law Flashcards
Mental health act 1983
facilitates preservation of safety of patient and others due to suspected mental illness
- section 136 - removal from public place by police
- section 5(4) - nurses detain until assessment by dotor
- section 5(2)- detention by doctor for 72 hrs for assessment
- section 2 - admission for 28 days for assessment
- section 3 - admission for 6 months for treatment
Misuse of drugs act 1971
controls drugs to prevent non-medical
classification A - C
penalties for possession, supply, production
A = crack cocaine, cocaine, MDMA, herin, magic mushroms
B = amphetamines, cannabis, ketamine
C = anabolic steroids, benzos
Psychoactive substances act 2016
restruct legal highs
any substance capable of production of psychoactive effect
mental capacity act 2005
legislation which empowers and protects people who lack capacity to make their own decisions
capacity = ability to use, understand information to make a decision and communicate that decision i.e. ability to make a decision
capacity is decision specific
5 principles
- capacity is assumed unless proven otherwise
- maximise potential for capacity
- unwise decisions doesn’t equate to lack of capacity
- make decisions in best interests if lacking capacity
- treatment should be least restrictive of rights and freedoms
Assessment of capacity
- does person have impairment of mind or brain
- does impairment mean person is unable to make a specific decision?
- understand relevant information
- retain information
- weigh up information to make a decision
- communicate that decision
good practice includes - encourage participation, find out persons past views, wishes, values, avoid discrimination, re-assess
consultation with others including LPA
Pitfalls in capacity assessment
- diagnosis of cognitive disorder e.g. dementia does not mean patient lacks capacity.
- cognition tools e.g. MMSE are not appropriate for assessing capacity
- capacity is time specific - lacking capacity at one time does not mean they will lack capacity the next. can decision wait?
- capacity is decision specific - lacking capacity for one decision doesn’t mean lacking for all
- has individual been provided with all relevant information
- has ability to communicate been maximised - SLT
- is individual subject to external pressures?
- disputes - case conference, second opinion, independent expert in assessing capacity, support from advocates, mediation, court of protection
resolving disputes about capacity
informal
- settle before serious dispute - communicating effectively, address worries
- setting out options in an easy way to understand
- invite colleagues, independent, advocate
- allow family time
formal
- mediation - independent, help solve problem arising through difficult relationships or communication
- PALS
- court of protection
DOLS
prevent unlawful restrictions to a persons freedom.
applied via local authority
under MCA patient can be restrained if lacking capacity and it is in their best interests
depriving liberty requires DOLS, rarely indicated in ICU as patient too unwell to be considered that they are deprived of liberty
formal authority sought to prevent patient leaving If physically capable
DOLS considerations
formal legal authority is required to deprive someone of their liberty. courts have ruled that concept of DOL applied differently in to context of provision of necessary life sustaining treatment
there is no deprivation of liberty, even if patient can’t consent
- patient is so unwell that they are at immediate risk of dying anywhere other than in hospital
- treatment is delivered the same way as if they had consented
formal authority should be sought
- prevent patient leaving if physically capable
- if circumstances amount to deprivation of liberty, then formal authority sought and care continue to be in best interests
Refusal to accept diagnosis of death using neurological criteria
no statuary definition of death - courts adopt AoMRC
family refusing to accept DNC - challenge to method
dispute –> application to high court to establish whether or not the patient is dead
(not court of protection for best interest or coroner)
application to court in parallel to other forms of mediation
evidence required to support diagnosis of death - confirmation that relevant codes and guidance have been followed, outcome of clinical tests and supporting medical records
if person declared dead by the court - withdrawal of mechanical ventilation must follow
rare when medical consensus of death for court to disagree
maintaining confidence in diagnosis of death using neurological criteria
DNC requires -
1. irreversible structural brain injury
2. confirmation of preconditions to ensure clinical state not treatable or reversible. requires patient to be deeply comatose, apnoeic
3. series of clinical tests to confirm absence of brainstem function
if uncertainty of confounding factors or ability to perform tests, expert advice and consideration of ancillary tests
Red flags in DNC
- < 6 hrs since loss of last reflex
- < 24hrs if cause in anoxic brain injury
- < 24hrs from rewarming following hypothermia
- prolonged fentanyl infusions
- neuromuscular disorder
- steroids in SOL
- decompressive craniectomy
- posterior fossa / brain stem pathology
disability and ICU
person has disability if mental or physical impairment which has substantial long term effect on ability to carry out day to day activities
equalities act 2010, ECHR
- think about process e.g. communication support
- outcome - steps needed to ensure person with disability is able to access critical care on the same basis
- discrimination may occur
steps taken relating to disability
- ensure consistent decision making and coumentation
- treatment decisions in consultation with disabled person
- DNACPR decision must involve person
- DNACPR discussion must involve appropriately interested person if person lacks capacity
- discrimination more likely when decisions about access to treatment are used on quality of life as opposed to survivability
- disabled patients - access to ACP
disclosure of genetic information without consent
- duty of confidentiality continues after patient has died
- circumstances when relevant information about a patient may be disclosed (public interest, protect others from serious harm)
- balance of duty to protect patient vs protect another from serious harm
- English law imposes duty of confidentiality
- depending on cue, clinicians may have duty to consider the interests of an at risk relative
- disclosing information should be under advice from experienced colleague, legal department
child protection
information may be legitimately shared without consent in the public intent to prevent harm to a third arty
- inform relevant authority promptly. if immediate danger police
- share information with local lead clinician for CP - identities and concerns
- inform patient regarding information shared
- clear record keeping
relatives recording conversation risk / benefits
benefirts
- assist relatives to reflect upon and understand the content of discussions and inform 0thers
- can form permanent record
risks
- incapaccted patients are unable to consent to creation of recordings containing personal information
- recordings on personal devices are not protected
- social media - inadvertent breach of confidentiality
recording conversations recommendations
may refuse if you believe it will negatively affect patient care e.g. inhibited discussions re. EOLC
- permission can be sought from hospital but recordings then stored in medical records
- remind all family members of importance of respecting confidentiality, being mindful of what patient information they post or share
- relatives who covertly record conversations should be aware that this will erode trust with healthcare workers, however it is unlikely they are breaking the law
disagreement on best interests
- formally established patient lacks capacity
- capacity assumed, all practicable steps, allowed to make unwise decision - assess patient past and present wishes, beliefs and values that would influence
- talk to anyone named by patient, anyone interested in welfare of patients, any LPA or deputy appointed
local / informal steps
- discussion with another clinician
- best interest meeting
- document
- allow time for reflection
- discuss with medical director
formal steps
- second opinion, external to trust
- mediation - civil mediation council, NHS resolution
- legal advice - court of protection
police access to critical care patients
is there obligation to disclose confidential information?
- when permitted by law, health care professionals should support police in their work
- police officer should be used about the basis they are seeking information. instances when disclosure of confidential information to police is required - terrorism act, road traffic act, FGM act
- confidential information disclosed if sufficient public interest e.g. preventing serious harm, national security, prevention or deception of serious crime
is request an emergency?
- emergency disclosure when non-disclosure would place one or more individuals at risk of harm
- all other requests in office hours, requests made in writing DP7 form
what to do next
- if time allows discuss request with information governance lead
- most senior clinician should speak with police officer and establish name and rank
- establish legal basis for request and information, sample requested
- if statuary requirement exists, disclosure may happen but relevant statue and name of police officer documented
gathering material evidence
- police may seize clothes and other property from victim if they have reason to believe a crime was committed
- doctor under no obligation to facilitate or podia other samples without court order
confidentiality
principles
- use minimum necessary personal information
- manage and protect information
- be aware of your responsibilities
- comply with the law
- shar relevant inför for direct care
- ask for explicit consent to dispose information
- tell patients about disclosures they would not reasonably expect
- support patients to cues their information
duties of confidentiality
trust essential part of relationship
confidentiality essential
duty to protect patients personal information
when you can disclose information
- patient consents - implicit or explicit for the sake of their own care or local audit
- patient given explicit cornet for other purposes
- disclosure is of overall benefit to patient who lacks capacity to consent
- disclosure I required by by law
- disclosure justified in public interest (notifiable disease, serious crime)
GMC good medical practice
principles values standards of care and professional behaviour expected of doctors
ethical framework
complaints to gmc
- risk to protecting, promoting, maintaining health of public
- risk to promoting maintaining public confidence in medical profession
- promotong nd maintaining proper professional stands
Four domains GMP
- knowledge, skills, development - good standard of practice, within competence, knowledge and skills up to date
- patients, partnership, communication - dignity, listen, parternships, confidentialty
- colleagues, culture and safety - work together, training, respect, compassion. act prompts if patient safety compromised, take care of self
- trust and professionalism - honesty, integrity,
Key changes to GMP 2024
- respectful, fair, compassionate workplaces
- promoting patient centred care
- tackle discrimination
- fair and inclusive leasfership
- support continuity of care
GMC 7 principles of consent
1 - all patients right to be involved in treatment and care
2 - decision making ongoing process
3 - patients have right to be listened to given information they need
4 - doctors should find out what mater to patients
5 - presumably capacity
6 - choices when they lack capacity overall benefit to them
7 - patients unable too onsent by law should be supported
duty of candour
open and honest with patients when something goes wrong in their treatment
- tell the person or advocate
- apologise
- offer appropriate support
- explain fully the short and long term effects
principles in duty of candour
discuss risks before treatment
speak as soon as possible
saying sorry - what happened, what can be done to help and to prevent future harm
Steps
- put matters right if possible
- apologise
- explain fully and prompty
- report the incident
NHS complaints procedure
1 - local resolution (hospital, GP, NHS England) (PALS)
2 - ombudsman - 12month
to care provider or commissioning body
