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Ethical + Legal Flashcards

1
Q

What are the principles of the Canada Health Act?

A

Public administration - provincial health programs must be administered by public authorities
Comprehensiveness - provincial health programs must cover all necessary areas
Universality - all eligible residents must be entitled to healthcare
Portability - emergency health services must be available to Canadians outside their home province
Accessibility - user fees + charges are not permitted

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2
Q

Describe an overview of the healthcare system

A

1 federal, 3 territorial + 10 provincial systems

Financed by public (70%) + private (30%)

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3
Q

What health responsibilities fall under the federal government?

A 
Healthcare for aboriginals + federal gov employees
Marine hospitals + quarantine 
Investigations into public health 
Regulation of food + drugs 
Inspection of medical devices 
Administration of health care insurance 
General info services 
Role in relation to criminal law eg Food + Drugs Act
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4
Q

What health responsibilities fall under the provincial government?

A 
Establishment, maintenance + management of hospitals, asylums + charities 
Licensing of practitioners 
Administering medical insurance plans 
Financing healthcare facilities 
Delivery of public health services
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5
Q

What is the legal foundation for the health system?

A

2 constitutional documents + 2 statutes

1) Constitutional Act 1867 - balance between federal + provincial
2) Canadian Charter of Rights + Freedoms (1982) - gov obliged to fulfil rights to equality
3) Canada Health Act (1984) - T&Cs that provincial systems need to meet to get federal payments
4) Canada Health + Social Transfer Act (1996) - fed gov gives 1 single payment which the province divides

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6
Q

What occurred in 1867, 1965 + 1984?

A 
1867 = Constitution Act established Canada as a confederacy. Provinces are to establish + maintain hospitals 
1965 = Royal Commission on health services. Recommends federal leadership w/ provincial gov operation 
1984 = Canada Health Act. Provides federal funds to provinces, regulates med insurance + bans extra billing by new 5th criterion "accessibility"
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7
Q

What occurred in 1996, 2001 + 2004?

A 
1996 = Canada Health + Social Transfer Act. Fed gov gives single grant to provinces 
2001 = Kirby + Romanow Commission. Reviewed history of system + plans for future public healthcare
2004 = first ministers meeting on future of healthcare. Provides 10 year plan
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8
Q

What occurred in 2005, 2011 + 2012?

A 
2005 = Chaoulli vs Quebec. Supreme Court of Canada decision. Rules that the banning of private insurance is unconstitutional. 
2011 = First progress report - reduced wait times, low uptake for EMR, little progress in pharmacy, increased funding 
2012 = 2nd progress report. Funding sufficient, more innovation needed. 46 recommendations made
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9
Q

What occurred in 2014, 2015 + 2017?

A 
2014 = expiry of 10 year funding agreement. Ruling that service shouldn't be reduced for refugees 
2015 = Negotiations for new Health Accord with $3bn investment 
2017 = New 10 year Accord with $11.5bn investment over 10 years
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10
Q

What are the sources of healthcare funding?

A

70% from public sector (65% provincial + territorial, 5% federal + municipal)
30% private (out of pocket 15%, private insurance 12%)

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11
Q

What does public funding not cover?

A

Any service provided by privately practicing professional (dentists, optometrists, osteopaths, physio, psychologist, naturopaths)
Prescription drugs, OTC drugs, residential care facilities

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12
Q

How is healthcare delivered?

A

Publicly funded hospitals delivered through private not-for-profit institutions

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13
Q

What are the key physician licensing bodies?

A

MCC
RCPSC (Royal College of Physicians + Surgeons)
CFPC (College of Fam physicians)
13 Provincial medical regulatory licensing bodies
CPSO (College of Physicians + Surgeons Ontario)

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14
Q

What does the MCC certify?

A

LMCC after MCCQE1 +2

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15
Q

What does the RCPSC certify?

A

Certifies physicians after residency

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16
Q

What does the CPSO certify?

A

Membership to the provincial licensing authority

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17
Q

What does the CFPC certify?

A

Family physicians after residency

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18
Q

What are the key professional organisations?

A

CMA (Canadian Medical Association)
OMA + PTMAS (Ontario Medical Assoc + Provincial/ Territorial Medical Assoc)
CMPA (Canadian Medical Protective Association)
RDoc (Resident Doctors of Canada) + PHO (Provinicial Housestaff Organisation)
CFMS + FMEQ (Canadian Federation of Medical Students)

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19
Q

What is the CMA?

A

Provides leadership for doctors, represents physicians

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20
Q

What is the OMA + PTMAs?

A

Negotiates fee + benefit schedules with provincial gov

Represents economic interests of docs

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21
Q

What is the CMPA?

A

Protects integrity of members

Provides legal defence + risk management programs

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22
Q

What is the RDoC + PHO?

A

Upholds economic + professional interest of residents

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23
Q

What is the CMFS + FMEQ?

A

Medical school membership association

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24
Q

What are the 4 principles of medical ethics?

A

Autonomy
Beneficence
Non-malificence
Justice

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25
What is the CMA code of ethics?
Quasi-legal standard for physicians, augmenting the law
26
What are reasons to breach confidentiality?
``` Child abuse Fitness to drive Communicable diseases Coroner report Duty to inform/ warn ```
27
What is the duty to warn?
Duty to warn police + potential victim if a patient makes a credible threat against them
28
When can disclosure of health records be compelled legally?
By a court order, warrant or subpoena
29
What is PIPEDA?
Personal Information Protection + Electronic Documents Act
30
What is a lock box?
Situation where pt has restricting doc from disclosing specific aspects of their care to others
31
What os the CPSO Policy consent?
Obtaining valid consent is an elementary step
32
What are the 4 concepts of consent?
Voluntary Capable Specific Informed
33
What is a SDM?
Substitute decision maker
34
What can the doc apply to if there is no SDM?
Apply to CCB (consent + capacity board) to appoint a patient representative
35
What is the criteria for providing treatment for an incapable pt in emergency situations?
Pt is experiencing extreme suffering | Pt is at risk of sustaining serious bodily harm if treatment is not administered
36
What risks do you need to disclose when consenting a pt?
Minor common risks + any serious risks
37
What are the major exceptions to consent?
Emergencies Public + mental health legislation Communicable diseases
38
What crime is committed when treating without consent?
Battery if no consent | Negligence if poor consent
39
What is the CPSO policy on capacity?
Capacity is an essential component of consent
40
What is the capacity assessment?
Test for understanding = can they recite what you have disclosed Test for appreciation = are his/ her beliefs responsive to evidence?
41
What is included in the aid to capacity evaluation?
Does pt have ability to: Understand medical problem Understand proposed treatment Understand alternatives Understand option to refuse treatment Appreciate reasonably foreseeable consequences of accepting + refusing treatment Make a decision based not on delusions or depression
42
What are the types of power of attorney?
Power of attorney for personal care - legal doc Guardian of the person - appointed by court Continuing power of attorney for property - legal doc Guardian of property - court appointed Public guardian + trustee - SDM as last resort for people without one
43
Describe the paediatric aspects of consent
No age of consent, depends on decision making capacity Quebec has an age of consent Infants + children are assumed to lack mature decision making capacity
44
What is non-negligent care?
Errors that a reasonably cautious + skilled MD could make
45
What are the 4 basic elements for action against a physician to succeed in negligence?
1) Duty of care owed to pt 2) breach of standard of care 3) some harm or injury to the patient 4) harm or injury caused by the breach of the duty of care
46
What is the CPSO policy on truth telling?
Physicians should supply pts with info that will have a bearing on medical decision making
47
What is open disclosure of AEs?
Docs must disclose adverse events to pts
48
What is the SPIKES protocol for bad news?
``` Setting Pt perceptions Invitation to recieve info Knowledge Emotions + empathy Strategy + summary ```
49
What is therapeutic privilege?
Witholding info from pt as the info may lead to severe anxiety or harm
50
When does the fetus have legal rights?
When it is born alive + with complete delivery from the mother
51
Treatment of preterms - at what age is treatment offered?
<22 weeks = non treatment is acceptable 23-25 = treatment given if physicians + parents agree >25 = treatment given
52
What did the 1993 Royal Commission on New Reproductive Technology recommend?
Medical treatment must never be imposed on a competent pregnant woman No law should be used to confine a pregnant women in the interest of her fetus The conduct of a pregnant woman in relation to the fetus should not be criminalised Child welfare should not be used to control a woman's behaviour during pregnancy
53
What did the assisted human reproduction act in 2004 state?
Surrogate mothers cannot be paid beyond reimbursement of their expenses
54
What is the CMA definition of abortion?
Active termination of pregnancy before fetus is >500g or >20 weeks
55
What is the CMA policy on abortion?
Counselling should be available Physicians can morally oppose + seek help from another physician Insurance should cover all costs
56
What about 2nd + 3rd trimester abortions?
Not illegal but usually only due to serious risk to mother, fetal death in utero or significant malformation
57
What is the tri-council policy statement?
1) Genetic treatment aimed at altering germ cells is prohibited 2) Embryo research is permitted up to 14 days post-fertilisation 3) Embryos created but no longer required may be used 4) Creation of embryos solely for research is prohibited 5) Physicians responsible for fertility treatment may not be part of a stem cell research team
58
What is the difference between euthanasia + medical assistance with dying?
``` Euthanasia = intentionally performing an act to end someone's life when that person has an incurable illness MAiD = administering or prescribing a substance, at the request of a person, that causes death ```
59
What is the Carter v Canada decision?
2015 | Criminal prohibition on assistance in suicide was ruled unconstitutional
60
What was Bill C 14?
2016 | Legalised MAiD by amending criminal code to exempt med practitioners to provide MAiD
61
What is the Bill C 14 criteria?
``` Pt eligible for publicly funded healthcare Pt >18 Pt has capacity Pt has grievous + irremediable condition Suffering is intolerable to pt Natural death is reasonably foreseeable ```
62
What occurs in the MAiD process?
Eligibility criteria satsified Pt signs + dates written request 2 witnesses sign request 2 assessors (MD or NP) provide written confirmation 10 days to elapse between request + day of MAiD HCP must give pt opportunity to withdraw before giving
63
What was the Cuthbertson vs Rasouli case?
Consent for withdrawal of life support must be sought from SDMs
64
When must you notify coroner of a death?
``` If it occurred due to: Violence, negligence, misconduct Pregnancy Sudden or unexpected causes Disease not treated Cause other than disease Suspicious circumstances MAiD ```
65
What are the CanMEDS competencies?
``` Communicator Collaborator Health advocate Leader Professional Scholar Medical expert ```
66
What are the guiding principles for research ethics?
Respect for persons, informed consent Beneficence: harm vs benefit Justice
67
How do you gain informed consent for research?
Purpose of study Sum of funding Name + probability of harm + benefits Nature of physicians participation including compensation Proposals must be submitted to ethics board
68
CMA + CPSO guidelines for physician-industry relations
``` Primary goal should be enhancement of health Relations guided by CMA Primary obligation is to patient Should avoid any self interest Should maintain autonomy + independance ```
69
What ethical dilemmas face resource allocation?
Fair chances vs best outcomes Priorities problem Aggregation problem (modest benefits to many vs significant benefits to few) Democracy problem

Canadian Ethics (1 decks)

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