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CSP 3 > Ethics > Flashcards

Ethics Flashcards

1
Q

What is the definition of negligence?

A
  • 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
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2
Q

Who has a duty of care

A
  • Health authority, hospital, senior doctor, and GP

- The doctor/ nurse

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3
Q

Is good samaritans an ethical or legal duty

A

Ethical

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4
Q

Can a patient sue a doctor for negligence if as a result of his report the person is denied insurance?

A

No- doctor has duty to insurance not the person

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5
Q

What is meant by breach of duty of care

A

Failure to reach the level of proficiency of peers

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6
Q

What is the idea behind the Bolam test?

A

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)

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7
Q

What was the Bolitho modification to the Bolam test

A

(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

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8
Q

What is meant by a breach of commission vs a breach of ommission

A

Commission: forceps left in the abdomen

Ommission- failure to attend a patient/ diagnose a condition

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9
Q

What is meant by res ipsa loquitur

A

The mere occurence of some types of accident is sufficient to imply negligence

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10
Q

What is covered in the traditional Hippocratic ethics in terms of what is ethical within research

A
  • 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
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11
Q

How did people justify experiements of humans in non-therapeutic circumstances, where consent wasn’t obtained properly

A
  • Search for truth
  • Benefit to mankind
  • They were already dying
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12
Q

What did Dr. Giuseppe Sanarelli do?

A
  • Searched for causative agent of yellow fever

- Injected candidates without their knowledge or consent

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13
Q

Describe the circumstances that led to the end of self- experimentation

A
  • Team of doctors allowed mosquitos infected with yellow fever to bite the team
  • Became illl. one died
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14
Q

Describe the circumstances that led to the paid or unpaid volunteer

A
  • Contract was drawn up allowing participants to receive £100 for being part of the trial and £200 if they becacme sick
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15
Q

What is the name of the code developed at the end of the second world war to ensure that trials were ethical

A

Nuremberg Code

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16
Q

What are the 2 key points in the Nuremberg code

A
  • Voluntary consent is essential

- Experiement should be such as to yield fruitful results for the good of society

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17
Q

What are the other points mentioned in the Nuremberg code

A
  • 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
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18
Q

What are the basic principles of the Helsinki declaration?

A

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

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19
Q

Define justice

A

Each getting what he or she is due

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20
Q

What is formal justice

A

Impartial and consistent application of principles, whether or not the principles themselves are just

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21
Q

What is substantive justice

A

When individuals can legitimately demand one another or of their government (positive rights)

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22
Q

What is retributive justice

A

When and why punishment is justified

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23
Q

What is correct justice

A

Fairness of demands for civil damages

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24
Q

What is commutative justice

A

Fairness of wages, prices, and exchanges

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25
Q

What is distributive justice

A

Fairness of distribubtion of resources

26
Q

What assumptions underly distributitive justice

A

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

27
Q

Why is there an increased demand for public health care supplies

A
  • Increased population
  • Rising life expectancy
  • Increase in unhealthy life expectancy
  • Greater public awareness of rights and possibilities
  • Low costs at point of delivery
28
Q

Why is there a decreased demand for health care supply

A
  • Medical technology more expenive
  • Lots of other national needs
  • Increase in defensive medicine
  • Global economic crisis
  • Decreased social solidarity (eg less organs for transplantation)
29
Q

What are some example of explicit rationing in terms of health care

A

1- Denial of drugs and surgery
2- Under funding
3- Co payments

30
Q

What are some examples of implicit rationing

A 
1- Long waiting lists
2- Decreased accessibility
3- Bureaucratic obstacles
4- Futility arguments
5- Public unclear about entitlement
6- Emphasis  on primary medicine
31
Q

What is meant by macro-allocation?

A

Class level, global/ international level, national level, regional, subregional. prevention vs ccure
e.g- shall we give money to psych unit or haemodialysis unit

32
Q

What is meant by micro allocation

A

Allocation of resources within a unit and among individuals

eg- who gets transplant

33
Q

Define utilitarianism

A

Allocation based on need or expected outcomes. Greatest happiness for the greatest number- pity the minority

34
Q

Define rights based solution

A

Allocation based on rights

35
Q

What is an Egalitarian approach

A
  • People have equal rights, so equal share for everybody

- Pity the rich

36
Q

What is a propery rights outweigh health care rights approach

A

The more you have, the more you get

-Pity the ill, poor, aged

37
Q

How is micro-allocated seen in the NHS

A

Waiting list and need

38
Q

How is macro- allocation seen in the NHS

A

Mixed criteria of social and individual needs depending on social acceptability

39
Q

Is loyalty to prevailing interests of society, or loyalty to patients more important

A

Society

40
Q

Define confidentiality

A

Agreement that gives the confider the right to expect discretion from the confidant

41
Q

What does confidentialy info refer to

A

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

42
Q

Which is confidential out of post mortem and death certificate

A

PM

43
Q

Who has a right to confidentially

A

ALL- inc. Gillick competent minors

44
Q

How should confidentiality be protected (6)

A

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

45
Q

Describe the rational argument behind confidentiality

A

No confidentiality- no trust- no info- no care

Improper confidentiality= legal and profesh consequences

46
Q

Describe the ethical argument behind confidentiality

A

Privacy and confidentiality and preconditions of autonomy and autonomy is vital for ethics

47
Q

What are the remedies for improper breach of confidentiality

A
  • Disciplinary: inc being struck off
  • Civil proceedings: having to pay compensation
  • Criminal proceedings
48
Q

When can duty of confidentiality be releaxed

A

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

49
Q

Is AIDS a notifiable disease

A

No

50
Q

Who must abortions be notified to

A

Chief medical officer

51
Q

Who must known/ suspected drug addicts be notified to

A

Home office

52
Q

What is the policy of GMC regarding HIV+ doctors

A

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

53
Q

What is meant by Caldicott guardian

A

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

54
Q

When is a normal license valid up to

A

70 years- at this point becomes automatically renewed

55
Q

7 stages of what to do if patient doesn’t inform DVLA about disability

A
  1. Inform the patient that he has a legal duty to
    inform the DVLA.
  2. 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.
  3. If the patient continues to drive, try to
    persuade him not to do so, possibly by
    involving the next of kin.
  4. If the patient still drives, tell him that the
    DVLA will be informed.
  5. Discuss the matter with his defence
    organisation.
  6. Give the medical information to the Medical
    Adviser at the DVLA.
  7. Write to the patient, informing him that you
    have done so.
56
Q

Name some prescribed drugs affecting fitness to drive

A 
Tranquilisers
Anti-epileptics
Anti- depressants
Antipsychotics
Analgesics
57
Q

When can you drive after an epileptic fit

A

a year

58
Q

What is the clinical benefit of truth telling

A

Promotes trust, induces truth telling by patient and contributes to compliance

59
Q

What is the moral importance of truth telling

A

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

60
Q

What is the legal importance of truth telling

A

Concealment of info may lead to charges of negligence

61
Q

When should you discretionally avoid telling info to patients

A
  • 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
62
Q

Do relatives have a right to be informed about a patient

A

No

CSP 3 (9 decks)

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