Deck 7 Flashcards
What are rights?
Rights are justified claims on others. It is normally argued that there is a correlative duty on others to fulfil that right. Thus, when we talk about someone having a right to something, what we normally mean is the person is entitled to the thing (whatever it is) and that that thing is due to him/her. Rights can be:
Legal
Moral (natural)
Human
What theories hold that we have rights as human beings?
Status theories hold that human beings have certain attributes (e.g. rationality, autonomy) that make it fitting to assign certain rights to them, and which make respect for these rights appropriate.
Instrumental theories hold that rights are justified by states of affairs they seek to promote (thus, a utilitarian might hold that recognition of rights is likely to bring about the greatest aggregate utility for members of a society).
What types of rights exist?
Positive rights – someone has duty to do something
Negative rights – others have a duty to refrain from acting in particular ways
Active rights – Allows people to act or not act as they choose
Passive rights – rights not to be done to by others in certain ways
Why are human rights important?
Security of expectations – Knows where one stands; predictable environment.
Protective boundaries – Limits actions of others in respect to vulnerable.
Conductive to goods – Dignity, respect, equality.
Minimum standards – Represent least can expect.
Ideal directives – What should be the case
The Human Rights Act 1998 brought about a number of rights that are relevant to healthcare. Which ones are they?
Article 2- right to life.
Article 3 - prohibition of torture or inhuman or degrading treatment or punishment.
Article 5 - right to liberty and security.
Article 6 - right to a fair trial.
Article 8 - right to respect for private and family life.
Article 9 - freedom of thought, conscience and religion.
The human rights convention is divided into three groups - what are these?
Absolute Rights – (Article 3) From which no derogation is permitted
Limited Rights – (Articles 2, 5 and 6) Where the limitations are explicitly stated in the wording of the article.
Qualified Rights – (Articles 8, 9, 10, 11, 12) where derogation is permitted but any action must be: based in law; meet convention aims (e.g. protects the rights of others); necessary in a democratic society; and, proportionate (not excessive).
The higher the levels of deprivation and long term illness, the higher proportion of carers in an area. What are the differences between formal and informal care?
A carer is someone, who, without payment, provides help and support to a partner, child, relative, friend or neighbour, who could not manage without their help.
Informal care is the term used in academic works but in other areas it is labelled as unpaid care and the individual as the carer.
Formal care is care provided by the statutory services or a voluntary organisation on a paid basis.
What are theh impacts of caring on health?
Carers report high levels of physical and mental health problems. Over twice as likely to be in poor health than non-carers.
Co-resident carers more likely than extra-resident carers to report health problems
Hard to establish causal link
Caring has greatest impact on carers emotional health
Carers ‘don’t have enough time to look after their own health’
Local authorities must identify and support carers (e.g. carers allowance benefit) but the NHS doesn’t have such a duty. GPs and other health professionals have a key role in signposting carers to sources of advice
Summarise all the modes of healthcare provision.
What financial support is available for carers?
Carer’s Allowance is a benefit for people who regularly spend at least 35 hours a week caring for someone with a severe disability who receives a qualifying disability benefit. The standard rate is £61.35pw (at May 2014), and is taxable. Impacted on by earnings.
Disability Living Allowance (DLA or PIP) - Many carers not only look after someone but are ill themselves.
Attendance Allowance (AA) - benefit for severely disabled people aged 65 or over who need help with personal care.
Also some top-up benefits or tax credits.
What needs to carers require?
Information and advice
- available services, and how to access them
- health needs and treatment of care recipient
- social security benefits
Practical and emotional support. 32% without, 47% of parent carers.
Training in caring activities (e.g. lifting)
Respite care and short-term breaks
What are the needs of carers for specific demographics?
Parents of disabled children: accessing mainstream services.
Rural carers: information and advice; practical support; transport.
Black and ethnic minority carers: culturally sensitive services; language issues.
Young carers: information and advice; emotional and practical support; transition into adulthood.
Young minority carers: contact with social services; interpreting for care recipient.
What are the challenges facing different types of carers?
Employed carers: juggling work and care; taking time off; access to phone.
Carers of people with dementia: practical support; alleviation of emotional stress; respite care and short-term breaks
Carers of people with mental health problems: fluctuating needs; stigma and discrimination; medical confidentiality.
What do carers say they want?
Quality of life for the person they care for
Quality of life for themselves
Accurate and honest information about services and what is on offer
Support and training with those aspects they find difficult
To know that someone will take over caring in an emergency
What is a randomised control trial?
- An experiment where participants are randomly allocated into groups.
- Intervention group - recieve experimental intervention.
- Control group - recieve current standard of care.
What is a clinical trial?
A planned experiment involving patients, designed to determine the most appropriate treatment of future patients with a given medical condition.
- Does not assume randomisation or control groups.
- Phase I-II are concerned with pharmacology, safety and initial investigation of treatment effect.
- Phase III trials are RCTs with one or more experimental treatments being compared against the standard (control) treatment, in which an attempt is made to draw a definite conclusion regarding benefit, or otherwise, of a new treatment.
What are the alternatives to RCTs?
- Case series - no control, no comparisons, not enough evidence.
- Historical controls - using results from published results of a similar trial
- Before/after - the same participants are measures before and after an intervention.
- Concurrent (non-randomised) controls.
What are the problems with Before/After studies?
Regression to the mean - occurs when a group is measured with an inexact measurement tool and then remeasured. Individuals with extreme values will have a high probability of regressing towards the mean on the second measurement.
Why randomise trials?
- Eliminates systematic bias in allocation of interventions.
- Helps ensure balance across comparative groups for any confounding variables that may affect the outcome.
Also ethical considerations:
Treatment is not decided by a person
Equipoise, i.e. we do not know which intervention is better than the other.
Sometimes the baseline factor cannot be balanced by randomisation alone. To ensure balance, stratification can be used.
What are the four types of bias.
If there is bias in allocation due to the healthiest patients being chosen, the effect of the intervention would be exaggerated. If the bias is the other way i.e. the sickest patients need the intervention, then the effects of the intervention would be diluted.
- Alternative Allocation
- Odd/even date of birth
- Randomisation lists should be prepared and stored confidentially by someone not involved in delivering and assessing the intervention.
- Sealed envelope.
- Coin toss.
- Independent organisation, such as a trials unit, who centrally organise randomised allocation via a computer program. (this is the best method of allocation concealment, it is designed to be unpredictable and is least subject to potential subversion of the allocation process).
Define allocation concealment and binding.
Allocation concealment is a technique used to prevent selection bias by concealing the allocation sequence from those assigning patients to the intervention groups, until the moment of assignment. This prevents researchers from influencing which patients are assigned to which group.
Blinding is a measure that can help reduce the potential for bias. Blinding of the allocated intervention and outcome assessment.
Summarise the hierachy of evidence again.
