Facts, Values and Ethical Reasoning

Question 1

Define autonomy

Answer 1

Ethical concept describing a continuum, several conceptions:

• Freedom from body inviolability, constraint and interference
• Self determination, freedom to pursue goals according to one’s own desire
• Principled/moral autonomy: having autonomy over one’s own actions according to one’s will and ability to reason
• First and second order desires:
  
  • Wanting something (e.g. wanting to smoke)
  • Wanting to want something (e.g.wanting to want to quit)
• Relational autonomy: agency and autonomy within a social context.

Question 2

What does the law say about autonomy?

Answer 2

Autonomy is a legal requirement: treatment without consent is battery

Question 3

What is a doctor’s duty of care?

Answer 3

• To respect autonomy​
  
  • Treat patients as individuals and respect their dignity
  • Give patients information they want or need in a way they can understand
  • Respect patients’ rights to reach decisions with you about their care
  • Support patients in caring for themselves to improve and maintain their health
• To act in a patient’s best interests
• To protect patient from harm

Question 4

How must autonomy be respected for a patient with capacity and one without?

Answer 4

With capacity: autonomy must be respected even if their decision results in harm (e.g. refusal of life saving treatments)

Without capacity: a doctor must treat them according to the principle of best interests and must protect them from harm.

Question 5

What are the conceptions of best interests?

Answer 5

Mental state (happiness): what would bring about the most happiness for the individual?

Desire fulfillment: best interests are consistent with the person’s autonomous choices

Objective list: set of agreed criteria for achieving wellbeing (e.g. independence)

Question 6

What does the Mental Capacity Act 2005 state about best interests?

Answer 6

When determining a patient’s best interests, should consider:

• Person’s past and present feelings and wishes
• Person’s beliefs and values- what would influence their decision if they had capacity?
• Other factors they would be likely to consider if they had capacity

Question 7

What should be considered in restraint and deprivation of liberty of a person without capacity?

What ethical principles can be conflicting in restraint and deprivation of liberty?

Answer 7

• Harm that will occur to the patient if they are not restrained
• The harm of restraining them (physical/psychological)
• Minimum level of restraint required
• Proportionality of the restraint to the benefit of treatment

Restraint can put the duty of respect for autonomy and duty to protect patients from harm into direct conflict.

Question 8

Describe the legal framework for restraint

Answer 8

Restraint of a person so they are not at liberty to leave: Deprivation of Liberty Safeguards (DoLS)

• Formal process at organisational level, for longer term restraint than needed for treatment (e.g. care homes)

Short term restraint: Mental Capacity Act

Question 9

What does the Mental Capacity Act say regarding capacity?

Answer 9

A person is not to be treated as if they do not have capacity to make a decision unless all practicable steps to help him to do so have been taken without success.

Question 10

Who do safeguarding duties apply to?

Answer 10

Any adult who meets the following criteria:

• Has care and support needs
• Is experiencing or is at risk of abuse or neglect
• Is unable to protect themselves because of their care and support needs