Ethics and Law

Question 1

What guidelines apply specifically to contraceptive advice and treatment in under 16’s?

Answer 1

Fraser guidelines

Question 2

What is used to determine if a child can consent to their own medical treatment?

Answer 2

Gillick competence

Question 3

What is Gillick competence?

Answer 3

Gillick competence is where a child (16 years or younger) is deemed competent to consent to their own medical treatment, without the need for parental permission or knowledge.

Question 4

what are the 5 criteria of the Fraser Guidelines

Answer 4

1. Patient has maturity to understand the nature and implications of treatment
2. Cannot be persuaded to inform their parents or to allow the doctor to inform them
3. Likely to begin or continue having sexual intercourse with or without contraceptive treatment;
4. Their physical or mental health are likely to suffer if contraceptive advice or treatment is withheld
5. Advice or treatment is in their best interests

Question 5

who does the mental capacity act (MCA) of 2005 apply to?

Answer 5

MCA applies to individuals in England and Wales aged 16 and over
Not Scotland

Question 6

5 key principles of mental capacity act (MCA)

Answer 6

5 key Principles of MCA

1. Presumption of capacity unless proved otherwise
2. Right for individuals to be supported to make their own decisions
3. Individuals retain the right to make unwise or eccentric decisions
4. All actions taken under MCA are in a patients best interests
5. Action taken on behalf of an incapacitated individual should be the least restrictive of their basic rights and freedom of action

Question 7

What does the FGM act 2003 cover?

Answer 7

UK (excluding Scotland)
Any person habitually resident in the U.K. (Not just UK citizens)
Illegal to carry out FGM / assist / take a girl abroad or assist another to do so / assist a girl to cut herself

Question 8

What is FGM type 1

Answer 8

FGM 1 - clitoroidectomy - partial or total removal of the clitoris / clitoral hood

Question 9

What is FGM type 2

Answer 9

FGM 2 - Excision - total or partial removal of the clitoris and labia minora with or without the labia majora

Question 10

What is FGM type 3

Answer 10

FGM 3 - infibulation - narrowing of the vaginal opening by cutting and stitching of the labia majora
With or without removal of the clitoris or labia minora

Question 11

What is FGM type 4

Answer 11

FGM 4 - any harmful procedure done to the female genitals not covered by FGM 1-3
E.g piercing, pricking, incising, scraping, stretching, burning

Question 12

Long term Consequences of FGM

Answer 12

PTSD
Anxiety 
Depression 
Dysparunia
Reduced sexual enjoyment
Chronic pain 
Painful urination 
Menstrual problems 
Keloid scarring 
HIV 
Obstetric complications - increased CS, PPH, instrumental delivery, prolonged labour

Question 13

Short term consequences of FGM

Answer 13

Pain 
Bleeding 
Shock
Infection 
Tissue swelling 
Risk of HIV transmission 
Urinary retention 
Dysuria
Psychological distress

Question 14

Possible pathways that lead people into commercial sex work?

Answer 14

A spectrum

• human trafficking
• Drug addiction
• Coercion
• lack of alternative options
• some work autonomously and by choice
• To pay off debt, fund higher education, cover family expenses
• may be intermittent or opportunistic in involvement in sex work
• some make a career decision to work in the sex industry

Question 15

Likely differences between indoor commercial sex work and street work?

Answer 15

Street sex work is usually higher risk

• more commonly linked with drugs.
• Sex may be exchanged directly for drugs.
• Drugs may be supplied by the pimp in exchange for earnings.
• Greater risk of violence and abuse from clients and pimps than those who work indoors
• greater pressure from clients for unprotected sex combined
• greater competition among workers leads to street increased sexual risk taking
• often homeless / living in squats / drug dens
• greater risk of TB / other diseases / general poor health

Question 16

What exceptions exist to the general concept that indoor sex workers are usually safer and more protected

Answer 16

Trafficked women
Children

They are usually hidden to avoid detection by police and social services
May frequently be moved between locations or across borders

Question 17

what are the four main categories of health risks faced by workers in the commercial sex industry.

Answer 17

1. STI risk
2. Harm through violence from clients or pimps,
3. Factors associated with the use of drugs
4. Mental health

Question 18

What factors are predictors of violence for commercial sex workers

Answer 18

Street-based sex work
Economic pressures
Use of heroine or crack cocaine while working
Not being able to control the location for sex
Sex in the client’s car
Being under the control of a pimp - due to pressure to earn more

Question 19

How does non-injecting drug use increase a persons risk of STIs?

Answer 19

Non-injecting drug use, particularly smoking crack cocaine

is an indirect risk factor for STI transmission

through impairment of judgement, and higher risk behaviors

Question 20

Among CSW what factors increase the risk of mental ill-health

Answer 20

strong link with risk-taking behaviors

• drug use
• risky sexual practices
• violence
• domestic violence
• rape
• childhood trauma
• imprisonment and trafficking
• coercion
• lack of control with clients
• inadequate social support
• The conditions in which sex work is conducted has a greater impact on mental well being than the work itself

Question 21

Laws relating to prostitution

What is legal vs illegal

Answer 21

Prostitution is legal.

It is illegal

• to loiter or conduct solicitation in a street /public place
• to engage in street prostitution
• for a potential client to solicit persistently,
• to solicit from a motor vehicle (“kerb crawling”).
• to own or run a brothel
• to supply or offer child prostitution (under 18)
• to work controlling prostitution for gain - e.g. pimping

Question 22

Harm reduction strategies for CSWs

Answer 22

• Screening and treating STIs
• provision of condoms
• education to reduce disease transmission / safer sex
• development of assertiveness and negotiating skills
• Cervical screening
• Contraception
• management or referal of gynaecological
• information and referal to termination of pregnancy services
• psychosexual counselling
• safety advice and awareness of potentially dangerous clients
• Distribution of ‘dodgy punter’ registers e.g. ‘ugly mugs’
• Needle and syringe exchanges
• education in safer injecting practices
• Drug rehabilitation
• methadone programmes,
• addiction programmes and withdrawal
• support and management of depression, anxiety, PTSD
• counselling / CBT
• practical measures such as emergency housing
• Peer support and peer educators

Question 23

Potential barriers to a person wishing to exit CSW

Answer 23

Obstacles depend on their level of vulnerability

• may need protection from pimps or violent partners
• may need emergency housing or shelters
• may need referral to drug rehabilitation programmes
• may need counselling services or other mental health support / treatment
• may have low educational levels
• may have learning difficulties
• may have a criminal record - harder re employment prospects

Question 24

Possible adverse consequences of laws against sex work

Answer 24

Lack of industrial rights such as sick pay and accident compensation
Lack of protection from exploitation
Workplaces are not subject to health and safety regulations
Difficulties accessing banking facilities
Difficulties accessing social assistance or civil justice
More likely to relocate frequently or live covertly
Brought into contact with other criminal activities.
Arrest or abuse increases sense
of powerlessness and lowers self-esteem
If sex is offered covertly in establishments condoms may be discouraged because they are evidence of prostitution
Less likely to report violence against them
Less likely to be treated seriously by police and courts.

Question 25

Can gillick competence be applied to under 13 year olds?

Answer 25

yes - no lower age limit

However, it is rarely appropriate or safe for an under 13 year old to consent to treatment without parental involvement

Question 26

What is the age of statutory rape

Answer 26

statutory rape is <13yo

ANY SI with <13yo must be passed on to safeguarding regardless of Gillick competence.

Question 27

What is the age of consent in UK

Answer 27

16 yrs