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ethics Flashcards

1
Q

summary of abortion UK

A
  • abortion legal up to 24 weeks of pregnancy with the approval of 2 doctors
  • can be medical or surgical
  • objections ok if life not at risk and patient has to be referred to place where they can have abortion
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2
Q

what is medical abortion

A
  • performed in first 10 weeks
  • involves person taking 2 pills causing the uterus to contract and expel embryo and uterine lining
  • lower risk of complications
  • greater chance of side effects such as cramping and bleeding
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3
Q

what is surgical termination

A
  • performed after 10 weeks
  • suction aspiration to suck out contents of uterus
  • dilation and evacuation where cervix dilated and contents removed with instruments
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4
Q

legality of abortion

A
  • performed by medical professional as long as two doctors agree that continuing it is greater risk than the abortion to life or health of mother
  • allowed after 24 weeks if mothers life in danger, foetus has severe abnormality or the woman at severe risk of physical or mental injury
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5
Q

ethical arguments support abortion

A
  • patient has right to decide what happens to own body
  • patients have right to remove themselves from risks to own health
  • embryo not sentient and doesn’t have capacity for independent life
  • criminalising them won’t stop them but will reduce their safety
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6
Q

ethical arguments against abortion

A
  • human life begins at conception
  • babies can be put up for adoption
  • abortion carries physical and mental risks
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7
Q

can doctors object to performing abortions

A
  • yes however they cannot object to abortions in cases where the patients life is at risk
  • if they do object they have to refer to a willing clinician
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8
Q

what does the law say about buffer zones around clinics

A
  • legal minimum distance from abortion clinics within which protesters are not allowed
  • has been passed in uk but not yet Scotland
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9
Q

summary of confidentiality

A
  • refers to the idea that medical professionals shouldn’t share any identifiable details bout patients with those not directly involved in care
  • both ethical and legal requirement
  • maintained through extensive training and regulation, data security and punitive measures
  • exceptions made when safety at risk of if doctor legally compelled to by a judge
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10
Q

why does confidentiality matter ?

A
  • a persons health is their own business
  • ensures patients are ore comfortable sharing information that may assist in their diagnosis and treatment
  • this is because they are less afraid of info sharing especially in stigmatised conditions such as STIs HIV and MH conditions
  • maintains strong relationships between doctor and patient
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11
Q

when do breaches occur

A
  • approx once every 62.5 hours of a clinicians practice
  • intentional - looking at record of friends family or celebrities
  • usually not and most frequently when discussing with there clinicians not involved in care
  • could be convos about info being overheard in public
  • revealing info to patients family before asking them
  • health cyberattacks
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12
Q

how can confidentiality be maintained ?

A
  • confidentiality training and educational programs is a core requirement and is assessed
  • significant consequence for breach
  • disciplinary proceedings by GMC resulting in probation or loss of licence
  • sued in civil court and fined
  • prosecuted and convicted of offence
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13
Q

when can you break confidentiality

A
  • minimise breach and seek patient consent first encouraging patient to share info themself
  • needed to protect patient when unconscious of incapacitated and someone need to make decisions
  • when believe child or vulnerable adult victim of abuse or neglect
  • indicated in public interest, to employer of DVLA if condition endangers other when working or driving, eg epilepsy needs seizure free for 12 months to drive
  • also info about infectious desires and genetic illness
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14
Q

what are Gillick Competence and Fraser guidelines

A
  • a child is deemed GC if under 16 years of age and understood to be intelligent and mature enough to fulls understand medical treatment or procedure proposed
  • Fraser Guidelines show when it’s allowed for HCP to give advice relating to contraception or sex to children under 16
  • do not apply to children over 16
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15
Q

what happened in Gillick case

A
  • Mother believed it to be unlawful that children under 16 could seek contraceptive advice from GP without parental knowledge or consent
  • approached the court and was unsuccessful & so GC&F guidelines were produced
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16
Q

what is Gillick Competence

A
  • child under 16 deemed to be intelligent and competent enough to fully understand treatment or decision proposed
  • can be deemed GC for once decision and not another as diff procedure require different intelligence and maturity levels to be understood
  • if child not GC then parental consent must be given
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17
Q

how is GC assessed

A

various factors taken into account
- intelligence and maturity gauged through discussion with the child
- the Childs past experiences such as the amount of experience within a hospital setting
- the ability of the child to understand the pros and cons of treatment gauged by asking the child questions about it

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18
Q

what are the Fraser Guidelines

A
  • permissable to give sex health advice and treatment to those under 16 if
  • child is mature and intelligent enough to understand treatment
  • the child cannot be persuaded to tell parent or guardian and won’t let doctor tell them
  • child likely to continue sex without contraception
  • mental or physical health of child likely to worsen without treatment
  • it is in the best interests of the child to receive treatment
  • confidentiality may need to be broken if child harmed or at risk to involve social services or police, but it is important that the child knows if confidentiality broken
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19
Q

what about 16 -17 yo

A
  • regarded as having capacity to consent
  • if refuse treatment can be overridden by parent and provide consent
  • 16/17 do not have the absolute right to refuse treatment that Is in their best interest
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20
Q

ethical considerations of guidelines

A
  • autonomy - respected when applied however parent are deprived of autonomy over their children
  • beneficence/non maleficence - HCP want to respect autonomy but have to balance this with ensuring no harm so child competency has to be assessed for every decision no assumed
  • justice - important to assess fairly regardless of age
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21
Q

legal consequence of non adherence to GC&F guidlines

A
  • for HCP - could face diciplinary action from GMC leading to loss of licence or negligence claims
  • for minors - child may reticence care they don’t fully understand or consent to leading to physical and mental consequences
  • for p-arents - affect parents right to provide consent and bypass parents involvement in Childs HC decisions
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22
Q

what is sympathy

A
  • the ability to understand another’s plight and recognises the difficulty of their situation without nescessarily emotionally connecting with them
  • this means having compassions for a person but not sharing their emotional experience
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23
Q

what is empathy

A
  • the capacity to feel the emotions of the other person to the point of being able to imagine being in their position
  • this creates a stronger bond and is a more powerful connection than sympathy
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24
Q

how are sympathy and empathy related

A
  • both imply and understanding of the emotions of another person
  • sympathy is more distant
  • empathy requires more engagement
  • feeling empathetic can create a deeper connection and strengthen bond between people
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25
Q

why is empathising difficult

A
  • requires a lot of emotional intelligence and understanding
  • can be hard to remain objective to avoid impairing judgement
  • empathy aims to understand emotional state to provide support and compassion
  • sympathy involves understanding feelings and showing you care
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26
Q

sympathy and empathy in patient care

A
  • diabetic patients with empathetic doctors get better desiese control, as emotional connection positively impacts patient health and management
  • oncologists displaying sympathy greatly reduced patient anxiety leading to better mental well being and overall satisfaction
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27
Q

the chalenges of expressing empathy and sympathy

A
  • compassion fatigue
  • misinterpreted sympathy as pity if not properly communicated
  • cultural differences - needs to adapt comms to meet emotional needs of diverse patients
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28
Q

cultural differences in empathy ad sympathy

A

western - through words such as I understand, or I’m sorry your going through this.
eastern - non verbal cues such as eye contact, expressions and body language

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29
Q

what is capacity

A
  • a persons ability to make a decision in medicine
  • a patient has capacity until proven otherwise
  • capacity is decision dependant
  • if a decision is strange or irrational they may still have capacity
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30
Q

what must a person be able to do to have capacity

A
  • understand info given to them
  • retain the info
  • use the info to make a decision
  • communicate that decision
  • only relevant to those 18 or over
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31
Q

how is capacity assessed stage 1

A
  • the functional test: involves determining is a person is able to make a specific decision at the time it needs to be made.
  • examines if a person can, understand info related to decision
  • retain that info long enough to make a decision
  • use or weigh that info as part of the process of making the decision
  • communicate that decision
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32
Q

how is capacity assessed stage 2

A
  • the diagnostic test
  • if the functional test shows that the patient is snake to make the decision then they are examined to see if this is because of an impairment or :
  • MH conditions
  • unconsciousness
  • alcohol
  • drugs
  • dementia
  • delirium
  • severe learning disabilities
  • brain damage
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33
Q

assessing capacity regularly

A
  • capacity can fluctuate over time and depends on complexity of decision so assessment should be repeated whenever nescessary
  • the lack of capacity for one decision doesn’t imply lack of capacity for another and vice versa
34
Q

who can assess capacity

A
  • the HCP directly involved in patients care at time of decision making process
  • sometimes needs to be tested for major decisions so a more experienced assessor may be used
35
Q

what is a person doesn’t have capacity

A
  • their HCP will make the decision for them
  • must be in best interest of the patient
  • HCP should encourage patient participation
36
Q

what are best interests

A

considers:
- patients past and present wishes
- beliefs that the patient has that would influence their decision if capable
- the views of anyone named by patient to be consulted in this situation
- the views of anyone that care for the patient
- the views of any donee of a lasting power of attorney

37
Q

what is an advance decision

A
  • decisions made to refuse treatment if in future they lack capacity to do so
  • specific treatments and situations need to be clearly stated
  • common is DNR, also refusal of ventilation and certain meds
  • must be made when person has capacity and needs to be signed by person and a witness
38
Q

what is lasting power of attorney

A
  • a person gives someone power to make decisions about health and welfare if they lack capacity
  • decisions include :
  • where the person lives
  • the persons medical care
  • the social activities the person takes part in
  • the care of the person
39
Q

ethical considerations for capacity

A
  • autonomy - promoted by capacity assessment as assumes all have capacity unless proven otherwise, however if mis assessed then restricts autonomy
  • beneficence- ensuring adults without capacity cannot consent or refuse to consent limits the harm that can happen
  • justice - ensures that all adults treated fairly so not assumed incapacity for all decisions and not based on age or appearance
40
Q

what is medical consent law

A
  • medical consent is the permission a person must give a HCP to give a test exam or treatment
  • there are a few exceptions
  • consent can be withdrawn
41
Q

how is consent given

A
  • verbally or in writing
  • verbally in the case of test or exam
  • written in the case of operation consent form
  • non verbal given such as rolling up sleeve in response to asking if BP can be taken however procedure needs to be well explained
  • consent even should be documented on patients notes
42
Q

what happens if consent isn’t given

A
  • if procedure etc carried out it is a criminal offence and HCP could be charged with battery
43
Q

elements of valid consent

A
  • voluntary - no pressure
  • informed - all info given
  • capacity
44
Q

what is informed consent

A
  • process of providing patient with all relevant info regarding procedure
  • respects patients right to autonomy and bodily integrity
  • patient must be competent
  • must be informed - risk benefits and alternatives
  • not be coerced or pressured
45
Q

info should include following for consent

A
  • what the procedure or treatment involves
  • the risks and benefits of the procedure
    the alternatives to the procedure or treatment
46
Q

when is consent not needed

A
  • in an emergency requiring life saving treatment
  • additional emergency treatment needed in surgery and cannot wait
  • when a person lacks capacity under the MH act
  • the patient is severely unwell and living in unhygienic conditions and can be taken to place of care without consent
47
Q

challenges of obtaining consent

A
  • language barriers - impartial interpreter
  • complex information - needs to be explained in an accessible way
  • patients with reduced hearing - raised voice or written out, if interpreter needed has to be impartial
48
Q

ethical considerations for consent

A
  • autonomy - promoted autonomy as it gives them tools to make best decision for them
  • beneficence - restricts harm and ensures patient protection
  • justice - incapacity not assumed unless assessed ensures fair treatment and that people are not discriminated on by the way they look or their condition
49
Q

summary of Charlie Gard case

A
  • baby born with rare genetic condition called mitochondrial DNA depletion syndrome
  • parents looks for alternative experimental treatments, but GOSH though that treatment wouldn’t be effective and further intervention wouldn’t help
  • case taken to court where judge ruled with GOSH to withdraw life sustaining treatments
  • case resulted in public debate on the role of government in medical decision making and the allocation of resources that are not unlimited EOL decision making and the rights of parents
50
Q

Charlie Gard ethics

A

protecting best interest
- balance between rights of parents to make decisions about Childs care and role of government to protect interest of those who can’t make decisions
distributive justice
- is it fair to allocate limited medical resources such as access to experimental treatment to one individual at the expense of others
autonomy
- question of the parent right to make decisions about charlies medical care even if against HCP

51
Q

Harold Shipman background

A
  • allegedly killed 250 of his patients over 15 years, using injection of lethal doses of drugs inc heroin
  • found guilty of killing 215 patients but could be as high as 500
  • evidence inc testimonies from colleagues and forensic evidence as well as forged medical records
  • sentenced to life in prison and struck off medical register
52
Q

what can be learnt from Harold Shipman case

A
  • importance of ensuring medical professionals held to highest standard of accountability and regulations to protect patients
  • need for MH professionals to be vigilant in identifying mental illness in patients
53
Q
A
54
Q

ethics Harold Shipman

A
  • autonomy - shipman abused this by preventing patients from deciding on care by letting them believe they needed more meds than they did
  • beneficence - shipman violated this by killing his patients
  • non maleficence - violated this by killing them causing physical and emotional harm
  • justice - violated this by targeting elderly women
54
Q

Lucy Letby case summary

A
  • neonatal nurse found guilty of murdering 7 infants in neonatal unit of hospital
  • injected babies with air force fed them milk and poisoned them with insulin
  • doctors has called her behaviour into question when 3 babies died in 2 weeks but this was ignored by management
  • Letby was remover a year after initial concerns were raised
  • found guilty of 7 counts of murder and 7 attempted murder
  • investigation since been launched to look into failures of hospital management.
55
Q

ethics in Lucy letby case

A

breach of patient trust
- NHS provides safe reliable patient care and HCP are trusted so breathing this has devastating consequences
- trust in hospital broken as failed to act upon concerns
whistle blowing
- if a paediatrician not aided concerns then the events leading to her conviction may not have been initiated
importance of vigilance communication and moral duty to prioritise patient safety above all else as entrusted with lives.

56
Q

Bawa garba case summary

A
  • 6 yo Jack Adcock with downs admitted to hospital and passed away from sepsis
  • many factors led to this including errors from dr BG and the NHS trust
  • Dr BG was convicted of gross negligence, manslaughter and suspended then struck off the GMC register
  • much discussion took place in medical and public circles inc a boycott of written reflections by doctors as these may be used against BG
  • eventually Dr BG was reinstated and is practicing medicine again
57
Q

ethics : To what extent should doctors be held accountable for errors made under unsuitable working conditions?

A
  • NHS faces inc systemic issues due to underfunding and understaffing and conditions on wards continue to deteriorate
  • clear in BG case that systemic issues contributed to JA death such as IT failure and lack of consultant
  • BG failings also systemic as she may not have made them is not soley responsible for managing understaffed ward
  • many doctors concerned about blae culture when clinicians scapegoated for systemic and governmental failures
58
Q

Bawa Garba: What is the role of teamwork and communication in preventing medical errors?

A
  • some of errors made due to insufficient communication
  • BG didn’t seek advice from consultant when one later became available
  • nurses didn’t sufficiently update BG on jacks condition and nobody informed mother that his heart meds should be discontinued
59
Q

Bawa Garba: What role did self-reflections play in the court case?

A
  • concerns were raised as to wether BG self reflections used in court case as they were worried this would discourage honest reflection
  • a boycott called on using self reflections in appraisals and even making them as doctors afraid to honestly admit to mistakes and learn from them
  • BG reflective noted not used as evidence but were included in materials seed by expert witnesses.
60
Q

Archie Battersbee case

A
  • 12 yo boy passed after suffering traumatic brain injuries following incident at home and was placed on life support
  • following testing drs believed him to be dead and wished to withdraw life support but his parents wanted it to be maintained
  • case brought before high court then court of appeal the high court again the the Supreme Court, then the United Nations and finally the European court of human rights
  • after many legal battles his life support was withdrawn
61
Q

legal disputed Archie Battersbee case

A
  • doctors believed him to be Brain stem dead so no hope of recovery from coma
  • drs wanted to conduct brain stem test but parents not consent and so taken to high court
  • ruled to conduct test but as he didn’t respond to peripheral nerve stimulation test it couldn’t be carried out
  • further case as to wether he could have MRI which he had eventually, led to huge ruling him brain dead
  • court of appeal ruled end of life support and appeal to UN and EU court of HR rejected
62
Q

medical issues raised by archie battersbee case

A

who should have right to make med decisions for children ?
- BMA states parents do except from when that isn’t in Childs best interest
when is it appropriate to withdraw life sustaining treatments ?
- legal for brain stem dead patients and diff from euthenasisa etc
- families don’t need judge consent to do this
- how doctors determine brainstem death is the irreversible stopping of brainstem function inc the ability to breathe on own
- must be tested for and certified by at least 2 doctors, examined for pupillary reflexes, pain response, caloric reflex, gag reflex and any attempt at breathing during short period of ventilator disconnection
- all tests must be failed to declare brain stem death, occasional limb or torso movement don’t affect this

63
Q

lancet MMR summary

A
  • MMR vaccine is safe and beneficial, and has protected millions of people from the effects of MMR
  • MMR scandal centred around unreliable study by Andrew Wakefield which claimed it was linked with autism
  • before controversy it significantly reduced impact of MMR but declining vaccination rates led to outbreaks and compromised public health
  • raised ethical concerns regarding the importance of research rigour and accurate reporting
  • since this there has been increased vaccine hesitancy among patients leading to outbreaks
64
Q

what is the MMR vaccine

A
  • safe combined injection targeting highly infectious viral desieses: measles mumps and rubella
  • live vaccine give in 2 doses at 12 mo, and 3y 4 mo old
  • reduces mortality associated with these viruses and lessens the serious implications including birth defects in pregnancy
65
Q

what happened to Andrew Wakefield

A
  • retracted paper (lancet) 12 years later
  • GMC investigted AW conduct and struck him off the register
66
Q

why was his study flawed AW

A
  • small sample size - 12
  • uncontrolled design - no control group
  • speculative conclusions - no substantial data
  • selective sampling - biased
  • conflict of interest - didn’t disclose financial support from lawyers against vaccine companies
  • ethical breeched - evidence of historic malpractice and ethical breached towards children in study
67
Q

ethical issues MMR scandal

A
  • patient safety - doctors must be sure that treatments are safe
  • scientific integrity - ensure acc research
  • long term trust impact - still ongoing emphasises need for HCP to prioritise trust building and ethical conduct
  • informed consent - children
  • COI - full disclosure of COI needed to maintain trust and credibility
  • retraction + accountability
  • duty to correct misinformation
68
Q

impact on public health

A
  • impact on vaccination rates
  • herd immunity declined
  • resurgence of preventable diseases such as measles
  • eroded trust in medical professionals and vaccine hesitancy still ongoing
69
Q

the Francis reports and mid Stafford hospital failings summary

A
  • the mid Stafford NHS trust scandal was one of the biggest misconduct instances in the NHS
  • significant problems occurred in the 2000s with 400-1200 excess deaths between 2005 and 2008 and many other failings in care
  • Francis reports laid out the scandal and problems that occurred and led to the dissolution of the NHS trust
  • failings found on behalf of the trust and staff at all levels
70
Q

What were the main problems in the mid-Staffs hospitals?

A
  • poor communication between HCP and patient relatives lead to misunderstandings and lack of trust
  • unanswered call bells led to delayed responses to needs
  • neglectful care led to patients in pain and unsanitary conditions
  • inaccessible food and drink led to patients not receiving enough nutrition
  • insufficient staffing led to too few people to provide care leading to receptionists reviewing patients and junior doctors being left alone
  • concealment of patient falls from family led to lack of trust
71
Q

6Cs recommended as result of FR

A
  • Care
  • Compassion - dignity should be awarded to all patients
  • Competence - all involved in care must have capacity
  • Communication - essential in MDT
  • Courage - must be able to speak out against wrongdoing
  • Commitment - NHS needs to be committed to patients and purpose
72
Q

How can a culture of secrecy in the NHS be dissuaded? FR

A
  • lack of staff speaking out against systemic issues
  • important to dissuade this by implementing protections for whistleblowers
  • many are afraid to speak out as are concerned they will be seen as betraying colleagues and career harmed
  • needs to be a culture where bravery is rewarded and encouraged rather than punished
73
Q

How should NHS trusts be regulated? FR

A
  • currently by CQC which is independent and responsible or monitoring inspecting and rating trusts
  • 4h target encourage trusts to improve quality of care ad make them accountable for performance
  • may be prioritised over other aspects of care
  • should be used in conjunction with satisfaction surveys to ensure patient centric
74
Q

what is marthas rule

A
  • proposal to allow patients and their family to request independent clinical reviews in the NHS if they feel as though they are not being listened to
  • created by mother of 13 yo Martha who dies of sepsis following number of failures by NHS doctors who didn’t listen to the family concerns
  • number of ethical complexities which need to be addressed before it can be fully implementing this
  • mirrors a number of international systems for second opinion medical reviews
  • in proposal stage challenges and barriers to it include limited resources and staffing
75
Q

marthas rule ethical considerations

A
  • doctor patient relationship is built on trust and they have duty of care, having the choice of a 2nd opinion may nit be trustworthy and may damage relationship
  • patient autonomy should allow them to make decisions about care, marthas rule provides routes for this
  • potential for abuse by patients or their families so systems must be in place to prevent this
  • risk of delay to necessary treatment which may risk harm
  • patient consent means clear documentation is needed regarding who can raise concerns about patient care thru this
  • hospital and staffing resources as even a small number of 2nd opinion requests could lead to a greatly inc strain on NHS resources and staff that are already strained.
76
Q

Shropshire Maternity scandal summary

A
  • inquest commissioned into death of newborn Kate Stanton Davies which led to investigations into other issues with midwifery in Shropshire
  • review found that significant amounts of wrongdoing had occurred in royal Shrewsbury and princess royal hospital in Telford
  • failures on behalf of Shrewsbury and telford NHS trust may have led to the avoidable deaths of 201 babies 12 mothers and the brain damage of over 80 babies
  • the failures were driven by a desire to meet specific targets on numbers of safe births meaning c sections were denied when needed leading to complications
  • a criminal investigation is currently taking place
77
Q

the ockenden review

A
  • investigated the failings of STNHS trust revealing stem issues in maternity care highlighting shortcomings in clinical practice, patient safety measures and handling of complaints
  • recommended need for improved staff training, enhanced monitoring of high risk pregnancies and a stronger focus on patient safety and transparency
  • impact of this was nationwide introspection in the NHS leading to a shift in policy towards more patient centred care, stringent safety protocols in maternity units and a review of NHS practices in maternal and neonatal care .
78
Q

ethical implications SMS

A
  • duty of care and patient safety
  • transparency and honesty
  • accountability in healthcare institutions
  • learning from mistakes
  • ethical leadership and decision making
  • reminder of the need for continued ethical training and awareness as well as systemic reform to ensure this is never repeated
79
Q

What role should targets play in the NHS?

A
  • can be a helpful tool to encourage good care and track progress over time
  • must be a part of evidence based medicine to ensure best patient outcomes
  • in SMS targets based on old fashioned ideas that C sections ate unnatural and an overestimation of their risks as a result
  • must not be focused on the the detriment of other important factors and aspects of medicine. care in the NHS must always be person and patient centred
80
Q

How can failing trusts be improved?

A
  • safe staffing
  • well trained workforce
  • learning from incidents
  • listening to families
81
Q
A

med interview (3 decks)

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