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YEAR 1 > Law and Ethics > Flashcards

Law and Ethics Flashcards

1
Q

What 5 factors must be considered when making a best interest decision on behalf of someone who lacks capacity?

A
  1. Equal consideration and non-discrimination
  2. All relevant circumstances
  3. Regaining Capacity
  4. Participation
  5. Wishes, Feelings, Beliefs and Values
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2
Q

What are the 4 criteria for assessing capacity in adults?

A
  1. Understand the information relating to the decision
  2. Retain that information
  3. Weigh up the information and reach a conclusion
  4. Be able to communicate the decision they have made
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3
Q

What is the mental capacity act 2005?

A

Applies to 16year olds + who lack capacity to make decisions about their care/treatment when that decision needs to be made.

Designed to protect vulnerable individuals who lack this capacity, ensuring the decisions made in their care involve them as much as possible and are done in their best interests.

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4
Q

What are 5 key principles of the Mental Capacity Act 2005?

A
  1. Presume capacity; it needs to be proven otherwise
  2. Least restrictive option
  3. Unwise decisions does not mean lack of capacity
  4. Maximise capacity by enabling people to make their own decisions
  5. Best interest of patients
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5
Q

What are 3 core principles of informed consent to be valid?

A
  1. Patient must have CAPACITY to consent
  2. Patient must be appropriately INFORMED to make decision
  3. Consent must be given VOLUNATRILY – not under any undue influence
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6
Q

What are the 4 principles of biomedical ethics?

A
  1. Autonomy
  2. Beneficence
  3. Non-malificence
  4. Justice
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7
Q

What is the Bolam Test?

A

Used to see if the doctor’s actions are supported by a responsible body of medical opinion.

“The test is the standard of the ordinary skilled man exercising and professing to have that special skill” (Bolam [1957]) - i.e. what can be expected of an ordinary doctor in that situation.

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8
Q

What is a disadvantage of the Bolam test?

A

The opinion used to support an action could be a minority.

Not enough for a doctor to potentially find just one body of opinion that supports their actions - the court has the right to scrutinise these actions and decide if they are logical or not.

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9
Q

What is the Bolitho Test?

A

Despite a professional opinion supporting a doctor’s conduct, if the course of action cannot stand up under scrutiny in court to the judge’s satisfaction, then a claim of negligence can be successful.

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10
Q

What crimes do not warrant breach of confidentiality?

A

Theft, fraud or damage to property where loss and damage is not substantial

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11
Q

What is a Caldicott guardian?

A

Responsible for safeguarding and governing the uses of patient information within the Trust and acting as the conscience of the Trust.

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12
Q

What is the Good Samaritan act?

A

When a doctor who is not on duty helps in an emergency situation
A professional duty but not a legal duty

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13
Q

What is Gilick competence?

A

Under 16 year olds who are competent to consent without a parent

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14
Q

Under which law can doctors and advocates make decisions on behalf of a patient who lacks capacity?

A

Mental Capacity Act 2005

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15
Q

What 3 things need to be proven for a doctor to be found liable in negligence?

A
  1. Duty of care was owed
  2. Breach of the appropriate standard of care
  3. Breach in the duty of care caused the patient harm
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16
Q

What is the role of General Data Protection Regulation?

A

Regulates the processing of personal data about living individuals

A health record is considered ‘personal data’

All personal data must be processed fairly and lawfully

Every living person or authorised representative the right to apply for access to their health records irrespective of when they were compiled

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17
Q

In what 4 circumstances can you breach confidentiality?

A
  1. Consent from the patient
  2. Patients best interests
  3. Public best interests
  4. Required by law
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18
Q

What 2 circumstances could be required by the law to breach confidentiality?

A

If ordered by a court or judge

To satisfy statutory requirements

  • Notifiable disease
  • Road traffic Act
  • Terrorism Act 2000
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19
Q

What is the definition of negligence?

A

Any act or omission which falls short of the standard to be expected of ‘the reasonable man’

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20
Q

What is duty of candour?

A

Every health and care professional must be open and honest with patients and people in their care when something that goes wrong with their treatment or care causes, or has the potential to cause, harm or distress.

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21
Q

What is the criteria to fulfil if breach of confidentiality is a necessity?

A

The patient should be warned that disclosure will be made.

Disclosure should be made on a need-to-know basis (i.e. only to the relevant people).

The disclosures made should be kept to a minimum (i.e. only disclosing relevant information).

The information should be anonymised, if possible.

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22
Q

What is the Doctrine of Double Effect

A

The Doctrine of Double Effect explains how we can accept an action if the intention is to cause a ‘good outcome’ (e.g. pain relief), even if it may foreseeably lead to a ‘bad outcome’ (e.g. death).

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23
Q

What is vicarious liability?

A

CCGs & hospitals owe a vicarious duty of care to patients.

If a professional negligently performs duty of care, the NHS is liable.

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24
Q

What is Fraser guidelines?

A

Used to decide if a child can consent to contraceptive or sexual health advice and treatment.

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25
Q

What is the Bristol Royal Infirmary Scandal ?

A

1990 Anaesthetist found and evidenced high mortality rates of babies undergoing surgery. No action until 1995: Private eye: GMC involved.
CEO & 2 surgeons professional misconduct: 170 hearts of babies kept without permission.

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26
Q

What is the scandal with Dr Hadiza Bawa-Garba?

A

2011 ST5 failed to recognise grossly abnormal blood results. Staff shortages and IT problems led to test result delays. 2015 found guilt of gross negligence manslaughter.
Struck off; later reinstated 2018. “Blame culture” not in line with proposed move towards patient safety & learning approach.

27
Q

What is the Alder Hey Liverpool scandal?

A

Redfern Inquiry: investigated unauthorised organ removal and retention. Organ retention was widespread across NHS.
Led to Donaldson report: culture of “retention”: docts felt telling patients too distressing, just signed documents (no informed consent).
Led to Human Tissue Act 2004 & Coroners Amendments Rules 2005.

28
Q

What is the Mid Staffordshire Scandal?

A

Complaints of poor quality of care, no official response until relatives went to media.

Francis Inquiry Report 290 recommendations: including openness, transparency and duty of candour as well as requiring stronger healthcare leadership to best serve and protect their patients.

29
Q

What is the role of the GMC?

A

Primary purpose to protect patients

Set standards for education and training

Maintain medical register

Revalidation of doctors

Ethical guidance

Investigate concerns

30
Q

What is the Harold Shipman scandal?

A

GP 1976 convicted of obtaining pethidine by forgery & deception. 10% higher patient death. Police failed to carry out basic checks.
Forged will on patient after giving lethal dose of morphine, family became suspicious and body exhumed.
Convicted of murdering 15 patients: thought to be 250+ over 23 years.

Shipman Inquiry: death certificates evaded coroner investigation, stringent controls required for drugs such as diamorphine. GMC failed primary task of looking after patients.

31
Q

What is the Shropshire maternity scandal?

A

Dozens of mothers and babies died on the ward.

Avoidable deaths, serious injuries and trauma

32
Q

What are the 3 principal ethical theories in the western canon?

A

Virtue - focus on the person
Deontology - focus on the act
Consequentialism/Utilitarianism - focus on the consequence

33
Q

What are the 4 ethical grounds for importance of confidentiality?

A

Respect for patient autonomy

Implied promise

Virtue ethics

Consequentialism

34
Q

What is paternalism?

A

A decision made for the sake of someones best interests, against their will.
Doctor acts as sole decision maker in treatment of patient

Soft/weak - patient capacity is unknown
Hard/strong - patient has capacity and ignored

35
Q

What are the issues with paternalism?

A

Interfering with persons autonomy in a free society

Infantalisation of patient in face of doctors superior knowledge

Doctor withholds painful information from patient

36
Q

What are justifications for strong paternalism?

A

Patient at risk of significant, preventable harm, benefits of paternalistic action will outweigh risks

Paternalistic action will prevent harm.

Must be the least restrictive means of achieving the benefits and reduce the risks.

37
Q

What are arguments against animal use in biomedical research?

A
  1. Alternatives to live animal research
  2. Animals cannot give consent
  3. Animals cannot understand nor rationalise suffering
  4. Not all animal trials are successful
  5. Effectiveness of animal research dubious (92% drugs safe in animals fail in humans)
  6. Are medical advances even necessary?
38
Q

What are arguments for animal use in biomedical research?

A
  1. Utilitarian, greater good.
  2. Suffering by omission if research not performed.
  3. Lesser of 2 evils, suffering outweighed by potential good.
  4. Many more animals die for food.
  5. Other options not adequate enough yet to fully replace.
  6. Animal suffering different to human suffering.
  7. Animals cannot give consent under our
    dominion
39
Q

What are the 3Rs for humane experimental technique?

A

Replacement: where possible use alternatives.

Reduction: minimal numbers of animals used.

Refinement of breeding, accommodation and care to minimise suffering.

40
Q

What are 5 rules of ethical human research?

A
  1. Obtain informed consent
  2. Minimise risk of harm to participants
  3. Protect anonymity and confidentiality
  4. Be transparent to subjects
  5. Respect participants right to withdraw
41
Q

Outline principles that allow a GP to speak to a child without a parent.

A

The young person’s best interest allows them to receive treatment without parental consent.
The young person has to be able to understand the professional advice.
The young person cannot be persuaded to inform their parents.

42
Q

How long do you have to register a birth?

A

42 days

43
Q

What rights does a foetus have?

A

A foetus does not have any legal rights until it can survive independently from its mother

44
Q

What is the Congenital Disability Act 1976?

A

Gives rights to a child born handicapped to sue in negligence in limited circumstances - mother exempted

45
Q

What is parental responsibility?

A

All the rights, duties, powers, responsibilities and authorities which by law a parent of a child has in relation to the child and his property

46
Q

Who has parental responsibility?

A

Birth mother by default will always get PR

  • If father married at time of birth/conception - also automatically has PR
  • If not married - father details do not have to be included

Mother can only lose PR if child is adopted

47
Q

What is a parental order?

A

A court order which makes the intended parent/s the legal parent/s, giving them PR

  • Must be genetically related to a child to apply for a parental order
  • In a relationship where you and your partner are either married or living as partners
  • Must have child living with you
48
Q

How can an unmarried father gain parental responsibility?

A

Marrying the mother
Having his name registered
Obtaining a parental order
Becoming Childs guardian on mothers death

49
Q

What is the legal role of a doctor in patient death?

A

Establish and confirmation of death

Fill out medical certificate as to COD

50
Q

When should the death be referred to a coroner? (Notifications of Deaths Regulations)

A
  • Identify of person unknown
  • No attending doctor to complete MCCD
  • Violence, trauma, or injury
  • Self harm
  • Neglect
  • Injury or disease attributable to any employment
  • Undergoing treatment or procedure of a medical or similar nature
  • Poisoning
  • Exposure to toxic substance
  • Death in custody or otherwise state detention
  • Death may be suicide
  • Use of medicinal product, controlled drug or psychoactive
  • Unnatural but does not fall within any other category
51
Q

Who can certify a death?

A

Statutory duty of the doctor who attended in the last illness to complete

- Doctor who cared for patient during illness that led to death
- Must be familiar with PMH, investigations and treatment
- Seen the patient in the last 14 days, and the body after death

If there is not a doctor who can fulfil the above - death referred to HM Coroner

52
Q

What is the role of a medical examiner?

A

Establishes medical cause of death and ensures it is accurately coded in the MCCD.

Detects significant problems in treatment and care, and where necessary reports death to coroner or governance systems.

Increases transparency for the bereaved.

53
Q

What are regulations for a post-mortem if the cause of death is already known?

A

Gain fuller understanding of the deceased’s illness or cause of death and/or to enhance future medical care - NEED FAMILY CONSENT

If death is unknown - does not require family consent to determine death

54
Q

What are the 3 checks before a cremation can occur?

A
  1. Cremation 4 - Doctor who saw deceased in last illness
  2. Cremation 5 - Confirmatory certificate - confirm death, mainly done by ME
  3. Medical referee at Crematoria
55
Q

What is the purpose of a coroners inquest?

A

Establish who the deceased was.
How, when and where they died.

(Cannot deal blame or criminal/civil liability)

56
Q

How long do you have to register a death?

A

5 days

57
Q

What is a regulation 28 report?

A

Report on action to prevent future deaths

Coroner now has a duty to issue a report to public authorities circumstances which pose a risk of future deaths

Copy of the report is sent to the chief coroner who publishes them

58
Q

What are common myths that contribute to vaccine hesitancy

A

Vaccines are ineffective
Vaccines overwhelms immune system
Vaccines commonly cause serious side effects
The disease to be vaccinated against is not serious
A decision that only affects them and their family and not the wider society

59
Q

What are factors for pro-vaccinations?

A

Beneficence - good for the individual
Utilitarian - leads to herd immunity - reduction in general suffering
Non-malificence - unvaccinated are at risk of harm
Justice - compromising herd immunity by refusing to be vaccinated or to vaccinate ones own child is not fair to others
Have saved more lives than abx

60
Q

What are factors for being con-vaccination?

A

Compulsion
Fear of other kinds of harm - side effects of vaccines - non-malificence
Individual freedom more important than herd immunity
Autonomy - right to refuse vaccine on same level with human rights
Distrust of medical profession
Distrust of big Pharma
Loudness of anti-vaxxers

61
Q

Thoughts on vaccination passports?

A

Not everyone can have the vaccine due to allergies or medical conditions
Alienating part of society
Is a health risk so significant to override individual autonomy

62
Q

What are main sources of vaccine hesitancy?

A

Distrust of medical community - big Pharma and doctors
Intrusion of personal autonomy
Andrew Wakefields research - MMR and autism link

63
Q

Why was Andrew Wakefields research discredited?

A

He had a undisclosed conflict of interest - accepted money
Falsified information claiming it had been approved by a research ethics committee - did he have consent from parents/children??
Procedures were invasive and not clearly justified

YEAR 1 (17 decks)

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