Law Flashcards
define autonomy
ethical right to self determination
define non-maleficence
to do no harm
define beneficence
the doctor should act in best interests of patient
define freedom
the ability and situation that allows one to be self-determining
define justice
the principle of fair and equal treatment for all
what is the difference between capacity and competence?
capacity = clinical assessment competence = legal assessment
define consent
agreement for something made with complete knowledge of all relevant facts
e.g. risks involved or any available alternatives
define paternalism
a practice of treating or governing people in a fatherly manner, especially by providing for their needs, without giving them rights or responsibilities
what is consequentialism?
moral approach that things are right or wrong based on the consequences it produces
what is utilitarianism?
- ethical theory based on action being the one that provides the greatest overall happiness
- means the moral worth of an action is determined only by its resulting outcome
what is altruism?
disinterestedd and selfless concern for the wellbeing of others
what are the pros and cons of consequentalism?
Pros: democratic apporach
Cons: predicting consequences
what is deontology (duty-based)?
- moral approach that certain things are right or wrong regardless of consequences
- judges morality of an action based on action’s adherence to a rule/rules
what are the pros and cons of deontology?
Pros: simple, easy to follow
Cons: how do we decide what’s right or wrong
what is virtue ethics?
Aristotle
Virtue can be nutured and developed and the right action is one which exercises ones’ virtue
what are the 4 cardinal virtues?
- courage
- wisdom
- temperance
- justice
what are the duties of a GMC doctor?
- care of pt is your number one concern
- maintains good standards of practice
- prompt action if you think your pt safety/ dignity/comfort is being compromised
- works within limits of competence
- keep professional knowledge/skills up to date
- respect dignity
- respect right to confidentiality
how do you enable autonomy?
- capacity
- adequate info
- clear explanation
- reasonable range of options and time to consider
- no undue pressure
- non-judgemental
what are the pros of autonomy?
- better shared decision making
- enhanced pt control
- improves confidence/ trust/ adherence
- pt less stressed/anxious
what are the cons of autonomy?
- in society we must respect autonomy equally
- limits to autonomy must be reasonable and fairly applied
- pt may not understand the options before them for decision making
what are the bros and cons of beneficence?
Pros: doctor knows best about medical best intersts
Cons: medical BIs aren’t always pt BI
what are the pros of paternalism?
- technical info too difficult to explain
- uncertainty in diagnosis/ outcomes
- pt cannot handle information
what are the cons of paternalism?
- withholding info rarely justified
- prevents autonomy
- pt BIs not necessarily medical BIs
what is mental capacity?
- all adults are assumed to be competent unless they show evidence of a lack of competence
- a bad choice does NOT mean a pt lacks capacity
what are the MCA 2005 statutory principles?
- presumption of capacity
- freedom to make unwise choices
- capacity must be decision specific
- decision making must be maximised (provide right info, provide time to weigh up info)
what is the 2 stage test of capacity?
- does the person have an impairment or a disturbance in functioning?
must be able to: understand, retain, weight up + balance, communicate a decision - is the impairment or disturbance sufficient to impair capacity to decide?
what is the precedence of an advanced directive?
- take precedence over LPA unless LPA was appointed after AD was made
- take precedence over consent by a court appointed deputy
- best interests do not apply
what is an exception of an AD?
can’t refuse treatment under the mental health act
what are the key features of AD?
- the request must be a REFUSAL of care, competent, informed, voluntary, treatment specific
- when written, pt must be informed and competent
- must be voluntary
- does not have to be written, can be witnesses oral statement
- withdrawal of AD can be oral and withdrawn at any point the pt remains competent
what happens in an emergency with an AD?
- if there is any doubt over validity/ applicability of AD, tx may be given to a pt
AD cannot refuse what?
- basic nursing care
- hydration and oral feeding (artificial feeding is considered treatment)
- mental health care
AD may be inapplicable if?
- significant changes have occurred since the AD was made
- significant changes in prognosis/tx of the condition the AD is concerned with has occured (e.g. HIV/AIDS tx)
when are AD invalid?
- through competent withdrawal
- LPA appointed after AD was made and LPA was given power to make decision
- the pt acted in a way which is inconsistent with AD
what must be the characteristics of AD to refuse life-sustaining treatment?
- signed and in writing
- witnessed and signed by a witness
- specifically stated that the decision is respected even if life is at risk
- indicate the marker of th AD has taken into account any changes in circumstance since decision was made
what is a LPA?
Lasting Power of Attorney
- legal document that allows a person’s authority to decide on another’s behalf
what are the features of a LPA?
- pt must have capacity when they appoint a LPA
- decisions must be in the persons BI
- donor can specify limits to attorney decision-making
what is a court appointed deputy?
appointed by court of protection if many decisions have to go to court due to disagreement with the LPA
cannot refuse life sus
what are the 2 types of LPA?
- welfare: including consent to tx and refusal of life sustaining tx
- property and affairs
what are the powers of a LPA?
- rights to access personal info
- complaints about the donors care or treatment
- where the donor should live and with whom
- who the donor may have contact with
- the donors day to day care
- consent/refusal of medical treatment
- life saving treatment
what are the criteria for a LPA?
- over 18
- must have capacity
- must be written and signed
- must be registered with the office of public guardian and court of protection
what decisions about adults lacking capacity must go before the courts of protection?
- withholding/ withdrawing artificial nutrition from patients in persistent vegetative states
- organ donation/bone marrow transplantation
- sterilisation for non therapeutuc purposes
- some TOP
what is an IMCA?
independent mental capacity advocates
are advocates not decision makers
what does the IMCA do?
- be independent of person
- provide information to help identify person’s best interests
- challenge decisions which appear to not be in person’s BI
- have right to see relevant healthcare records
when should an IMCA be sought?
for people lacking capacity who have no one else to support them when:
- making decisions about serious medical conditions
- when proposing/ changing accommodation in hospital (>28 days) or a care home (> 8 weeks)
- only exception is URGENT decision
what is the mental health act (1983)?
a law which sets out who can be admitted, detained and treated in hospital AGAINST their wishes
can only be done if pt is putting their own safety or someone else’s at risk AND you have a mental health disorder
what is important to remember with AD and the MHA?
AD can be overidden if the pt is subject to compulsory treatment under the MHA
which treatments can be refused by an AD?
treatments for mental health conditions
when can confidentiality be broken?
- necessary for prosecution of a crime
- public interest disclosure
- statutory obligations
- permission from pt
- within medical team
- consent is implied (i.e. audit purposes)
what can acting without consent lead to?
- criminal offence (assault and battery) or civil action from pt (to claim for damages)
what are the exceptions to consent?
- emergency
- implied
- waiver (some pt don’t want to hear details and just want tx to commence)
- best interests
what do you need for valid consent?
- pt competent
- competence is determined decision-specific
- consent must be given without coercion
what are the presumptions of competence?
- adults (+16) HAVE competence unless evidence suggests otherwise
- children (<16) assumed to LACK competence unless evidence suggests otherwise
what are the main features of the Children Act (1989)?
- child’s welfare is PARAMOUNT
- dr can override any parents if not in child’s best interest
what is important to remember in the consent for children?
- age of consent for medical treatment = 16
- only one parent consent is necessary
when is a child considered Gillick competent?
- ask child whether you can tell one/both parents
- assess how mature the child is (do they understand tx and complications)
- the child is likely to suffer physical/ mental harm without tx
- it is in their best interest to receive treatment
what are the features of Gilick competency?
- no lower age limit
- they can accept tx but CANNOT refuse tx that is in their best interest
what are the disclosures required by statute that don’t require consent?
- notification of death
- notification of TOP
- notable infectious diseases
- treatment of drug addicts with specific drugs
- informing DVLA
what are the conditions that require disclosure information to the police?
- under a warrant from a circuit judge
- air police in all matters regarding terrorism
- aid police to identify drivers suspected of RTA
what are the rights at the beginning of life?
- foetus has NO rights until birth
- she can engage in any behaviour that is harmful to foetus
- can refuse medical tx inc caesarean even if it risks life of baby
what are the legal grands for abortion?
- pregnancy is <24 weeks and risks to physical and mental health of woman/ children in fam
- continuing pregnancy would involve greater risk to health of pregnancy woman
- termination is necessary to prevent grave/ injury to mother
- susbtantial risk that the child will be born with physical/ mental abnormalities
define death
- irreversible loss of capacity for consciousness
- combined with irreversible loss of capacity to breath
- so brainsteam death = death of individual
is someone in a persistent vegetative state still alive?
YES
- cerebral cortex lost activity
- retained brainstem function
- able to breathe unassisted
- normal sleep wake cycle
- periods of wakeful eye opening
- no evidence of awareness
- swallowing reflex may be preserved
what is withdrawing tx classed as?
considered an omission rather than an act
you are returning the pt to a condition they would have been if they had not received tx
what are the arguments for ending life by removing treatment?
- quality of life (difference between having a life and being alive)
- futile treatment (tx that fails to meet its own objective)
- Law (lawful to cease giving medical tx, considering tx involves invasive manipulation of the pts body)
- doctrine of double effect (if doing something morally good but has a morally bad side effect, it is ethically okay to do providing bad side effect wasn’t intended)
what are the arguments against ending life by removing treatment?
- sanctity of life (intrinsically wrong to end a human life)
- vitalism (human life has an absolute moral value)
- religious views (life is a gift from God, we have a duty to preserve it)
what are the different personal characteristics resource allocation can be based on?
- age
- social worth
- personal responsibility
- lottery
- first come, first served
what are the arguments in favour of ageism?
- older people have already enjoyed a large portion of life
- older people have little left to contribute to society
- older people have less life expectancy
what are the arguments against ageism argument?
- older people have contributed more so far to society
- difficult to draw line on what is old
- older ppl value life as much as young
what are the arguments for fair innings?
- over a certain age, any extra time is bonus. doesn’t warrant public resources
- use restricted ageism (rations scarce/ expensive tx)
what are the argument against fair innings?
- even trivial issues over that age would be ignored e.g. appendicitis (unfair, dying of curable illness)
what is social worth?
prioritize individuals that have made a greater contribution to society or have more potential to do so
what are the arguments for social worth?
- greater social worth has committed to society longer
- prioritise those with dependents
what are the arguments against social worth?
- devalues disabled lives
- difficult to determine social worth
- some factors beyond our control
what is personal responsibility?
those responsible for their own health issues should be less prioritised
BUT:
- difficult to determine how much responsibility is due e.g. genes, would have to deny tx to players of extreme sports
what are the different ways of choosing between diseases instead of individuals?
- QALYs
- EBM
- public opinion
- personal choice
what are QALYs?
- average life expectancy, following an intervention, adjusted by quality of life expected
- quantifiable measure of benefit
- subjective preference scores (not often accurate)
- doesn’t differentiate between life saving and life enhancing
- equates quality of life to value of life
what is EBM?
- using clinical evidence to determine what interventions should be provided
- biased towards medical perspectives (not pt) as to what is considered effective
- interventions with little research are likely deprioritised (industry bias)
what is public opinion?
ask public for their healthcare priorities
- may prioritise those who can shout loudest
- those conditions with less public sympathy will be underrepresented
what is personal choice?
giving indivduals the money they need to invest in a personal healthcare plan which is in line with their personal needs
would result in social diff in healthcare access (some may choose cosmetic plans whilst other practical)
what is maximising lives saved?
primary prevention technically saves more lives, so it could be argued that more resources should be directed here
BUT
- difficult to determine what factors need to be prevented to reduce certain outcomes (e.g. not considering genetics)
- may medicalise otherwise healthy individuals with screening programmes (takes away money and resources)
