ethics

Question 1

compassion

Answer 1

1. arises when a person is affected by the suffering or distress of another
2. and is moved by a desire to relieve that person’s suffering or distress

Question 2

honesty

Answer 2

quality of being truthful, open and candid

Question 3

integrity

Answer 3

1. to be whole and complete
2. sound in one’s principles and character
3. unimpaired and free from corruption

Question 4

responsibility

Answer 4

1. capability of fulfilling duty and obligation to the patient
2. quality of being reliable and trustworthy
3. closely linked with being accountable

The doctor owes a duty of care to Mr T. Knowing that Mr T’s decision is not in Mr T’s own best interest, the doctor should ensure that the interventions for Mr T will be in Mr T’s best interest.

Question 5

participation

Answer 5

1. take part in something; share something in common
2. to engage in a partnership
3. do these things willingly

Question 6

empathy

Answer 6

ability to understand and appreciate another person’s feelings, experience and needs

Question 7

respect

Answer 7

1. be considerate and have regard for the patient as a person
2. recognise the patient’s personal quality and intrinsic worth
3. foster patient’s control over their lives and refrain from carrying out unwanted interventions

demonstrated by actively protecting patients’ rights, incl right to info

Question 8

sensitivity

Answer 8

1. sensitive / mindful towards someone or something
2. fine-tuned awareness of the behaviour, feelings and motives of the patient
3. alert to other’s responses, circumstances, social and economic support

Inquiring into the reason for Mr T’s decision shows sensitivity for his decision-making capacity, his competency and respects him as a person who have his own preferences, perspectives, rights and freedom of choice.

Question 9

justice

Answer 9

treat patients fairly and equitable, according to their medical needs with neither prejudice nor preferance
i. fair treatment no discrimination
ii. equal distribution of healthcare resources

Question 10

autonomy

Answer 10

1. acknowledges patient’s right to hold views, make choices and take action for his/her healthcare based on their personal values and beliefs
2. doctors need to provide all relevant information required to make an informed decision

Autonomy means to respect patient’s rights to decide for themselves and to help patients make informed decisions and ensure that patient’s decisions are voluntary.

Question 11

3 components of informed consent

Answer 11

1. Disclosure: communication of relevant information
2. Capacity / competency: patient’s ability to understand information and foreseeable consequences (including risks/complications, benefits, alternatives, reason for recommended treatment and the result of no treatment)
3. Voluntary: patient’s RIGHT to come to a decision freely

Question 12

beneficence

Answer 12

a. do what is in the patient’s best interests
b. moral obligation to act for the others’ benefits

Question 13

non-maleficence

Answer 13

do no harm or injury to patient, seek to prevent harm

i. negligent -> careless or unreasonable risk of harm upon another
ii. provide a proper standard of care that minimises risk of harm
iii. medical competence

Question 14

Gillick competence

21/22 Pros MEQ

Answer 14

Gillick competence relates to an individual possessing sufficient maturity and understanding to consent to treatment.

Gillick competence only applies to minors agreeing to treatment (e.g. when parents refuse), not to minors refusing treatment

Question 15

4 features of ethics of care

18/19 Pros MEQ

Answer 15

• Focuses on how, & how well, the human needs of particular people are attended to
• Sees people as relational & interdependent
• Considers moral issues within family & other social relationships
• Respects the particular (relationship) claims that arise within actual human relationships
• Regards emotions & relational capabilities as important for understanding what is good

Caring supports the professional attribute of responsibility by ensuring that the proper standard of care is given to the patients. It also supports sensitivity by recognising that people have different perspectives about what is good care for themselves.

Question 16

What is patient empowerment?

18/19 Pros MEQ

Answer 16

• Defined as helping patients discover & use their own innate ability to gain mastery over their disease
• acknowledges that patients have the ability to make informed decisions & set behavioural goals to make changes of their choosing

ask why he feels that way and provide information about the care that he must receive and ensure that he
- understands the information
- remembers the information
- weighs the information
- can communicate the decision

Question 17

5 statutory principles of the MCA

17/18 Pros MEQ

Answer 17

1. Assume a person has capacity unless you establish the opposite
2. Take all practicable steps to help a person make a decision
3. A person has the right to make an unwise decision
4. Always act in the person’s best interests
5. Choose the less restrictive option

Question 18

2 stage test for assessing capacity under the MCA

17/18 Pros MEQ

Answer 18

1. Is the person suffering from an impairment of brain function?
2. If yes, does the impairment cause the person to be unable to make a decision when required?

A person is deemed to be unable to make a decision if they are unable to
- understand the information
- remember the information
- weight the information
- communicate the decision

Question 19

2 considerations of futility

16/17 Pros MEQ

Answer 19

If an intervention is
- non-beneficial and/or harmful
- not able to achieve goals of care

• likelihood of success of a proposed medical intervention is very small
• patient’s QOL is unacceptable

judgments of futility will require a holistic assessment of Mr Y’s condition, and in a manner that is consistent with the ethical principles of beneficence and non-maleficence. It should not be a unilateral position to be made by Ms M

Question 20

What is legal duty of care?

15/16 Pros MEQ

Answer 20

A duty of care is a legal obligation imposed on an individual requiring adherence to a standard of reasonable care while performing acts likely to harm others.

It exists when a doctor-patient relationship is established.

Question 21

Medical negligence

15/16 Pros MEQ

Answer 21

Mr Z was owed a duty of care
The duty of care was breached
And as a result of the breach, Mr Z suffered legally defined harm

Question 22

In cases of medical negligence in Singapore, how is the standard of care measured?

15/16 Pros MEQ

Answer 22

Bolam-Bolitho Test
Doctor is not negligent if he has
- acted in accordance with the practice of a respectable, responsible, reasonable body of professionals
- actions & justification is able to withstand the scrutiny of logic, internal consistency & recent advances, where benefit > harm