Flashcards

Question 1

Define Utilitarianism

Answer 1

This is the moral theory that is developed by Jeremy Bentham, which argues that the rightness of an action is dependant on the consequence rather than the action itself. Hence, can be described as a form of consequentialism. It further describes how the action committed should result in the greatest happiness for the greatest number of people. This is also known as the principle of utility. Furthermore, this theory takes the equal weight of everyone’s interests and needs as well as upholding autonomy. Agree with generally held moral views?

Question 2

What is normative dominance?

Answer 2

When moral norms take dominance over all other norms.

Question 3

What is universality?

Answer 3

When it can be universally applied to individuals that are similarly situated.

Question 4

Impartiality

Answer 4

Decisions that are based on an objective criteria rather than subjective (bias).

Question 5

Reasonableness

Answer 5

Governed by being in accordance with reason.

Question 6

Deontology

Answer 6

This is a branch of normative ethics that is concerned with the right and wrong actions. The moral philosophers Immanuel Kant developed this theory and argues that the right and wrong is contained with the action itself rather than the consequence. Deontology also tells us to act out of duty by using the categorical imperative as well as to understand that other individuals should be treated with respect as they have unconditional worth.

Question 7

Virtue ethics (teleological)

Answer 7

This is the branch of philosophy, derived by Aristotle, that is primarily concerned with acting on virtue, which is the standpoint between two vices. This is a necessity to develop a virtuous character and to moreover become a good person. The ultimate goal is hence, moral excellence.

Question 8

What are the 4 moral principles?

Answer 8

1. Autonomy
2. Beneficence: act in the best interests of the patient
3. non-maleficence: do no harm (treatment may cause harm, but it should outweigh negatives)
4. Justice: fair decisions made

Question 9

5 moral virtues

Answer 9

1. Compassion (sympathetic concerns for those suffering)
2. Discernment (ability to judge well)
3. Truth worthiness
4. Integrity
5. Conscientiousness (quality of wishing to do one’s work or duty well)

Question 10

What are the 4 domains doctors must possess to obtain trust?

Answer 10

1. Knowledge and skills
2. safety
3. communication and teamwork
4. maintaining trust

GMC 2013

Question 11

Diminished autonomy

Answer 11

A person incapable of acting on their basis or desire

Question 12

What are the requirements for autonomy?

Answer 12

Need the capacity to think, decide and act freely.

Question 13

Define informed consent and the 3 main factors required.

Answer 13

A voluntary, uncoerced decision made by a sufficiently competent individual with capacity on the basis of adequate information. (Gillon 1986)

Capacity requires the individual should:

• Understand fully the nature of the proposed treatment, anticipated effects and the consequences of their refusal.
• They are well informed of expected benefits and risks, alternatives and consequences of no treatment.
• The decision made is voluntary and uncoerced

Question 14

What are the 3 elements of valid informed consent?

Answer 14

1. Capacity
2. Voluntariness
3. Informed

Question 15

What is the mental capacity act 2005?

Answer 15

• For those aged 16 and over
• the presumption of capacity
• Individuals supported to make their own decisions
• Freedom to make unwise decisions. Don’t treat a person as lacking the capacity to make a decision just because they make an unwise decision.
• choose the less restrictive option of their basic rights and freedoms.

Question 16

In the Mental Capacity Act (when individuals do not have capacity), which 2 people can be designated to make decisions?

Answer 16

1. Lasting power of attorney
2. Court-appointed deputy

If there is no one appointed then, doctors should act in the best interests of the patient.

Question 17

What is the deprivation of liberty safeguard?

Answer 17

This is an act put in place for those that lack mental capacity and are at the deprivation of liberty (people placed in care homes) are considered to be in their best interests to protect them from harm.

Question 18

How can capacity be judged?

Answer 18

• The ability to understand
• Retain
• Weigh-up as a part of the decision making
• Communicate their choice

Question 19

Describe confidentiality (GMC 2004)

Answer 19

Doctors must hold information about patients which is private and sensitive and not disclosed unless given consent to or you can justify the disclosure.

Question 20

What are the 4 doctor-patient relationships?

Consider these for each relationship:

Is autonomy respected?

Is the principle of beneficence upheld?

Is the principle of nonmaleficence upheld?

Is the principle of justice upheld?

Answer 20

1. Deliberative (discussion of patient values and the doctor tries to challenge them to steer the patient towards what he believes is in their best interest-doctor seen as a friend).
2. Interpretive (Discussion of patient values but promotes patient understanding of the consequence of their decisions-doctor seen as advisor).
3. Paternalistic (like father and child where the doctor has the patient’s best interest in mind and therefore overrides their choice).
4. Informative (the doctor provides facts regarding treatment which allows the patient to make the decision that is in their best interest - increased autonomy - doctor is an expert).

Question 21

When can patient-doctor relationships be terminated? When can it not?

Answer 21

• Violence shown by patient towards members or staff
• Acts unreasonably
• Stealing

Cannot be terminated if

• A complaint
• shortage of staff
• the difference in political views

Patients must be informed of this termination of the relationship as well as the reason. Continuity of care should be maintained by passing on the patient’s details to a suitable colleague.

Question 22

What determines if the individual is competent enough to provide valid consent?

Answer 22

• understand the information relevant to the decision
• retain that information
• use or weigh up that information as part of the process of making the decision

Question 23

How is capacity determined under the mental capacity act?

Answer 23

Determined using a 2-step test

1) Does the person have an impairment of their mind or brain, whether as a result of an illness, or external factors such as alcohol or drug use?
2) Does the impairment mean the person is unable to make a specific decision when they need to? People can lack capacity to make some decisions, but have capacity to make others. Mental capacity can also fluctuate with time – someone may lack capacity at one point in time, but may be able to make the same decision at a later point in time.

Where appropriate, people should be allowed the time to make a decision themselves.

Question 24

Can a 16/17 refuse treatment?

Answer 24

No, they cannot, they can only consent to treatment providing that they have the capacity.

If they refuse treatment, but their parent consents, then we can override the child’s request and proceed with the treatment.

Question 26

What is Gillick competence?

Answer 26

This is where under 16s can consent to their own treatment given that they are competent and have the capacity. This means that they are able to understand, retain, weigh-up and communicate their decisions. If they are Gillick competent, they have the advantage of consenting to treatments without their parent’s input (as they may be against it). However, they are unable to deny treatment and if in this case, the parents consent to it, their decisions override the child’s ones.

Question 27

What are the Fraser guidelines?

Answer 27

These specifically relate only to contraception and sexual health for those under 16.

Question 28

If life-threatening situations, what should you do if you cannot obtain consent from parents?

Answer 28

Always act in the patients best interests and in favour of the preservation of life.