Consent and ethical practice Flashcards
What is consent?
- Informed (PARQ) P= procedure A= alternatives R= risks Q= questions
- Voluntary
= can refuse treatment
= not coorced (forced/pressure)
= transparent conversation between doctor and patient
- Competence o Understanding o Retain o Weigh up o Communicate decision o Capacity can vary over time - dont ask patient at 3am lol
What should patients be allowed to say to a doctor?
- should be given the option to say no
What is competence?
- Patient must understand
- Retain information
- Weigh up information
- Communicate their decision
What act is competence under?
Mental Capacity Act 2005
Why is consent important?
- Legal requirement
- respect patient autonomy
- establish trust with patient
- benefit patient
What does benefiting patient require?
a. Subjectiveness of ‘benefit’ (e.g., Jehovah’ Witness)
b. More realistic expectations (pt. feels they are in control)
c. More co-operation (e.g. they will fast before surgery) If
What happens if the patient refuses beneficial treatment?
- doctor must assess if the patient is competent and is giving valid consent
- COMPETENT ADULTS CAN refuse a life-saving procedure
- doesn’t matter if this feels irrational to doctors
Where is consent not needed?
- Necessity: patient not competent but treatment needed
- Emergency: Dr must act e.g. if ambulance brings in a patient
- patient posing risk to others= can cause public health risk
- if patient declines all information - not informed
What are ethical practices?
- Moral Perception
- Moral Reasoning
- Moral Action
What is moral perception?
- consider ethical dimensions which may not be apparent at first sight
What is moral reasoning?
The 4 principles:
- Autonomy
- Non-maleficience
- Beneficience
- Justice
What is autonomy?
- respect decision making capacities of autonomous person
- enable individuals to make reasoned informed choices
What is non-maleficience?
- HCP shouldn’t harm the patient
- all treatment involves harm, but harm should not be disproportionate to the benefits of treatment
What is Beneficience?
- balance the benefits of treatments against the risks and costs
- HCP SHOULD BENEFIT THE PATIENT
What is justice?
- distributing benefits, risks and costs fairly
- all patients should be treated in same manner
What are the attributes of a HCP?
- Belong to an organisation (NHS)
- Exercise autonomy over their work
- Pledge assistance to those in need
- Possess ‘esoteric’ knowledge= deep knowledge understood by few
- Licensed by state
What are the duties of a HCP?
- Moral duty – is it the correct ethical expression? (guilty)
- Professional duty – what does the regulatory body say (GMC)? (sacked)
- Legal duty – is it within the boundaries of the law?
What is the ICD-10?
code of:
- diseases
- signs
- symptoms
- abnormal findings
- complaints
- social circumstances
- external causes of injury or diseases (classified by WHO)
What is the GMC?
- legal body
- deals with complaints about doctors
- its like a police lol
- give doctors general guidance on practising medicine
- outlines duty of a doctor
- registers F1 doctors
- ensures suitable care for the public
Are the GMC rules the law?
- GMC guidance created NO LEGAL duty
- does carry weight in law and courts
What is the BMA?
- group of doctors, philosophers, lawyers, theologians and lay people (family)
- has medical ethics department
- answers ethical enquiries from doctors
- produces guidelines and books on ethical issues
What is competence?
- task specific + Fluctuating e.g. during shock
What is consent?
- continuing (patient needs to know they can change their mind at any point) + Specific
