ethics and law

Question 1

medical consent in children

Answer 1

at 16 years or older a young person can be treated as an adult and can be presumed to have capacity to decide

under the age of 16 years children may have capacity to decide, depending on their ability to understand what is involved

where a competent child refuses treatment, a person with parental responsibility or the court may authorise investigation or treatment which is in the child’s best interests*

*in Scotland those with parental responsibility cannot authorise procedures a competent child has refused

Question 2

Utilitarianism

Answer 2

An act is evaluated solely in terms of its consequences. It acts to maximise good e.g. killing one to save many

Question 3

Deontology

Answer 3

The theory that the features of the act themselves determine worthiness.

Question 4

Virtue ethics

Answer 4

These focus on the character of the person, integrating reason and emotion. An action can be virtuous only if it is performed by a person in the right state of mind (i.e. genuinely intending to do the right thing).
The five focal virtues are:
Compassion
Discernment
Trustworthiness
Integrity
Conscientiousness

Question 5

components of capacity assessment

Answer 5

1. He or she has an ‘impairment of, or disturbance in, the functioning of the mind or
   brain’ whether permanent or temporary AND
2. He or she is unable to undertake any of the following
   a. understand the information relevant to the decision
   b. retain that information
   c. use or weigh that information as part of the process of making the decision
   d. communicate the decision made by talking, sign language or other means

Question 6

advance decisions

Answer 6

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

Treatments that can be refused include life-sustaining treatments. It cannot refuse basic care (such as washing), food or drink by mouth, measures designed purely for comfort (e.g. painkillers), or treatment for a mental health condition if the individual is sectioned under the Mental Health Act. It can also not demand specific treatment or something that is illegal (e.g. assisted dying).

Question 7

What revision of the mental health act is currently used?

Answer 7

1983

Question 8

Define mental disorder for the purposes of mental health act

Answer 8

Any disorder or disability of the mind, excluding alcohol and drug use as primary problems.

Question 9

Section 2 MHA

Answer 9

Duration : 28 days (cannot be renewed)

Purposes : assessment (although treatment can be given without patients’ consent)

Professionals involved : 2 doctors (one S12 approved), AMHP

Evidence required:
a) the patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment
b) the patient ought to be detained for their health or safety, or the protection of others

Question 10

Section 3 MHA

Answer 10

Duration : 6 months (and can be renewed)

Purposes : treatment

Professionals involved : 2 doctors, 1 AMHP

Evidence required

a) The patient is suffering from mental disorder of a nature or degree which makes it appropriate for the patient to receive medical treatment in a hospital ; and
b) The treatment is in the interests of his or her health and safety and the protection of others ; and
c) Appropriate treatment must be available for the patient

Question 11

Section 4 MHA

Answer 11

Duration : 72 hours

Purposes : only in an “urgent necessity” when waiting for a second doctor would lead to “undesirable delay”

Professionals required : 1 doctor (S12) and 1 AMHP

Evidence required
a) The patient is suffering from a mental disorder of a nature or degree that warrants detention in hospital for assessment ; and
b) The patient ought to be detained for their own health or safety, or the protection of others
c) There is not enough time for a 2nd doctor to attend (risk)

Not used often, A&E, community

Question 12

Section 5 (4)

Answer 12

For a patient already admitted (can be psychiatric or general hospital - not A&E - AMU is fine) but wanting to leave

Nurses’ holding power until doctor can attend

6 hours

Cannot be treated coercively whilst under section

Needs to be done by admitting team

Question 13

Section 5 (2)

Answer 13

For a patient already admitted but wanting to leave

Doctors holding power - 72 hours

Allows time for section 2 or section 3 assessment

Cannot be treated coercively

Needs to be done by admitting team

Question 14

Section 136

Answer 14

police section
person suspected of having a mental disorder in a public place

Question 15

Section 135

Answer 15

police section
needs court order to access patient’s home and remove them to a place of safety

Question 16

Section 17a

Answer 16

Supervised Community Treatment (Community Treatment Order)
can be used to recall a patient to hospital for treatment if they do not comply with conditions of the order in the community, such as complying with medication

Question 17

notifiable deaths

Answer 17

unexpected or sudden deaths
when the doctor attending the deceased did not see them within 14 days before death
if a death occurs within 24 hours of hospital admission
accidents and injuries
suicide
industrial injury or disease (e.g. asbestosis)
deaths occurring as a result of ill treatment, starvation or neglect
the death occurred during an operation or before recovery from the effect of an anaesthetic
poisoning, including taking illicit drugs
stillbirths - if there is doubt as to whether the child was born alive
prisoner or people in police custody
service disability pensioners

Question 18

death certification points

Answer 18

old age’ as 1a is only acceptable if the patient was at least 80 years of age . It can be used if certain conditions are met but is discouraged

‘natural causes’ is not acceptable

organ failure (e.g. ‘liver failure’) can only be used if you specify the disease or condition that led to the organ failure (e.g. 1b: Hepatitis C)

abbreviations should be avoided (except HIV and AIDS*)

Question 19

Giving contraception to children laws/guidelines

Answer 19

the age of consent for sexual activity in the UK is 16 years. Practitioners may however provide advice and contraception if they feel that the young person is ‘competent’. This is usually assessed using the Fraser guidelines (see below)
children under the age of 13 years are considered unable to consent for sexual intercourse and hence consultations regarding this age group should automatically trigger child protection measures

Question 20

Fraser guidelines

Answer 20

should understand the clinician’s advice,

they cannot be persuaded to discuss the situation with their parents,

are likely to continue having intercourse without treatment,

are likely to suffer (mentally or physically) without treatment,

it is in the patient’s best interests to provide the prescription.