Clinical Negligence and Duty of Candour (Law and Ethics)

Question 1

What must be demonstrated to prove negligence in a civil suit?

Answer 1

That the doctor had duty of care (easy to prove)

Duty of care was breached (requires proof of what the standard of care should have been)

Breach caused significant harm (difficult to prove) “But for” test

Question 2

Legal options in the case of negligence

Answer 2

Criminal action (rare) e.g. gross negligence, manslaughter

Civil action - the patient could sue for damages either through Tort of Negligence (NHS and private) or breach of contract (private only)

Question 3

3 types of law?

Answer 3

Common - Based on individual cases, decided by judge, malleable

Quasi - rule set by regulatory body

Statute - written law by govt., legislators (difficult to change)

Question 4

What is defensive medicine?

Answer 4

The action of performing tests to safeguard against possible malpractice liability rather than to ensure health of patients

A response to the litigation crisis - Doctors are actively avoiding getting sued

Therefore they do many tests to self safeguard rather than in the patient’s best interests

Question 5

Some issues with defensive medicine?

Answer 5

Expensive

Disrupts resource allocation (justice)

Violation of trust

Unnecessary tests may cause harm

Ethically, unnecessary tests can’t be justified (virtue ethics)

Question 6

What is duty of candour?

Answer 6

A professional requirement of healthcare providers to be open and transparent with those who use their services for treatment. Particularly when it does wrong.

Question 7

What are the 2 obligations you have as an NHS professional?

Answer 7

Contractual - As per NHS contract you sign for when hired as a medical professional

Statutory - Legal duty that NHS, trusts, gov, and other are providers must uphold

NPSI Notifiable Patient Safety Incident - organisations have a statutory obligation to report NPSI

Professional - Admit mistakes, integrity, maintain trust relationship

Question 8

What is the GMC requirement for Duty of Candour?

Answer 8

Fix mistakes

Apologise to patients

Explain consequences of your mistake

Question 9

What is the four pillars approach?

Answer 9

Autonomy

Non maleficence

Beneficence

Justice

Question 10

What’s the four quadrants approach?

Answer 10

Indications- establish diagnosis, options for treatment, prognosis. Linked to beneficence/non-maleficence.

Preferences of the patient- Are they competent? What do they want? If not is it the patients best interest? Links to autonomy

Quality of life - Will the treatment improve QOL?

Contextual features- How do religious, cultural, social and legal factors impact? Justice