Ethics Flashcards
What is the definition of negligence?
- The defendant had a duty of care to the claimant
- There was a breach of the duty of care
- The claimant suffered actionable harm or damage
- The damage was caused by the breach
Who has a duty of care
- Health authority, hospital, senior doctor, and GP
- The doctor/ nurse
Is good samaritans an ethical or legal duty
Ethical
Can a patient sue a doctor for negligence if as a result of his report the person is denied insurance?
No- doctor has duty to insurance not the person
What is meant by breach of duty of care
Failure to reach the level of proficiency of peers
What is the idea behind the Bolam test?
A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.
This should be judged by ones peers (aka doctors at a similar level, not very senior doctors)
What was the Bolitho modification to the Bolam test
(1) “The court should not accept a defence argument as being ‘reasonable’, ‘respectable’ or ‘responsible’ without first assessing whether such opinion is susceptible to logical analysis”, and
(2) “However, where there is a body of medical opinion which represents itself as ‘reasonable’, ‘respectable’ or ‘responsible’ it will be rare for the court to be able to hold such opinion to be other than represented”.
basically- genuine errors of clinical judgement sare not negligent if based on reasonable skill
What is meant by a breach of commission vs a breach of ommission
Commission: forceps left in the abdomen
Ommission- failure to attend a patient/ diagnose a condition
What is meant by res ipsa loquitur
The mere occurence of some types of accident is sufficient to imply negligence
What is covered in the traditional Hippocratic ethics in terms of what is ethical within research
- Experiment must be placed within a therapeutic or preventitive context
- Any trial should entail potential benefits to the patient/ participant
- Patient shouldn’t be treated as mere means for learning
How did people justify experiements of humans in non-therapeutic circumstances, where consent wasn’t obtained properly
- Search for truth
- Benefit to mankind
- They were already dying
What did Dr. Giuseppe Sanarelli do?
- Searched for causative agent of yellow fever
- Injected candidates without their knowledge or consent
Describe the circumstances that led to the end of self- experimentation
- Team of doctors allowed mosquitos infected with yellow fever to bite the team
- Became illl. one died
Describe the circumstances that led to the paid or unpaid volunteer
- Contract was drawn up allowing participants to receive £100 for being part of the trial and £200 if they becacme sick
What is the name of the code developed at the end of the second world war to ensure that trials were ethical
Nuremberg Code
What are the 2 key points in the Nuremberg code
- Voluntary consent is essential
- Experiement should be such as to yield fruitful results for the good of society
What are the other points mentioned in the Nuremberg code
- Prior with animals
- Avoid uneccesary harm
- Assurance that no death or injury will result
- Researchers must be scientifically qualified
- Subject has a riight to opt out
- Researcher has duty to stop if it is harmful
What are the basic principles of the Helsinki declaration?
1- Research must conform to basic scientific principles
2- Must conform with local laws
3- Be led by scientifically qualified person who take responsibility for wellbeing of subjects
4- Importance of research objective must be proportional to inherent risk
5- Must assess risks beforehand
6- Respect privacy and autonomy
7- Doctors should abstain from engaging in research
8- Physician must preserve accuracy when publishing results
9- Subjects must be informed of aims
10- Consent should be written and duress
11- In casse of legal incompetence informed consent must be from guardian
Define justice
Each getting what he or she is due
What is formal justice
Impartial and consistent application of principles, whether or not the principles themselves are just
What is substantive justice
When individuals can legitimately demand one another or of their government (positive rights)
What is retributive justice
When and why punishment is justified
What is correct justice
Fairness of demands for civil damages
What is commutative justice
Fairness of wages, prices, and exchanges
What is distributive justice
Fairness of distribubtion of resources
What assumptions underly distributitive justice
1- Resources are always limited and finite
2- Current crisis unfortunate but natural
3- Rationing is therefore inevitable
4- Should be based on principles of justice
Why is there an increased demand for public health care supplies
- Increased population
- Rising life expectancy
- Increase in unhealthy life expectancy
- Greater public awareness of rights and possibilities
- Low costs at point of delivery
Why is there a decreased demand for health care supply
- Medical technology more expenive
- Lots of other national needs
- Increase in defensive medicine
- Global economic crisis
- Decreased social solidarity (eg less organs for transplantation)
What are some example of explicit rationing in terms of health care
1- Denial of drugs and surgery
2- Under funding
3- Co payments
What are some examples of implicit rationing
1- Long waiting lists 2- Decreased accessibility 3- Bureaucratic obstacles 4- Futility arguments 5- Public unclear about entitlement 6- Emphasis on primary medicine
What is meant by macro-allocation?
Class level, global/ international level, national level, regional, subregional. prevention vs ccure
e.g- shall we give money to psych unit or haemodialysis unit
What is meant by micro allocation
Allocation of resources within a unit and among individuals
eg- who gets transplant
Define utilitarianism
Allocation based on need or expected outcomes. Greatest happiness for the greatest number- pity the minority
Define rights based solution
Allocation based on rights
What is an Egalitarian approach
- People have equal rights, so equal share for everybody
- Pity the rich
What is a propery rights outweigh health care rights approach
The more you have, the more you get
-Pity the ill, poor, aged
How is micro-allocated seen in the NHS
Waiting list and need
How is macro- allocation seen in the NHS
Mixed criteria of social and individual needs depending on social acceptability
Is loyalty to prevailing interests of society, or loyalty to patients more important
Society
Define confidentiality
Agreement that gives the confider the right to expect discretion from the confidant
What does confidentialy info refer to
Patient identifiable datat
Health data: medical illustration, tape recordings, vodeos, tissue tamples, test results, disease or genetic registers, x-rays, computer files, medical records
Non clinical- hosp. attendance, address, any personal info
Which is confidential out of post mortem and death certificate
PM
Who has a right to confidentially
ALL- inc. Gillick competent minors
How should confidentiality be protected (6)
1- Do not discuss about, or talk to, patients in public areas
2- Store, transfer and dispose of confidential info carefully
3- Record holders are only trusts for NHS, GPs a nd private clinics
4- Retain health records for 8 years mmin
5- Never disclose more than needed
6- Disclose only necessary info
Describe the rational argument behind confidentiality
No confidentiality- no trust- no info- no care
Improper confidentiality= legal and profesh consequences
Describe the ethical argument behind confidentiality
Privacy and confidentiality and preconditions of autonomy and autonomy is vital for ethics
What are the remedies for improper breach of confidentiality
- Disciplinary: inc being struck off
- Civil proceedings: having to pay compensation
- Criminal proceedings
When can duty of confidentiality be releaxed
1- Patient gives explicit consent
2- Patient gives implied consent to give info to relatives
3- If it best interest of person (eg risk of harm to self, child abuse) or best interest of society (TB, DVLA)
4- If professional has dual responsibility
5- Serious crime/ assualt on professional- disclose to police
6- Court of law can compel the disclosure
7- Tax inspectors can compel disclosure of financial info
Is AIDS a notifiable disease
No
Who must abortions be notified to
Chief medical officer
Who must known/ suspected drug addicts be notified to
Home office
What is the policy of GMC regarding HIV+ doctors
Only in the most exceptional circumstances, where the release of doctos name is essential for protection of patients, may the doctors status be disclosed without his or her consent
What is meant by Caldicott guardian
A Caldicott Guardian is a senior person responsible for protecting the confidentiality of people’s health and care information and making sure it is used properly
When is a normal license valid up to
70 years- at this point becomes automatically renewed
7 stages of what to do if patient doesn’t inform DVLA about disability
- Inform the patient that he has a legal duty to
inform the DVLA. - If the patient refuses to accept the diagnosis
or the associated risks, suggest a second
opinion. Advise the patient not to drive until
it is obtained. - If the patient continues to drive, try to
persuade him not to do so, possibly by
involving the next of kin. - If the patient still drives, tell him that the
DVLA will be informed. - Discuss the matter with his defence
organisation. - Give the medical information to the Medical
Adviser at the DVLA. - Write to the patient, informing him that you
have done so.
Name some prescribed drugs affecting fitness to drive
Tranquilisers Anti-epileptics Anti- depressants Antipsychotics Analgesics
When can you drive after an epileptic fit
a year
What is the clinical benefit of truth telling
Promotes trust, induces truth telling by patient and contributes to compliance
What is the moral importance of truth telling
Truth information is a necessary precondition of autonomy and moral action. If people have the right the choose and act autonomously they also have a right to be truthfully informed
What is the legal importance of truth telling
Concealment of info may lead to charges of negligence
When should you discretionally avoid telling info to patients
- Any info the patients don’t wish to have
- Info about alternative options if patient can’t afford them
- Inifo about negligible risks
- Info about rationing considerations
- Info about professional comopetence and identity of urgeon
- Info about futile treatment
Do relatives have a right to be informed about a patient
No
