Ethics Lectures Flashcards
what are the three steps of valid consent
freely given - truly the will of the patient
given by a person with capacity
informed
why must valid consent be informed
respect for autonomy
a person cant make a decision that is right for them without relevant info
consent is specific and intentional - must know what it is you are consenting to
how much information do we need to give patients
you must give the patient the information they want or need in a way they can understand (what they ask for and any other info needed for them to make a decision
what kind of information can we give patients
clinically appropriate treatments
nature of treatment
outcome
risks - burdens or side effects
what is the bolam test
test to decipher whether there has been clinical negligence
what are the problems with the bolam test
what medical opinion determines as proper should be subject to scrutiny when it does not involve empirical factual matters
what is paternalism
action performed with the intent of promoting another’s good but occurring against the other’s will or without the other’s consent
what are guidelines for
they set a floor or minimal standards
you must make judgements based on understanding of an respect for the core values of medical ethics
what are the basic principles of medical ethics
autonomy
justice
beneficence
non-maleficence
what is autonomy
The right of patients to make decisions about their medical care without their health care provider trying to influence the decision.
what is justice
The idea that the burdens and benefits of new or experimental treatments must be distributed equally among all groups in
society.
what is beneficence
the intent of doing good for the patient involved.
what is non-maleficence
Requires that a procedure does not harm the patient involved or others in society
why do we have autonomy
patients have the right to make their own decision
they can refuse treatment and decide which treatment they would like
what are the limits of autonomy
the patient doesn’t have the authority to demand treatment that is not clinically appropriate
the doctor must provide appropriate clinically justifiable treatment
what is the difference between paternalism and the doctor refusing to do certain treatment
it is unethical to provide treatment that is the doctors clinal judgement is not appropriate ie it could be harmful, ineffective ,wastes resources
when should CPR be applied
it should only be attempted if likely to be successful and will be overall beneficial to the patient
what are the risk of CPR
may cause rib fracture and damage to internal organs
if unsuccessful the patient may die in an undignified manner
if the burdens, risks and benefits are all roughly balanced who has the right to make the decision
the patients request
why should CPR be discussed with patients before hand
cpr is not always successful
patients expect that CPR will be attempted
creates transparency about end of life
informs patients - respects autonomy
what is a DNACPR decision
how an individual chooses to pass the closing days and moments of her life and how she manages her death - again concerns patient autonomy
what must you tell patients if the decision is not to provide CPR
you must tell the patient that this is the case and why it is
what is the HRA article 8
Article 8 protects your right to respect for your private life, your family life, your home and your correspondence
what is the duty of candour
to be honest with patients or where appropriate family and carers if treatment goes wrong or has the potential to cause harm
what is capacity
an adult with capacity has the right to make decision about their care even if those decisions appear unwise or irrational
when does a person develop capacity at different ages
develops gradually
age 18 - full legal rights to refuse and consent
age 16-17 - right to consent but not refuse - they cant refuse unless others agree with the refusal (presumed to have capacity to consent)
under 16 - right to consent if you can prove you are competent
when can refusal be overridden in treating young people
by courts on the basis of a best interests judgment when life/death and serious permanent har could result
how might someone under 16 prove they have capacity to make a decision
they have the intelligence - maturity and independence of the mind
they must fully understand the risks, emotional and psychological impacts on him/her and others around them
why is competence asymmetrical
Refusal carries greater risks so you need a higher degree of competence when refusal risks death or serious lasting harm.
have the power to consent to life saving treatment but not necessarily the power to refuse it.
what is transitional paternalism
“safety net” - justifies shared power to consent
courts or parents can overrule refusal which is necessary as the person transitions to full capacity or maturity
