs the Personal and Professional Development Theme and teaches students and clinicians about ethical practice, quality and safety. Her interests include enhancing the training environment for medical students and doctors and advocating for patients to be fully engaged in health care at every level. She was the founding Commissioner for the NSW Health Care Complaints Commission (1993-2000), and is a board member of the NSW Institute for Medical Education and Training and chairs its Prevocational Training Council.