Legal Aspects Flashcards
Domain 1 of MRPBA
See something, say something
Assess deteriorating patients
Deliver patient/client care
Identifying urgent and unexpected findings
Taking appropriate and timely action
Potential range of reactions to medicines
Actively monitor the effects of medication and manage adverse reactions
Domain 3 of MRPBA
Make appropriate adjustments to communication style to suit patient need
Active listening and appropriate language and detail: verbal and non-verbal clues
Active listening components
Paraphrasing
Clarifying
Reflecting
Summarising
Legal Aspects of care
Consent
Palliative treatment
Assisted dying
Advance care directing and enduring Power of Attorney
How is consent valid
- The patient has the capacity to make a decision about the specific issue
- the consent is given voluntarily, free from manipulation or coersion
- the discussion between the patient and healthcare practitioner is transparent and involves two way communication
- the patient is able to clearly understand the information (it is provided in a manner the patient can understand)
- The information provided and the consent given relate to the specific health care provided
- The patient has sufficient to consider and clarify information
What is implied consent?
Patient indicates their agreement through their actions or by complying with the health care practitioners instructions
Explicit/express consent
Person clearly states their agreement to healthcare
May be verbal or in writing
Can consent be withdrawn?
Any patient who has capacity to consent may also decline any or all health care at any time, even when this is contrary to medical recommendations and in circumstances may result in the death of the patient.
Patient considerations for when consent is withdrawn
Confirm the patient has capacity to make the decision
Check the patient’s understanding and looking for any health literacy or communication issues
Exploring the reasons for the decisions including:
- a refusal or an inability to sign the form
- any cultural or religious conflict that the patient may have
Exploring other health care options that might be acceptable to them
Define informed consent
A persons decision, given voluntarily, to agree to a healthcare treatment, procedure or other intervention that is made
Decision is made with adequate knowledge and understanding of the benefits and material risks of the proposed intervention
Advance care directive
If a person loses the capacity to make the decision → ACD provides instruction that a person has made about future medical treatment/healthcare
Only applies if a person loses capacity
Signed and dated by a health professional who is not witness to the person
If there is an AHD and later an EPOA makes a decision → the AHD will prevail
If there is any uncertainty of the direction → must first consult the substituted decision make - if there is one
Enduring power of attorney
legal document
Outline who you would like to manage your medical affairs when you no longer have capacity
If an EPOA is appointed, and another is appointed down the line → the earlier POA will be revoked
Direction is inconsistent with good medical practice
Circumstances changed
Powers of attorney requirements
- Power over 18 years have capacity
- In writing
- Signed by person/person instructed on behalf of person and not a witness or persons enduring power of attorney
- Witnessed
- Signed and dated by a health professional who is not witness or not connected to the person
Ryan’s Rule
3 step process to support patients of any age, their families and carers to raise concerns if a patients health condition is getting worse or not improving as well as expected
How to evoke ryan’s rule
- Call nurse
- Call doctor
- Evoke Ryan’s rule
Gil lick competent
applies to younger people consent issues
Assessment performed by an eligible health practitioner
Euthenasia
deliberate and intentional act of one person to end the life of another to relieve their suffering
Voluntary (At the request)
Non-voluntary (not competent)
Involuntary (without request)
Paraphrasing
Restate the same information, using different words to more concisely reflect what speaker said
Allows speaker to hear and focus on his or her own thoughts
Allows speaker to see that you are trying to understand the message
Clarifying
Invite the speaker to explain some aspect of what she or he said
Gives the speaker the opportunity to elaborate and clarify what was said.
Gives opportunity to identify anything that is unclear
Reflecting
Relaying what was said back to the speaker to show that you understand how he or she feels about something
Deepens understanding of feelings and content
Allows the speaker to see that you are trying to understand his/her message and perceptions
Summarising
Identify, connect, and integrate key ideas and feelings in what the speaker said
Helps both listener and speaker identify what was most important to the speaer
Active listening - do’s
Listen more than talking
Let the speaker finish before responding
Ask open ended questions
Remain attentive
Be aware of own biases
Manage own emotions
Be attentive to ideas and problem solving opportunities
Give verbal and nonverbal messages that you are listening
Listen for both feelings and content
Active listening- dont’s
Dominate the conversation
Interrupt
Jump to conclusions
Finish the speakers sentence
Respond with blaming or accusatory language
Become argumentative
Demonstrate impatience or multitask
Mentally compose your responses about what to say next
Listen with biases or shut out new ideas
Double Doctrine Effect
only apply when the patient is near death, most critical
element is intention. As long as intention was to relieve the pain and symptoms and
not cause death (although no Court Case in Australia to confirm doctrine – applied in UK, US, Canada and NZ – similar legal systems. In QLD legislation has been introduced to cover version of the double effect.
VAD considerations
Initial discussion
Capacity to make decision
Coercion
Discussing ineligibility
Initial discussion - VAD
What are patients’s concerns
Impact on QOL
Options in solving concerns
Does the patient meet the requirements
Patient needs to make formal request to doctor
Capacity to make decisions - VAD
Does the patient understand
Does the patient retain information
Can the patient use the information
Can they communicate their decision (not necessarily verbally)
Coercion - VAD
VAD decision must be volunatry
Can involve discussions with family and friends but cannot be coerced by their decision
Discussing ineligibility - VAD
Only available for people dying within 6 months
Does not allow people to die whenever they want but gives the patient an option if they meet legal criteria
Patient can access 2nd opinion
Provide patients with other options to improve QOL
When can health professionals be non-compliant to AHD
Direction is inconsistent with good medical practice
Uncertainty of the direction
Circumstances changes - i.e. advances in medical science
What are the principles of VAD in QLD
Value of Human Life
Dignity
- Every person has inherent dignity and should be treated equally and with compassion and respect
Autonomy
High Quality Care and Treatment
Accessibility
Informed Decision Making
Protecting those who are vulnerable
Respect for diversity
How can a VAD substance be legally administered in QLD
Self administration
- Default method of administration
Practitioner administration
- May be followed through if coordinating practitioner deems self administration is inappropriate
What is the role of the coordinating practitioner in the VAD process
Coordinates VAD process and acts as primary clinical contact
Receives the first, second and final requests from the patient
Performs the initial eligibility assessment and the final review
Prescribes the VAD substance
Explain the term Voluntary Starvation
Every competent adult has the right to refuse to eat and drink, and not to be force fed contrary to their wishes.
If a person dies as a result of this → patient will not have committed suicides
Person would have not committed suicide but would have exercised their right to refuse food or drink
Eligibility for VAD In QLD
Must be diagnosed with condition that
- Is advanced and will cause death
- Is expected to cause death within 12 months
- Is causing intolerable suffering
Have decision making capacity in relation to VAD
Be acting voluntarily without coercion
Be at least 18 years old
Australian citizen or permanent resident
What is the process for VAD in QLD
Phase 1: Request and Assessment
- First Request (not considered –> person seeking additional information, person making request to a non medical practitioner)
- First assessment (performed by coordinating practitioner)
- Subsequent Consultation (performed by external practitioner –> now consulting practitioner)
- Second Request (written request)
- Final Request (cannot occur until 9 days have ended since the first request)
- Final Review (coordinating practitioner states patient has decision making capacity)
Phase 2: Administration of VAD substance
- Administration Decision
- Appointing the contact person (anyone over 18; must inform coordinating practitioner once patient dies)
- Prescription of VAD substance
- Supply of VAD substance
- Administration and Patient Death (self administration or practitioner administration)
Phase 3: After patient death
- Disposal of substance
- Death notification (must complete death certificate)
VAD
more commonly used in Australia to refer to the
assistance provided to a person by a health practitioner to end their life. ‘Voluntary’
indicates that the practice is a voluntary choice of the person, and that they are
competent (have capacity) to decide to access VAD.
