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Medicine > Ethics > Flashcards

Ethics Flashcards

0
Q

Circumstances when error IS reported (x5)

A
  1. When mandatory - eg. At a coroners report, peri-operative deaths
  2. Serious harm has occurred
  3. When the fault is with system
  4. Obvious error has occurred
  5. Another departments fault
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1
Q

Reasons why people do not report errors

A

“PC DUTCH”
Petty
Consequences (for themselves - careers, others)
Duty - believe that it is someone else’s
Uncertain - whether something does need reporting
Tedious
Changes - will they take place?
Hierarchy - senior colleagues will have to be involved

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2
Q

Elements of an effective reporting system

A 
"FP AEO"
Formalise (to discourage informal gossips)
Protection for whistle blowing
Anybody can report.
Early reporting culture encouraged
Open reporting system
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3
Q

What is the 2-stage competent assessment?

A
  1. A threshold diagnostic test:
    A person lacks capacity in relation to a matter if AT THAT MATERIAL TIME they are unable to make a decision for himself IN RELATION TO THE MATTER, because of an IMPAIRMENT OF, OR DISTURBANCE IN THE FUNCTIONING OF MIND OR BRAIN. (Incl. intellectual disability, intoxication, delirium, dementia etc.)
  2. Is unable to make the decision if they:
    Do not understand
    Unable to retain
    Unable to balance pros and cons to make informed choice
    Cannot communicate decision back.
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4
Q

Two other notes about capacity

A
  1. Capacity is decision specific, and can fluctuate
  2. We have a duty to MAXIMISE capacity, including using simple language and diagrams etc in a form in which patient is able to understand.
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5
Q

Capacity of children to give consent.

What is under the FAMILY LAW REFORM ACT 1969?

A
  1. Young people 16-17y/o are presumed to have capacity, if they demonstrate “Gillick competence”
  2. REFUSALS of treatment can be overridden by parents, if the parental decision is within the “Zone of Parental Control”, and consistent with:
    - what is expected in the society and human rights decisions
    - BEST INTERESTS
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6
Q

8 data protection principles of Data Protection Act

A
  1. Fairly and lawfully processed
  2. Processed for limited purposes and not in any manner incompatible with those purposes
  3. Adequate, relevant, not excessive
  4. Accurate
  5. Not kept longer than necessary
  6. Processed in line with the data subject’s rights
  7. Secure
  8. Not transferred to other countries without adequate protection
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7
Q

The 3 occasions where confidential fun formation may be divulged for reasons other than clinical care of the patient.

A
  1. With patient’s consent
  2. Law requires disclosure
  3. Overriding public interest in disclosure (ie. poses dangerous problem to public, eg. Murder, terrorist etc.)
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8
Q

Things to do when asked to provide information about patients

A
  1. Inform patient, and seek consent (unless likely to lead to significant harm), incl when data needed for audits or care etc and they can object.
  2. Keep info disclosed to a minimum necessary
  3. Anonymise where possible
  4. Keep up to date with the requirements of statute and common law
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9
Q

The legal requirements for info disclosure by the law (5 main scenarios)

A
  1. Terrorism Act
  2. Infectious diseases Act
  3. RTA Act
  4. Coroners court
  5. Disclosure for Statutory bodies (eg. GMC)
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10
Q

Two other notes about capacity

A
  1. Capacity is decision specific, and can fluctuate
  2. We have a duty to MAXIMISE capacity, including using simple language and diagrams etc in a form in which patient is able to understand.
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11
Q

Capacity of children to give consent.

What is under the FAMILY LAW REFORM ACT 1969?

A
  1. Young people 16-17y/o are presumed to have capacity, if they demonstrate “Gillick competence”
  2. REFUSALS of treatment can be overridden by parents, if the parental decision is within the “Zone of Parental Control”, and consistent with:
    - what is expected in the society and human rights decisions
    - BEST INTERESTS
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12
Q

8 data protection principles of Data Protection Act

A
  1. Fairly and lawfully processed
  2. Processed for limited purposes and not in any manner incompatible with those purposes
  3. Adequate, relevant, not excessive
  4. Accurate
  5. Not kept longer than necessary
  6. Processed in line with the data subject’s rights
  7. Secure
  8. Not transferred to other countries without adequate protection
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13
Q

The 3 occasions where confidential fun formation may be divulged for reasons other than clinical care of the patient.

A
  1. With patient’s consent
  2. Law requires disclosure
  3. Overriding public interest in disclosure (ie. poses dangerous problem to public, eg. Murder, terrorist etc.)
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14
Q

Things to do when asked to provide information about patients

A
  1. Inform patient, and seek consent (unless likely to lead to significant harm), incl when data needed for audits or care etc and they can object.
  2. Keep info disclosed to a minimum necessary
  3. Anonymise where possible
  4. Keep up to date with the requirements of statute and common law
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15
Q

The legal requirements for info disclosure by the law (5 main scenarios)

A
  1. Terrorism Act
  2. Infectious diseases Act
  3. RTA Act
  4. Coroners court
  5. Disclosure for Statutory bodies (eg. GMC)
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16
Q

Criteria to detain someone under Mental Health Act (x4)

A
  1. Must be diagnosed with a mental disorder (ie. any disorder or disability of the mind, except learning difficulties in isolation)
    - DIAGNOSTIC TEST
  2. They are suffering at a degree which warrants detention; Tx in hospital which can only be achieved through detention
    - PROPORTIONALITY TEST (ie. how severe they are suffering)
  3. Treatment must be available in hospital (incl. nursing, psych intervention, mental health rehab and care etc.)
    - THERAPEUTIC INTENT
  4. Detain in the interest of his own health/safety, or with a view to protect other people.
    - RISK TEST

(If to detain because patient does not have capacity, would be performed under the MCA.
Therefore incapacity is not a prerequisite for detaining under MHA, as they probably can “understand, retain, balance and communicate decision”, but decision is crazy.

17
Q

Patients whom the MHA does not include

A

Drug or alcohol dependence.

18
Q

Diagnostic thresholds for:

  1. MCA
  2. MHA
A
  1. Impairment, disturbance in functioning of mind or brain
  2. Diagnosed with a Mental disorder, which does not include:
    - learning difficulties in isolation
    - alcohol or drug dependence.
19
Q

Proportionality test for:

  1. MCA
  2. MHA
A
  1. Try to make decisions in LEAST RESTRICTIVE manner
  2. Suffering the condition to an extent which requires medical treatment only available in hospital. Can only obtain hospital treatment with detention under the MHA
20
Q

Therapeutic intents for:

  1. MCA
  2. MHA
A
  1. ? Mainly permits actions without consent for patients HEALTH and WELFARE
  2. Only medical treatment, which must be available at the hospital in which patient is detained. Includes nurses, psychological experts, medical staff and psychiatric rehab facilities
21
Q

Considerations of interest in:

  1. MCA
  2. MHA
A
  1. Patient’s OWN best interests taken into consideration

2. Patients own health and safety, and other people’s health and safety are at interest in detaining under MHA

22
Q

MHA Section 2

A

Assessment
Lasts 28 days
No diagnosis needed

2 doctors, one of whom is certified under s12 and other one ideally knows the patient
AMHP (approved mental health practitioner)
- all 3 needs to agree that the patient fulfils the 4 criteria for sectioning.

Can appeal in first 14 days

Can give treatment for assessment, and then treat when a diagnosis is made, but should really be on s3

23
Q

MHA Section 3

A

Treatment section
6/12 duration
? Same need 2docs and an AMHP

Renew: lasts another 6/12, then 1yr afterwards

Allowed to appeal

24
Q

MHA section 4

A

EMERGENCY for OUTPATIENT detention
Lasts 72hours
Equivalent to s5(2) but for outpatient detention.
Applied for by relative or AMHP, with ONE doctor.
Insufficient time and resources to section under s2 or s3

25
Q

MHA s5(2)

A

Doctors holding power for inpatients
Lasts 72hours
Only one doctor needed, to detain patient for ?further assessment

26
Q

MHA s17

A

Patient on leave from hospital on s2 or 3

Allows transition back into community life.

27
Q

MHA s117

A

? Community treatment order
Requires an MDT decision.
To ensure adequate aftercare after patients are discharged from s3
Sets a criteria under which patients in s3 can leave into the community with a set of conditions.

28
Q

MHA s136

A

Police detention, takes patient to a place of safety
Lasts 72hours
Await for formal mental health assessment

29
Q

MHA s135

A

Magistrates order

Allows police to ENTER SOMEONE’S PROPERTY to take a patient to place of safety for further assessment

30
Q

Consider DNACPR order when:

A
  • unlikely to be successful
  • not in accord with the recorded and sustained wishes of the patient, nor a valid AD which must be specific against life-sustaining treatment
  • after CPR, likely that patient will have a length and quality of life not in the best interests of the patient to sustain.
31
Q

CPR should be attempted in a situation without DNACPR order, except in:

A

Patient has refused…(?)
Patient is in TERMINAL phase of illness
Burdens of treatment outweighs benefits

32
Q

6 public interest factors AGAINST prosecuting a suspect of ASSISTED SUICIDE

A
  1. Victim made decision which was Voluntary, Informed and Clear decision.
  2. Motivations purely driven by compassion
  3. Minor actions to assist, or simple encouragement
  4. They were reluctant actions made in the face of a determined wish on the part of the victim
  5. Had tried to dissuade the patient from taking own life
  6. Reported the suicide to the police, and gave full details regarding circumstances in which the assisted suicide was carried out.
33
Q

Abortion Act (1967)

A

Person shall not be guilty of an offence, when a pregnancy is terminated by a registered medical practitioner, if two practitioners are of the opinion formed in good faith.

  1. If <24wks, TOP reduces risk of serious physical or mental harm to mother or any other children in her family
  2. Continuing pregnancy WILL result in PERMANENT physical or mental harm to mother, regardless of gestation
  3. Continuation results in increased risk to mothers life, regardless of gestation
  4. Substantial risk that baby would suffer from physical or mental abnormalities to be seriously handicapped (regardless of gestation)
34
Q

Infant life preservation act (1929)

A

Illegal to kill a child CAPABLE OF BEING BORN ALIVE, which applies to all pregnancies >28/52.

Unless to PREVENT DEATH of woman

35
Q

Offences Against Person Act (1861)

A

Illegal to procure drugs to kill a fetus.
Illegal to use drugs or instruments to procure abortion by anybody

(Basically, it was illegal for abortion under all circumstances, and the exceptions gradually were made by parliament)

36
Q

Utilitarian ethics

  1. One-liner
  2. Advantages
  3. Disadvantages
  4. When it may be used
A
  1. Consequentialism, “End justifies the means” - ie. intention does not matter
  2. Easy to understand, flexible, simple to apply.
  3. Minority usually suffer for the “greater good for population”. Doctors obviously cannot apply this as have individual doctor-patient relationships.
  4. Usually in population decisions that are impartial. Eg. Which treatment of fund
37
Q

Deontology

  1. What it is
  2. Advantages
  3. Disadvantages
A
  1. Actions rather than consequences that are considered right or wrong.
  2. Distinguishes acts from omissions (eg. Treatment withdrawal and euthanasia). Can just follow rules once they are made
  3. Complicated to generate rules, and there would always be exceptions
38
Q

Virtue ethics

  1. What is it
  2. Advantages
  3. Disadvantages
A
  1. Moral standards (eg. Self-control, prudence/wisdom, courage, justice)
  2. No idea. Intuitive
39
Q

Four main parts of an audit cycle

A
  1. Set and agree on standards
  2. Monitor performance
  3. Identify any deviations
  4. Make changes

Medicine (20 decks)

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