Ethics of Consent, Capacity and Confidentiality Flashcards

1
Q

If a patient has capacity to make a decision that may not be recommended by medical staff, then we must accept this decision is in the patient’s best interests.

What reasons may they have for this decision?

A
  • Happiness and pleasure?
  • Self-fulfilment?
  • Keeping one’s dignity?
  • Absence of pain and suffering?
  • Life/surviving at any cost?
  • Consideration for family?
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2
Q

What are the only times that an adult over the age of 16 can be treated without their consent?

A
  • If it is an emergency (NOT just presenting to A&E)
  • You can apply the Adults with Incapacity Act (form)
  • You can apply the Mental Health (Scotland) Act
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3
Q

What legal issues can doctors face if they fail to consent a patient to treatment?

A
  1. Battery - “unlawful touching”
    => person need not be harmed by procedure to claim damages
  2. Negligence
    - If relevant information is not provided
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4
Q

Consent is not equivalent to contract. What are the differences between the two?

A

Consent = Not binding
=> There are no consequences of withdrawal and this must be respected

Contract = Binding
=> Withdrawing may have consequences (e.g. financial penalties)

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5
Q

Why does consent need to be continually given throughout a patient’s treatment?

A
  • Valid consent is a continuous process, not just ONE signature
  • just because a patient is okay with one procedure does not mean they will be okay with all
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6
Q

How do we aim to allow patients to make a fair decision on their treatments?

A
  • discuss all treatment options openly
  • respect the patients views
  • let them decide
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7
Q

How can we improve our patient’s capacity to consent?

A
  • Additional support (e.g. pictures or other aids)
  • Use simple language
  • Suggest they bring a relative, friend or translator
  • Address patient’s unspoken anxieties (e.g. fear of pain or other underlying problems)
  • Give patient time to reflect upon their decision
  • Allow time for them to ask questions
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8
Q

How can you check if a patient has or lacks capacity?

A

Do they:

  1. Understand the treatment options and can weigh up
    the benefits and risks?
  2. Retain the information provided
  3. Weigh up, decide and communicate their decision
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9
Q

For what reasons may a patient have capacity yet be unable to communicate their decision?

A
  • Locked in syndrome
  • Stroke
    etc
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10
Q

What are the 3 requirements for VALID consent?

A
  • Patient has capacity
  • Patient received enough information and understands
  • Voluntariness: deciding voluntarily (not coerced)
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11
Q

How must a patient be treated in an emergency if no consent has been given?

A
  • Treated without consent if immediately necessary to save a life or prevent deterioration
  • Treatment must be least restrictive of the patient’s future choices
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12
Q

If there is uncertainty or disagreement as to whether valid consent was obtained, who can you contact?

A
  • more senior colleague for advice
  • independent advisor
  • defence organisation (e.g. Medical Defence Union)
  • professional body
  • Clinical Ethics Committee
  • independent court/statutory ruling
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13
Q

What are the basic rules on how children are treated as they do not have capacity to consent?

A
  • Parent/s (or legal guardian/s) must be consulted about child’s treatment (unless absolute emergency)
  • Parents make decisions and must be consulted from birth
  • Child’s consent should ideally be sought even from
    toddlers
  • The State must protect the best interests of the child, => can override parents’ (guardians’) wishes (e.g. in situations of child neglect/abuse)
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14
Q

What can occur if parents disagree with the healthcare team?

A

Judge (courts) can assess the situation and override parents’ refusal of consent if they feel medical treatment is necessary

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15
Q

All people aged 16 and over are presumed in law to have the capacity to consent to treatment unless there is evidence to the contrary. TRUE/FALSE?

A

TRUE

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16
Q

A person under the age of 16 years has legal capacity to consent to any surgical, medical or dental procedure where a qualified medical practitioner deems them capable of understanding the nature and possible consequences of the treatment. TRUE/FALSE?

A

TRUE

17
Q

Who has parental responsibility for a child?

A
  • both parents, if named on birth certificate (whether married or not)
  • If parents divorce, both retain PR for the child, no matter who the child lives with /spends most of their time with.
  • PR is lost by giving the child up for adoption
  • Adoptive parents get PR once formally adopted
18
Q

In what situations can you disclose personal information about a patient?

A
  • The patient consents (e.g. for a referral to secondary care)
  • Required by law in the public interest e.g. infectious diseases, risk of death/harm, serious crime
19
Q

Who should you NOT disclose a patient’s personal information to without consent?

A
  • patient’s employer or school
  • relatives
  • lawyer or an insurance company
  • the police
20
Q

Patient information needs to be anonymised so that the patient it details cannot be identified. The information also needs to be non-identifiable, what does this mean?

A
  • This means that although the patient details such as name and DOB have been excluded, the patient should still not be able to be identified from their medical conditions or from other features of the data
21
Q

If a patient is no longer fit to drive, should you inform the DVLA of this?

A
  • You should inform the patient of a legal duty to inform the DVLA about their condition
  • If the patient continues to drive you should make every effort to persuade them to stop
  • If they admit that they are continuing to drive or you SEE them driving, contact the DVLA immediately and disclose relevant medical information to the medical adviser
  • You must immediately inform the patient once you have done this and send a copy in writing
22
Q

How should you contact if there is uncertainty/disagreement surrounding confidentiality?

A
  • more senior colleague
  • Caldicott Guardian
  • defence organisation (e.g. Medical Defence Union)
  • Contact your professional body
  • Clinical Ethics Committee
  • Legal advice