ethics and law Flashcards
medical consent in children
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
Utilitarianism
An act is evaluated solely in terms of its consequences. It acts to maximise good e.g. killing one to save many
Deontology
The theory that the features of the act themselves determine worthiness.
Virtue ethics
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
components of capacity assessment
- He or she has an ‘impairment of, or disturbance in, the functioning of the mind or
brain’ whether permanent or temporary AND - 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
advance decisions
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).
What revision of the mental health act is currently used?
1983
Define mental disorder for the purposes of mental health act
Any disorder or disability of the mind, excluding alcohol and drug use as primary problems.
Section 2 MHA
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
Section 3 MHA
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
Section 4 MHA
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
Section 5 (4)
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
Section 5 (2)
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
Section 136
police section
person suspected of having a mental disorder in a public place
Section 135
police section
needs court order to access patient’s home and remove them to a place of safety
Section 17a
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
death certification points
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*)
Giving contraception to children laws/guidelines
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
Fraser guidelines
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.
What is advanced care planning?
a voluntary discussion between HCPs and patients with the aim of identifying an individual’s own preferences and wishes about future care, in advance of that individual’s loss of capacity.
What is an advanced statement?
general statements about their wishes, beliefs, feelings and values and how these influence their preferences for their future care and treatment.
Not by itself legally binding, but legally must be taken into consideration when making a “best interests” decision on someone’s behalf under the Mental Capacity Act (MCA), 2005.
What is an advanced decision?
An advanced decision to refuse treatment/advanced directive is a legally binding document.
Its purpose is to ensure that an individual can refuse a specific treatment(s) that they do not want to have in the future.
What can an advanced decision refuse / not refuse
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).
What 5 things are needed for an advanced decision to be legally binding?
It must be valid (this means it must have been made at a time when the individual had capacity to make that decision).
It must be applicable (this means the wording must be specific to the medical circumstances, and not vague or unclear).
It must have been made when the individual was over 18, and fully informed about their decision.
It must not have been made under the influence or duress of other people
It must be written down, be signed and witnessed (if it concerns a refusal of life-saving treatment)
What are the reasons a death should be referred to the coroner
Unnatural death:
- complication related to an intervention
- occupation
- overdose
- suicide
- violence
- accidents eg RTA or fall –> NOF
- no clear cause of death
- prisoner
- still birth
when should non-pregnant women be referred to the police for safeguarding concerns
‘There is no requirement to report a nonpregnant adult woman aged 18 or over to the police or social
services unless a related child is at risk. The patient’s right to confidentiality must be respected if they do
not wish any action to be taken. No reports to social care or the police should be made in these cases.5,34
It is not mandatory to report every pregnant woman identified as having had FGM to social services or
the police. An individual risk assessment must be made by a member of the clinical team caring for the
woman during her pregnancy. If the unborn child, or any related child, is considered to be at risk of
FGM, then a report must be made to children’s social care or the police’.
