Confidentiality and Consent

Question 1

What are the 3 broad scenarios in which you can breach confidentiality?

Answer 1

If it is required by law
If the patient implicitly or expressly consents
If it is justified in public interest

Question 2

Can you routinely disclose personal information to police officers, solicitors or court officers?

Answer 2

No, unless it is required by law or justifiable in public interest

Question 3

What are the 2 most common reasons for implied consent to disclosure of information?

Answer 3

Sharing information within the healthcare team or with others providing care
Local clinical audit

Question 4

What are 5 examples of secondary uses of patient information that may serve important public interests?

Answer 4

Research
Education and training
Public health surveillance
Health service planning 
Epidemiology

Question 5

When can you breach confidentiality regarding situations potentially requiring police assistance?

Answer 5

If others may continue to be at risk - e.g. Someone using weapons, if there are children at risk

Question 6

What are the most common reasons for disclosing a patient’s personal information after death?

Answer 6

Coroner or equivalent
When disclosure is required by law, public interest or for education/research
National confidential enquiries
Local clinical audit
Death certificates
Public Heath surveillance
Parent asking for information about child’s death
Close relative asking for info about patient’s death and no logical objection
Right of access to records

Question 7

What are Caldicott Guardians?

Answer 7

Senior people who are responsible for protecting the confidentiality of patient information and enabling appropriate information sharing

Question 8

What is section 251 of the NHS act 2006?

Answer 8

Allows for disclosure despite the common law requirement to obtain consent
But does not normally authorise disclosure to which a patient has objected (unless in public interest)

Question 9

What can/should the doctor do if a patient with capacity opts for a treatment that the doctor does not deem to be of overall benefit to the patient?

Answer 9

Explore the reasons why and explain why the doc feels that way
Doctor does not have to provide the treatment but should explain why and what else can be done, and that patient can seek a second opinion

Question 10

What should you do if a relative or carer of a patient asks that you withhold some information about a patient’s condition from them?

Answer 10

Not withhold the information, unless the patient themselves strongly object or if you believe disclosing the info would cause more serious harm than not disclosing

Question 11

There are 5 situations that require written consent. What are they?

Answer 11

The investigation or treatment is complex or involves significant risks
There may be significant consequences for employment, social or personal life
Providing clinical care is not the primary purpose of Ix or Rx
The treatment is innovative or part of a research programme
It is mandated by law e.g. For fertility treatments

Question 12

At what age can a young person be presumed to have capacity to consent to most medical decisions?

Answer 12

16

Question 13

What 3 scenarios might make you consider discussing advance care planning with patients?

Answer 13

Patient has a condition that will affect length or quality of life
Patient has a condition that will impair capacity as it progresses (e.g. Dementia)
Patient is facing a situation in which impairment or loss of capacity is a possibility

Question 14

What should you do if your assessment of a patient’s capacity leaves you in doubt?

Answer 14

Ask nursing staff and other close carers or relatives about normal decision making ability or communication needs
Ask colleagues with relevant experience e.g. Psychiatrists, neurologists, speech and language therapists
If still unsure, ask for legal advice with view for court determined capacity

Question 15

Can a competent pregnant woman refuse treatment even if that refusal may result in harm to her or her unborn child (e.g. For pre eclampsia)?

Answer 15

Yes

Question 16

What are the 5 criteria for Gillick competency - that is, being allowed to give contraceptive advice and treatment to an under 16?

Answer 16

Child has sufficient maturity and intelligence to understand nature and implications of proposed treatment
Child cannot be persuaded to tell parents or allow doctor to tell them
Child is very likely to begin or continue sex with or without contraceptive treatment
Physical and mental health likely to suffer unless they receive advice or treatment
Advice or treatment is in patients best interest

Question 17

What 3 situations do Gillick competence generally apply to?

Answer 17

Contraceptive treatment and advice
STD treatment
Abortion

Question 18

What are the 5 principles of the MCA?

Answer 18

Patients should be presumed to have capacity unless proven otherwise
Make all practicable steps to allow patient to make decision before treating them as otherwise
Patients have a right to unwise decisions
Best interests if lacking capacity
Least restrictive option

Question 19

Below what age are children considered by law to be unable to consent to sex?

Answer 19

13

Question 20

When does an unmarried father have parental responsibility?

Answer 20

When they were registered after 1 December 2003, as long as they are named on the birth certificate

Question 21

Can unmarried fathers acquire parental responsibility?

Answer 21

Yes - Parental Responsibility Agreement with child’s mother, or Parental Responsibility Order from courts

Question 22

Do parents lose parental responsibility if they divorce?

Answer 22

Not automatically; but they do if the child is adopted