Ethics + Law Flashcards
When can you breach confidentiality for crimes?
- serious crime
- threat to public safety
What does the Road Traffic Act (1988) state?
legal requirement to disclose information to police to identify driver involved in a collision
- initially name + address only
Describe consent in children
16-17 = presumed competent to consent to medical treatment (but not refuse it)
16> = if gillick competent: rights of child to have confidential advice + treatment more important than any right of parent
not gillick competent: person with parental responsibility involved in treatment
Describe confidentiality and consent in adults lacking capacity
owed duty of confidentiality
Mental Capacity Act (2005) = people involved in care should be made aware of wishes/values/beliefs
Describe confidentiality in deceased patients
confidentiality survives death
only break confidentiality:
- to assist coroner
- when disclosure required by law
When can you breach confidentiality?
- consent of patient (implied/expressed)
- patient’s best interests (eg in emergency)
- required by law (eg Road Traffic Act/child protection)
- protection of patients + others (‘public interest’) (eg serious crimes)
What constitutes valid consent?
- patient has capacity to consent to intervention (understand, retain, weigh up + communicate)
- patient appropriately informed (use simple language, complications, material risk)
- must be given voluntarily (free to agree to/refuse)
5 principles of capacity
(PLUMB)
Presumption of capacity
Least restrictive = consider other ways to promote rights + freedom
Unwise decisions = a patient with capacity can make unwise decisions
Maximise capacity = consider pictures/translator - make adjustments
Best interests = if lacking capacity, decisions/actions should be made in best interests
Functional test of capacity
Understand information
Retain information
Weigh up information
Communicate decision
When can treatment be given without consent
- emergency (save life/limb)
- not practicable to communicate with patient + treatment necessary (eg require another medical procedure in surgery + waiting would be detrimental)
- in patient’s ‘best interests’
- risk to public health (communicable diseases)
- always document the decision
What is material risk?
- effect on that patient
- would a reasonable person in patient’s position attach significance to it
(focusses on patient in context of procedure)
Informed consent
permission granted in knowledge of possible consequences
Types of consent
- implied (eg arm offered for venepuncture)
- oral (verbal conversation)
- written (needed for significant/risky + fertility procedures)
What are the challenges in obtaining consent?
- organisational = limited patient time, too much delegation breaks continuity of Dr-patient relationship
- patient = difficulty assessing capacity, understanding what’s important to patient (+ material risk), providing information in simple enough terms
- doctor = lack of up-to-date knowledge on some procedures/treatments
Bolam test
A doctor must provide a level of care that can be expected of an ordinary doctor in that circumstance (ie not the gold standard of a specialist)
Bolitho test
used to scrutinise if actions undertaken by a doctor stand up to logical scrutiny
What are the 3 ethical theories?
virtue ethics
duty ethics (deontology)
consequentialism (utilitarianism)
Describe virtue ethics
balance between extremes (the mean)
‘the good’ = human flourishing
good actions = ones that display virtuous character
Describe duty ethics
adhering to fixed standards
performing duties
Describe consequentialism
outcomes are what matter
no absolute prohibitions
utilitarianism = greatest good/happiness for greatest number
What are the four principles of medical ethics?
autonomy = self-rule, capacity to make reasoned decisions + act on them
non-maleficence = hippocratic oath, do no harm
beneficence = make care of patient first concern
justice = fairness, respect for rights, fair use of resources
What is critical reasoning?
critical application of moral theories as useful tools
no theory will give ‘correct’ answer
decisions don’t just affect patients
identify conflict between principles
What is a fact?
truth can be demonstrated (empirically or by inference)
truth is not a matter of opinion
What is a hypothesis?
believed to be true subject to empirical falsification or verification
What is value judgement?
held to be true but empirical evidence/inference cannot establish truth or falsity
How do you respect autonomy in medicine?
provide accurate + truthful information
facilitate informed consent
maintain confidentiality
When is autonomy and right to confidentiality not absolute?
may be overridden by other concerns, for example notifiable diseases, safeguarding concerns
How is duty ethics involved in confidentiality?
doctor-patient relationship viewed as contract
confidentiality = part of contract
breach confidentiality = breach contract
duty of confidentiality may conflict with other duties (legal obligations/moral concerns)
Describe 3 motivations for sharing information?
malicious intent (including gossip)
benefit to an individual (patient themselves, their family, another person)
benefitting someone else/wider public (eg. notifiable diseases)
What are attributes of a virtuous medic?
reliability trustworthiness professionalism integrity honesty beneficence non-maleficence
What harm can result from divulging personal information?
loss of trust in that doctor
general distrust of medical profession
anger/distress to patient
Arguments for compulsory vaccination
beneficence - good for individual
non-maleficence - unvaccinated = at risk of harm
utilitarian - ‘herd immunity’ = general reduced suffering
justice - compromising herd immunity by refusing to be vaccinated or vaccinate own child = not fair to others
Arguments against compulsory vaccination
autonomy - individual’s right to choose for themselves/their children
fear of ‘other kinds of harm’ - astrazeneca blood clot/wakefield MMR
distrust of medical profession
distrust of ‘big pharma’
vehemence (sometimes violence) of some ‘anti-vaxxers’
What is the main conflict with regards to compulsory vaccination?
public health vs individual liberty
What are some problems for the parent with regards to choosing whether or not to vaccinate their child?
harm vs benefit - will vaccine benefit child?, will it harm child?
knowledge vs belief - do you know that the vaccine is safe?
trust - is doctor, via drug company, getting money/incentives for vaccinating?
individual vs population vs patient autonomy - why should I risk my child for the sake of herd immunity?
What is a vaccine passport and what are some ethical considerations surrounding them?
certificate to permit access to some venues or transport etc
refusal to admit those without a passport
not everyone can be vaccinated
might lead to some ‘collateral damage’ - alienating patients from health services + professions, discrimination against groups or those refusing vaccination
some might feel compelled to get vaccinated
Define euthanasia. Is it legal?
action of bringing about a death, especially of a person who requests it as a release from incurable disease
- any form of euthanasia = illegal
What is the Doctrine of Double Effect?
If doing something morally good has a morally bad side-effect, it is ethically OK to do providing the bad side-effect was not intended
True even if foresaw bad side-effect would happen
Eg. Morphine: decreases respiratory rate, sedates + may hasten death → but helps reduce pain
Define death
irreversible loss of consciousness, combined with the irreversible loss of capacity to breathe
Define brain stem death
irreversible cessation of integrative function of the brain stem equates with death…and allows the medical practitioner to diagnose death
Define MCCD and describe it’s main features
Medical Certificate as to the Cause of Death
Enables family to register death
Provides info on how/why patient died
Informs research into health effects of exposure to a wide range of risk factors
Direct cause on line 1a + work back with factors/conditions that led to that
When does the foetus acquire legal rights?
Foetus does not acquire any legal rights until it is capable of surviving independently from its mother
What does the Congenital disability (civil liability) Act 1976 state?
rights to a child born handicapped to sue in negligence in limited circumstances → mother exempted
Define live birth
a fetus (any gestational age) exits maternal body and shows any signs of life (voluntary movement, heartbeat, pulsation of umbilical cord) for however brief time + regardless of placenta/umbilical cord being intact
Define premature birth
born alive before 37 completed weeks of pregnancy
Define full term birth
born between 38-42 completed weeks gestation
Define miscarriage
spontaneous loss of a pregnancy before 24 weeks gestation
Define stillbirth
born after 24 weeks of pregnancy and did not at any time after being completely expelled, breathe or show any other signs of life
Describe the registering of a birth
Births and Deaths Registration Act 1953
birth of baby must be registered within 42 days in England and Wales
Who can register the birth if the parents are married?
either mother or father can register birth on own and both parents can be included on certificate
If the parents of a child are unmarried, when can the details of both parents be on the birth certificate?
sign the birth register together
statutory declaration of parentage
court order giving father parental responsibility
Who can sign the birth certificate with same-sex female couples?
married/civil partners = either can register if child born by donor insemination of fertility treatment
unmarried = partner seen as 2nd parent if treated together in UK by licensed clinic + made a ‘parenthood agreement’ but can only be on certificate if meets same requirements as unmarried opposite sex couples
Who can sign the birth certificate with same-sex male couples?
must get a parental order
cannot get until 6 weeks after birth
therefore birth mother must register
Who has parental responsibility (PR)?
birth mother automatically has parental responsibility
father who is married to child’s mother at time of birth = PR from birth, not lost if later divorce
adoptive parent acquires PR on adoption
How can unmarried fathers gain parental responsibility?
marrying mother having their name registered making PR agreement with mother obtaining PR order from court obtaining residence order from court becoming child's guardian on mother's death
Do foster parents have parental responsibility?
no
PR either remains with parents or is shared between foster parents + local authority
Are sperm donors the legal parent of the child?
no, if done through HFEA licensed clinic
unlicensed clinic = legal father of child
Are egg donors the legal parent of the child?
give birth = legal mother, even with donated egg
What is HFEA?
Human Fertilisation + Embryology Act (2008)
Define surrogacy
Surrogacy Arrangements Act (1985)
surrogate mother = a woman who carried a child in pursuance of an arrangement:
- made before she began to carry the child
- made with the view to any child carried in the pursuance of it being handed over to another person(s)
surrogacy arrangements = not legally enforced, even if contract signed + expenses paid
Who has parental responsibility in surrogacy?
surrogate = legal mother until parenthood transferred (by parental order/adoption)
- husband of surrogate also has PR
- surrogate has legal right to keep child
Who can complete a MCCD?
statutory duty of doctor who attended in last illness to complete
- cared during last illness
- familiar with PMH
- seen pt in last 14 days + seen body after death
cannot fulfil above = refer death to HM coroner
What is the role of the medical examiner (ME)?
independent senior doctors
all deaths subject to ME scrutiny or coroner’s investigation
agree proposed cause of death + accuracy of MCCD with doctor
discuss cause of death with next of kin + establish questions/concerns
inform local mortality arrangements
What is a post mortem and why is it used?
coroner orders it to try to determine cause of death
agreed upon by hospital + family to gain fuller understanding of deceased’s illness/cause of death/inform future medical care
need to observe Human Tissue Act (2004)
Describe a coroner’s post mortem
does not require consent of family
must be done by a suitable practitioner as soon as reasonably possible
must comply with Human Tissue Act (2004)
coroner must release body for burial/cremation as soon as practicable (usually within 28 days)
if post mortem concludes natural cause of death, coroner does not need to hold an inquest
What is HM coroner?
independent judicial officer of the crown
employed by local authority
all new coroners = lawyers
When is the coroner involved?
identity of person unknown no attending doctor to complete MCCD violence, trauma, injury self-harm neglect undergoing medical treatment injury/disease caused by employment poisoning toxic substance exposure death in custody suspected suicide use of medicinal product, controlled drug or psychoactive substance unnatural but not in other category
duty on doctor to report to coroner even if someone else (eg. family) reported death
What is the purpose of a coroner’s inquest?
who deceased was
how, when, where they came by their death
fact-finding hearing, not to apportion blame
What isa regulation 28 report?
report on action to ‘prevent future deaths’
coroner has duty to issue report if concerns of risk of future deaths
copy of report sent to chief coroner (CQC)
