Law Flashcards
Describe the process of registering a birth
Must be registered within 6 weeks of birth (42 days)
Opposite sex
- married at time of birth or conception either mother or father can register
- unmarried - both parents details if sign register together, statutory declaration of parentage or court order giving father PR (Parental responsibility),mother can choose not to put father on certificate
Same sex female
- married - either can register if born by donor insemination or fertility treatment
- unmarried - partner seen a second parent if treated together by licenced clinic and made parenthood order but same criteria as opposite sex unmarried couples
Same sex male couples
- must get parental order which you cannot get in 6 weeks so birth mother must register
Surrogacy
- birth mother is legal mother unless/until parenthood transferred
- husband of surrogate has PR
- surrogate has legal right to keep child
Define Live Birth, Premature birth and Surrogacy
Live Birth - a fetus, whatever it’s gestational age, that exits the maternal body and shows any sign of life (voluntary movement, heartbeat or pulsation of the umbilical cord) for however brief a time and regardless of whether the umblical cord or placenta are intact
Prematurity - born alive before 37 completed weeks of pregnancy
Miscarriage - spontaneous loss of pregnancy less than 24 weeks gestation
Still birth - born after 24 completed weeks of pregnancy and no sign of life after exiting the mother’s body
Surrogacy - an arragement made where a woman carries a chlid agreed bfore she began to carry the child and made with a view to hand over the child to another person or persons
- not legally enforcable even if contract or payment
- not regulated by HFEA (Human Fertilisation an dEmbryology Act) 2008
Parental Responsibility - all the rights, duties, powers and responsibilites and authorites which by law a parent has in relation to child and property
- consent for treatment usualy needed by someone with PR
- mother automatically has PR
- father married to mothe at tme of birth - ongoing even if divorce
- can acquire PR - father marrying mother, court orders, adoption
Describe the legal status of the fetus in English law and under the human rights act
The fetus does not acquire any legal rights until it is capable of surviving independently from it’s mother
Key legal principles relevant to the care of individuals at the end of life
Death - the irreversible loss of capacity for consciousness combined with the irreversible loss of capacity to breathe Brain stem death - irreversible cessation of the integrative function of the brainstem equates with death and allows the diagnosis of death A registered medical practitioner.. shall sign a certficate in the precribed form stating to the best of their knowledge and belief the cause of death Certifying death - statutory duty of doctor looking after person in last illness to complete (rules on duration etc) and if unable to do must refer to Coroner Medical Examiner (Senior Doctor) or Coroner to review cause of death on certificate
Describe the process of certifying and registering a death and the role of HM Coroner and the inquest process
Doctor attending patient in last illness to complete certificate giving cause of death
If unable to do refer to HM Coroner (all new Coroners are lawyers) and certain categories eg undergoing treatment, possible suicide, death in prison/custody, related to employment eg asbestos
Cause of death should be a disease process or condition not eg organ failure
PM if HM Coroner requests to ascertain cause of death or family and hospital agree to gain fuller undrstanding of illenss/ death
Coroner’s PM does not need family to agree, must be completed within 28 days
If PM confirms natural cause no inquest needed
Inquest - public hearing, Coroner calls witnesses, family may have legal representation, Trust solicitor if Hospital Team involved - to answer who is the deceased, medical cause of death, how , when and where they died
- conclusions include eg natural causes, accident/misadventure, killed themselves, drug dependence, open verdict if not enough evidence, narrative verdict where describes death
- adverse findings Neglect or Regulation 28 (report on action to prevent future deaths - may be a trust action)
- can refer doctor to GMC
Describe the basic structure of the English law system as it relates to medicine
Law matters - rules of the game, professional behaviour
Key issues
- Consent
- Professional standards
- What to do when things go wrong
- Protecting patient confidentiality
- Acting in best interests of vulnerable patients eg children, mental illness
Ethical vs Lawful
Purpose of Law
- to establish and define standards of acceptable behaviour
- to maintain standrds and punish ‘offences’
- to protect the vulnerable
- to resolve disputes
Learn from mistakes of others
Drive improvements
Distinction between criminal (government/legal) and civil (disputes) law
Describe basic legal principles eg the common law system of precedent, tort, contract and Human Rights Act(HRA)
Precedent - follow previous decisions
Tort - civil liability for breach of obligations leading to loss or harm eg negligence
Contract - contracts with patients (to follow management plan) or employers
Human Rights Act (UK Law 1998)
series of rights which include Right to Life, Right to respect and Right not to be discriminated against
Discuss the professional and legal duies of confidentiality, the role of GDPR and the situations where disclosure is appropriate
Duty of Confidentiality is
- Legal
- Professional codes of conduct
- Terms of Employment
Legal - HRA - right to respect for private and family life and GDPR (General Data Protection Regulation) and Data Protection Act (2018)
Caldicott Principles (Caldicott Guardian) - responsible for safeguarding and governing the uses of patient information within the Trust
Professional - GMC - good practice in handling patient information central to trust between doctors and patients but appropriate information sharing is essential
Terms of Employment - specific requirement and part of mandatory training
Problems come for Technology (eials fowraded, information lists misplaced), Casual conversations, Social Media, Enquiries about patients
Consequences of breach of confidentiality - risk registration, criminal prosecution, dsmisssal, bad publicity for Trust, financial penalty
Children - depends on age. 16 and 17 y - same duty of confidentiality as adults. Under 16 y - Gillick competence, if not confidential may not seek advice and treatment
Adults who lack capacity - owed duty of confidentiality, Mental Capacity Act states people involved in care should be consulted, discussion should be limited and in patient’s best interests
Deceased - duty of confidentiality continues but Coriner may request information gto assist investigation ot may be required by law
Limited circumstances where you can breach confidentiality
Consent of patent
In patient’s best intersts
Required by law
For protection of patient and others - ‘Public Interest’
Describe the medico-legal position concernng consent in adults and in children, in both emergency and non-emergency situations and how mental capacity may affect this
Consent
- patient must have capacity to consent, consent must be informed and given voluntarily
- process not a form
Mental Capacity Act (PLUMB)
Presumption of Capacity - most people can make some decisions
Least Restrictive - consider other ways to promote rights and freedoms
Unwise Decisions - unwise is not the same as unable
Maximise Capacity - consider time, use of eg pictures and language and adjust as necessary
Best Interests - any decison must be made in patient’s best interests
Does patient have capacity - 2 stage test - 1. Is the patient suffering from an impairment of functioning of the mind/brain and 2. Does this affect the patient’s ability to make a decision at the time - understand/retain and use information and communicate decision
Mental Capacity vs Mental Illness - can have capacity even if have mental illness
Lack of capacity can be temporary
Appropriately Informed
Undue Influence
Capacity 16/17y - can consent to treatment but not refuse
Under 16y - Doctor can provide contraception in exceptional circumstances - needs child’s consent to inform parents, encourage to discuss
Explain the doctor’s legal duty of care, and discuss the concepts of liability and negligence and the duty and standard of care, and the issues that arise in Good Samaritan’s acts
Negligence is part of civil law - it is a tort (civil action). We have a duty to act reasonably to those around us who are likely to be affected by our acts or omissions - ‘duty of care’
eg delayed or mis-diagnosis, incorrect treatment, surgical mistakes, incorrect medication prescribed, perinatal damage, not giving teatment needed, not explaiing risks, delay in giving appropriate treatment
- claimant must establish 4 things - owed a duty of care, duty of care was breached, they have suatined an injury and the injury was caused by the breach in duty of care with standrad of proof - balance of probabilities
Bolam Test - A doctor is not guilty of negligence if they have acted in accordance with accepted practice - judged by peers
Hower Bolitho review - Courts not medical profession have final decision - may lead to cautious practice
gudelines - if deviate must document reasoning
Good Samaritan
- doctor , not on duty, helps in emergency
- no legal obligation to treat someon who is not your patient
- but professional duty - hippocratic oath
- must take into account your own safety, your competence (outside of abilities or if have eg been drinking), the other available options
- make detailed record, obtain consent if possible, explain what you are doing
Vicarious Liability - by NHS trust/CCG for doctors during employment
NHS Indemnity/Clincal Negligence Scheme for Trusts (Insurance Policy for Trusts)
Describe the NHS Complaints Process works, with particular reference to how it relates to a doctor’s duty of candour
A complaint is a subject or ground of dissatisfaction or grievance that one wishes to express (OED)
- pt has right to have compliant dealt with efficiently and promptly, to know outcome of investigation, take complaint to independent Health Service Ombudsman if not satisfied
- NHS must treat you courtesy and provide support, complaint will not affect future care, NHS will acknowledge mistakes, apologise and explain and put things right, learn from mistakes to prevent/reduce risk of future mistakes
Informal and Formal complaints
Complaints often because lack of information, lack of compassion, not treated with dignity and care, poor staff attitudes, lack of resources
Prevent by dealing with issues at the time, put yourself in the complinants place, ask advice senior staff
Complaint process - timely (set timescales), honest and thorough - listen, respond , identify faults and take remedial action
Claims = Clinical Negligence - duty of acre, breach of duty, injury(loss) and injury was cause
Duty of Candour
- Statutory/Contractural DoC and Professional DoC
Statutory - pt/family must be informed if any suspected/actual patient safety incident (resulting in moderate or severe harm or death) within 10 days of incident being reported
Professional - must be open and honest, respond honestly
Saying sorry - OK to say sorry, sincere, right information, right time, sensitively, make it persons and provide further support if needed
