ethics, prioritisation

Question 1

‘A 21-year-old female arrives in the emergency department following a traumatic accident. You are a junior doctor who has successfully controlled the bleeding, but she
is now in a coma due to blood loss and will not survive without a blood transfusion. The nurse informs you that the patient is a Jehovah’s Witness, based on information found in her personal belongings.’

What steps would you take in this situation?

Answer 1

-clinical urgency: patient’s survival depends on blood transfusion so decision needs to be made in timely manner

-ESCALATE TO SENIOR

-patient needs to consent and show capacity BUT not possible in this situation

-autonomy: patient has right to make decisions and religious beliefs should be accounted for

-ensure validity of religious beliefs through advanced directive, legal documents, next of kin, hospital records

-alternative treatments inline with patient’s beliefs

-consequences could be legal, damage doctor-patient relationship

Question 2

What are the ethical considerations of medicine? Which would you consider the most important?

Answer 2

Autonomy - tie into consent
Justice
-NEA?
Non-maleficence
Beneficence
-WE to describe non maleficence vs beneficence

Others: Confidentiality - better healthcare outcomes

ALL very interconnected and very important, hard to prioritise or disregard any single one of them

Most important: Autonomy or consent - dr primary role is for patients

Question 3

A homeless patient with severe liver disease demands to be discharged from the hospital, despite receiving life saving treatment.

Explain how to assess capacity.

Answer 3

-Capacity is a patients ability to consent
-Understand, retain, weigh up, decide, communicate
-example of how capacity is tested

-can be affected by age, mental health condition, learning disability

-understand reasoning behind choice
-try and provide all alternative courses of action
-ensure patient is fully educated about their options and consequences of all options

-ensure patient isn’t being influenced

-respect patient autonomy over their medical treatments
-patient isn’t just medical condition, if they believe treatment isn’t their best choice of action, aligns with beneficence

-provide support for patient, regardless of whether they change their mind or not
-homeless so may req help

Question 4

Explore the ethical implications of genetic testing in minors, especially when the test results could reveal information about late onset-conditions.

Answer 4

-Genetic testing is the analysis of DNA to identify any changes or mutations that could indicate presence/risk of certain genetic conditions

-Could be useful in identifying genetic conditions
-Late onset conditions are conditions which typically manifest later in life
-eg Alzheimer’s disease

-However, complicated by the fact its w minors
-Minors cannot consent so may be diff to protect their autonomy

-Parents and guardians give consent
-Involve all parties in decision making and informing
-In contradicting situations, Gillick’s competency assessment could be used

-Dr needs to do no harm
-Diagnoses could cause psychological stress and harm to patient, esp due to young age, or maybe not treatable

-Support should be provided throughout
-If any conditions spotted, follow up provided

-could provide benefits due to early diagnosis/preventative measures
-complicated as child can’t communicate what they want

Question 5

Evaluate the ethical implications of using prisoners as organ donors.

Question 6

The use of restraints in psychiatric patients raises ethical concerns.

How would you approach the decision to use these interventions while safeguarding patient rights?

Question 7

Discuss ethical considerations surrounding the involvement of medical professionals in capital punishment.

Question 8

Discuss the ethical aspects of medical paternalism when dealing with a non-compliant patient with a chronic condition

Question 9

How can the NHS work to uphold a doctor’s right to autonomy

Answer 9

-Ability of doctors to make decisions about patient care based on their professional judgement and expertise

-provide supportive work environment, dr feel empowered to make clinical decisions
-manageable workload, more time for patient care
-professional development

Question 10

A 14-Year-Old Patient Goes To The GP And Asks For The Oral Contraceptive Pill…

Discuss The Ethical Issues Involved.

Question 11

A Patient Diagnosed With HIV Reveals To Their GP They Have Not Disclosed This Information To Their Partner…

Discuss The Ethical Issues Involved.

Question 12

You Are A Student At Medical School…

One Day In The Teaching Hospital, You See One Of Your Fellow Students Putting Medical Equipment From The Stock Room Into Their Bag. When You Ask Them About It, They Say They Only Want To Practise Their Clinical Skills And Ask You Not To Tell Anyone.

What Would You Do?

Question 13

What Does ‘Patient Confidentiality’ Mean?

When Would It Be Appropriate To Breach This?

Question 14

A 13-Year-Old Patient Reveals To You That They Are Sexually Active And That Their Parents Do Not Know…

What Would You Do As A Doctor In This Situation?

Question 15

A Depressed Patient Who Has Refused Treatment Has Mentioned Having Suicidal Thoughts And You Are Concerned About His Wellbeing…

Discuss The Ethical Issues Involved.

Question 16

Do You Think The NHS Should Fund Treatment For Smokers?

Question 17

What Would You Do If You Saw A Colleague Making A Mistake With A Patient’s Medication?

Question 18

Is It Ever Ethically Acceptable For NHS Doctors To Go On Strike?

Question 19

You Are A GP And Your Patient Confides In You That They Are Regularly Using Illicit Drugs…

What Should You Do?

Question 20

Should Vaccination Of Children Become Mandatory?

Question 21

If you notice that a colleague has turned up to work drunk, what would you do?

Question 22

You are given details of 15 individuals, including their age, sex and occupation. A nuclear attack is imminent and you are only allowed to save five of them from destruction. Which ones and why?

Question 23

You are given details of six people, including their occupation and skills. You are asked which of them you would take with you on a trip to the jungle.

Question 24

You are a waiter working alone on a busy Friday evening in a popular restaurant. The
restaurant is full, and your colleagues are all busy with other tasks, so you are
responsible for managing the customers.

During the dinner rush, several situations
arise at once:
1. A table of four is waving you over to take their order. They look impatient and
check their watches frequently.
2. A child at another table has accidentally spilled a drink all over the table and
the floor. The parents appear embarrassed and are attempting to clean up but
need assistance.
3. A customer with a food allergy at a nearby table appears distressed and has
raised their hand to gain attention, concerned the meal may contain an allergen.
4. The phone at the bar starts ringing, and you know it might be a customer trying
to make a reservation or an inquiry.

Question : How would you prioritise these tasks, and what factors would influence your
decision-making?

Question 25

what is the GMC

Question 26

what are the 4 ethical principles?
what are the most/least important

Question 27

What is confidentiality? When can it be broken?

Question 28

Can doctors ever refuse to treat patients?

Answer 28

CAN
-patients can’t demand treatment
-cons outweigh pros (medical ethics: non-maleficence)
-not in patients best interests
-legalities
-can decline if against religious belief, obligated to refer to another doctor to get second opinion
-if patients being violent, abusive
-if it is outside their expertise or ability

CANNOT
-based of protected characteristic
-duty of certain standard of care
-emergency, doesn’t matter if they’re on holiday

Question 29

You are the newly elected CEO of the NHS responsible for a budget of £150 billion.
How would you allocate the funds.