Ethics and Law

Question 1

What is an advanced directive

Answer 1

written document when patient in sound mind for preferences when it comes to medical treatment should they become unable to express those wishes directly

Question 2

All advanced directives are legal binding unless

Answer 2

The decision has been subsequently withdrawn
Power to make such decisions has been conferred to another person by creating a Lasting Power of Attorney
Since making the will the patient has acted in a way that is clearly inconsistent with the advance decision remaining their fixed decision
The person is not incapacitated and can decide for themselves
The treatment in question is not that specified in the advance decision
Any of the circumstances specified in the advance decision do not exist
There ‘are reasonable grounds for believing that circumstances exist which the person did not anticipate at the time of the advance decision and which would have affected his decision at the time of the advance decision.’

Question 3

What does the AOMRC define death as

Answer 3

.the irreversible loss of the capacity for consciousness, combined with irreversible loss of the capacity to breathe

Question 4

Certifying death requires a practioniner to check for

Answer 4

body temperature > 35ºC. In addition, the body must show no evidence of substance misuse or misadventure
and

No spontaneous movements.
No respiratory effort (examine for at least one minute).
No heart sounds or palpable pulses (examine for at least one minute).
No corneal reflex.
Pupils are fixed and dilated.

Question 5

If CPR is attempted then

Answer 5

the individual should be observed for signs of life for a minimum of 5 minutes by the supervising clinician,

if DNA cpr then
confirmation of the absence of pupillary light reflex, corneal reflex and of any response to painful stimuli (usually the application of supraorbital pressure).
confirmation that there is no palpable central pulse and no heart sounds on auscultation for 2 minutes.

Question 6

When can a nurse verify death

Answer 6

the death is expected and occurs a private residence, hospice, residential home, nursing home or hospital AND
a valid ‘Do not attempt cardio-pulmonary resuscitation’ document has been completed AND
there are no features that would prompt a referral to the local Coroner.

Question 7

What are the 3 types of consent?

Answer 7

1. Informed
2. Expressed
3. Implied

Question 8

consent forms in the NHS

Answer 8

Consent Form 1 For competent adults who are able to consent for themselves where consciousness may be impaired (e.g. GA)

Consent Form 2 For an adult consenting on behalf of a child where consciousness is impaired

Consent Form 3 For an adult or child where consciousness is not impaired

Consent Form 4 For adults who lack capacity to provide informed consent

Question 9

Capacity in a person is

Answer 9

decision and time specific

1. Understand and retain information
2. Patient believes the information to be true
3. Patient is able to weigh the information to make a decision
   All patients must be assumed to have capacity

Question 10

Capacity in a person is

Answer 10

decision and time specific

1. Understand and retain information
2. Patient believes the information to be true
3. Patient is able to weigh the information to make a decision
   All patients must be assumed to have capacity

Question 11

parents providing consent

Answer 11

biological mother always can provide consent
The childs father can consent if the parents are married (and the father is the biological father), or if the father is named on the birth certificate (irrespective of marital status).

Question 12

a controlled drug prescription must have

Answer 12

name and address of the patient
the form, and where appropriate the strength, of the preparation
- either the total quantity (in both words and figures) of the preparation, or the number (in both words and figures) of dosage units to be supplied
the dose (cannot write ‘as directed’)
prescribers name, signature, address and current date

Question 13

Duty of candour

Answer 13

All healthcare professionals must be honest when something has gone wrong. They must:
Tell the patient when something has gone wrong
Apologise to the patient (or carer or family member where appropriate)
Offer an appropriate resolution
Explain the potential short and long-term effects of the error

Question 14

Accepting gifts as a doctor

Answer 14

‘You must not ask for or accept from patients, colleagues or others any inducement, gift or hospitality that may affect or be seen to affect the way you prescribe for, treat or refer patients or commission services for patients’

Question 15

If a consutlant gives a job to the reg and he messes up is he at fault?

Answer 15

if delegating to a more junior doctor the consultant is not accountable for their decisions but are accountable to ensure that junior member is adequately trained and experienced to do the job

Question 16

if a patient wants certain information not be shared but it is vital

Answer 16

If a patient objects to a disclosure, which is considered essential to the provision of safe care, you should explain that you cannot refer them or otherwise arrange for their treatment without also disclosing that information.

Question 17

If a doctor thinks he himself is well

Answer 17

‘If you know or suspect that you have a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague.’
‘You must follow their advice about any changes to your practice they consider necessary.’
‘You must not rely on your own assessment of the risk to patients.

Question 18

What offences must the gmc be aware of

Answer 18

Are found guilty of a criminal offence
Are charged with a criminal offence
Formally admit to committing a criminal offence (for example, by accepting a caution)
Accept the option of paying a penalty notice for an ASBO
Receive a cannabis warning
Have had your registration restricted, or have been found guilty of an offence, by another medical or other professional regulatory body.
Your conduct (including as part of a management team) has directly contributed to an organisation that has entered into a deferred prosecution agreement.

Question 19

teaching students

Answer 19

Thus we can conclude from this that both you and your colleague have a duty to teach the students. Thus allowing him not to teach or you also sending the students away will result in neither of you fulfilling your duty.

Question 20

if a patient objects to anyone knowing whats the ruling

Answer 20

Most patients expect that some information will be shared with those who are directly involved in their care.

you should not disclose the information. The exceptions are: if it is justified for the public interest (as detailed below) or the patient lacks capacity.
You should explain to the patient the potential consequences of not allowing personal information to be shared and reach a compromise where possible.
In cases where a patient cannot be informed about information sharing, such as an emergency setting, you should pass relevant information to those providing the patient’s care.

Question 21

in which circumstances can information be shared

Answer 21

You must be accessing the information to support the patient’s direct care, or be satisfied that it is being shared for that purpose.
Patients should be kept informed regarding how their personal information will be used. It should be clear that they have the right to object.
You must have no reason to believe the patient has objected to the information being shared.
You must be satisfied that anyone you disclose the information to understands that you are giving it to them in confidence.

Question 22

sharing information to relatives

Answer 22

You should gain explicit consent.
When a patient lacks capacity, it may be necessary to share some relevant information with friends/ relatives. This does not entitle the person to full access to the patient’s clinical records

Question 23

when must something be disclosed by law

Answer 23

Following an order made by a judge or presiding officer of a court.
In certain cases of communicable disease, when you must inform the local authority.
To prevent an act of terrorism.
To comply with a statutory request made by a regulatory body such as the GMC.

The police should usually be informed whenever a person presents with a gunshot wound, given the potential risk to others.
They should also be informed of most knife injuries- unless the injury appears to be accidental or a result of self-harm.
Personal information (such as the patient’s name and address) should not be disclosed in the initial contact with the police, and the police will respond even if the patient’s identity is not disclosed.

Question 24

in order to assume a person has capacity they must be able to?

Answer 24

They must be able to understand the information surrounding a decision and its consequences
They must be able to retain the information long enough to make a decision
They must be able to use the information, by weighing up the pros and the cons of the decision
They must be able to communicate the decision

Question 25

When can we end a professional relationship with a patient

Answer 25

patient being violent, threatening you or being abusive or the patient having stolen from you or the premises. It also includes the patient persistently acted inconsiderately or unreasonably or if they have made a sexual advance to you.

You should not end a relationship due to a complaint or due to resource implications.

Before you end the relationship you must warn the patient you are considering ending it and do what you can to restore the relationship.

When you end a relationship you must be satisfied that your reason is fair and does not discriminate. Then make sure the patient is told this is happening, and why. If practical do this in writing.

Question 26

If youre against a procedure what must you do

Answer 26

Inform the patient that they have the right to see another practitioner
Provide the necessary information and support towards the patient seeking another doctor. In doing so, refrain from expressing disapproval of the patient’s lifestyle, choices or beliefs
Find another doctor to substitute you if it is not practical for the patient to arrange to see another doctor

Question 27

What is an intimate examination

Answer 27

Essentially this is anything the patient would consider intimate or intrusive
This will most commonly be examinations of the rectum, genitalia and breasts

You should make sure they are happy to proceed and ensure they have had all their questions answered
In addition you should explain that you will stop the examination at any point if asked to by the patient

Question 28

who can be a chaperone

Answer 28

They should be a healthcare worker who has no relation to the patient or doctor. Patients may also wish to have family members present for support but they cannot be relied upon as chaperones as they are not impartial
The full name and role of the chaperone should be documented in the medical records with the examination findings

Question 29

who can be a chaperone

Answer 29

They should be a healthcare worker who has no relation to the patient or doctor. Patients may also wish to have family members present for support but they cannot be relied upon as chaperones as they are not impartial
The full name and role of the chaperone should be documented in the medical records with the examination findings

Question 30

Is it mandatory to have a chaperone

Answer 30

It is not mandatory to have a chaperone and many patients may wish to be examined without another individual present. In these cases, the offer and refusal should be documented in the medical records
A doctor should not feel pressured to perform an examination without a chaperone if they do not wish. However, they should ensure the patient is referred to a colleague who is comfortable doing so and that they would not wait unnecessarily for treatment because of this

Question 31

5 principles of the mental capacity act

Answer 31

A person must be assumed to have capacity unless it is established that he lacks capacity
A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success
A person is not to be treated as unable to make a decision merely because he makes an unwise decision
An act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests
Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action

Question 32

best interest decisions

Answer 32

1. Whether the person is likely to regain capacity and can the decision wait.
2. How to encourage and optimise the participation of the person in the decision.
3. The past and present wishes, feelings, beliefs, values of the person and any other relevant factors
4. Views of other relevant people

Question 33

LPA

Answer 33

The Act allows a person to appoint an attorney to act on their behalf if they should lose capacity in the future, replacing the current Enduring Power of Attorney (EPA). In addition to property and financial affairs the Act also allows people to empower an attorney make health and welfare decisions. The attorney only has the authority to make decisions about life-sustaining treatment if the LPA specifies that. Before it can be used an LPA must be registered with the Office of the Public Guardian

Question 34

what is an advanced decision

Answer 34

Advance decisions can be drawn up by anybody with capacity to specify treatments they would not want if they lost capacity. They may be made verbally unless they specify refusing life-sustaining treatment (e.g. Ventilation) in which case they need to be written, signed and witnessed to be valid. Advance decisions cannot demand treatment

Question 35

what is an advanced decision

Answer 35

Advance decisions can be drawn up by anybody with capacity to specify treatments they would not want if they lost capacity. They may be made verbally unless they specify refusing life-sustaining treatment (e.g. Ventilation) in which case they need to be written, signed and witnessed to be valid. Advance decisions cannot demand treatment

Question 36

what can a patient complaint be

Answer 36

verbal complaint
informal or formal written complaint addressed to the doctor concerned
complaint addressed to a managing body e.g. hospital trust or GP practice
complaint to the GMC

It should of course be remembered that patient complaints or comments may be unwarranted or without basis and therefore a formal reply is usually required to ensure the doctor has given their account of what has happened.

Question 37

patients who refuse treatment

Answer 37

common law: used to treat patients in emergency scenarios
Mental Capacity Act: (MCA) used in patients who require treatment for physical disorders that affect brain function. Remember this may be delirium secondary to sepsis or a primary brain disorder such as dementia
Mental Health Act (MHA): used in patients who require treatment for mental disorders. For patients already admitted to hospital, a section 5(2) is used if there is not the time for a more formal section 2 or 3. A typical scenario would be a patient who has a mental health disorder attempting to discharge themselves, when it is thought this may result in harm