Block 11 Flashcards
Outline arguments in favour of assisted reproductive technology:
- procreative autonomy
- welfare interests
Outline ethical objections to IVF:
- involves destruction of embryos
- harmful to those trying to conceive
- it’s “unnatural”
What does the Human Fertilisation and Embryology Act (1990) say about the interests of the future child?
- women won’t be provided with fertility treatment unless account has been taken of the welfare of any child who may be born as a result of that treatment
- includes need of that child for a father
What is the right to an open future?
dilemmas should be resolved so as to ensure that children will have a maximally open future e.g. will enjoy the widest possible range of opportunities
What are the criticisms of the “welfare criterion” in the Human Fertilisation and Embryology Act 1990?
- fertile couples don’t have to meet this criterion (maybe they should have to ?? positive vs negative rights)
- research suggests a father is not always required for a child to flourish (2008 Act replaced “need for a father” with “need for supportive parenting”)
What are the uses of Pre-implantation genetic diagnosis?
- avoid genetic disease
- sex selection
- saviour siblings
Under what circumstances is abortion legal according the Abortion Act?
If two medical professionals agree:
A)
- the pregnancy has not exceeded the 24th week
AND
- continuing the pregnancy would be more risky than termination
OR
- the termination is necessary to prevent mental or physical injury to the women
B)
- there is substantial risk that if the child were born it would suffer physical or mental abnormalities such that it would be severely disabled
Explain the premises and conclusions of the pro-life argument
1) abortion end the life of a foetus
2) a human foetus has the same moral status as a person
3) it is wrong to end the life of an entity with the moral status of a person
= abortion is morally wrong
Who can make treatment decisions about children under the age of 16?
- the child themselves if they are Gillick competent
- someone with parental responsibility (legal obligation to make decisions in the best interest of the child - courts should be involved if they don’t)
- doctors if it’s an emergency
Why should parents generally be allowed to make treatment decisions for their children, and what is this principle called?
- assumption that parents know their children best (best interests does not equal clinically indicated)
- assumption that close parental bonds will motivate parents to do what is best for their children
- principle of parental autonomy
Who can make decisions about young people aged 16-17?
- presumed competent to consent at 16 so consent should be obtained from the young person before treating
- if a young person refuses treatment then the law allows treatment to be given if in best interests and approved by parents or courts
When was the Midwives Institute formed? Who formed the institute?
- 1881
- elite group of philanthropic, middle class, upper middle class and aristocratic women
What did the Midwives Act (1902) say?
- normality in childbirth is the midwives role - referring to doctors is only necessary when an abnormality occurs
- childbearing women should have equal access to midwives and doctors, regardless of socioeconomic status
- aimed to drive out laity in midwifery (handywomen)
- made physicians/obstetricians societies the gatekeepers of midwifery education
What did the 1970 report of the Peel Committee say?
Facilities should be sufficient to allow 100% of childbearing women to give birth in hospital
What are the disadvantages to the statement: “Childbirth can only be considered normal in retrospect” (Walsh, 2007)
- turns physiological event into a medical procedure
- interferes with freedom to experience birth how and where women choose
- leads to unnecessary interventions
- concentrates women in technically equipped hospitals which is costly, and their care is influenced by standardised protocols
How many childhood deaths are there in England and Wales? How does this compare to other places?
- 5000/year (infants, children and adolescents)
- higher rate than comparable european countries
What is the pattern of childhood deaths in England and Wales?
Mortality rate varies by age:
- highest mortality in infancy
- low rates in middle childhood
- rises again in adolescence
Cause of mortality also varies by age:
- perinatal and congenital causes predominate in infancy
- acquired natural causes more prominent in later childhood and adolescence
- more than half adolescent deaths occur due to external cause
Mortality also varies by sex:
- higher mortality in males than females at all ages
- biggest difference between sexes during adolescence
> 50% of external death in adolescents are attributable to…
Traffic accidents
What types of child death causes may be non-intentional?
- drowning
- falls
- fire related injuries
- road traffic collisions
- poisoning
How do rates for suicide and self-harm change in children and young people in the UK?
- rare in children under 10
- higher in adolescent boys
- > 60 deaths per year in adolescent boys
- deaths due to intentional self-harm and suicide have not changed in 30 years
50% of poisoning cases occur in what age range?
under 5’s
What are the implications of chronic illness in children?
- potential physical, mental and social deficit due to missed school
- caregiver burden on parents
- effects on other siblings
- financial worries related to logistics of attending treatment or due to the need for parents to reduce time in work
- stigma
- financial / infrastructure / workforce planning for the government and health services
What proportion of deaths in under 19s occur in the first year of life?
50%
What is the most frequent cause of death in children post-infancy?
Injury
What is the 14th leading cause of global disease burden? (Comparable to TB or malaria burden)
Patient harm
What is an adverse event?
- AKA: patient safety event
- an unintended event resulting from clinical care and causing patient harm
What is a near miss?
A situation in which events (or omissions) arising during clinical care fail to develop further, whether or not as the result of compensating action, thus preventing an adverse event
What is the adverse event rate in the UK hospital sector? How much is preventable?
~10% (850,000/year) -
~30% is preventable
Give examples of adverse events
- wrong site surgery
- medication errors
- pressure ulcers
- wrong diagnosis
- failure to treat
- patient fall (most common)
- nosocomial infection
What are serious incidents?
Events where the potential for learning is so great, or the potential consequences are so significant, that they warrant using resources to investigate and act
What are never events? Give examples and rates
- serious incidents that are entirely preventable (guidance/safety recommendations are available at a national level and should be implemented by all providers)
- around 500/year
- examples include: wrong site surgery, retained foreign object post procedure, medication administration by wrong route
What are the consequences of patient harm?
- £2bn cost in extra days of admission
- clinical negligence claims (11,000/year)
- £1.63bn in settlements
- reduced patient trust in health professionals
How is hospital safety measured?
- mortality data
- reports of never events and serious incidents
- inspections e.g. CQC
Why is standardised mortality rate not a suitable measure of hospital safety?
- largely dependent on non-hospital care (e.g. large hospice nearby with good care available = less hospital deaths)
- variation in definitions and coding
- not a valid screening instrument: no relationship with quality of care has been demonstrated
What does the Swiss cheese model show?
Latent conditions and active failures - all the holes in the cheese (active failures) between to permit the hazard (latent condition) to cause the adverse event
What are active failures?
- unsafe acts committed by people in direct contact with patient
- two types (errors, violations)
What are the three types of active failure errors?
Knowledge-based:
- forming wrong plans due to inadequate knowledge or experience
Rule-based:
- misapplication of a good rule OR application of a bad rule
Skills-based:
- unintended deviation from what may have been a good plan e.g. attention slip / memory lapse
What is a violation active failure? What are the subtypes?
- people intentionally break rules
Routine: violation has become normal behaviour
Situational: context-dependent e.g. poor staffing
Reasoned: deliberate deviation from rule which is thought to be in patients best interest at the time
Malicious: deliberate act to cause harm
What are examples of latent conditions?
- poor training of staff
- socio-cultural factors
What are the important elements of a safety culture in healthcare?
- leadership
- teamwork
- use of evidence
- good communication
- learning culture (not blame culture)
- fairness
- patient-centeredness
How can healthcare use a human factors approach to reduce adverse events?
- Acknowledge human fallibility, the inevitability of error and that error does not equal incompetence
- Design everything with the assumption that people will make mistakes so that mistakes cannot happen e.g.
- avoid reliance on memory
- make things visible
- review and simplify processes
- standardise common processes and procedures
- routinely use checklists
- decrease reliance on vigilance
