Block 4 VLE Flashcards
Outline the different conceptions of autonomy
1) Principled/moral autonomy (cf. Kant)
- Having authority over one’s actions
- According to one’s will and ability to reason/impose one’s own moral laws
2) First- and second-order desires
- To want something
- To want to want something
3) Relational autonomy
- Embeds agency and autonomy within social context;
- Rejects overly-idealised aspects of autonomy
What is the legal requirement to respect autonomy?
- Treatment without consent is battery (common law)
- A person is not to be treated as unable to make a decision unless all
practicable steps to help him to do so have been taken without success (MCA
s1.3). - Standard of care for provision of information - what that person would want
to know (negligence)
What is duty of care?
- GMC – ‘make the care of your patient your first concern’
- Respect dignity
- Give info they want/need
- Adult has capacityautonomous decision must be respected EVEN if it
results in harm - Adult lacks capacitytreat according to principle of best interests & protect
them from harm
What are the three conceptions of best interests? And how do these relate to patient care?
- Mental state (happiness) - Experiential, what brings about the most happiness for this person
- Desire fulfilment - Best interests tied to the person’s autonomous choices
- Objective list - Set of agreed criteria for achieving wellbeing, e.g. independence,
ability to have meaningful relationships, knowledge
The person making the determination of best interests must consider, so far as is reasonably ascertainable—
- the person’s past and present wishes and feelings (and, in particular, any relevant written statement made by him when he had capacity),
- the beliefs and values that would be likely to influence his decision if he had capacity, and
- the other factors that he would be likely to consider if he were able to do so
Describe how you would decide on whether or not to restrain/deprive of liberty?
Must consider:
- The harm that will occur to the person if you do not restrain and treat them
- The harm of restraining them (physical and psychological)
- The minimum level of restraint required
- The proportionality of the restraint to the benefit of the treatment
legal framework:
• Restraint (short term): Mental Capacity Act
• Restraint or detaining a person so that they are not at liberty to leave (longer
than necessary for immediately necessary treatment): Deprivation of Liberty
Safeguards (DOLS)
• DOLS: formal process at an organisational level with independent oversight
Who might be at risk with regards to safeguarding?
- an older person who is particularly frail
- an individual with a mental disorder, including dementia or a personality disorder
- a person with a significant and impairing physical or sensory disability
- someone with a learning disability
- a person with a severe physical illness
- an unpaid carer who may be overburdened, under severe stress or isolated
- a homeless person
- any person living with someone who abuses drugs or alcohol
- women who may be particularly at risk as a result of isolating cultural factors
What are your responsibilities when it comes to safeguarding?
- Identify adults who have safeguarding needs Criteria:
- Has care and support needs AND
- Is experiences or is at risk of abuse or neglect AND
- Is unable to protect themselves because of their care and support needs
- Respond to immediate risks
- Assess the individual’s ongoing needs
- Assess capacity
- Identify relevant services
- Seek consent?
- Review
Describe the legal framework and professional guidance on assisting someone in an emergency situation
Legal framework
- No legal obligation to assist
- Legal obligation is in setting where professional duty of care has been established e.g. If doctor identifies themselves as such, and offers assistance in that capacity, then legal duty of care is established
- Must only act within your clinical competence.
- Social Action, Responsibility, and Heroism Act 2015
o Applies when a court is determining the steps that a person was required to take to meet a standard of care. Court must consider:
- Was the person acting for the benefit of society?
- Did the person demonstrate a ‘predominantly responsible approach’?
- Was the person ‘acting heroically’?
Professional guidance
GMC
You must offer help if emergencies arise in clinical settings or in the community,
taking account of your own safety, your competence and the availability of other options for care
Indemnity
NHS Litigation Authority provides indemnity for clinical negligence claims, but only for those duties listed in the doctor’s contract (so not necessarily Good Samaritan acts).
Does not cover:
- Disciplinary issues by employer
- Referrals to GMC
- GP contractors, locum GPs, salaried GPs
Does not apply to:
- Contract work for any other agency
- Voluntary/charity work
- Overseas work
Outline arguments for an ethical requirement for doctors to assist in emergency situations
Consequentialist:
o Doctors have greater ability to help due to more knowledge/skill/experience;
Deontological
o Professional duty of care;
Virtue ethics
o Virtues particularly expected of doctors?
Describe the professional guidance on responding to requests for advice or treatment outside the usual professional relationship
‘[W]herever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship’
‘Wherever possible you must avoid prescribing for yourself or anyone with whom you have a close personal relationship.’
Explain the link between personal and professional behaviour and its implications for medical students and doctors
- ‘You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession.’
- You must not use your professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them.
