Ethics

Question 1

Discuss competence
-Who should be considered incompetent
-What should be done if the doctors is unsure regarding competence
-If not competent then who can consent be gained from
-If not competent and no one to give consent then what should be done

Answer 1

1. Who is incompletent
   -Everyone should be considered to have competence unless reasonable grounds for believing they are not
   -Intellectually disabled
   -Unconscious
2. If unsure of competence then consult
   -Another doctor
   -Seek legal advice
3. In individual not competent then can gian consent from:
   -Legal gaurdian
   -Enduring power of attorney for care and welfare
4. If incompetent and no one to give consent then:
   -Act in best interest of the consumer
   -Make reasonable attempts to determine what they would want
   -Act in accordance with what the doctor believes the informed choice of the patient would be

Question 2

Discuss providing care for the following situations
-Sterilisation in an incompetent patient
-Contraception in an incompetent patient
-Treatment in an emergency

Answer 2

1. Sterilisation in an incompetent patient
   -Parental consent is not sufficent basis to perform sterilisation
   -Can perform in child if: parental consent, doctor satisfied that it is in the child’s best interest, least dramatic intervention
   -In an adult sterilisation needs court intervention unless an emergency.
   -Always get legal advice
2. Contraception
   -Can administer contraception to women or girls who are sub-normal as long as in patients best interests
   -If incompetent but not subnormal then need to seek legal advice
3. Treatment in an emergency
   -A competent adult can refuse treatment in an emergency
   -If the patient is not competent then urgent treatment to preserve life or avoid serious harm is required then treatment should be in their best interests

Question 3

Discuss consent from children

Answer 3

1. Gilick competence - based on understanding and maturity not age
2. In NZ children >16yrs have the right to consent or refuse treatment. Parents cannot override
3. Parents retain a gaurdianship role until 18 and can therefore give consent in the case of incompetence
4. Seek leagal advice if the gaurdian refuses treatment for a child that the doctor believes is in the best interest of the child
5. A child of any age can consent to a TOP if competent

Question 4

Discuss RANZCOG guidelines for women with disability for contraception and fertility (4)

Answer 4

1. Women have the right to make decisions about using contraception and which type to use including those with a disability
2. Reversible methods including LARCS should be considered 1st line over irreversible methods
3. Treatment offered to women with intellectual disability must be in accordance with legal jurisdiction
4. Consult with experienced colleagues if considering irreversible approaches or if there is a lack of consensus around care.

Question 5

Discuss requirements of duty to inform as per NZ code of rights - right 6 (5 points)

Answer 5

Patients can expect information about the following:
-Explanation of their condition
-Explanation of options available
-Estimated time of when services should be provided
-Whether they will be involved in teaching or research
-results of tests and procedures