All Flashcards
Define confidentiality.
Keeping or being kept secret/private
What are the 4 domains of good medical practice?
- Knowledge, skills and performance
- Safety and quality
- Communication, partnership and teamwork
- Maintaining trust
What is the only exception to confidentiality rules?
Medical certificate with cause of death
What does the common law say regarding confidentiality?
Doctor must not disclose info unless legal basis
What are the 6 principles that GDPR is based around?
- Be processed lawfully
- Be processed for specific, explicit and legitimated purposes
- Be adequate, relevant and limited to what is necessary
- Accurate and up-to-date
- Kept for no longer than necessary
- Be secure
What does the GMC say in their confidentiality guidance?
- Use minimum necessary info
- manage and protect info
- be aware of responsibilities
- comply with the law
- share relevant info for direct care
- ask for explicit consent
- tell patients
- support patients to access info
Discuss situations where confidentiality can be breached.
- With patient’s consent
- With other medical practitioners in patients interest
- In doctors own defence
- Statutory requirements
- When directed by a court
- Protection of others
- Child abuse
What is Quintuple Jeopardy?
Complaint procedure - 5 steps
What are the 5 steps taken when a complaint is made?
Local complaints (must reply) Disciplinary action Civil claim (less common in UK) Medical council Criminal prosecution
What happens with a complaint with regards to the GMC?
Complaint -> GMC case worker -> case examiners -> MPTS -> sanctions can be imposed -> all parties have right to appeal
Give examples of types of criminal allegation.
prescription fraud, indecent assault, manslaughter
What is the difference between civil and criminal law?
Civil = individuals vs organisation, compensation, no one sent to prison
Criminal = affect society, criminal prosecution by state, court
Define medical negligence.
A lack of reasonable care and skill as a result of which the patient suffers
What are the 4 pillars of medical ethics?
- Autonomy
- Beficience
- Justice
- Non-maleficence
What is autonomy?
Promote right to self determination, cannot force patient under normal circumstances to accept treatment
What is beneficence?
Must always do what benefits the patient
What is non-maleficence?
Must do no harm
What is justice?
Act in a fair way and within the law
Fairness/equity
Individual vs. population
What are ethics?
Body of moral principles or values governing or distinctive of a particular culture or group
Principles, Values, Honesty, Standards
Where do ethics come from?
2 traditions: deontology (duties - wrong/right, absolute values), utilitarianism (consider benefits/harms to individuals and society)
What is consequentialism?
Type of utilitarianism. Normal worth of an action is determined by its outcomes.
What is morality?
Attitudes, behaviours and relations to one another.
What is a duty of candour?
Be open and honest when something goes wrong with patients care which can cause or have the potential to cause harm.
What are the “Big 3” in relation to social media use?
- Maintain patient confidentiality
- Don’t accept friend requests from patients
- Remain professional online
Define defamation.
Damaging the good reputation of someone (Scot’s Law will compensate wronged party)
What must consent be?
Voluntary + informed + capacity
What is consent?
Give permission before receiving any type of medical treatment, test or examination
Describe types of expression of consent.
- Implied or verbal e.g for BP
- Express e/g routine bloods
- Written e.g surgery
How do you receive informed consent?
Discuss practicalities, benefits/risks if done and benefits/risks if not done
How do you assess capacity?
Based on whether they can understand, believe, retain and weigh necessary info
What can be obstacles to capacity?
Impaired intellectual/mental capacity Intoxication Communication difficulties Unconsciousness Age
What are the principles of the act concerning confidentiality?
Any action/decision must benefit Least restrictive option Take account of person's wishes Consultation with relevant others Encourage existing/new skills
What are the two different types of power of attorney?
Financial
Welfare
What are the age restrictions for capacity?
16 or over - can consent
Under 16 - can consent if believed to be Gillick competent
If young person refuses treatment can this be overruled?
Yes in a court of protection
What do the Fraser guidelines apply to?
Contraception in under 16s
Define a complaint.
Expression of dissatisfaction that requires a response
What is the most common reason for a complaint?
Poor communication
How do you deal with complaints?
Seek support from seniors, defence organisation, guidance, BMA, student support
What is the SPSO?
Scottish Complaints Procedure Public Service Ombudsman
- -> redress and recommendations to board
- -> SEA carried out
Discuss the NHS Scotland complaints procedure (2017).
Complaint officer has 5 days to respond
Document
Acknowledge in 3 days if formal procedure
Written or verbal response or meeting
Full response in 20 days
If dissatisfied consider mitigation and contact NHS Ombudsman within 28 days
Name a set of guidance for complaints.
‘Raising and acting on concerns about patient safety’ (GMC)
When should you raise a concern with the GMC?
- can’t raise with responsible person/local authority
- if unsatisfied through local channels
- immediate risk to patients
What is an ethical dilemma?
Situation in which a difficult choice had to be made between 2 courses of action
Give 3 examples of case scenarios relating to genetic controversies.
Huntington’s disease
Pre-natal testing
Breast cancer gene mutation
With regards to genetic controversies and supporting patients this can have a personal impact. What should you do?
Be self aware
Seek support, discuss cases with others
Maintain objective approach
What are the 2 main pieces of civil mental health law?
- Mental Health (Care and treatment) (Scotland) Act 2003
2. Adults with incapacity (Scotland) Act 2000
What are reasons for involuntary treatment for mental illness?
Severely unwell
Lost touch with reality
Risk to self or others
Why should you not give involuntary treatment for mental illness?
Ill-liberal
Conterproductive for some
Practical problems in administering treatment
May be poorly compatible with human rights
What are ethical justifications for involuntary treatment?
Beneficience
Autonomy
Right-to-treatment
Paternalism (soft - shaping)
What are ethical criticisms for involuntary treatment?
Non-maleficience
Autonomy
Paternalism (hard - ignores patient views)
Non-discrimination
What does mental health legislation provide?
Legal mechanism - power to provide compulsory care
What does the MH(C&T)(S)A 2003 define mental disorder as?
Any mental illness, personality disorder or learning disability however caused or manifested
What does the adult support and protection (Scotland) act 2007 deal with?
Harm inflicted by others, self-harm and neglect
What civil compulsory powers does the MH(C&T)(S)A 2003 allow?
Detain, Assess, Treat
What are the different types of detention certificates?
- Emergency (up to 72 hrs)
- Short term (up to 28 days)
- Compulsory treatment order (up to 6 months)
- Nurses holding power (up to 2 hours)
What is the criteria for detention?
- Mental disorder
- Significant impairment of decision making about mental disorder
- Significant risk to health, safety or welfare of the person or others
- Treatment available
- Order necessary
What is SIDMA?
Significant Impairment of Decision Making Ability
What is the MHTS?
Mental Health Tribunal for Scotland
When can police detain?
From public place for up to 24 hours
How do you assess capacity?
Carers, family, notes, POA, previously stated views, previous assessments
Communication, understanding, retention of information, decision
What section of the AWI(S)A 2000 should be completed?
Section 47
What is the difference between an advanced directive and advanced statement?
AD: not statute, still valid
AS: in line with MH(C&T)(S)A
Which adults are defined as “at risk” under the Adult Support & Protection (S) 2007.
- Unable to safeguard own well-being
- Risk of harm
- Affected by diability, mental disorder, illness or physical or mental infirmity
What are the questions that surround who should be parents and the right to fertility treatments?
Regulation, access, equity, autonomy vs non-maleficence, societal interference, welfare of potential child, ideal vs real families, funding, who should be treated, what treatment is offered
What are sex selection arguments?
Gender ratio imbalance, undermine women, against nature, potential love
What are issues surrounding social egg freezing?
Financial implications
Preventative medicine
Pregnancy beyond menopause
Impact of age on female fertility
When does the HFEA say life begins?
14 days - primitive streak
RCPCH resuscitation guidelines for neonates are?
24 weeks - age of viability
23 weeks - resuscitation discussed with parents
<23 weeks - guidance against resuscitation
What is the risk of disability in successful resuscitations of under 24 weeks?
Over 2/3
What are the ethical issues at the beginning of life?
Involve 2/3 individuals ( 1 with no voice)
Autonomy for whom?
Beneficience for whom?
Non-maleficence- what is harmful?
Utilitarianism - individual vs collective good
Can the end justify the means?
What are considerations surrounding abortion?
Sexual and reproductive rights of women Unwanted pregnancy can harm physical and mental health Safe abortion saves lives Potential human is not a child Wanted children thrive Denial of rights of embryo/fetus Eliminating potential life Contraception alternative
When is abortion legal in Scotland?
Up to 20 weeks then sent to England (up to 24 weeks)
When was the Abortion Act written?
1967
What are the two abortion drugs and when are they given?
Mifepristone and misopristol (under 9 weeks, given in clinic and taken at home)
What factors are considered at the end of life?
Dignity
Respect
Patient autonomy
Quality of Life
Do you tell the patient at the end of life?
Depends on capacity, benefit, autonomy, ?POA
What is collusion at the end of life?
Secret agreement between clinical and family to hide diagnosis from patient –> against principle of GMP!
What is a DNACPR?
Not a legal document (record of decision), guidance for clinicians who don’t know patient
Define conscientious objection.
Refusal to perform legal role because of moral or other beliefs
What charge would be made if continued unwanted treatment?
Battery
What does the 2016 DNACPR guidance say?
Patient must be made aware
If patient lacks capacity, inform family without delay
If clinically certain that it will remain in place, don’t need to review
When is “letting die” acceptable?
Medical technology useless
Patient validly refuses medical technology
Define euthanasia.
Deliberately end life to receive suffering
Define assisted suicide.
Deliberately assist another to kill themselves
Define physician assisted suicide.
Prescribing lethal drugs intended explicitly to end life, person takes medication themselves.
Define futility.
Pointlessness/uselessness
Define sanctity.
State or quality of being holy, sacred or saintly
What are arguments for physician assisted suicide?
Suicide is legal Those who are disabled are disadvantaged since can't take their own life Withdrawing treatment is accepted Suffering can outweigh benefits Respect patient autonomy
What are arguments against physician assisted suicide?
Good palliative care Discourage palliative care research Vulnerable patients at risk Slippery slope - euthanasia of 'undesirable' Contrary to aims of medicine
What is an advanced statement?
Explains wishes but not legally binding
What is an advanced directive?
AWI(S)A - requires past and present wishes to be taken into account.
Name 4 countries where physician assisted suicide is legal.
Switzerland, Japan, Belgium, Albania, Canada, Netherland (where capacity)
What are commonly advanced arguments agains physician assisted suicide?
Religious argument
Slippery slope argument
Medial ethics argument
No reason for any person to ever feel they are suffering intolerably with good care
Individual freedom of choice
Passive euthanasia allegedly already a widespread practice
What is the purpose of healthcare research?
Prevent illness, detect or diagnose, treat, improve Qol, support patients/staff, value for money, improve clinical effectiveness, generates new knowledge
What is the purpose of a clinical audit?
Understand whether service is meeting demands/standards of best practice
Help to enforce good clinical practice
Produce internal recommendations
What are the 5 steps of a clinical audit?
- Identify problem/issue
- Set criteria and standards
- Observe practice/datat collection
- Compare performance with criteria and standards
- Implementing change
What is the purpose of research governance framework?
Improves quality fo research
Safeguards public
What is the role of research sponsors?
Responsible for initiation, management, financing, ensure design meets standards
Who provides ethical approval for research in the NHS?
NRES
Why is R&D approval required in research?
Training, permission, QA, funding, reporting, ensure high standards, provide guidance, central portfolio management system, finance, contracts, lease with commercial companies
Define sodomy.
Anal or oral sex or sexual activity between a person and non-human animal (beastality)
What is sexual assault with penetration?
Person with any part of their body or anything else without consent penetrates the vagina or anus
What is sexual assault?
Penetration of vagina, anus or mouth, engages in any other form of sexual activity and has physical contact with semen ejaculation into or onto a person. Emission of urine or saliva in a sexual manner
What is voyeurism?
Installation/operation of equipment for live viewing or recording with intention of enabling the individual or others to observe
Discuss consent in relation to sexual activity.
May be withdrawn at any time
Consent for one act doesn’t apply to all
Age of consent is 16
Being in a relationship/marriage doesn’t imply consent
What should you do when encountering victims of sexual assault as a medical professional?
Seek advice
Document all conversations and findings
Don’t undertake examinations unless experienced
Consider consultation with forensic pathologists
always have a chaperone
Psychiatric support
Pregnancy and STI prophylaxis
What is involved in an external examination of victim and assailant?
Retain clothing, establish points of contact, swab for saliva, DNA, semen or blood, condom?, comb hair, fingernail swabs/clippings, document injuries, samples for toxicology
What is involved in an internal examination of victim and assailant?
Examine skin around genitalia and anus, sexual swabs, colposcopy/speculum/colonoscopy, imaging
How long can DNA from the penis last?
12 hours
How long can DNA from fingers in the vagina last?
12 hours
How long can lubricant from a condom last?
30 hours
How long can DNA last in the vagina and endocervix?
7 days
What should you always consider in ethics surround sexual health?
The 4 main principles of medical ethics
What does the GMC’s guidance on serious communicable diseases (2017) state?
You may disclose info to a person who has close contact with a patient who has a serious communicable disease if you have reason to think that:
- person is at risk of infection that can result in serious harm
- the patient has not informed them and cannot be persuaded to do so
Give an example of language that should be use when informing the contact of a serious communicable disease?
“Contact of treatable bacterial infection”
What areas of sexual health can have ethical considerations?
STIs, contraception in adolescents, sex and consent, gender incongruence, sex lives of adults with cognitive impairments
