confidentiality, consent and other ethical principles

Question 1

give the 4 ethical principles of biomedical ethics

Answer 1

relevance- a dilemma occurs when two or more of these principles clash

1. beneficence- act in patients best interests
2. non-maleficence- do no harm
3. autonomy- patient has the right to chose what they want
4. justice- patients must be treated fairly

Question 2

give some simples measures that can be used to maintain confidentiality

Answer 2

1. not leaving computers on with patient record unattended
2. carefully considering your reactions to questions asked by relatives or outside organisations e.g. legal organisation posing as a social worker at new street
3. not using the public as translators, even if they offer

Question 3

state some examples of where breaching confidentiality is appropriate?

Answer 3

1. sharing information with other healthcare professionals or others involved in the care of the patient e.g. sending a letter back to the GDP after treatment- consent is implied but may need confirmation
2. disclosure in the public interest and to protect the patient or others from risk of serious harm or death e.g. HIV patients knowingly infecting others
3. court order
4. treatment of children or incompetent adults

Question 4

what should you do when breaching confidentiality?

Answer 4

you should always discuss it with the patient beforehand- being open and honest is generally appreciated by patients even in challenging situations

Question 5

what is the difference between competence and capacity?

Answer 5

• competence is a legal judgement about whether a person is capable of making a rational decision by themselves
• capacity is a medical judgement and is formally assessed by doctors and nurses who must be sure that a patient is able to understand the proposed management, comprehend the risks and benefits and to retain the information long enough to make balanced choices

Question 6

describe the capacity assessment as is in the Mental Capacity Act 2005

Answer 6

1. understands the information provided in relation to the decision that needs to be made
2. is able to retain the information
3. is able to use and weigh up the information
4. can communicate his decision by whatever means possible

every adult is assumed to have capacity
an unwise decision does not imply a lack of capacity

Question 7

what happens regarding a patient’s care when a patient lacks capacity?

Answer 7

The doctor must provide care which is in the patient’s best interest. The doctor should take into account a wide range of issues regarding the care of the patient.

Question 8

state the issues that should be taken into account when making decisions for a patient that lacks capacity

Answer 8

1. has the patient signed an advanced directive
2. the views of any individuals who are legally representing the patient or whom the patient has said they wanted to involve
3. views of any individuals who are close to the patient and may be able to comment on their beliefs, values and feelings
4. whether the lack of capacity is temporary or permanent

Question 9

can children give informed consent?

Answer 9

all children aged 16 and above can be assumed to be competent i.e. essentially they can be treated in exactly the same way as an adult. Children under 16 can give consent if they are deemed to be gillick competent

Question 10

what determines if a child is gillick competent or not?

Answer 10

a child is deemed gillick competent if they can understand, retain, use and weigh up the information given and they have understanding of benefits risks and consequences.
note that you should make every effort to involve the parents. Parents CANNOT override consent from a gillick competent child.

Question 11

can children refuse treatment?

Answer 11

in England and wales they cannot. No minor can refuse consent to treatment when consent has been given by someone with PR or by the court. This applies even if the child is competent and specifically refuses treatment that is considered to be in their best interest

Question 12

what was the futher 1990 ruling in relation to gillick?

Answer 12

a gillick competent child can prevent their parents from viewing their medical records- consent must be sought explicitly

Question 13

what are fraser guidelines?

Answer 13

these guidelines state that a doctor or other health professional providing contraceptive advice or treatment to someone under 16, without parent consent must be satisfied that certain guidelines are met such as the young person cannot be persuaded to tell their parents or allow the doctor to tell them that they are seeking contraceptive advice

Question 14

what is ‘lasting powers of attorney’ LPA (MCA 2005)?

Answer 14

a patient with capacity is allowed to appoint an attorney to make health and welfare decisions on their behalf should they ever lose capacity

Question 15

what is an independent mental capacity advocate (IMCA)?

Answer 15

the IMCA cannot make decisions, but represents the patient by bringing to the attention of decision-makers (e.g. doctors) the important factors that need to be considered such as the patients beliefs, feelings and values . The IMCA can also challenge decisions on behalf of the patient.

Question 16

consent when dealing with emergencies in the clinical setting- what should you do if the patient is not competent?

Answer 16

you can treat them without their consent on the condition that the treatment that you administer is limited to what is immediately necessary to save their life or to prevent a serous deterioration of their condition.
In the case of a child… of the parents disagreed with your emergency treatment, then you would be entitled to proceed with what you perceive to be in the best interest of the child

Question 17

what are the qualities of a good teacher?

Answer 17

1. sets appropriate, specific and challenging goals
2. has a clear plan to achieve his or her goal and has a clear delivery of the topic
3. is positive and enthusiastic and relays this effect on to students
4. gathers feedback and reflects on negative feedback

Question 18

what makes you a good leader?

Answer 18

CPR
1. Change
somebody who has a vision of how departments or teams should develop or change and is able to drive that change
2. People (developing people)
a leader takes people with him towards the objectives that he has set and creates an environment where people work together and cooperate
3. Results (delivering results)
ability to meet set goals and expectations. this involves making decisions that plan, delegate and get things done

Question 19

duty of candour

when something goes wrong with a patients care that causes harm and distress, what should the dentist do?

Answer 19

1. tell the patient
2. apologise to the patient
3. offer appropriate remedy to put things right
4. explain fully the short and long term effects of what has happened

Question 20

statutory duty of candour- (health and social care act 2008)

Answer 20

A notifiable patient safety incident has a specific statutory meaning: it applies to incidents where something unintended or unexpected has occurred in the care of a patient and appears to have resulted in:

• impairment of sensory function for 28 days or more
• changes to the structure of the body e.g. erroneous extraction
• prolonged pain- continuous for 28 days or more

An area of difficulty may be deciding whether an incident reaches the threshold for notification OF THE CQC under the statutory duty.

Question 21

who has parental responsibility?

Answer 21

For births registered in England and Wales:

1. A child’s natural parents both have parental responsibility if they were married at the time of the birth or marry later.
2. A father who is named on the birth certificate will usually have parental responsibility if the child was born on or after 1 December 2003.
3. If a child was born prior to this date, and the parents were unmarried, then only the mother has automatic parental responsibility. However, the father may acquire parental responsibility if he becomes registered as the child’s father, or makes an agreement with the mother (including by marriage) or by a court order.

Question 22

parental responsibility for same sex parents

Answer 22

For same-sex parents:
Same-sex parents who were civil partners at the time of the treatment (eg, fertility treatment or donor insemination) will both have parental responsibility.
For non-civil partners, the second partner can either apply for parental responsibility if a parental agreement was made, or become a civil partner of the other parent and make a parental responsibility agreement, or jointly register the birth.

Question 23

can a 16-18 year old give consent?

Answer 23

The age at which children are deemed capable of giving consent for dental treatment in England and Wales, Scotland and Northern Ireland is 16.
Although in England and Wales children remain minors until they are 18, once a child reaches the age of 16 they are deemed to be capable of consenting to treatment as an adult.

Question 24

is there parental responsibility for patients aged 16-18?

Answer 24

Valid consent of a child over 16 cannot be overridden by a refusal from those with parental responsibility.
However, in some cases a refusal of consent by a child over 16 can be overridden by a child’s parents or guardians, or by the court.
Although there is no legal requirement to do so, if a 16 or 17-year old needs to undergo major or hazardous elective surgery, you may wish to discuss the treatment with the parents, subject to the patient’s permission.

Question 25

explain about consent for children in care

Answer 25

In England and Wales, The Children Act 1989 makes a clear distinction between children who are the subject of a care order and those who are being looked after on a voluntary basis.
The local authority does not have parental responsibility over children who are looked after on a voluntary basis.
You should seek consent from the child under 16, if Gillick competent, or authority from someone with parental responsibility for the child, before starting non-emergency work.