ethics and law

Question 2

medical consent in children

Answer 2

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 3

Utilitarianism

Answer 3

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

Question 4

Deontology

Answer 4

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

Question 5

Virtue ethics

Answer 5

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 6

components of capacity assessment

Answer 6

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 7

advance decisions

Answer 7

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 8

What revision of the mental health act is currently used?

Answer 8

1983

Question 9

Define mental disorder for the purposes of mental health act

Answer 9

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

Question 10

Section 2 MHA

Answer 10

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 11

Section 3 MHA

Answer 11

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 12

Section 4 MHA

Answer 12

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 13

Section 5 (4)

Answer 13

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 14

Section 5 (2)

Answer 14

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 15

Section 136

Answer 15

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

Question 16

Section 135

Answer 16

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

Question 17

Section 17a

Answer 17

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 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.

Question 21

What is advanced care planning?

Answer 21

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.

Question 22

What is an advanced statement?

Answer 22

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.

Question 23

What is an advanced decision?

Answer 23

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.

Question 24

What can an advanced decision refuse / not refuse

Answer 24

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 25

What 5 things are needed for an advanced decision to be legally binding?

Answer 25

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)

Question 26

What are the reasons a death should be referred to the coroner

Answer 26

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

Question 27

when should non-pregnant women be referred to the police for safeguarding concerns

Answer 27

‘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’.