Legal + Ethical Issues

Question 1

4 Ethical pillars of medicine

Answer 1

1. Beneficence
2. Autonomy
3. Maleficence
4. Justice

Question 2

What is capacity

Answer 2

Ability to make own choices + decisions

Question 3

What are some principles of capacity

Answer 3

1. It is time + decision specific
2. Always presume capacity
3. Individuals should always be supported to make their own decisions
4. People are allowed to make their own decisions
5. All decisions must be in the pts best interest
6. In the event someone lacks capacity, all options mist be considered before a decision is made + decision must be the least restrictive option

Question 4

How do you determine capacity

Answer 4

1. does Pt have impairment/disturbance in mind/brain?
2. If yes, does this mean that the patient is unable to make a decision at the time if required?

if yes:

Patient must not be able to do any of these 4 things to be deemed without capacity:

1. Understand what they’ve been told
2. Retain the information
3. Weigh up risks and benefits
4. Communicate that decision back

Question 5

When may capacity be questioned

Answer 5

Refusal of treatment 
Pt wants to go home w/ no support but can't cope
Puts self at risk
Pt is confused
Family members worried over cognition

Question 6

What is an advance directive to refuse treatment

Answer 6

Refusal by an >18 y/o w/ necessary capacty to extend life if treatment is required in the future + they don’t have capacity.

Not legally binding

Only relevant in absence of capacity

Question 7

Lasting power of attorney

Answer 7

Financial Welfare
Person appointed ahead of time to make decisions when patient can’t
2 types: property/finance + health/welfare
Must be registered

Question 8

What is the independent mental capacity advocate service

Answer 8

Service for when no-one can advocate for a patient that lacks capacity
May only speak for pt, not make decisions
Must seek advice in connection with serious medical treatment

Question 9

What is the court of protection used for

Answer 9

Court for those who lack capacity, appoints deputies to make decisions in best interests

Question 10

What are deprivation of liberty safeguards and when should they be used

Answer 10

Form/Legal request to restrict someones liberty, allows restriction + restraint but only proportional to harm being sought to be prevented

Only should be used for restraint to treat a PHYSICAL problem in someone without capacity

Question 11

How do you assess driving ability in dementia

Answer 11

SAFE DRIVE checklist

Safety record
Attention skills
Family report
Ethanol use

Drug use
Reaction time
Intellectual impairment
Vision/visuospatial function
Executive function

Question 12

What are the legal obligations for driving post dementia diagnosis

Answer 12

Patient must inform the DVLA of diagnosis, then it is up to the DVLA to investigate further

Bus/Lorry = Instant disqualification
Car/Bike = Case by Case basis