Student projects

Exploring Medical Students’ Understanding of the Concepts of Consent and Confidentiality: Fiona Tenters

Doctors regularly face ethical dilemmas and it is therefore important that medical students, as potential doctors, are equipped with the necessary reasoning skills to enable them to make appropriate decisions, whilst incorporating relevant guidelines and legislation. Ethical dilemmas surrounding consent and confidentiality are common across clinical settings but are often complex in nature, making the process of decision-making challenging.

Fiona Tenters undertook a BMedSc project, as part of her year 4 medical studies, to explore medical students’ understanding of:-

• the concepts of consent and confidentiality
• how they apply this in a range of scenarios.

She used focus group interviews to facilitate discussion around a series of case studies, from different clinical specialities, to gain an insight into how medical students think through ethical problems and dilemmas and how they work to find a consensus – or otherwise – as part of making decisions together.

Fiona presented her research at Institute of Medical Ethics in September 2014.

Comparing the views of undergraduate medical and music students on organ donation in the UK: James A. Locke-Scobie

James carried out a study this year which compared the views of undergraduate medical and music students on organ donation in the UK. The idea came to him having taken the 3rd year Ethics and Philosophy SSU, having argued the case that organ donation is considered “right” by most ethical schools of thought. There is a huge mismatch between the amount of people who are willing to donate their organs and the number who are signed up to the organ donation register. For this reason, organisations such as the NHS Blood and Transplant service are constantly looking at ways to increase the pool of potential donors. Plenty of literature suggests that students are a group of people with consistently positive attitudes towards donation however they do not always sign-up to the register.

James' study ascertained that at the University of Southampton, both medical students and music students alike were mostly willing to donate their organs however medical students who were willing to donate were more likely to have signed up to the register. It also found that religion was an important co-variable, with religious participants being consistently more anti-donation. A change of political default to an opt-out system was supported considerably more by medical students. His research has a number of potential future applications both in directing new research to be carried out, and suggesting ways to change the system to increase the potential pool of donors.

James presented his research at Institute of Medical Ethics in September 2014.

Broad consent and surplus surgical tissue: Zakk Borton

Obtaining suitable consent from patients participating in medical research is a core tenet of research ethics involving humans and current guidelines, governance, and practice serve to uphold it. The requirements for valid consent are laid down in the World Medical Association’s Declaration of Helsinki, which states that for ‘medical research involving competent human subjects, each potential subject must be adequately informed of the:

• aims,
• methods
• anticipated benefits and potential risks of the study
• any discomfort it may entail
• any other relevant aspects of the study.

In the UK this declaration has by and large been interpreted as necessitating specific consent for each particular research project that a patient participates in. Whilst this is clearly important in interventional research (such as drug trials), for research utilising surplus tissue removed at surgery, the question arises whether specific consent for each research study is desirable for both research progress and research participants. Surplus tissue could be stored and researched for many years, each study posing few, if any, risks to the patient. Anecdotal reports suggest that the practical hurdles of re-contacting tissue donors reduce the likelihood of research on these samples, and that patients themselves may prefer to provide a one-off “broad” consent to current and future research, as long as it meets certain criteria (such as approval by a research ethics committee).

This type of “broad” consent model raises a number of ethical issues which are hotly debated in the literature, but what do those who would potentially be giving such consent think on the matter? In this project Zakk, supervised by Angela Fenwick and Anneke Lucassen, will consider the views of members of patient support groups on broad consent, and use the results to pilot a questionnaire which could then seek wider public opinion.

Projects: 2011/12

Managing the possibility of IFs: Catherine Hyatt

Incidental findings (IFs) are increasing in prevalence due to advances in medical technology and improvements in research techniques and there is now a need to provide an appropriate framework for action in cases where incidental findings arise. Catherine, supervised by Gillian Crawford and Angela Fenwick, explored the views and experiences of healthcare professionals and more broadly at the validity of consent in two clinical contexts where incidental findings occur:

• brain MRI scanning
• antenatal screening

Most of the research in this area has focused on incidental findings from the research setting and there is limited information available relating to the clinical context. There is, therefore, a real need to address the issue of incidental findings generated in the course of clinical practice.

Predictive genetic testing and adoption: Celia Dewell

Predictive genetic testing can be used to determine the likelihood of a child developing a disease in the future. In most cases if the onset of the disease is not expected for many years, and there are no medical benefits in finding out now (such as screening or treatment), then genetic testing is delayed until the child can take part in a conversation and have a say as to whether or not predictive genetic testing should be done. However, there have been several reported cases where predictive genetic testing is being requested for children in the fostering and adoption services to discover which inherited diseases they may have, in the hope that this will increase the likelihood of them being adopted.

Celia, supervised by Ingrid Holme and Anneke Lucassen explored how predictive genetic testing is perceived within adoption. During her study she interviewed a range of professionals, including:

• social workers,
• doctors and
• adoption agency managers

This was to explore a range of healthcare professional perspectives and experiences. Celia explored whether adoption is a special case in this situation, or that all cases should be treated equally whether the child is up for adoption or not. If you would like more information please email Celia. You can view Celia's presentation via the 'useful download' link above.

Newborn screening: survey of parents’ views and experiences: Robert Clarke

Current newborn screening in the UK involves a blood spot sample taken for analysis where testing is carried out to diagnose for an array of inborn metabolic conditions such as phenylketonuria and cystic fibrosis.

There is now, however, scope for increasing the number of tests to include genetic testing for disease susceptibility (such as cancer) as part of the heel prick test. The issues associated with possible screening expansion have been widely discussed and include:

• the potential benefits and harms to the newborn
• risks of inaccurate results
• value of uncertain risk indicators
• ethical themes such as confidentiality and maintenance of patient autonomy

Little is known on the views in regards to these issues. This study, carried out by Robert and supervised by Angela Fenwick and Anneke Lucassen, explored parents’ views and experiences of,

• their child’s heel prick test, in particular the consent and communication processes that were involved
• their opinions about the future possibility of receiving information about disease susceptibility.

Parents’ views were sought using a survey questionnaire, targeting parents of children five years and under.  You can view Rob's presentation via the 'useful download' link below.

Previous Projects: 2010/11

• Medical students’ attitudes to euthanasia and physician assisted suicide
• Medical students’ attitudes to abortion and the factors influencing these factors
• Specialist interest groups’ perspectives on the limits of confidentiality in genetic medicine