ETHICS AND PROFESSIONALISM

Question 1

What are human factors?

Answer 1

Enhancing clinical performance through an understanding of the effects of teamwork, tasks, equipment, workspace, culture and organisation on human behaviour

Question 2

Give examples of some human factors?

Answer 2

Fatigue
Stress
Poor communication
Heavy workload
Distractions in personal lives
Technology
Culture norms
Lack of resources
Complacency
Lack of teamwork
Pressure
Lack of assertiveness
Situational awareness

Question 3

What is the Swiss cheese model?

Answer 3

There are many levels of defence in a system and each level of defence has ‘holes’ which are caused by poor design/decision making/lack of training etc
If these holes become aligned over successive levels of defence there will be a window of opportunity for a patient safety incident to occur

Question 4

Outline the importance of teamwork for protecting pt safety?

Answer 4

Good teamwork can help mitigate the impact of human factors on pt safety
Good teamwork can avoid errors by promoting information sharing, cross-checking and redundancy
Team members can catch and correct errors before they reach a pt
Team members can provide feedback to each other which can help identify areas for improvement and prevent future errors

Question 5

What are some principles of good team working?

Answer 5

Clear roles and responsibilities
Open and effective communication between members of team and between them and the pt
Mutual respect for individual roles
Shared goals
Effective leadership
Regular meetings
Training on team working

Question 6

What is the professional duty of candour?

Answer 6

a professional responsibility to be honest with patients when things go wrong

HCP must be open and honest with the pt and people in their care when something has gone wrong with their treatment or has the potential to cause harm or distress
They must tell the person, apologise, offer support to put matters right and explain fully to the person the short and long term effects of what has happened

Question 7

Who are patient safety incidents reported to?

Answer 7

National Reporting and Learning System- the Learn from patient safety events (LFPSE) service

Question 8

Where must you report suspected adverse reactions to medicine?

Answer 8

UK-wide yellow card scheme
MHRA

Question 9

Why is it important to report mistakes?

Answer 9

Reporting mistakes is essential for patient safety and quality improvement. It allows healthcare organizations to identify and address the root causes of errors, and develop strategies to prevent future incidents.

Question 10

What are the potential consequences of failing to report mistakes?

Answer 10

Failing to report mistakes can have serious consequences, both for patient safety and for your professional reputation. It may also breach your professional obligations, and could result in disciplinary action or sanctions from the GMC.

Question 11

What are the main ethical dilemmas in organ transplantation?

Answer 11

Allocation of limited organs
Informed consent
Financial incentives
Determining brain death
Issues regarding the recipient e.g. smokers, drinkers, organs damaged by their vices
Utility - allocate organs in a way that maximises the benefits to society

Question 12

What are the main ethical dilemmas in blood donation?

Answer 12

Safety of blood
Informed consent
Discrimination e.g. men who have sex with men
Privacy of blood donors

Question 13

Whats the law on organ donation?

Answer 13

Max and Keiras law - The Organ Donation (Deemed Consent) Act 2020 - opt out system

Question 14

What are the ethics of an opt out organ donation system?

Answer 14

Opt out may increase the number of organs
Opt in system places unnecessary burden on individuals and their families to actively register their willingness to donate their organs
Opt out system easier
Opt out could infringe on individual autonomy
Some individuals wont opt out simply because they are unaware of the new system which could result in donations being made against their wishes
Opt oust system may impact vulnerable populations who may be less likely to opt out due to cultural or religious reasons
Concerns on how the spreads the word on opt out systems
Opt out systems may not actually increase organ donation numbrs

Question 15

Outline the role of family in the opt out organ donation system?

Answer 15

even if an individual has not explicitly opted out of organ donation, their family or next of kin can still be consulted in the event of their death to confirm whether they wish to donate their organs. This is known as “deemed consent” or “presumed consent” with a family override.

In the absence of an explicit decision by the deceased, the views of their family or next of kin are taken into account when deciding whether to proceed with organ donation. If the family or next of kin object to donation, their wishes will generally be respected, even if the deceased had not opted out.

However, it is important to note that the family or next of kin’s decision is not legally binding, and ultimately it is the responsibility of the medical team to determine whether organ donation is possible and appropriate based on the medical criteria. Nonetheless, the family or next of kin’s decision will usually be respected, as it is important to ensure that they are supported and their wishes are taken into account during the difficult time following the death of a loved one.

Question 16

What is the Human Tissue Act 2004?

Answer 16

The act that regulates the removal, storage and use of human tissue

Question 17

What are offences under the HTA 2004?

Answer 17

Removing, storing or using human tissue for Scheduled Purposes without appropriate consent.

Storing or using human tissue donated for a Scheduled Purpose for another purpose.

Trafficking in human tissue for transplantation purposes.

Carrying out licensable activities without holding a licence from the HTA (with lower penalties for related lesser offences such as failing to produce records or obstructing the HTA in carrying out its power or responsibilities).

Having human tissue, including hair, nail, and gametes, with the intention of its DNA being analysed without the consent of the person from whom the tissue came or of those close to them if they have died.

Question 18

What can you donate as a living donor?

Answer 18

Kidney
Part of liver
Bone
Placenta

Question 19

What are the benefits of living donation?

Answer 19

Can provide a fast transplant process as recipient dies not have to wait for a deceased organ donation
Better outcomes as organ is transplanted whilst its healthy and functioning

Question 20

What are ethical considerations in living donation?

Answer 20

Informed consent
Potential coercion
Fairness in allocation of organs

Question 21

Ethics of compulsory detention and treatment in mental health

Answer 21

Autonomy can be limited
Least restrictive option - Should only be used when all other options have been exhausted or are not feasible
Justification based off clear specific criteria and regular reviews should be conducted to ensure its still necessary - as iy goes against article 5 of human rights!!
The right to legal representation, the right to appeal decisions, the right to be informed of options
Balance risks and benefits - protecting them from harm but negative psychosocial effects

Question 22

What are the key principles of the MCA/

Answer 22

Presumption of capacity
Right for individuals to be supported to make their decisions
The right to make what might be seen as an eccentric or unwise decision
Best interests
Least restrictive intervention

Question 23

Whats the 2 stage test of capacity?

Answer 23

1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use?

2) Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions, but have capacity to make others. Mental capacity can also fluctuate with time – someone may lack capacity at one point in time, but may be able to make the same decision at a later point in time.

Question 24

When does MCA say a person is unable to make a decision?

Answer 24

understand the information relevant to the decision
retain that information
use or weigh up that information as part of the process of making the decision

Question 25

What is an advance decision?

Answer 25

a statement of instructions about what medical and healthcare treatment you want to refuse in the future, in case you lose the capacity to make these decisions.
It’s legally binding

Question 26

When can you make an advance decision?

Answer 26

You have the capacity to make those decisions now
You’re an adult (aged 18 or over)
You can make your advance statement orally or in writing. If you want to refuse life-sustaining treatment, you must make it in writing

Question 27

What must you do to refuse treatment in an advance decision?

Answer 27

You will need to:
Make your advance decision in writing
Make it clear that you understand you are refusing life-saving treatment, and that you understand the consequences
Include a statement confirming that your advance decision applies to life-saving treatment
Sign your advance decision in front of a witness, and get them to sign it
Include all relevant personal details, including your name and address

Question 28

Can you refuse future treatment that could be made to have if you’re sectioned?

Answer 28

You cannot generally use an advance decision to refuse future mental health treatment that happens when you are sectioned under the Mental Health Act 1983. For example, you cannot refuse mental health medication in this way, in case you’re sectioned in the future.
The exception is with electroconvulsive therapy (ECT). You can use an advance decision to refuse ECT in the future, even if you end up being sectioned.

Question 29

What is an advanced statement of wishes?

Answer 29

A written statement setting down your preferences, wishes and beliefs regarding your future care
It’s not legally bindings but it lets people know your wishes and preference if you lose capacity

Question 30

Whats a deprivation of Liberty?

Answer 30

Being deprived of liberty means that you’re not free to go anywhere without permission or close supervision. It also means that you’re continuously supervised. This is against the law unless it’s done under the rules of the Mental Capacity Act.

A deprivation of liberty should only be used if it’s the least restrictive way of keeping you safe. Or making sure that you have the right medical treatment.

Question 31

What are the key elements to consider when considering DoLS?

Answer 31

Whether its in their best interest
Whether its become necessary and unavoidable - i.e is it the least restrictive options

Question 32

Deprivation of liberty safeguards (DoLS) conditions

Answer 32

You’re age 18 or over
You lack capacity to agree to the restrictions
You’re staying in a care home or hospital, and they’ve successfully applied for an authorisation from the local authority
The deprivation of liberty safeguards have been followed

Question 33

Court of Protection conditions

Answer 33

The Court of Protection should be used to lawfully deprive you of your liberty if:

You’re age 16 or over
You lack capacity to agree to the restrictions
You live at home, in supported accommodation or in a shared lives placement
You’re in a care home or hospital but there’s a dispute over your placement there - DoLS can’t be used to take you aware from your home to a care home or hospital so you need an order from the Coiurt of Protection

Question 34

What are the differences between DoLS and detained under MHA?

Answer 34

DoLS dont need to have treatment for a mental health problem
DoLS can be for keeping you safe or treating other health problems
DoLS only apply to people who are deprived of their liberty in care homes, hospitals, and other medical facilities, and are not designed to apply to people who are detained under the MHA.

Question 35

what were deprivation of liberty safeguards meant to be replaced by in April 2023?

Answer 35

Liberty protection Safegaurds

Question 36

why were DoLS going to be replaced by LPS?

Answer 36

The new system was intended to provide greater clarity around when and how restrictions on a person’s liberty could be imposed, and to involve families and carers more closely in decision-making processes. The LPS were also intended to be more flexible than the DoLS, so that they could be applied to a wider range of care settings, including people’s own homes.

Question 37

What was the Bournewood case? What was the significance?

Answer 37

a man with autism and learning disabilities who was detained at a hospital in 1997. He was not formally detained under the Mental Health Act 1983, but was deemed to be informally detained under the common law principle of “necessity” due to his inability to consent to his care and treatment.
His family challenged his detention in court, arguing that his rights to liberty and autonomy had been violated. The case ultimately reached the European Court of Human Rights, which ruled in 2004 that HL’s detention had been a violation of his human rights.

This case highlighted a gap in the law regarding the deprivation of liberty of people who lack the capacity to consent to treatment - led to development of DoLS under the MCA

Question 38

What are the issues with DoLS?

Answer 38

It goes against article 5 of the human rights act which is the right to liberty and security which should protect us from having our freedom taken away

Question 39

Which laws protect confidentiality?

Answer 39

Data protection Act 2018
Common law of confidentiality
General data protection regulation
Human rights act 1998

Question 40

when can you breach confidentiality in mental health?

Answer 40

There are concerns that you’re at risk of serious harm or you’re in danger.
There are concerns that someone else is at serious risk of harm or that they’re in danger.
You’re unable to make the decision about sharing your information.
Someone is told they have to by law.

Question 41

Give examples of the broad ethical and legal issues in dealing with individuals who present a risk of violence to others

Answer 41

Duty to protect third parties from harm
Confidentiality
Involuntary hospitalisation if they present a risk of violence to others - ethical concerns on autonomy (goes against article 5 of human rights)
Use of restrains and seclusions - coercive measures and potential for abuse (also goes against article 3 of human rights)
Use of medication - issues of consent and harms of SE

Question 42

What takes precedent MHA or MCA?

Answer 42

MHA

Question 43

Whats the purpose of MDT meetings in cancer?

Answer 43

Review and discuss each patient’s diagnosis and medical history, and agree on the best course of treatment for the individual.
Consider the patient’s physical, psychological, and social needs when developing a treatment plan.
Identify any potential problems or barriers that may affect the patient’s treatment, such as side effects, risk of infection, or other complications.
Develop an ongoing care plan that may involve follow-up appointments, ongoing monitoring, and rehabilitation services.

Question 44

What are effective MDT working requirements?

Answer 44

Clear communication
Clearly defined roles and responsibilities
Collaborate approach to decision making
Access to appropriate resources
Meeting regularly
Respect each other

Question 45

What are challenges can hinder effective team working in MDTs?

Answer 45

Lack of communication: Poor communication between team members can result in misunderstandings and poor decision-making.
Role confusion: If team members do not understand their roles and responsibilities, this can lead to duplication of effort or gaps in care provision.
Resource constraints: Limited access to resources, such as diagnostic tests or treatment options, can limit the MDT’s ability to provide the best care possible.
Conflicting priorities: Team members may have different priorities, making it challenging to agree on the best course of action.
Uneven workload

Question 46

Outline how effective co-working with other NHS specialities and non-NHS agencies maintains high quality patient care

Answer 46

patients receive comprehensive and coordinated care that addresses all their medical, physical, emotional, and social needs.
It helps to avoid fragmented care
Avoids duplication of services
It allows better use of resources
Increases pt satisfaction

Question 47

What is a death certificate?

Answer 47

a legal document issued by a medical practitioner which states when a person died, or a document issued by a government civil registration office, that declares the date, location and cause of a person’s death

Question 48

Whats the purpose of a death certificate?

Answer 48

Enables deceaseds family to register the death
Permenant legal record of the death
Enables family to arrange disposal of the body and settle the deceased’s estate

Question 49

When should deaths be registered?

Answer 49

Within 5 days of their occurrence unless there is to be a coroner’s postmortem or an inquest

Question 50

Who certifies a death?

Answer 50

the statutory duty of the doctor who has attended in the last illness to issue the MCCD

Question 51

when should you report a death to a coroner?

Answer 51

The death was due to poisoning including by an otherwise benign substance
The death was due to exposure to, or contact with a toxic substance
The death was due to the use of a medicinal product, the use of a controlled drug or psychoactive substance
The death was due to violence, trauma or injury
The death was due to self-harm
The death was due to neglect, including self-neglect
The death was due to a person undergoing any treatment or procedure of a medical or similar nature
The death was due to an injury or disease attributable to any employment held by the person during the person’s lifetime
The person’s death was unnatural but does not fall within any of the above circumstances
The cause of death is unknown
The registered medical practitioner suspects that the person died while in custody or otherwise in state detention
The attending medical practitioner is not available within a reasonable time of the person’s death to sign the certificate of cause of death
The identity of the deceased person is unknown

(Basically the only way that you do not is it you know what illness caused the patient’s death and have seen and treated them for that illness within the 28 days before they died)

Question 52

What are the 4 principles of biomedical ethics?

Answer 52

Autonomy
Beneficence
Non-maleficience
Justice

Question 53

What is autonomy?

Answer 53

The individual freely acts in accordance with a self-chosen plan
The ethical duty is to ensure patient’s decisions are informed and voluntary

Question 54

What is beneficence?

Answer 54

The moral obligation of a doctor to act in the best interest of the pt and promote good for society

Question 55

What is non-maleficience?

Answer 55

An ethical duty to avoid harming or injuring the pt

Question 56

What is the bolam test?

Answer 56

a doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a reasonable body of medical men skilled in that particular art

I.e. you have to show that any medical professional who was in the same position as them would have done the same, giving the same outcome

Question 57

What is justice?

Answer 57

All patients are treated fairly (with equity)

Question 58

What is negligence?

Answer 58

A breach in the legal duty of care which results in damage

Question 59

What principle can establish whether a doctor breached the duty of care and thus were negligence?

Answer 59

Bolam principle

Question 60

What is bolitho test?

Answer 60

An adaptation of the bolam principle - it builds on the Bolam test by introducing an additional requirement that the medical opinion relied on by the defendant must be capable of withstanding logical scrutiny

Question 61

A patient presents to the emergency department with symptoms of a heart attack. The triage nurse does not take the patient’s symptoms seriously and does not refer them to a doctor. Later, the patient suffers a heart attack and requires emergency treatment. Was the nurse negligent, and would they pass the Bolam or Bolitho test?

Answer 61

In this scenario, the triage nurse did not refer a patient with symptoms of a heart attack to a doctor, and the patient suffered a heart attack later. The nurse may be found negligent under the Bolam principle if it is determined that a reasonable body of medical professionals would have referred the patient to a doctor in the circumstances. If the Bolitho test is applied, the nurse may still be found negligent even if they can demonstrate that their actions were in line with accepted medical practice, if it is determined that their medical reasoning was flawed or did not withstand logical scrutiny.

Question 62

What is normative ethics?

Answer 62

that branch of moral philosophy, or ethics, concerned with criteria of what is morally right and wrong

Question 63

What are the 3 sub fields of normative ethics?

Answer 63

Virtue ethics
Deontological ethics
Consequentialist ethics

Question 64

What is virtue ethics?

Answer 64

An action is only right if it is an action that a virtuous person would carry out in the same circumstances

Question 65

What is deontological ethics?

Answer 65

An ethical theory that states it is possible to determine the rightness or wrongness of actions by examining actions themselves without focussing on the consequencues

Question 66

What is consequentialist ethics?

Answer 66

An ethical theory that it is possible Tod determine the rightness or wrongness of actions by examining its consequences
I.e. an action that brings more good is better

Question 67

What is utilitarianism?

Answer 67

the right thing to do in any situation is whatever will “do the most good” (that is, produce the best outcomes) taking into consideration the interests of all concerned parties;

Question 68

What is Gillick competence?

Answer 68

The legal term used to describe the ability of a child or youn g person under 16 to make decisions about their own medical treatment, without the involvement of parents/guardians, if they are deemed to be mature and capable of understanding (i.e. if they are competent)
They can accept treatment but cannot refuse treatment!
Once over 16 they are assumed competent unless proven otherwise and can accept and refuse treatment

Question 69

What is the harm principle?

Answer 69

individuals should be free to act as they please, as long as their actions do not cause harm to others.
The only purpose for which power can be rightfully exercised over a person against their will is to prevent harm to others

Question 70

Should vaccines be compulsory according to thw harm principle?

Answer 70

Harm principle support vaccines being compulsory - decreases risk of disease transmission to vulnerable populations

Question 71

Outline the Fraser guidelines?

Answer 71

they must understand all the professionals advice
They must not be persuaded to inform their parents
They will likely begin or continue having, sexual intercourse with or without contraceptive treatment
Unless they receive contraceptive treatment their physical or mental health are likely to suffer
Their best interests require them to recieve contraceptive advice or treatment with or without parental consent

Question 72

What should you do if a person under 13 comes in for contraception?

Answer 72

Cannot apply Fraser guidelines as under 13
You should inform the parents/social services/police as this is statutory rape and pt cannot consent at this age

Question 73

Who deals with issues of sterilisation for patients without capacity

Answer 73

Court of Protection
They can make decisions on behalf of individuals who lack capacity, including decisions about medical treatment, such as sterilization. If a healthcare professional believes that sterilization may be in the best interests of a person who lacks capacity, they can make an application to the Court of Protection for a decision to be made.

Question 74

What was the disability discrimination act 1995?

Answer 74

UK law that aimed to protect people with disabilities from discrimination in a wide range of areas, including employment, education, and access to goods and services. The act made it illegal for employers, service providers, and educational institutions to discriminate against people with disabilities, and required them to make reasonable adjustments to ensure that people with disabilities were not put at a disadvantage.
E.g. allowing someone with anxiety to have their own desk, reasonable adjustment during recruitment, installing ramps for wheel-chair access, letting disabled persons work on ground floor, allow flexible hours

Question 75

What is the principle of equity?

Answer 75

a fundamental ethical principle that pertains to fairness and impartiality. In healthcare, the principle of equity means that all patients should be given access to the same quality of care and should not be discriminated against based on factors such as race, gender, age, socioeconomic status, or health condition.

Question 76

What is the principle of utility?

Answer 76

a fundamental ethical principle that is concerned with promoting the greatest good for the greatest number of people. Also known as the principle of consequentialism or the greatest happiness principle, this principle suggests that actions or decisions should be made based on their ability to maximize overall happiness and well-being.

Question 77

What is the principle of justice?

Answer 77

fair distribution of resources and benefits within a society or healthcare system. Both principles aim to ensure that everyone has an equal opportunity to access healthcare services and receive the care they need.

Question 78

What is some criticism on the principle of utility?

Answer 78

It can be difficult to measure or define “happiness” or “well-being” in a way that is objective and applicable to all situations.
it can lead to decisions that are not equitable or just, as it may prioritize the interests of the majority over the needs of minority groups.
Lack of consideration for other important ethical principles

Question 79

What is deontology?

Answer 79

Deontological theories of morality emphasize the importance of following moral rules or duties. These theories argue that certain actions are inherently right or wrong, regardless of their consequences

Question 80

What are some ethical issues that multidisciplinary teams often face when a patient has advanced dementia?

Answer 80

Need to respect confidentiality - ensure information is shared appropriately between those involved in the care
Working in pt best interests
Decision-making capacity
Autonomy

Question 81

What are some challenges pt with dementia might raise for an MDT?

Answer 81

Practical challenges of working within systems of care
Communication difficulties which make it hard for the MDT to understand their needs and preferences
Behaviour changes may be difficult for MDT to manage
Including the wishes and needs of others such as carers
Ethical challenges e.g. respecting confidentiality
Challenges regarding responsibility and decision making
Concern over elder abuse
Risk assessment

Question 82

How might behavioral changes in patients with dementia affect their care, and what strategies can a multidisciplinary team employ to manage these changes effectively?

Answer 82

Increased risk of falls and injuries due to agitation/wandering - remove tripping hazards, provide adequate lighting, develop a plan to ,on it or behaviour
Diffiuclt with ADLs - visual aids, social support
Increased risk of social isolation as harder to engage in social activities - group activities or one-on-one visits with staff members
Increased caregiver stress

Question 83

What are some common issues that may arise around medication management for patients with dementia, and how can a multidisciplinary team ensure safe and effective medication use?

Answer 83

Difficulty in remembering to take medications or managing medication schedules - dossette box, clear instructions to caregivers
Difficulty in communicating side effects or adverse reactions to medications - leaflets, educate caregivers about potential side effects
Increased risk of medication errors due to impaired cognition
Difficulty in administering medications (such as injections) due to behavioral changes - - use alternative medication delivery methods e.g. transdermal patch

Question 84

How might the limited life expectancy of patients with dementia impact their end-of-life care, and what factors should a multidisciplinary team consider when making decisions about end-of-life care for these patients?

Answer 84

Patients with advanced dementia may have limited life expectancy and may require palliative care or hospice care.
A multidisciplinary team should consider the patient’s wishes and goals of care, as well as the family’s wishes and cultural beliefs.
The team should consider the patient’s physical and emotional comfort, and ensure that the patient receives appropriate pain management and symptom relief.
The team should provide support to the patient and their family during the end-of-life process, and facilitate discussions about advanced care planning and decision-making.

Question 85

In what ways might communication difficulties impact the care of a patient with dementia, and how can a multidisciplinary team address these challenges?

Answer 85

Difficulty understanding the pt’s needs and preferences if they have difficult expressing these - use a range of communication startegies e,g. Visual aids
Difficulty conveying information to the pt - simple language, repetition, visual aids
Difficult building rapport which can impact the quality of care provided - active listening skills, non-verbal communication and empathy
Difficulty involving the pt in decision making - impacts autonomy - involve family members or caregivers

Question 86

What are some ethical and legal issues for managing challenging behaviour?

Answer 86

Valid/informed consent
Principle of best interest
Duty of care - HCP must ensure they are providing safe and effective care that meets pt needs. This includes managing challenging behaviour in a way that minimises harm and promotes positive outcomes for pt
Human rights law article 3 prohibits inhumane and degrading treatment - use of restrains may go against this unless alternative methods have been explored first
Human rights law article 5 - right to liberty
Coercion and force - violates human rights and may be considered abuse
Ethics - breaches their autonomy but may be beneficient/maleficient
Legal responsibility of a HCP is to report incidents of abuse and neglect
Legal - minimum level of force for the least amount of time needed
Justification for use must be to prevent injury to oneself or to others, or to prevent serious damage to property
Ethics - imbalance of power
Section 6 of the mental capacity act defines restraint and says its only permitted if the person using it reasonably beehives its necessary to prevent harm and if the restrain used is proportionate to the likelihood and seriousness of that harm

Question 87

What is a restraint?

Answer 87

An act carried out with the purpose of restricting an individual’s movement, liberty and/or freedom to act independently

Question 88

Outline ethical and legal issues of involuntary mental health treatment?

Answer 88

Beneficence - treatment will mitigate symptoms of illness which are severe enough to harm them or others
Reduces their autonomy
MHA - legal
Is it the least restrictive option?
Pt must ahve the right to a fair trial, right to legal representation, right to an IMHA etc

Question 89

Outline the ethical and legal issues of forced-feeding in eating disrders?

Answer 89

Autonomy - violation
Ethical - may have a significant psychological impact e.g. exacerbating feelings of guilt which can complicate their progress
Medical risks e.g. aspiration pneumonia, refeeding syndrome
Mist be the least restrictive option
Does the pt have capacity
Is it in their best interests?
Mental health act