Ethical and legal issues Flashcards
When patients are under 16 years of age…
A 15-year-old girl cannot consent to termination of pregnancy
Her mother must be informed before the procedure takes place
She can refuse to take antibiotics if she is found to have a sexually transmitted infection
Only a clinician can decide whether a 15-year-old is capable of consenting to any procedure
Social services must be informed if she reveals that her boyfriend is 19 years old
All false
Regarding consent to surgery…
A - Damage to the bowel at the time of laparoscopy can be repaired without written consent
B - Tissue for research purposes can be kept without specific consent
C - A woman refuses caesarean section despite fetal distress. Her partner can overrule her decision
D - An unexpectedly viable pregnancy can be terminated without the woman’s consent if it is to save her life
Only C false
Please refer to GMC guidance on this issue:
“In England, Wales and Northern Ireland, the Human Tissue Act 2004 requires consent to be obtained before the storage and use of a living person’s organs, tissue or cells for the purpose of research in connection with disorders in, or the functioning of, the human body. In a number of specific circumstances, there are exceptions to the consent requirements; for example, a living person’s organs, tissue or cells may be stored and used without consent if the researcher is unable to identify the person it has come from, and if it is used for a specific research project that has been approved by a research ethics committee”.
Which one of the following is NOT a statutory ground for terminating a pregnancy according to the Abortion Act?
1 - The pregnancy has NOT exceeded its 24th week and the continuance would involve risk, greater than if the pregnancy were terminated, of injury to the physical and mental health of the existing child(ren) of the family of the pregnant woman
2 - The pregnancy has NOT exceeded its 24th week and the continuance of the pregnancy would involve risk to the life of the woman greater than if the pregnancy were terminated
3 - The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman
4 - The pregnancy has NOT exceeded its 24th week and the continuation of the pregnancy would involve risk or injury, greater than if the pregnancy were terminated, to the physical or mental health of the pregnant woman
The pregnancy has NOT exceeded its 24th week and the continuance of the pregnancy would involve risk to the life of the woman greater than if the pregnancy were terminated
For consent to be valid, the patient must:
1 - be competent to make the particular decision
2 - have received sufficient information to make the decision
3 - not be acting under duress
Engineer not on gunpoint
The consent form should be signed and the person should write their name in upper case as well. The four elements are therefore:
understanding
retaining
deciding
communicating.
What is a risk?
- risk is material whether patient requests information or not. A material risk, therefore, is one to which:
- the doctor attaches significance and would be supported by a reasonable body of medical opinion
- the patient would be able to attach significance.
A 15-year-old girl attends the outpatient clinic with her stepmother, who has not adopted her. Her father, who has only recently re-married, could not attend the appointment. The patient is due to have a laparoscopic cystectomy for an 8 cm dermoid cyst in a week. The consultant has deemed the patient to have capacity and has explained the procedure, risks and benefit, and alternatives to her and her parents on a previous clinic visit. Both the father and stepmother support the patient’s decision to proceed with surgery.
What is the most appropriate means of completing the consent form?
Only the patient’s birth mother can sign the consent form
The consent form requires only the patient’s signature
The consent form requires only the stepmother’s signature
You are required to invite both parents back to sign
You are required to invite only the patient’s father back to sign
The consent form requires only the patient’s signature
The consent form requires only the patient’s signature. The patient is deemed Fraser competent and can give consent for treatment, but cannot refuse treatment. The stepmother has no legal right to consent for the patient.
A 12-year-old girl, who lives in a care home, attends the Sexual Health Clinic requesting contraception. After taking a thorough sexual history you discover that her partner is 16 years old and she does not feel they are doing anything wrong. She has asked you not to share her information with your Safe guarding team because she is afraid of getting her partner in trouble.
What should you do?
Agree with her request for confidentiality and issue the contraceptive
Agree with her request for confidentiality but refuse to give her any contraceptives as she is under the age of consent for intercourse.
Inform the police immediately
Issue a contraceptive and involve the Safeguarding team
Not issue the contraceptive but involve the Safeguarding Team
Issue a contraceptive and involve the Safeguarding team
Children under 13 are not deemed able to consent and must all be reported to the Safeguarding Team. Also a significant age gap of more than 4 years should raise alarm bells for grooming and exploitation. It is likely that intercourse will take place even if you advise against it so it is better to protect the patient from unwanted pregnancy and STI.
A 38-year-old lawyer is 34 weeks into her first pregnancy. She has developed pre-eclampsia and her blood pressure is inadequately controlled on two antihypertensives. Her most recent scan shows a severely IUGR baby, with estimated fetal weight less than the fifth centile, reduced liquor volume with AFI of 4.2 cm, and raised umbilical artery dopplers. She has capacity and is declining steroids and delivery by caesarean section within the next two weeks because she believes everything will be fine and she would like to avoid surgery.
What is the most appropriate management option if you were the consultant in charge of her care?
Admit her under the Mental Health Act and give her the advised treatment
Involve another consultant to see if they can convince the woman to change her mind
Respect the woman’s wishes and discharge her from his care
Respect the woman’s wishes and ensure regular follow up
Seek a court order to force the patient to have the advised treatment
Respect the woman’s wishes and ensure regular follow up
The answer is respect the woman’s wishes and ensure regular follow up. Beneficence and non-maleficence are an important consideration here. The unborn fetus has no rights and giving treatment against the patient’s will constitutes battery.
Mrs X gave birth to Baby Y on 13th June 2011. There was meconium staining of the liquor and an abnormal CTG for several hours before Baby Y was delivered by a traumatic forceps delivery. Baby Y was born in poor condition and now suffers with severe cerebral palsy.
What is the date by which Baby Y can bring a claim for medical negligence (the limitation period)?
13th June 2014
13th June 2026
13th June 2029
13th June 2032
No limitation
There is no limitation.
Mrs A suffers with severe dementia and develops pneumonia, which worsens to the extent that she now requires ventilation. Her respiratory function deteriorates despite ventilation. A decision needs to be made regarding continuation of ventilation.
Who is able to make the final decision?
An advance directive from Mrs A before the onset of dementia which does not specifically mention mechanical ventilation
Her consultant, using best interest principles
Her daughter, to whom Mrs A once confided that she did not want to suffer if placed in such a situation
Her son, who has lasting power of attorney
Her husband
Her consultant, using best interest principles
The answer is her consultant, using best interest principles.
Mrs Y is HIV positive and refuses treatment with antiretrovirals throughout her pregnancy. She is advised to deliver by caesarean section due to a high viral load, but refuses and wants to deliver vaginally. She is advised to avoid breastfeeding and it is recommended the baby is treated with antiretrovirals once born.
Looking back at her care, what would have been the best course of legal action be to reduce the risk of transmission to the baby?
Arrange a court order to force Mrs Y to deliver by caesarean section
Arrange a court order to force Mrs Y to take antiretrovirals during the pregnancy
Arrange an emergency protection order once the baby is born so that the baby can be treated without delay
Contact Social Services before the baby is born so that he/she is removed from Mrs Y once born
Obtain consent from the father of the baby to treat with antiretrovirals
Arrange an emergency protection order once the baby is born so that the baby can be treated without delay
The answer is arrange an emergency protection order once the baby is born so that the baby can be treated without delay.
The parents of a 22-year-old mentally handicapped woman come to see you in the gynaecology clinic requesting sterilisation for their daughter. The woman had recently become sexually active and she describes it as ‘very nice’ and ‘fun’. Her partner is a member of the care home she lives in. She does not understand that her actions may lead to a pregnancy and she thinks it will be nice to have a baby to take for walks in the garden. The lady will not allow a pelvic examination and an implant inserted a few months ago was removed with her fingernails and a fork.
How would you manage this case?
Offer long-acting forms of contraception, such as the levonorgestrel intrauterine system under general anaesthesia
Perform sterilisation as the lady does not understand the implications of getting pregnant
Refer the case to a court for judgement
Refuse to perform sterilisation as the woman is not in a position to consent to the treatment
Suggest moving care homes to prevent further sexual activity
Refer the case to a court for judgement
The answer is refer the case to a court for judgement.In this scenario, the woman lacks the capacity to consent to treatment and not providing a reasonable form of contraception would be detrimental to the woman’s wellbeing. The woman does not understand the implications of her actions or pregnancy and may not ever understand them. For this reason, it is advisable to get legal input as the decision cannot be based on the parents/guardians wishes.
A 15-year-old girl is pregnant by her 19-year-old boyfriend. Her parents are not aware of the sexual nature of their relationship. Which team/ group of individuals should be informed regarding this relationship?
A named nurse/midwife
Her parents
The general practitioner
The police
Social services
Social services
In case the case of a minor, if the age gap between the minor and his/her partner is more than 4 years, then social services should be involved.
Sexual Offences Act 2003 – Sexual activity with a child; Section 9
A 14-year-old girl presents to A&E accompanied by her parents. A diagnosis of ruptured ectopic is made. She is tachycardic, hypotensive, clinically in shock and has lost consciousness. Before she loses consciousness she refuses to go to theatre. What is the most appropriate step for the clinician to take to manage this situation?
A second opinion should be sought before any decision is made
The clinician can overrule this decision in a life threatening scenario
The courts should be involved to overrule
The general practitioner of the patient should be asked
The parents can make a decision on her behalf
The clinician can overrule this decision in a life threatening scenario
In the case of a minor, treatment can be given. A minor can agree to treatment but cannot refuse it if the clinician deems appropriate.
