Legal and Ethical Issues Flashcards
What are the principles of medical ethics?
autonomy
beneficence
non-maleficence
justice
What is the first principle one should follow when assessing capacity?
You must assume the pt has it
until proven otherwise
What must a pt have first to be assumed not to have capacity?
a disturbance of the mind or brain
and it must be stated what this is
Once the first criteria is met, what then must be the case for the pt to not have capacity?
The pt must be unable to make the decision at that TIME
as capacity can fluctuate
What four things must a patient be able to do for them to have capacity?
1) Understand the info
2) Retain the info
3) Use the info in their decision making
4) Communicate their decision
What is the single test for capacity?
NO single test exists
as capacity is task specific
What must a person be able to do to be said to have testamentary capacity (i.e. make a will)?
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
What are the five main principles of the Mental Capacity Act 2005?
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
Regarding least restrictive options what does the restriction relate to?
The pts basic rights
and freedoms
When making a best interests decision how many options must you consider?
2 or more
What must you take into account when making a best interests decision?
Previous + current views, beliefs and values
Those who know the person: family, carers, appointees
Take a participatory approach with pt
Least restrictive option
Other than capacity itself what are the other provisions of the MHA 2005?
Independent Mental Capacity Advocates (IMCA)
The Court of Protection
Advance Decisions to Refuse Treatment (ADRT)
Lasting Powers of Attorney (LPA)
What are the factors a pt must have to make an advance directive to refuse treatment (ADRT)?
Over 18
Must have had necessary capacity
What types of procedure can an advance directive to refuse treatment (ADRT) apply to?
any medical, surgical or dental treatment
when the pt is not able to give or refuse consent
Is a pt able to ask for specific treatments with an advance directive to refuse treatment (ADRT)?
No it is only for pts to refuse treatment not demand it
Is an advance directive to refuse treatment (ADRT) legally binding?
No but it must be taken into consideration
What are the two types of lasting power of attorney (LPA)?
Financial + property LPA
AND
Health and welfare LPA
With whom must a LPA be registered with?
Office of the public guardian
What is the condition that only applies to health and welfare LPAs?
They can only be used once the person loses capacity
When must LPAs be made?
Whilst the person has capacity to make that decision
What is the independent mental capacity advocate (IMCA) service?
A service that provide people with advocates
if they lack the capacity to make specific important decisions
If they have no family or friends
In what circumstances may an independent mental capacity advocate (IMCA) be used even when the person has a family member or friends?
If the family member or firend has abused the pt
What are included in the umbrella term “specific important decisions” relating to the IMCA service?
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
What is the court of protection?
A specialist court for those who lack capacity
The court of protection can appoint deputies in best interests for what things?
Property
Financial affairs
Health and welfare
What is the aim of deprivation of liberty safeguards (DOLS)?
Parts of the MHA
that aim to protect people who lack capacity
from being inappropriately deprived of their liberty
What are deprivation of liberty safeguards (DOLS)?
A thing that is in place to be used to deprive a person of their liberty
lawfully
when they lose capacity
Give 2 examples of a deprivation of liberty safeguards (DOLS)?
Medication being given against a person’s will
Staff restricting a person’s access to friends or family
Do pts with early dementia generally say they would wish to be informed? (an what do those that have been told say)
Yes they would like to be informed
and those that have been told say it is preferable
What are the positives of telling a pt they have dementia?
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
What should be used to assess driving in people with dementia?
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
Who is a patient with dementia obliged to tell about their diagnosis?
DVLA
their insurance company
What is the DVLA’s role in dementia and driving?
They will investigate GP and psych reports
And they might assess the pt themselves
What are the two possible outcomes of informing the DVLA that a pt has dementia?
Valid driving licence for 1 year
Licence revoked
What should a doctor do if they beleive a pt has not told the DVLA?
Ultimately if the pt is not telling the DVLA
the doctor must break confidentiality and inform the DVLA
