Ethics Flashcards
Definition:
Beneficence
To do good
Definition:
Non-maleficence
To do no harm
Definition:
Autonomy
the right of competent adults to make informed decisions about their own medical care
Definition:
Justice
Ensuring fairness
4 pillars of medical ethics?
And 2 other principles
Autonomy
beneficence
Non-maleficence
Justice
2 other principles:
- Dignity and honesty
Ethical debate:
CS for maternal request
Most common reason for request- tocophobia
Recommendation is to explore reasoning behind request rather than focus on risks only
Factors driving request for CS: fear of pain/childbirth, perineal trauma, perinatal morbidity/mortality, sociocultural factors, previous adverse experience
Ethical issues:
- Respect for patient autonomy
- Balanced with fairness- responsibility of health care workers to appropriately allocate health resources that have a net benefit for women
Evidence suggests that CS rate>15% doesn’t result in improvements in perinatal outcomes
Exploring fears of childbirth with counselling/psychology input has been shown to allay some of these fears and highlight women at risk of PTSD/adverse mental health outcomes. Women who undergo counselling and have a vaginal birth have been found to have better birthing experiences than women who have not undergone this counselling.
If after counselling women still request CS then this should be considered as it may cause more long term harm to the woman
Explore factors such as size of family etc
Ethical debate:
CS for maternal request
Most common reason for request- tocophobia
Recommendation is to explore reasoning behind request rather than focus on risks only
Factors driving request for CS: fear of pain/childbirth, perineal trauma, perinatal morbidity/mortality, sociocultural factors, previous adverse experience
Ethical issues:
- Respect for patient autonomy
- Balanced with fairness- responsibility of health care workers to appropriately allocate health resources that have a net benefit for women
Evidence suggests that CS rate>15% doesn’t result in improvements in perinatal outcomes
Exploring fears of childbirth with counselling/psychology input has been shown to allay some of these fears and highlight women at risk of PTSD/adverse mental health outcomes. Women who undergo counselling and have a vaginal birth have been found to have better birthing experiences than women who have not undergone this counselling.
If after counselling women still request CS then this should be considered as it may cause more long term harm to the woman
Explore factors such as size of family etc
Consider- autonomy, justice and non-maleficence in this context
When to breach confidentiality?
Only breach when:
- sharing is part of pt care e.g. to the GP,
- disclosure required by law,
- disclosure required to prevent serious harm.
If you breach confidentiality you should inform the patient.
How to assess competence and capacity
Situation and time specific.
4 principles:
- Understand
- Retain
- Weigh up pros and cons
- Communicate decision
All possible measures must be taking to try to enable a pt to do each of these things.
Every adult is presumed to have capacity unless proven otherwise.
Consent must also be given without coercion.
Informed consent-
Competent:
- must gauge pts current understanding, then discuss all options including: diagnosis, prognosis, different treatment options, benefits and side effects, right to a 2nd opinion.
- All in a way the pt can understand and is relevant to the pt.
- Pt then weighs this up and communicates their wishes.
Pts unable to give consent:
- advanced directive?
- Views of family/POA- but bearing in mind pts best interests, try to achieve conflict resolution through negotiation.
Consent for children
If over 16 they are competent,
If under 16 assess gillick competence by assessing the same 4 requirements for capacity to consent and taking into account the maturity of the child
What are the Fraser guidelines?
For contraception/sexual health specifically - meet the following criteria:
U - a minor should understand the doctor’s advice
P - the minor cannot be persuaded to inform her parents that she is seeking contraceptive advice
S - she was likely to have sexual intercourse even if treatment were not offered;
H - unless she received contraceptive advice, her physical and/or mental health would suffer; and
I - her best interest required treatment or advice without parental consent.
