Ethics + Law Flashcards

1
Q

When can you breach confidentiality for crimes?

A
  • serious crime

- threat to public safety

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2
Q

What does the Road Traffic Act (1988) state?

A

legal requirement to disclose information to police to identify driver involved in a collision
- initially name + address only

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3
Q

Describe consent in children

A

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

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4
Q

Describe confidentiality and consent in adults lacking capacity

A

owed duty of confidentiality

Mental Capacity Act (2005) = people involved in care should be made aware of wishes/values/beliefs

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5
Q

Describe confidentiality in deceased patients

A

confidentiality survives death
only break confidentiality:
- to assist coroner
- when disclosure required by law

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6
Q

When can you breach confidentiality?

A
  • 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)
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7
Q

What constitutes valid consent?

A
  • 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)
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8
Q

5 principles of capacity

A

(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

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9
Q

Functional test of capacity

A

Understand information
Retain information
Weigh up information
Communicate decision

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10
Q

When can treatment be given without consent

A
  • 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
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11
Q

What is material risk?

A
  • effect on that patient
  • would a reasonable person in patient’s position attach significance to it
    (focusses on patient in context of procedure)
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12
Q

Informed consent

A

permission granted in knowledge of possible consequences

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13
Q

Types of consent

A
  • implied (eg arm offered for venepuncture)
  • oral (verbal conversation)
  • written (needed for significant/risky + fertility procedures)
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14
Q

What are the challenges in obtaining consent?

A
  • 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
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15
Q

Bolam test

A

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)

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16
Q

Bolitho test

A

used to scrutinise if actions undertaken by a doctor stand up to logical scrutiny

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17
Q

What are the 3 ethical theories?

A

virtue ethics
duty ethics (deontology)
consequentialism (utilitarianism)

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18
Q

Describe virtue ethics

A

balance between extremes (the mean)
‘the good’ = human flourishing
good actions = ones that display virtuous character

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19
Q

Describe duty ethics

A

adhering to fixed standards

performing duties

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20
Q

Describe consequentialism

A

outcomes are what matter
no absolute prohibitions
utilitarianism = greatest good/happiness for greatest number

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21
Q

What are the four principles of medical ethics?

A

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

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22
Q

What is critical reasoning?

A

critical application of moral theories as useful tools
no theory will give ‘correct’ answer
decisions don’t just affect patients
identify conflict between principles

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23
Q

What is a fact?

A

truth can be demonstrated (empirically or by inference)

truth is not a matter of opinion

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24
Q

What is a hypothesis?

A

believed to be true subject to empirical falsification or verification

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25
What is value judgement?
held to be true but empirical evidence/inference cannot establish truth or falsity
26
How do you respect autonomy in medicine?
provide accurate + truthful information facilitate informed consent maintain confidentiality
27
When is autonomy and right to confidentiality not absolute?
may be overridden by other concerns, for example notifiable diseases, safeguarding concerns
28
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)
29
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)
30
What are attributes of a virtuous medic?
``` reliability trustworthiness professionalism integrity honesty beneficence non-maleficence ```
31
What harm can result from divulging personal information?
loss of trust in that doctor general distrust of medical profession anger/distress to patient
32
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
33
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'
34
What is the main conflict with regards to compulsory vaccination?
public health vs individual liberty
35
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?
36
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
37
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
38
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
39
Define death
irreversible loss of consciousness, combined with the irreversible loss of capacity to breathe
40
Define brain stem death
irreversible cessation of integrative function of the brain stem equates with death…and allows the medical practitioner to diagnose death
41
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
42
When does the foetus acquire legal rights?
Foetus does not acquire any legal rights until it is capable of surviving independently from its mother
43
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
44
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
45
Define premature birth
born alive before 37 completed weeks of pregnancy
46
Define full term birth
born between 38-42 completed weeks gestation
47
Define miscarriage
spontaneous loss of a pregnancy before 24 weeks gestation
48
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
49
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
50
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
51
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
52
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
53
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
54
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
55
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 ```
56
Do foster parents have parental responsibility?
no | PR either remains with parents or is shared between foster parents + local authority
57
Are sperm donors the legal parent of the child?
no, if done through HFEA licensed clinic | unlicensed clinic = legal father of child
58
Are egg donors the legal parent of the child?
give birth = legal mother, even with donated egg
59
What is HFEA?
Human Fertilisation + Embryology Act (2008)
60
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
61
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
62
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
63
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
64
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)
65
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
66
What is HM coroner?
independent judicial officer of the crown employed by local authority all new coroners = lawyers
67
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
68
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
69
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)