D. ETHICS OF TRANSPLANTATION Flashcards
what is the 4 stage decision making model
- gather relevant information
- Criminal Law
- Administrative Law
- Professional Law
- Civil Law
- Professional/clinical knowledge
- Situational information (patient)
- Ethical frameworks
- Availability of help - prioritise and ascribe values
- generate options
- select option and action
what type of principles are the 4 bioethical principles
prima facie
what is autonomy
- right of a patient to make decisions about themselves
- capacity to think and decide and to act on the basis of such thought and decision
- need informed consent
- patients have rights to disagree with a health professionals advice
- person’s autonomy can be restricted by certain circumstances
what are the restrictions of autonomy
- To prevent people from harming others (harm principle)
- To prevent that person from harming themselves (soft paternalism)
- To benefit that person (hard paternalism)
- To benefit others (social welfare principle)
Note: paternalism overrides the principle of respect for autonomy, soft paternalism is overriding an incompetent person’s wishes; hard overriding a competent person’s wishes
what is beneficence
- duty to promote the health and welfare of the patient, not merely to avoid harm
- act in best interest of patient
- may conflict with autonomy
- patient interest isn’t always 1st principle here
what is non-maleficence
- duty not to harm anyone
- expresses the commitment to the protection of patients from harm
- affirms the requirement of competence and the standard duty of care
what issues concern the principle of non-maleficence
- withdrawing or withholding life sustaining treatment
- treatment of terminally ill patients
- provision of futile treatment (NICE requires professionals to stop prescribing medicines of dubious efficacy)
- what about surgery
- what about potential adverse drug events
what is justice
- moral obligation to act on the basis of fair adjudication between competing interests
- equality/equity
- important to treat equals equally
- important to treat unequals unequally in proportion to the morally relevant inequalities
- requires that morally defensible differences among people be used to decide who gets what
what is the difference between equality and equity
- Equality: each individual or group of people is given the same resources or opportunities
- Equity recognizes that each person has different circumstances and allocates the exact resources and opportunities needed to reach the same outcome
what are the 3 types of justice
- distributive justice (fair distribution of scarce resources)
- rights-based justice (respects for peoples rights)
- legal justice (respect for morally acceptable laws)
4 types of basis’ for distributive justice
- Needs Based – distribution to those that need it most
- Maximisation based – distribution to maximise outcomes
- Egalitarian based – distribution based on equality
- Merit-based – distribution based on merit
example of rights-based justice
- if a patient has the right to be excused work because they are unfit to work, then doctor ought to provide medical certificate, but if fit to work, then that right does not exist
- more and more merging into legal justice with incorporation in legislation (e.g. ECHR)
example of legal justice
- provision of healthcare for foreign visitors
- NHS act allows for emergency treatment only - at taxpayers expense
what is utilitarianism
- consequentialism: the view that morality is all about producing the right kinds of overall consequences
- principle of utility = degree to which an action “produces good”/ “avoids evil”
- actions should be judged on “happiness” conferred
- originally “all forms of happiness are equivalent”, now accepted there will/must be variations
- very commonly used argument for decision making at population level
can you discriminate on the basis of age according to equality act
No
what is it called when you choose someone based on ability and talent, rather than wealth, social class, or race
meritocracy
conditions for a liver transplant
- alcoholically clear
- promise to the contract
what can be transplanted
heart
lungs
pancreas
liver
small bowel
corneas
skin and bone
where do most organ donations come from
people who have died while on a ventilator in a hospital ICU
(living donors - kidney and split liver)
why is there decreased available donor organs
- increased road safety and medical information
where are registrations made for organ donors
65% via driving license
13% through boots advantage card
why do people need kidney transplants
- CKD
- kidney failure
*normally been on CAPD first
2 types of renal transplant
- cadaveric donor
- living donor
cadaveric donor
- DCD: donor circulatory (cardiac) death, damage to other areas other than brain (distributed regionally)
- DBD: donor brain stem death, other organs in good state, distributed nationally
what does the points-based system for allocation of donor organs include
- Waiting time
- HLA match and age combined
- Donor-recipient age difference
- Location of patient relative to donor
- Other HLA criteria
survival rates for kidney transplant for deceased vs living donor
QoL and length significantly better when living donors used
what conditions need to be met to have a kidney transplant
- they are well enough to withstand the effects of surgery
- the transplant has a relatively good chance of success
- the person is willing to comply with the recommended treatments required after the transplant – such as taking immunosuppressant medication and attending regular follow-up appointments
exclusion criteria for a transplant
- ongoing infection (this will need to be treated first)
- heart disease
- liver failure
- cancer that has spread to several places in your body (metastatic cancer)
- AIDS (however, people who have HIV that is being effectively controlled with medication can often have a kidney transplant)
2 types of living donors
- paired/pooled donation (PPD)
- altruistic donor chains (ADC)
- D1 TO R1
- D1 is a living donor to recipient 1, usually will know each other
what is the new approach to organ and tissue donation in England
- From spring 2020 everybody will be considered willing to donate their organs after they die unless
they have recorded a decision not to do so or are in an excluded group:
<18 years old
Lacking mental capacity
People who have not been ordinarily resident in England for at least 12 months (for example tourists and short-term visitors) - while the default position will change, there will always be a discussion involving the family, the specialist nurse, and clinicians, if donation is a possibility on someone’s death
- Wishes of the deceased will be respected unless family can produce compelling evidence to the contrary
- since faith often plays an important part in one’s organ donation decision, we have proposed measures
to make sure people feel confident that their faith will be considered, if they sign up to be a donor” - Faith leaders can be consulted to advise on how donation can go ahead whilst meeting faith obligations
