Ethics and Philosophy Flashcards
What are the roles of the GMC?
Keep up to date registers of qualified doctors
Foster good medical practice
Promote high standards of medical education and training
Enforce doctors Fitness to Practise guidelines and standards
What is the law?
The principle and regulations established in a community by some authority, which is applicable to its people. This may be in the form of legislation, customs or policies and are enforced by judicial decision
What is a statute?
This is written law that has been passed or expressed in writing
What is common law?
this is a concept which is part of English law that is derived from customs and judicial precedent
e.g. one has a duty to read contracts
What is referred to as a ‘criminal law?’
Crimes against the government or community at large
What is civil law?
disputes between private parties
e.g. slander, property damage
What is the golden triad of thought for moral philosophy?
Virtue ethics
Consequentialism
Deontology
What is virtue ethics?
action is judged by the moral character of the person carrying out the action
i.e. action should be virtuous
What is consequentialism?
An action is right if it promotes the best consequences
What is deontology?
An action is right if it is in concordance with a correct moral rule or principle. This school of thought is much more in accordance with a fixed set of rules or principles
e.g. duties, roles, justice
What is the ‘four principles’ model often used to judge ethics?
non-maleficence
beneficence
autonomy
justice
What is the ‘Paradigm case process’ in ethics?
Medical indications
Patient preferences
Quality of life
Contextual features (e.g. conflict of interest)
What is the ‘Structural Case Analysis Model?’
Summarise the case
State the moral dilemmas
State the assumptions being made
Analyse case with ref to ethical principles
Analyse case with ref to consequences
Analyse case with ref to the virtuous healthcare professional
Analyse case with ref to the law
Identify justifiable and non-justifiable ethical solutions
State preferred approach with explanation
What is meant by informed consent?
A voluntary, independent decision made by a competent and autonomous individual on the basis that they have been provided with adequate information and deliberation, to accept rather than reject some proposed action
What 3 features feed into ‘valid consent?’
Information
Voluntariness (individual should not be pressured into the decision and must be given the opportunity to say no)
Competence
What is legally defined as competence?
Mental Capacity Act 2005 requires: patient must understand retain information provided Weigh up information Communicate their decision
What is meant by information in the context of ‘valid consent?’
GMC says:
patient must understand in broad terms the nature and purpose of treatment and should be aware of any significant risks
What is voluntariness in the context of ‘valid consent?’
Free choice
Free of coercion
Free of undue pressure or perceived coercion
Why is consent important?
respect for autonomy Control of own treatment Realistic understanding of treatment Establishes trust between patient and practitioner Respect and dignity Legal and professional requirement
What is a useful acronym of gaining informed consent?
Procedure
Alternatives
Risks
Questions
Adequate info for consent is assessed by 3 models:
Professional practice standards (This is a medical judgement e.g. Bolam test)
Reasonable person standard
Subjective standard (this is the particular significance to the patient)
What are the attributes of consent?
can be task-specific
can fluctuate
an irrational decision is not an incompetent decision
What is voluntariness in gaining consent?
patients must be able to refuse and know they are allowed to do so
patient must be free from undue pressure (perceived or otherwise)
When is consent is not possible/necessary?
Patient is not competent
patient poses serious risk to others if untreated or unrestrained
declines all information
What are the main problems with consent?
not possible when patient declines information
Difficult to present info when it is complex or there is clinical uncertainty
Effect of emotion on informed consent (e.g. fear, paternalistic doctor figure, patient influenced by way info is presented)
time consuming
not required if patient poses a risk to others or themselves
What is the human tissue act consent?
needed for removal, storage and use for:
transplantation
education or training
public display
What is a Notifiable Patient Safety Incident (NPSI)?
An incident here a patient has suffered or could have suffered unintended harm that may result in death, severe or moderate harm or prolonged psychological harm
What is the appropriate course of action if a NPSI occurs?
put matters right where possible
apologise
explain fully and prompt what has happened and the likely consequences
What are the patient complaint options?
NHS complains procedure
GMC fitness panel
What are the outcomes of a GMC fitness panel?
conditions placed on doctor’s registration
suspend registration
remove registration
What are the 2 legal options for medical malpractice?
Criminal action e.g. gross negligence, manslaughter
Civil action e.g, patient can sue for damages (Tort of negligence statute)
What is the Bolam test?
Test used to assess whether a doctor was acting in accordance with a practice accepted as proper
What attributes are assessed in the Tort of negligence?
Doctor:
breach of duty of care (both patient-doctor relationship and proper accepted practice)
breach caused harm (causation required)
Lack of expertise
Legal responsibility for prescribing for e.g.
good notes vital
Why is confidentiality important?
public trust in patients
individual right to privacy
legal requirement
When is breaking confidentiality permissible?
it is required by law
patient consents
justifiable to public interest (e.g. protecting society/individuals from harm)
What are the requirements when breaking confidentiality?
disclose as little info as possible
use anonymised/coded info where possible/practical
observe all legal requirements
notify patient in advance if time allows and doing so will not out others at risk
How does the GMC duty of confidentiality change through life?
It continues after death
Note that legally the duty dies with the patient
Which areas of confidentiality are referred to in statutory provisions?
(tricky areas) disease that affect driving genetic disease STIs domestic/child abuse immigration issues
What is ‘reflective practice?’
learning though experience toward failing new insights used to better one’s practice
What are the 3 types of reflective practice?
knowing in action (that which we do almost in reflex)
reflection in action (thinking on your feet)
reflection on action (conscious activity after an event)
What is the purpose of reflective practice?
metacognition improves cognitive function
expected criteria of academic examinations and clinical work
What is an error?
failure of planned actions to achieve their intended outcome
What are the types of error?
slips and lapses: good plan, poor execution
mistake: bad plan, executed well
violation: deliberate attempt not to follow accepted approaches
What are the broad reasons why errors occur?
Personal
Interactive/system
The deadly 10
What are the deadly 10 causes of errors?
defects in: communication triaging/prioritisation system design error playing the odds insufficient skill sloth/minimum effort fixation bravado or timidity ignorance teamwork
What are active causes or error?
actions which are close to the patient
more likely to occur if staff are tired, depressed or overloaded or overconfident
What are latent causes of error?
Actions which occur in the system of care (upstream of patient)
Systemic deficit make active areas more likely. Poor communication is often involved
