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YEAR 1 MED > Ethics / law > Flashcards

Ethics / law Flashcards

1
Q

what are the four ethical principles / pillars?

A
  • Autonomy: the patient has the right to make their own decisions and act upon them
  • Beneficence: act in the patient’s best interest
  • Non-maleficence: do no harm
  • Justice: ensure fairness (distribute resources, including your time and skill, equitably)
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2
Q

Describe what questions you would ask yourself in each of the 4 ethical principles?

A
  • Autonomy: does the patient lack capacity? can the decision be deferred? the patient has the right to refuse treatment?
  • Beneficence: think both medical for the patient and also for others around them, family? friends?
  • Non-maleficence: should treatment be forced upon a patient if it is the “right” thing to do? does this lose trust in doctors?
  • Justice: bear in mind other patients and staff?
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3
Q

What is paternalism?

A
  • the idea that “the doctor knows best”
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4
Q

Species used in biomedical research…

A
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5
Q

What are some of the arguments FOR vaccines?

A
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6
Q

What are some of the arguments AGAINST vaccines?

A
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7
Q

Describe sources that a doctor could use to get information on the different medications that a patient may be taking

A
  • Ask relatives
  • Contact the GP
  • Contact their local pharmacist
  • Check patient’s own list of medication
  • Examine previous hospital notes if applicable
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8
Q

Describe act certainty vs omission possibility in the case of using animals in biomedical research.

A
  • Act certainty vs omission possibilty: animals will surely suffer by the act, humans might suffer without the research
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9
Q

What are the 5 rules of ethical (human) research?

A
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10
Q

Mother worried about vaccine, she asks “is it 100% safe?”, how should a doctor answer this truthfully?

A
  • All vaccines carry some degree of risk, but evidence for this vaccine suggests that it is safe
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11
Q

Describe four ways in which Wakefield’s paper was ethically problematic.

A
  • He falsified information claiming it had been approved by a research ethics committee
  • The procedures involved were invasive and not clearly justified
  • The justification for the research was not clear
  • Wakefield had an undisclosed conflict of interest
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12
Q

Describe the legal elements of capacity

A
  • Being able to understand information
  • Retain information
  • Process information
  • Communicate one’s decision
  • (Relate to a specific moment in time)
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13
Q

A patient is not deemed to have capacity, a family member phones the doctor and wishes to be given information about the patient, how should the doctor address the patient’s confidentiality in this scenario?

A
  • If the patient lacks capacity, then the doctor must act in the patient’s best interest (beneficence)
  • In determining the patient’s best interest, the doctor is under a duty to consult with the patient’s next of kin
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14
Q

When addressing concerns about safeguarding, describe four ethical issues that clinical teams should consider when sharing clinical or personal information

A
  • The patient’s consent to disclose
  • The patient’s capacity
  • The patient’s autonomy
  • The relationship between the patient and their carer
  • Consequences of disclosure (best interest of patient)
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15
Q

Describe three key principles of a palliative care approach

A
  • Provides relief from pain
  • Intends neither to hasten or postpone death
  • Integrates the physical, psychological, and spiritual aspects of patient care (holistic)
  • Offers a support system to help the family cope
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16
Q

Name four of the most common symptoms associated with the late stage of dying

A
  • Pain
  • Restlessness
  • Increased respiratory secretions
  • Drowsiness
  • Skin colour changes
17
Q

Which group of drugs is most commonly used for the management of severe pain in palliative care?

A
  • Opioids
18
Q

In law, how is a child defined by the children act 1989?

A
  • A child is an individual under 18 years old
19
Q

Discuss the principles of consent to treatment in an individual who is not an adult

A
  • Gillick competence
  • If child is deemed to have capacity then can give consent without parents/guardian
  • Although, child would be unable to refuse treatment
20
Q

How would a doctor assess whether a patient is competent to consent?

A
  • Test ability to retain and comprehend information
  • Test ability to make a decision
  • Test ability to communicate a decision
21
Q

Explain two principles of confidentiality that the doctor needs to practice, in order to respect the patient’s right to confidentiality

A
  • The doctor owes the patient a legal and professional duty of confidentiality
  • Information held in confidence should not be released to a third party without the patient’s consent (except in exceptional circumstances)
22
Q

The GP wants to speak to the girl alone, outline two legal principles that underpin the GPs ability to do this, in spite of her age (15 years old)

A
  • The young person’s best interest allows them to receive treatment without parental consent
  • The young person has to be able to understand the professional advice
  • The young person cannot be persuaded to inform their parents
23
Q

List the people who are able to verify that death has occurred

A
  • Any medical practitioner with a license to practice
24
Q

An 87 year old man is confused. He urgently requires a urinary catheter, the patient does not appear to understand the doctors explanation. Explain the legal considerations that allow the doctor to proceed with the task

A
  • Capacity: a patient is presumed to have capacity to consent to treatment under the Mental Capacity Act 2005 (MCA)
  • Under the MCA: a patient lacks capacity if they are unable to understand the information, retain it, process it, and communicate the decision
  • Consent: this patient lacks capacity as he is unable to understand the explanation and therefore cannot consent to the procedure
  • Best interests: as this patient lacks capacity, the doctor is under duty to act in the patient’s best interests. The doctor is under duty to consult with family to determine the best interests
  • Emergency: if urgent treatment is required, the doctor can provide treatment proportionate to achieving the aim (ie. Preventing the patient from coming to harm)
25
Q

Describe virtue ethics, deontology, and consequentialism-utilitarianism and how they might be used in medical context.

A
  • Virtue ethics: considers what a virtuous person (honesty, compassion, integrity) would do in a given situation to make sure the patient has the best possible outcome
  • Deontology: places importance on the ethical codes, professional guidelines, and respecting the autonomy of the patient (actions are based on their alignment with moral principles rather than their outcomes)
  • Consequentialism-Utilitarianism: focuses on maximising overall utility or happiness and minimising harm or suffering. utilitarianism seeks to achieve the greatest good for the greatest number of people (eg. a doctor might allocate limited resources to those who will benefit the most from them)
26
Q

Confidentiality (Hippocratic oath and department of health definition)

A
27
Q

Describe the process of registering a birth

A
  • birth must be registered within 6 weeks of birth (42 days)

Notes…
Opposite sex:
- married at time of birth or conception either mother or father can register
- unmarried - both parents details if sign register together, statutory declaration of parentage or court order giving father - PR (Parental responsibility), mother can choose not to put father on certificate
Same-sex female
- married - either can register if born by donor insemination or fertility treatment
- unmarried - partner is seen as a second parent if treated together by licensed clinic and made parenthood order but same criteria as opposite-sex unmarried couples
Same-sex male couples
- must get parental order which you cannot get in 6 weeks so birth mother must register
Surrogacy
- birth mother is legal mother unless/until parenthood transferred
- husband of surrogate has PR
- surrogate has legal right to keep child

28
Q

Define live Birth, premature birth, still birth, miscarriage, and surrogacy, and abortion

A
  • Live Birth: a fetus, whatever it’s gestational age, that exits the maternal body and shows any sign of life (voluntary movement, heartbeat or pulsation of the umbilical cord) for however brief a time and regardless of whether the umblical cord or placenta are intact
  • Prematurity: born alive before 37 completed weeks of pregnancy
  • Miscarriage: spontaneous loss of pregnancy before 24 weeks gestation
  • Stillbirth: born after 24 completed weeks of pregnancy and no sign of life after exiting the mother’s body
  • Surrogacy - an arragement made where a woman carries a child agreed before she began to carry the child and made with a view to handing over the child to another person or persons
  • note: not legally enforceable even if contract or payment
  • note: not regulated by HFEA (Human Fertilisation and Embryology Act) 2008
  • Abortion laws: in UK can have abortion before 24 weeks, unless baby is found to have a very high risk/fatal condition then any time during pregnancy abortion can occur
  • consent for treatment usualy needed by someone with PR
  • mother automatically has PR
  • father married to mothe at tme of birth - ongoing even if divorce
  • can acquire PR - father marrying mother, court orders, adoption
29
Q

Describe the legal status of the fetus in English law and under the human rights act

A
  • The fetus does not acquire any legal rights until it is capable of surviving independently from it’s mother
30
Q

Key legal principles relevant to the care of individuals at the end of life (what is death?)

A
  • Death = the irreversible loss of capacity for consciousness combined with the irreversible loss of capacity to breathe
  • note: brain stem death - irreversible cessation of the integrative function of the brainstem equates with death and allows the diagnosis of death
  • a registered medical practitioner signs a certificate in the prescribed form stating to the best of their knowledge and belief the cause of death
  • Certifying death: statutory duty of doctor looking after person in last illness to complete (rules on duration etc) and if unable to do must refer to Coroner
  • Medical Examiner (Senior Doctor) or Coroner to review cause of death on certificate
31
Q

Describe the process of certifying and registering a death and the role of HM Coroner and the inquest process

A
  • the doctor attending patient in last illness to complete certificate giving cause of death
  • note: if unable to do refer to HM Coroner (all new Coroners are lawyers)
  • certain categories: eg. undergoing treatment, possible suicide, death in prison/custody, related to employment eg. asbestos
  • note: Cause of death should be a disease process or condition not eg organ failure
  • post-mortem if HM Coroner requests to ascertain cause of death or family and hospital agree to gain a fuller understanding of illness/death
  • note: Coroner’s PM does not need family to agree, must be completed within 28 days
  • if post-mortem confirms natural cause no inquest needed

more notes…
- Inquest - public hearing, Coroner calls witnesses, family may have legal representation, Trust solicitor if Hospital Team involved - to answer who is the deceased, medical cause of death, how , when and where they died
- conclusions include eg. natural causes, accident/misadventure, killing themselves, drug dependence, open verdict if not enough evidence, narrative verdict where describes death
- adverse findings Neglect or Regulation 28 (report on action to prevent future deaths - may be a trust action)
- can refer doctor to GMC

32
Q

Discuss the professional and legal duties of confidentiality; the role of GDPR and the situations where disclosure is appropriate.

A
  • GDPR = General Data Protection Regulation
33
Q

Access to notes of deceased patients (principles)…

A
34
Q

Caldicott principles 1-8…

A
  • ‘the Caldicott guardian is responsible for safeguarding and governing the uses of patient information within the Trust and acting as the “conscience” of the Trust

YEAR 1 MED (49 decks)

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