Quality Improvement in general practice: enabling general practitioners to judge ethical dilemmas

摘要

Quality improvement (Ql) is fundamental to maintaining high standards of health care. Significant debate exists concerning the necessity for an ethical approval system for those Ql projects that push the boundaries, appearing more similar to research than Ql. The authors discuss this issue identifying the core ethical issues in family medicine (FM), drawing upon the fundamental principles of medical ethics, including principles of autonomy, utility, justice and non-maleficence. Recent debate concerning the application of Ql ethics boards is discussed with relevance to primary care and issues such as general practitioner (GP) intentions, the impact of Ql on patients and the use of confidential patient data and the impact of dissemination. The authors conclude that a system of Ql ethical approval leaves many issues unresolved and potentially creates several barriers to implementing Ql. To ensure ethical Ql work is generated within FM it is essential for GPs to learn about and engage in more ethical reflection so that they can better judge and resolve these issues.