Ethics

Question 1

Dilemma….

Answer 1

when 2 principles clash

Question 2

4 principles

Answer 2

Autonomy:	choice, capacity
(risk vs benefit)
Beneficence: Best interest	
Non maleficence: Do no harm
Justice:		fair and equal treatment

Question 3

Confidentiality: when to breach

Answer 3

Disclosure by law 
– communicable disease, court order
Public interest – public safety
Lack capacity: children, incompetent adults
Use of data in audit

Question 4

Competence/capacity

Answer 4

Mental health act 2005:
Presumed until proven otherwise
Understand, retain, weigh, communicate
Unsure: ask nursing staff, other colleagues, psychiatrist or neurologist.

Question 5

Process gaining Consent from patient

Answer 5

Reason for procedure:
Risks vs benefits,
Risks include: side-effects, likelihood of success, serious/common risks
Anticipated further procedures (may be necessary)
– Right to second opinion
understand, retain, weigh, communicate
(can change mind at any time)

Question 6

Patient who lacks capacity

Answer 6

Work for best interest
?Advanced directive – only thing that overrides doctors decision
Views of people legally responsible
View of people close to relative

Question 7

Competence in children

Answer 7

Competent >16 unless proved otherwise

Gillick competent

Question 8

Gillick competent if:

Answer 8

understand, retain, weigh, communicate

Question 9

Gillick competent Rights

Answer 9

Undr 16 can give consent,
but cannot refuse treatment
– prevent parents accessing medical records
– parents cannot override consent
– Scotland children can refuse treatment

Question 10

Fraser guidelines – contraceptive advice

Answer 10

Understands advice
Cannot be persuaded to tell parents
Likely unprotected sex
Physical/mental health is likely to suffer
Best interests: contraception without parental consent

Question 11

Mental Capacity Act 2005

Answer 11

No one can b assumed to lack capacity due to a condition
Act in best interest unless Advnaced directive
Restraint only if in patients best interest
Person with capacity can appoint lasting power of attorney for health and welfare decisions
IMCA (independent mental capacity advocate) for those without anyone

Question 12

Consent when dealing with emergencies not competent

Answer 12

Treat what is immediately required in their best interest

Limited intervention, least restrictive to patients future choices

Question 13

Emergencies outside of clinical setting:

Answer 13

Must offer help in emergencies (GMC guideline, not law)

Once involved you have duty of care