[6] Legal and Ethical Issues Flashcards
What are the 4 principles of biomedical ethics?
- Respect for autonomy
- Beneficence
- Non-maleficence
- Justice
What is meant by respect for autonomy?
Respecting the decision-making capacities of an autonomous person
What does respect for autonomy enable individuals to do?
Make reasonable informed choices
What is meant by beneficence?
Balancing the benefits of treatment against the risk and costs
What is ensured in beneficence?
The HCP acts in a way that benefits the patient
What is meant by non-maleficence?
Avoiding the causation of harm
What does non-maleficence mean in a practical sense?
All treatment involves some harm, even if minimal, but the harm should not be
disproportionate to the benefits of treatment
What is meant by justice?
Distributing benefits, costs, and risks fairly
What is meant by mental capacity?
A person’s ability to make their own choices and decisions
How is mental capacity judged under UK law?
According to the specific decision to be made
What is the result of mental capacity being judged according to the specific decision to be made?
A person may have sufficient capacity to make simple decisions, but not more complicated ones
What should be done in order for a patient to consent?
Staff should make an assessment of whether a person does or does not have capacity to consent to care or treatment
What are the 5 main principles of the MCA?
- Presumption of capacity
- Right for individuals to be supported to make their own decisions
- Should not be assumed that someone lacks capacity because their decisions seem unwise or eccentric
- All decisions should be made in patients best interest
- If someone lacks capacity, all options should be considered before a decision is made, and the option chosen should be the least restrictive of their basic rights and freedoms
What important question should be asked when determining capacity?
Does the patient have an impairment/disturbance of the mind or brain affecting how it works
What might cause an impairment/disturbance of the mind or brain affecting how it works?
- Dementia
- Learning disability
- Mental illness
- Delirium/unconscious
- Stroke
- Alcohol/drugs
- Head injury
- Neurological disorder/long term brain damage
What should be considered if a person does have an impairment/disturbance of the mind or brain?
Does that mean the person is unable to make the decision at the time it needs to be made
What factors must be considered to provide evidence that someone lacks mental capacity?
If the patient cannot demonstrate 1 of these, they are deemed to not have capacity;
- Understand
- Retain
- Use
- Communicate
Give 5 examples of when a patient’s capacity may be questioned?
- Patient refuses intervention
- Patient wants to go home with no support, but cannot cope
- Puts self at risk, and appears to be unaware of own limitations
- Patient is confused and does not answer questions appropriately
- Family members report concerns over patient’s cognitive state
What is the ICF Checklist?
A practical tool to elicit and record information on the functioning and disability of an individual
What should be done in the absence of mental capacity?
Employ decision making (best interests)
How can a patient’s best interest be established?
By considering;
- Is the person likely to regain capacity, and when?
- Maximise participation in process
- Past and present wishes of person
- Beliefs, values, and other factors
- Views of carers and other nominated/appointed persons
What must you not base a best interest decision on?
Age, appearance, or unjustified assumptions based on their condition
What do you need to document when making a best interests decision?
Clear and objective reasons as to why you are acting in the person’s best interests
What provisions were made in the Mental Capacity Act (2005)?
- Advance directive to refuse treatment (ADRT)
- Lasting power of attorney (LPA)
- Independent Mental Capacity Advocate service (IMCA)
- Court of Protection
What is an Advance Directive to Refuse Treatment (ADRT)?
A refusal of any medical, surgical, or dental treatment or other procedure and intended to have effect at any subsequent time when he or she may be without capacity to give or refuse consent
Who can make an ADRT?
A person aged >18 years and with the necessary capacity
Can an ARDT accept treatment?
No
Is an ADRT legally binding?
No, must consider, but not legally binding
When is an ADRT relevant?
Only when the person loses capacity
What is the purpose of lasting power of attorney (LPA)?
Allows patient to transfer their decision making should they lose capacity
What happens in LPA?
A capable adult appoints person(s) ahead of time to make decision from them if they become unable to do so for themselves
What are the varieties of LPA?
- Property/financial
- Health/welfare
What must be done for a LPA to be used?
Registered with the Office of the Public Guardian
When can health and welfare LPAs be used?
Only once the person is unable to make their own decisions
When is an Independent Mental Capacity Advocate service needed?
When nobody is willing to advocate for the patient, they lack capacity, and a major medical decision or long-term placement is proposed
What does a IMCA have the right to do?
Speak up for the patient (not to make decisions)
What is a court of protection?
A specialist court for those who lack capacity to make specific decisions
What does a court of protection do?
Appoints deputies to make decisions in best interest
What can a Court of Protection make decisions regarding?
- Property
- Finances
- Health and welfare
What does article 5 of the Human Rights Act state?
Everyone has the right to liberty and security of person, and no one shall be deprived of his/her liberty unless in accordance with a procedure prescribed in law
What is the aim of the deprivation of liberty safeguards?
To protect people who lack capacity from being inappropriately deprived of their liberty, and ensures patient is being managed in the least restrictive manner possible, to protect vulnerable patients from unchallenged institutions
Do deprivation of liberty safeguards (DOLS) provide additional powers?
No
When are DOLS needed?
When the patient lacks capacity, is under continuous supervision and control in an institution, and is not free to leave for a significant length of time
Why are DOLS put in place?
To make sure that a place only restricts someone’s liberty safely and correctly
What is the only situation in which DOLS is done?
When there is no other way to take care of that person’s safety
What does the MCA allow in terms of deprivation of liberty?
The restriction and restraint to be used in a person’s support, but only if they are in the best interests of a person who lacks capacity to make the decision themselves
What must be true of the restrictions and restraints used under the MCA?
They must be proportionate to the harm the care giver is seeking to prevent
Give 3 examples of restrictions/restraints that may be used under the MCA
- Restraint in hospital
- Medication against will
- Restricted friend/family viewing
Why do the family often prefer for the patient not to be told if they have dementia?
They worry the patient will be distressed and not understand
What do patients feel about being told they have dementia?
Patients with early dementia generally wish to be informed, and those who have been told feel that it is preferable, even though they may find it upsetting
What are the positives to disclosing the diagnosis of dementia?
- Helps acertain treatment preferences
- Make a will/MPA/advance directive
- Helps plan for disability
- Avoids danger of colluding with family
- Have ‘a right to know’ their diagnosis
- Better support and access to help psychological adjustment
What should be done when telling a patient they have dementia?
- Use MDT approach to answer questions and make recommendations
- Consider telling patient and carer together, and allow each separate time to talk and ask questions
- Arrange follow-up meetings to continue discussions
- Discuss how disease may progress
- Agree care plan
- Provide written education materials
- Arrange further support e.g. supportive counselling
Why is it important to consider driving in patients with dementia?
Driving is a complicated task, and the skills required are not simply correlated with a simple test of cognitive function e.g. MMSE
What aspects of cognitive function are more likely to lead to problems with driving?
- Visual-spatial deficits
- Impaired judgement
- Executive functioning
What acronym can be used when considering if a person with dementia is safe to drive?
SAFE DRIVE
Using SAFE DRIVE, what are the things to consider when deciding if a patient with dementia is safe to drive?
S afety record
A ttention skills
F amily report
E thanol use
D rug use R eaction time I ntellectual impairment V ision and visuospatial function E xecutive functions
What is a patient diagnosed with dementia legally obliged to do regarding driving?
Tell DVLA and insurance company when giving diagnosis of dementia, or doctor advises them of the likelihood
What will the DVLA do when a patient informs them they have dementia?
Undertake investigations, including;
- Asking for GP and psychiatric records
- May need driving assessment
What are the possible outcomes of the DVLA investigation into a patient with dementia?
- New license valid for 1 year
- Old license revoked
Can confidentiality be broken regarding driving in dementia patients?
Yes
What mental abilities are required in order to be able to drive safely?
- Attention and concentration
- Visuospatial skills
- Problem-solving skills
- Judgement and decision making
- Reaction and processing skills
What might happen if a license holder with dementia does not contact the relevant licensing agency promptly?
Risk fine of up to £1000
