Ethics and Law Flashcards
Verification of death
No response to verbal or painful stimulus
No palpable carotid pulse
No heart sounds (2 minutes)
No breath sounds (2 minutes
Pupils fixed and dilated
Should be documented in medical notes (date and time, notify consultant, discuss cause of death for certificate)
Medical Certificate of Cause of Death
- The doctor attending during the last illness of a person who dies has “… a statutory duty to issue a medical certificate of the cause of death (MCCD)”
- “Conversely, if you did not attend the deceased … you cannot complete the death certificate”
1997 OPCS Guidance on Referral: Completion of the medical certificate of cause of death
Office of National Statistics
1a, 1b, 1c, II format
Part II
Office of National Statistics
1a, 1b, 1c, II format
- 1a is ultimate cause of death
- 1b causes 1a
- 1c causes 1b
- Part II – other diseases related to cause of death but not related to 1a-c.
Do not include other diseases that did not contribute to the cause of death
What are the features of a consented autopsy?
<10%
To determine:
- extent of disease
- response to treatment
- occult disease
To support:
- teaching/training
- research/audit
What are the types of medicolegal autopsy?
1.Forensic
- Coroner’s Rules
- Forensic pathologist
- Police involvement
2.Coroner
- Coroner’s Rules
- General pathologist
When to refer to the coroner?
- Unknown cause of death
- Not seen by a Dr during last illness or last 14 days
- During or within 12 months of pregnancy
- Death in custody
- While detained under Mental Health Act
Death due to:
- Suicide
- Accident/trauma
- Industrial disease
- Medical/surgical treatment
- Abortion
- Anaesthetic care
- Lack of medical care
- murder
- Self-neglect
- Any history of violence
- Any element of suspicion
- Any allegation of medical negligence
- Any other unusual/disturbing feature
If in doubt, refer
What is article 2 of the HRA
Everyone’s life shall be protected by law
Features of article 2 of the HRA
- The right is absolute with respect to intentional killing
- Not all avoidable death counts as intentional killing
- There is no absolute obligation to provided life saving treatment
- Withdrawal of futile treatment will not breach article 2
- The right does not extend to the fetus
What is article 3 of the HRA
Article 3 – No one shall be subjected to torture or to inhuman or degrading treatment or punishment.
Features of article 3 of the HRA
- This right is absolute
- Non-consensual treatment of an incompetent individual may contravene article 3 if it is not therapeutically necessary
- Excessive restraint may contravene article 3
- Failure to stop an individual’s suffering will only breach article 3 if the suffering is inhuman and due to the State’s actions
What is article 5 of the HRA
Article 5 – Everyone has the right to liberty and security of person
Features of article 5 of the HRA
- This right is not absolute
- Detention is lawful if necessary for a mental illness
- Individuals must have access to an effective and speedy means of challenging detention
–Appeal process under Mental Health Act
–Deprivation of Liberty Safeguards
Article 8 of the HRA
Article 8 – Everyone has the right for his private and family life
Features of article 8 of the HRA
- This right is not absolute
- Protects a patient’s right to confidentiality
- Protects the right to refuse medical treatment even if life saving
- Article 8 will not be contravened if a breach is in accordance with the law AND is necessary in a democratic society
B is a 61 year old man who attends A+E with a history of fever and cough. He is a heavy smoker but denies any previous health problems. The on call FY2 Dr R sustains a needlestick injury whilst taking an arterial blood gas. Dr R’s consultant is informed and asks B if he would be willing to have an HIV test. B refuses. Dr R does not want to take post exposure prophylaxis unless it is necessary.
A.Dr R should go back and try to persuade B to consent to the test
B.The HIV test cannot be performed without consent
C.Dr R should ask the lab to do a CD4 count instead
D.B must consent to the test as otherwise it would be a breach of Dr R’s human rights under Article 3
E.Dr R can do the HIV test on a sample previously taken provided she does not disclose the result to B
F.The hospital must perform the HIV test otherwise it will contravene Dr R’s right to life under article 2
•
1.The HIV test cannot be performed without consent
