Communication Flashcards
4 principles of medical ethics
Autonomy
Non-maleficence
Beneficence
Justice
Divisions of the medico-legal system
Common (case) law
Statute law (Acts of Parliament)
Public (criminal) law
Private (civil) law
Court decisions follow …
Judicial precedent
Most common law breached in medical malpractice
Law of tort
Most important within that are negligence and battery
Negligence: claimants need to prove:
The doctor had a duty of care
There was a breach of the appropriate standard of care:
- Bolam test - acting in accordance with a reasonable body of medical opinion (even if in the minority)
- Bolitho test - must withstand logical analysis
The breach caused harm
Gillick competence
Those under 16 can consent to BUT NOT REFUSE treatment if they are deemed mature enough to understand the implications of their actions
Consent: Montgomery v Lanarkshire
Ruling stated that if there was a significant risk that could affect the decision made by a reasonable patient, it is expected a doctor would inform them of that risk
Disagreements with the attorney (LPA)
Court of Protection adjudicates on the decision
Mental Health Act 1983 is evoked to
Treat psychiatric illness in non-consenting patients
Section 5(2): AKA
Emergency doctors holding power
Section 5(2): content
Applied on inpatient for psychiatric assessment
72 hour duration
Convert to Section 2 or 3 unless cleared or discharged
Section 2: AKA
Admission for assessment order
Section 2: content
Applied by 2 written medical recommendations and an approved social worker or relative
In the community
28 day duration
May be converted to Section 3
Patient can appeal to tribunal within 14 days
Section 3: AKA
Admission for treatment order
Section 3: content
Applied as in Section 2 on patient with known disorder
6 month duration
Section 4: AKA
Emergency admission to hospital order
Section 4: content
Applied by one doctor and an approved social worker or relative
Urgent necessity is demonstrable
Can be converted to Section 2 or 3
Doctors must breach confidentiality to the relevant authorities in the following cases:
Notifiable diseases
Drug addiction
Abortion
In vitro fertilisation
Organ transplant
Births and deaths
Police requests
Search warrant signed by a circuit judge
Court order
Prevention, apprehension, or prosecution of terrorists or perpetrators of serious crimes
End of life: sanctity of life arguments
Non-maleficence
- extending life results in suffering
Justice
- trivial life extension occurs at enormous monetary expense
Withdrawing treatment is considered to be a
Passive act and not killing
Are food and water medical treatments that can be withdrawn?
Yes
Doctrine of double effect distinguishes actions that are intended to harm versus
Those where harm is foreseen but not intended
- morphine to palliate pain -> respiratory arrest
— primary aim is to alleviate pain
When a decision to withhold potentially life saving treatment/CPR is being made, does the patient/family have to be involved?
Yes
Information delivery: approach
Introduce self and reason for discussion
Check level of knowledge
- describe nature of condition using simple language
Facilitate and answer questions
Medication explanation
- indications, logistics, side effects
Precipitating factors
Lifestyle
Plan of action
Reiterate discussion and ensure understanding
Offer further sources of information
Organise appropriate follow up
Close interview
Breaking bad news: approach
Private setting
Invite other healthcare workers for support
Introduce self and purpose of the discussion
Offer opportunity for relatives to attend
Check existing awareness
Gauge how much information they would like
Give bad news clearly and simply
Pause and acknowledge distress
Explore concerns
If unsure of the treatment options advised it will be discussed at MDT
- arrange appointment for after this meeting
Recap and check understanding
Offer another chance to speak/support groups/ leaflets
Enquire as to how they are getting home
Breaking bad news: dealing with denial
Reiterate key message
Confront inconsistencies in perception
Acknowledge denial in sensitive way
May need to arrange another discussion at a later date to allow news to sink in
Breaking bad news: dealing with anger
Acknowledge anger and empathise
Terminate the session if necessary and arrange to meet at later date
Breaking bad news: prognosis questions
Explore why they would like to know
- what will it change about the way they are living
Answer in broad terms
