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bHCE > Legal and Ethical Issues > Flashcards

Legal and Ethical Issues Flashcards

1
Q

What are the principles of medical ethics?

A

autonomy

beneficence

non-maleficence

justice

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2
Q

What is the first principle one should follow when assessing capacity?

A

You must assume the pt has it

until proven otherwise

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3
Q

What must a pt have first to be assumed not to have capacity?

A

a disturbance of the mind or brain

and it must be stated what this is

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4
Q

Once the first criteria is met, what then must be the case for the pt to not have capacity?

A

The pt must be unable to make the decision at that TIME

as capacity can fluctuate

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5
Q

What four things must a patient be able to do for them to have capacity?

A

1) Understand the info
2) Retain the info
3) Use the info in their decision making
4) Communicate their decision

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6
Q

What is the single test for capacity?

A

NO single test exists

as capacity is task specific

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7
Q

What must a person be able to do to be said to have testamentary capacity (i.e. make a will)?

A

They must know:

The extent of their property

Who their blood relations are

Extent of their material/other assets

AND they must be able to make a reasonable judgement

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8
Q

What are the five main principles of the Mental Capacity Act 2005?

A

A presumption of capacity

Right for individuals to be supported to make their own decisions

Must not assume no capacity due to unwise or eccentric decisions

If lack capacity, decisions must be done in their best interests

If lacks capacity all options must be considered before a decision is made AND must choose least restrictive option

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9
Q

Regarding least restrictive options what does the restriction relate to?

A

The pts basic rights

and freedoms

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10
Q

When making a best interests decision how many options must you consider?

A

2 or more

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11
Q

What must you take into account when making a best interests decision?

A

Previous + current views, beliefs and values

Those who know the person: family, carers, appointees

Take a participatory approach with pt

Least restrictive option

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12
Q

Other than capacity itself what are the other provisions of the MHA 2005?

A

Independent Mental Capacity Advocates (IMCA)

The Court of Protection

Advance Decisions to Refuse Treatment (ADRT)

Lasting Powers of Attorney (LPA)

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13
Q

What are the factors a pt must have to make an advance directive to refuse treatment (ADRT)?

A

Over 18

Must have had necessary capacity

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14
Q

What types of procedure can an advance directive to refuse treatment (ADRT) apply to?

A

any medical, surgical or dental treatment

when the pt is not able to give or refuse consent

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15
Q

Is a pt able to ask for specific treatments with an advance directive to refuse treatment (ADRT)?

A

No it is only for pts to refuse treatment not demand it

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16
Q

Is an advance directive to refuse treatment (ADRT) legally binding?

A

No but it must be taken into consideration

17
Q

What are the two types of lasting power of attorney (LPA)?

A

Financial + property LPA

AND

Health and welfare LPA

18
Q

With whom must a LPA be registered with?

A

Office of the public guardian

19
Q

What is the condition that only applies to health and welfare LPAs?

A

They can only be used once the person loses capacity

20
Q

When must LPAs be made?

A

Whilst the person has capacity to make that decision

21
Q

What is the independent mental capacity advocate (IMCA) service?

A

A service that provide people with advocates

if they lack the capacity to make specific important decisions

If they have no family or friends

22
Q

In what circumstances may an independent mental capacity advocate (IMCA) be used even when the person has a family member or friends?

A

If the family member or firend has abused the pt

23
Q

What are included in the umbrella term “specific important decisions” relating to the IMCA service?

A

If the decision is in connection with serious medical treatment

OR

Before placing a person in either

hospital for >8 weeks

or

in accomodation for >28 days

24
Q

What is the court of protection?

A

A specialist court for those who lack capacity

25
Q

The court of protection can appoint deputies in best interests for what things?

A

Property

Financial affairs

Health and welfare

26
Q

What is the aim of deprivation of liberty safeguards (DOLS)?

A

Parts of the MHA

that aim to protect people who lack capacity

from being inappropriately deprived of their liberty

27
Q

What are deprivation of liberty safeguards (DOLS)?

A

A thing that is in place to be used to deprive a person of their liberty

lawfully

when they lose capacity

28
Q

Give 2 examples of a deprivation of liberty safeguards (DOLS)?

A

Medication being given against a person’s will

Staff restricting a person’s access to friends or family

29
Q

Do pts with early dementia generally say they would wish to be informed? (an what do those that have been told say)

A

Yes they would like to be informed

and those that have been told say it is preferable

30
Q

What are the positives of telling a pt they have dementia?

A

Helps ascertain treatment preferences

Make a Will/LPA/Advance Directive

Helps plan for disability

“a right to know” their diagnosis

Better support and access to help psychological adjustment

31
Q

What should be used to assess driving in people with dementia?

A

The SAFE DRIVE checklist

S afety record
A ttention skills
F amily report
E thanol use
D rug use
R eaction time
I ntellectual impairment
V ision and visuospatial function
E xecutive functions
32
Q

Who is a patient with dementia obliged to tell about their diagnosis?

A

DVLA

their insurance company

33
Q

What is the DVLA’s role in dementia and driving?

A

They will investigate GP and psych reports

And they might assess the pt themselves

34
Q

What are the two possible outcomes of informing the DVLA that a pt has dementia?

A

Valid driving licence for 1 year

Licence revoked

35
Q

What should a doctor do if they beleive a pt has not told the DVLA?

A

Ultimately if the pt is not telling the DVLA

the doctor must break confidentiality and inform the DVLA

bHCE (18 decks)

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