Consent, Competence and Confidentiality (Law and Ethics) Flashcards
What is consent?
Patient’s VOLUNTARY AGREEMENT to treatment, examination, or other aspects of healthcare
Waiving of the right to bodily integrity
Shows respect for patients dignity autonomy
Builds/maintains a relationship of trust between patient and doctor
Consent is specific to the task and is dynamic
Why do we need consent?
Legal and professional requirement in healthcare
Respect for patient autonomy
Upholds trust
Maintains dignity
Provides full information to allow patients to make informed choices
What makes consent voluntary?
Patients must be able to refuse
Patients must know that they are able to refuse
Must be free from undue pressure (coercion and perceived pressure)
What is adequate consent?
Patient must be informed on nature and purpose of the procedure
Informed briefly on benefits and risks
BUT
No risk
No Questions
Alternatives in depth
Benefits in depth
What is valid consent?
PARQCC
Informed on nature of PROCEDURE
Informed about ALTERNATIVES
Informed about RISKS
Answer any QUESTIONS
Continuous
Capacity
Some issues with consent?
Consent cannot be obtained if no capacity
Time consuming to check all criteria
Information may be too complex for patient to understand
Some patients may not wish to hear all the information
Consent forms may be inadequate to prove full consent was obtained
How do we determine competence?
Understand
Retain
Weigh the pros and cons
Communicate their decision
Competence can fluctuate - such as delirium
Avoid bias - an unwise decision does not mean an incompetent one
3 approaches to assessing competency? How much information is necessary?
Subjective approach - GMC - Explain any risks to which the patient may attach particular significance
Hypothetical reasonable person approach - department of health - Doctors have the responsibility to inform a patient of a significant risk that would affect the judgement of a reasonable patient
Professional practise approach - Bolam’s test - Proving you acted in a way that other healthcare professionals would
Define confidentiality
Maintaining a patients right to privacy, ad upholding the trust in a clinician when divulging sensitive information
Examples of inappropriate breach of confidentiality?
Talking in public areas
Talking to people not involved in care
Posting confidential information on social media
Using shared computers to access confidential information
Not disposing of confidential information as per trust guidelines
Why do we need confidentiality?
Patients legal right to privacy
Respect for patients autonomy
Maintains trust in healthcare professional-patient relationship
In some cases patient safety
Virtue - a good person would do this
Consequentialism - better for the patient
Deontology - duty
What is a justifiable disclosure?
In public interest and patient is not competent
Consent to disclose would put others at risk
Time necessity
Real and serious risk of harm to identifiable individual
What is a statutory disclosure?
Legal duty of NHS, trusts, govt and other care providers and organisations
Must disclose certain things by law
Appropriate breaches to confidentiality?
Risk of significant harm to the individual or someone else
Notifiable diseases
Births and deaths
Terrorist incidents
Court ordered
Serious work incident investigation
Fertility treatment and terminations
Poisonings
Drug addiction
