Ethics Flashcards
when is sex selection of embryos permitted in UK
for medical conditions that are linked to a gender
why would you create an embryo with 2 genetic mothers
to avoid mitochondrial diseases
when can you refuse assisted reproduction treatment
issues with child welfare
reduced success rate (older female age etc)
increased risk of harm (obesity and smoking)
when it is not legal (e.g. sex selection not for medical conditions)
how many cycles of IVF is funded on NHS in scotland
3
how many IVF cycles is funded in patients aged 40-42
1
how long is embryological research permitted for
14 days (when primitive stream appears)
how late can you get an abortion
24 weeks
later if severely handicapped or significant risk to maternal life
what are the rights of donors of genetic materials
to choose the outcome of their genetic material
to be anonymous
is egg donation legal
yes
does the child have a right to find out biological origins
yes at age 18
does sexual consent have to be informed
no- can be free agreement
can a child under 13 consent to any sexual activity
no- if you are told this by child need to inform social services
can an older child ages 13-15 legally have sexual intercourse
no
but consensual touching, kissing and sexual conversations are considered part if growing up
when can you provide contraception for a child under 16
when you have assessed that the child is:
- fully competent
- has sufficient maturity and intelligence to understand the implications
- has not been persuaded
- is likely to continue sexual activity without the contraception
- if their physical or mental health will suffer without the contraception/ advice
when is a person over 16 not considered able to consent to sexual decisions
if lack capacity (e.g. mental disorder)
or other person is in a position of trust (teacher, family member etc)
in incapable then will need advocate to make decisions for them (adults with incapacity act)
when would you perform a genital exam on a child/ someone who is not sexually active/ doesn’t have consent
always ask a senior before hand
never do smear or vaginal exam on someone who is not sexually active unless symptomatic or extenuating circumstances- again always ask someone first and have chaperone
seek consent from a responsible person, unless emergency
what are the only times you can treat an adult (16+) without their consent
If is an emergency (real emergency, not just in A&E)
You can apply the Adults with Incapacity Act (form)
You can apply the Mental Health (Scotland) Act
what is battery
unlawful touching
- could apple if you act without a patient’s valid consent
- person may need not be harmed by procedure
how is consent different from a contract
consent can be withdrawn at anytime without penalties, this removal of consent should be respected immediately, not binding (getting valid consent is a continuous process)
contract- withdrawing can have consequences, it is binding
can a patient refuse/ demand any treatments
can refuse any (inc life saving)
cannot demand treatment
in competent patients who refuse Tx, does their reasoning have to be: Logical Prudent Rational Reflected Justified Communicated Discussed Correct according to you or your colleagues ?
no
how can you improve someones capacity to consent
discuss anxieties, fear of pain/ other problems
written maternal, pictures, other aids
meet communications needs
use clear simple language
suggest they bring a friend/ relative/ translator
give them opportunities and time to ask questions and answer honestly- capacity may change over time
give time to reflect on their decisions (give consent forms and information in advance)
what is included in assessment of capacity
check patient can:
1. Understand the treatment options and weight up potential benefits, risks, burdens and side effects of the options
- Retain the information provided
- Weigh up, decide and communicate their decision
what is required for valid consent
capacity (competence)- ability to give/ withdraw consent
information- enough information and it is understood (both parties ask questions to ensure this)
voluntariness- not coerced
what are the rule in an emergency
If the treatment is immediately necessary to save a someone’s life or to prevent a serious deterioration:
- You can treat people without their consent
- The treatment must be the least restrictive of the patient’s future choices
can you assume someone is incapable of consent
no- in adults capacity is assumed until proven other wise
should you inform patient of all options available to them
yes
what should you do if there is uncertainty/ disagreement between yourself and colleagues/ patient/ patients family
Consult it with other colleagues
Ask more senior colleague for advice
Ask for second opinion
Consider mediation or involving an independent advisor
Contact your defence organisation (e.g. Medical Defence Union)
Ask your professional body
Find out if there is a Clinical Ethics Committee
Seek legal advice
Apply for independent court/statutory ruling
what are the rules of treatment of children
Parent/s (or legal guardian/s) must be consulted about their child’s treatment (unless it is an absolute emergency)
It is assumed that parents make decisions in the best interest of their child, and must be consulted from the moment of birth
Child’s consent should ideally also be sought, even from toddlers
However, the State must protect the best interests of the child, so can override parents’ (guardians’) wishes
The power can be devolved to others – e.g. doctors, nurses, social workers etc.
what is the most recent guidlines on treatment of children
Children and Young People (Scotland) Act 2014
what happens if parents disagree with the healthcare team
Judge (courts) can assess the situation and override parents’ refusal of consent
In urgent situation this can be dealt with over the phone in a matter of hours
who has parental responsibility
Births registered from 4 May 2006 in Scotland: PR rests with both parents, if they are named on the birth certificate, whether married or not.
Births registered before 4 May 2006 in Scotland: father automatically has PR only if he was married to the mother. If not, he needs a Parental Responsibility Agreement/Order. A step-parent or civil partner may also obtain PR in this way.
If parents divorce, both retain PR for the child, no matter who the child lives with or spends most of his/her time with.
PR is lost by giving the child up for adoption. When the child has been formally adopted, the adoptive parents get PR.
can people under 16 consent
yes if assessed to have capacity
when can you disclose personal information
if the patient consents to this
if it is required by law in the public interest (infectious disease, risk of death/ serious harm/ serious crime- murder but not left)
can police, solicitor, employer, school, relatives, insurance company get a patients information
have to have a judicial order or by required by an act of parliament
what are the rules of patient information that is released
All released information should be protected, anonymised or coded
People should be NOT IDENTIFIED, but also NOT INDENTIFIABLE
People have the right to be informed about all disclosures (unless it would cause serious risks, e.g. in cases of serious abuse or child neglect)
when can information be shared with family
If a person below the age of 16 is assessed as having capacity to consent to certain treatment, then the information about this treatment cannot be disclosed to his/her parents without her/his explicit consent
If an adult patient has no or limited capacity (e.g. is in a coma or detained under the Mental Health Scotland Act) then certain information can be released to nearest relatives, friends or others – but the rules can be complex
what should you do if a patient is no longer fit to drive
inform her/him of a legal duty to inform the DVLA or DVA about the condition
If s/he continues to drive when they may not be fit to do so, you should make every reasonable effort to persuade them to stop
If you discover that they are continuing to drive against your advice, you should contact the DVLA or DVA immediately and disclose any relevant medical information to the medical adviser
You should then also inform the patient immediately as well as in writing once you have done so
