Ethics formative Flashcards
What are the 3 types of consent?
Implied
Verbal
Written
What act allows doctors to allow in the best interest of patients when they lack capacity?
Mental capacity act 2005 (england)
Adlts with incapacity act (scotland)
What are the key features of the mental capacity act 2005?
A person is assumed to have capacity unless it is established that he lacks capacity
A person is not treated as unable to make a decision unless all practical steps to do so have been taken without success
A person is not to be treated as unable to make a decision merely because he makes an unwise decision
An act done or a decision made under this Act on behalf of a person who lacks capacity must be done or made in his best interests and should not be done if the outcome can be achieved in a way that is less restrictive of the person’s rights and freedom of action
Who can consent?
A patient with capacity
A court for a child
A parent for a child
The court can state that a treatment is lawful for an adult
Someone acting under the mental capacity act or the adults with mental health act.
In the mental capacity act, who is described as lacking capacity?
They are unable to make a decision if :
Unable to understand the information relevant to the decision
Unable to retain that information or use or weigh it as part of the process of making that decision
Unable to communicate his decision by any means
Unable to decide one way or the other or the consequences of failing to decide
Not unable if can communicate in any way, nor if able to retain the information for short period of time long enough to make the decision
People who are under 16
(the childrens act in Sclotland presumes competence to any child who is aged 12 or over)
Must take reasonable steps to ascertain if the patient lacks capacity - make use of communication aids
Must take reasonable steps to ascertain if it will be in the patient’s best interests - this might involve talking to a wider range of family/friends or looking to see if there is an advance directive
When making decisions on behalf of someone, how can you peserve their freedom?
Where it is determined that an intervention is to be made, such intervention shall be the least restrictive option in relation to the freedom of the adult, consistent with the purpose of the intervention
What is the definition of adult and unable according to the adults with incapacity act Scotland?
“Adult”: means a person who has attained the age of 16 years
“Incapable”: means incapable of:
(a) acting: or
(b) making decisions; or
(c) communicating decisions; or
(d) understanding decisions; or
(e) retaining memory of decisions
What is the office of public guardians?
The Office of the Public Guardian (OPG) protects people in England and Wales who may not have the mental capacity to make certain decisions for themselves, such as about their health and finance.
What is the role of the mental welfare comission?
Protect people with an intervention or guardianship order
Visit the adult - bring matters of importance to health boards or local authorities
What does the continuing power of attorney relate to?
Finance and property
What does the welfare attorney relate to?
Personal welfare
What is the responsiblity of the solicitor when creating a power of attorney / welfare of attorney order?
- They must have interviewd the patient immediately before the granting
- He must take measures to ascertain that the patient knows the nature and the power of the order
- Makes sure there are no external factors / stressors
- Document has to be registered with the public guardian.
Important to note thet the patient has to have consent before being able to do this!
When is research allowed on people with incapacity?
Reseasrch of similar nature cannot be carried out on someone who is capable
The purpose of the research is to obtain knowledge of the causes, diagnosis, treatment or care of the adult’s incapacity or the effect of any treatment etc
When might it not be possible to go through the consenting process?
- Patient unconscious?
- Patient does not have capacity?
- Expediency?
- Cannot communicate?
What is meant by Gillick Competency?
Children under 16 can consent to medical treatment if they understand what is being proposed. It is up to the doctor to decide whether the child has the maturity and intelligence to fully understand the nature of the treatment, the options, the risks involved and the benefits.
A child who has such understanding is considered Gillick competent (or Fraser competent). The parents cannot overrule the child’s consent when the child is judged to be Gillick competent. For example, a 15-year-old Gillick competent boy can consent to receiving tetanus immunisation even if his parents do not agree with it.
The court can over rule this competency
What is an advanced directive?
It is made when the person has capacity for the potential future where they lack capacity - preferred treatment/non-treatment is outlined
What steps must be taken to make the advanced directive valid?
In writing
Signed
Clear written statement applying to the specific treatment
Advanced directive can be made invalid if the person changes their mind (does something agains tthe advanced directive)
What predisposing factors might increase chances of making mistakes as a doctor?
Excessive work load
Poor self-care
Maladaptive coping strategies
Shift and night work
Time pressure
Poorly functioning teams
Poor communication
Bullying and harrassment
Poor levels of social support at work
Stress (burnout, mental and physical health)
Anxiety
Depression
Alcohol and drug use
Behavioural addictions
What is the effects of alcohol and drugs in the workplace?
–Absenteeism, inefficiency; poor decision-making; impaired customer relations
–Inconsistent performance; poor quality of work; lower productivity (slower); more mistakes and accidents
Alcohol impairs:
- thinking
- concentration
- Judgment
- Mood
What are the barriers to seeking help?
Work related:
- difficulty taking time off
- Heavy workload
Fear and Shame:
- Fear of lack of confidentiality (and punitive response)
- Fear of stigma
Concerns about professional future
Lack of knowledge about what to do:
- Insufficient knowlede of services
- Experience of how other colleagues have been treated
What are individal and organisational means to cope with stress/mental health at work?
•Individual
–Reduce stigma
–Change the culture
•Facilitative and encouraging rather than punitive
–Support /“morally reward”
–Mentoring
–Coaching
–Opportunities for continuing education
•Organisational
–Involve doctors / dentists at all levels
–Workplace stress management strategies
–Trust initiatives
–HEE initiatives
–College initiatives
- Startwell and PSS (RCPsych)
- First Five (RCGP)
What is meant by resilience?
•The ability to withstand and bounce back from adversity
What determines the capacity for resilience?
–Self-directedness
•strongest correlation with resilience
–Co-operativeness
–Harm avoidance
–Persistence
WHat are predictors of resilience?
•Personal Factors
–Personality
–Previous adversities
–Coping strategies
•Organisational Factors
–Workload
–Hours
•Socio-cultural Factors
–Culture within medicine / dentistry
–Rise of blame and claim culture of litigation in wider society
–Didactic teaching
What people are most resilient?
Being female
Maintaining work life balance (relaxation, meditation, exercise, help-seeking)
Laughter/humour
Beliefs/ spirituality
Self-reflection/insight/mindfullness
Professinoal identity
What are the aims of the practitioner health programme?
This is essentially the care practitioners receive when they are having trouble (actual therapy can include CBT and group psychotherapy)
Safeguard patients
Maintain good health care delivery
Enhance well being of health professionals
Practioner health programme:
- Located in an established GP surgery
- Confidential
- Separate IT systems
- Separate staff
- Separate rooms
What resource is available for GPs who are struggling in England?
NHS GP Health Service
- Objectives:
- Retain in work
- Return to practice
- Reduce stigma
NOT Occupational health and it does not replace the NHS
What treatments are available in the GP health service?
- Assessment and case management provided by GPs, psychiatrists, and specialist mental health and addiction nurses
- General psychiatry
- Addiction psychiatry
- Psychological therapies, e.g. Cognitive behaviour therapy (CBT)
- Short term psychotherapeutic intervention
- Local interventions groups (therapeutic groups to address specific issues affecting mental health in a particular area)
What is the practical application of using the GMC guidance?
- Putting patients first
- Being honest
- Having the knowledge to practise medicine legally
- Knowing one’s limitations
- Being knowledgeable and keeping up to date
- Treating people with dignity
- Treating people consistently
- Being able to admit you are wrong
What are the 4 domains of good medical practice?
Knowledge, skills and performance
Safety and quality
Communication, partnership and teamwork
Maintaining trust
What is personal data?
Basically anything that you can use to identify somone
•The GDPR defines personal data as:
‘any information relating to an identified or identifiable natural person (‘data subject’); an identifiable natural person is one who can be identified, directly or indirectly, in particular by reference to an identifier such as a name, an identification number, location data, an online identifier or to one or more factors specific to the physical, physiological, genetic, mental, economic, cultural or social identity of that natural person’
What is the guidance regarding keeping personal information?
- Be processed lawfully, fairly and in a transparent manner
- Be processed for specified, explicit and legitimate purposes and not in any manner incompatible with those purposes (this means that bascially it must be necessary)
- Be adequate, relevant and limited to what is necessary in relation to the purposes (not too much not too little)
- Be accurate and up to date
- Must not be kept for longer than is necessary
- Be secure.
What does the equality act 2010 define protected characteristics as?
- age;
- disability;
- gender reassignment;
- marriage and civil partnership;
- pregnancy and maternity;
- race;
- religion or belief;
- sex;
- sexual orientation.
What are the limbs of a successful megligence claim?
- Failure in Ones Duty of Care
(Falling below the standard)
- ‘Foreseeable’ damage must result
‘Causation’
Wilsher v Essex Health Authority
What are ethics?
•The body of moral principles or values governing or distinctive of a particular culture or group
What are the duties of a doctor?
Make the care of your patient your first concern
Treat every patient politely and considerately
Respect patients dignity and privacy
Listen to patients and respect their views
Give patients information in a way they can understand
Respect the rights of patients to be fully involved in decisions about their care
Keep your professional knowledge and skills up to date
Recognise the limits of your professional competence
Be honest and trustworthy
Respect and protect confidential information
Make sure that your personal beleifs do not prejudice your patient’s care
Act quickly to protect patients from risk if you have good reason to believe that you or a colleague may not be fit to practice
Avoid abusing your position as a doctor
Work with colleagues in the ways that best serve patient’s interests
In all these matters you must never discriminate unfairly against your patients or colleagues. And you must always be prepared to justify your actions to them.
What is meant by the duty of candour?
This means that you must be open and honest with patients when something goes wrong with a patient’s treatment or care which causes, or has the potential to cause, harm or distress.
You must apologise to the patient and offer an appropriate remedy or support to put matters right (if possible) and explain fully the short and long term effects of what has happened.
This duty requires you to be open and honest with all parties as well as any relevant organisations such as your employer, practice principal or the Health Authority or Board; you must take part in reviews and investigations when requested.
You must raise concerns where appropriate if you believe a patient’s best interests potentially have been or actually have been compromised.
As a doctor or a student you should encourage other peers and colleagues to be open and honest; you must not stop someone who has concerns from raising concern
When is it okay to breach confidentiality?
“If you consider that failure to disclose the information would leave individuals or society exposed to a risk so serious that it outweighs the patient’s and the public interest in maintaining confidentiality, you should disclose relevant information promptly to an appropriate person or authority. You should inform the patient before disclosing the information, if it is practicable and safe to do so, even if you intend to disclose without their consent
