Medical ethics Flashcards
What is consequentialism?
The moral worth of an action is determined by its outcome
What is deontology?
Duties, “right + wrong” actions, absolute values
What is Utilitarianism?
Look at benefits and harms to individuals + society as a whole
Looks at consequences
What are the duties of a doctor?
Make care of patient first concern
Respect right of patients to be involved in care
Reconise limits of own professional competence
Act quickly to protect patients from risk if you have reason to believe you or another may cause harm/be unfit to practice
Avoid abusing position
Be honest & trustworthy
Listen & treat equally
Protect confidential information
What are the four principals of medicine?
Respect for autonomy
Non-malfeasance
Beneficence
Justice
What is autonomy?
medicine of self-determination
Confidentiality
Informed consent
Promote capacity
What is non-malfeasance?
Avoidance of harm
What is beneficence?
To do good
What is justice?
Fairness/equity
Individual vs population
Recognise give one person super drug or 1000 people normal drug
What is consent?
Any adult with sound mind has absolute right to determine what is done with their own body
Doctor performing surgery without consent is commiting assault or battery
Patient must be given enough information to come to a decision whether they wish treatment to be carried out
What does a negligence claim require?
Causation with forseeable damange
The burden of proof on claimant
Requires failure of duty
What does a lack of consent claim require?
Failure to gain consent - requires burden of proof on claimant plus demonsatrion of valid process by defendant
Does not need causation
Does not matter if correct procedure/carried out correctly
What are the prinicapls of the mental capacity act (england)
People assumed to have capacity until prooved otherwise
Only treated as unable to make a decision if all steps have been taken without success
People not to be treated as unable to make decisions if they make unwise decisions
Any decisions under act must be done in their best interest
What is the process for gaining consent?
Adjudge competency if any doubt
Must give patient sufficient information in a language they understand so they can come to a rational decision
Do not have to give so much information they would not have treatment
Must obtain consent for treatment AND delivery method
How do you judge competency?
Need evidence that patient can undeerstand both the information given and the consequences it heralds
Evidence that they can make reasonable choices based on rationality (not randomness)
Under the Scottish adults with incapacity act, when will there be intervention?
When the person responislbe is satisfied that the intervention will benefit the adult
AND cannot be reasonably achieved without that intervention
Must be least restrictive
Whos views should be taken into account in an adult with incapacity?
Past/present wished of adult
Nearest family members + primary adult
Any guardian/legal representative
What is the function of the mental welfare commission?
Exercising protective function in respect of adult
Visit adult and bring attention to relative authorities
Whar is Gillick (fraser) competency?
That children can consent as long as they can show the maturity and intelligence to understand the nature of treatment, options, risks involved and benefits
Parents cannot overrule this
What is professionalism?
A set of values, behaviours and relationships that underpins the trust the public has in doctors
What are the five times you can break confidentiality?
Consent and patients Court order Statutory obligation Public interest Best interest
What is public interest disclosure?
If you think that not disclosing information would lead individuals or society to a risk so serious that it outweighs patient + public interest in confidentiality
You should tell patient first if it’s practical and safe to do so
What are the problems with social media?
Confidentiality Denigration Defamation Crime Pt making negative comments of facebook
What are the roles of the GMC?
Setting standards for doctors
Overseeing doctors education/training
Managing the UK medical register
Investigating and acting on concerns about doctors
Helping to raise standards through revalidation
How do you respond to complaints?
Constructively and honestly
Co-operate with any complaints procedure
Must not prejudice patients care because of complaints
When appropriate offer an apology
Identify each reason and respond to them. Explain valid concerns from happening again
What is the procedure for a complaint?
Local compaint Discipilanry action from eemployer Civil claim Medical council Criminal prosecution
Why do patietns sue?
Predisposing factors of rudeness, inattentiveness, micomunication
Precipitating events - adverse outcome, iatrogenic injury, incorrect care, system erroes
Often poor communication
What process should one go through when communication go wrong?
Meet patient/family Try to see their perspective Explain Be courteous, objective and professional Apologise when appropriate
What factors contribute to resilience?
Being female
Personal behaviour
Medictation, exercise. work life balance
Asking for help
Cognitive (belief, self reflection, mindfulness)
Professional values
What are the four domains to good medical practice?
Knowledge, skills and performance
Safety and quality
Communication, partnership and teamwork
Maintianing trust
What is considered personal data?
Any information relating to an identified or indetifiable naural person - directly or indirectly
I.e name, ID number, or physical genetic mental etc idenity of the person
What are the protected characteristics of the equality act?
Age Disability Gender reassignment Marriage and civil partnership Pregnancy/maternity Race Relgion or belief Sex Sexual orientation
How do you protect yourself from complaints?
Join a defence union Be aware of and follow GMC's advice "good medical practice" Be aware of local complaints procedure Put patients first - act in their best interest Do not be judgmental Don't be afraid to get a second opinion Clinical audit Peer review Act responsibly Don't break the law
What is the complaint procedure?
In a formal procedure have 3 days to acknowledge complaint
Determine what the response requires
Give full response in 20 days unless impossible (must let patient know and why)
Must let them know they can contact others if still unsatisfied
If remain unsatsfied sugest mediation
DOCUMENTATION very important
What is the difference in the scottish and rest of UK complaints procedure?
Have a period of 5 days for complaints officer to decide if imformal complant might be better
Must tell complainer and hair their agreement
Documentation still imporant
Also prudent to respond within 3 days of recieving complaint
What are the rights of a patient in the complaints procedure?
Any complaint is dealt with effciently and properly investigated
To know the outcome of any investigation
Take their complaint to Ombudsman if unsatisfied with way NHS deals with complaint
Claim for judicial review if directly affected by unlawful act/decision
Right to compensation if harmed by negligent treatment
Can patients demand treatment?
If they doctor does not think it indicated then no, although they can get a second opinion
Can refuse but cannot demand specific treatments
When is someone deemed incapable?
When they are incapable of: Acting Making decisions Communicating decisions Understanding decisions Or retaining memory of decisions
Who are considered bulnerable groups?
Vulnerable adults
Mentally compromised
Children
What is adult abuse?
Single or repeated act or lack of appropriate actions occuring within any relationship where expetation of trust
Causing harm to vulnerable person
What is a vulnerable adult?
18+ in need of community care by reason mental or other diability age or illness
Unable to care for self
What are the risk factors for abuse?
Increasing age Lack of mental capacity Physically dependant on others Low self esteem Previous history of abuse Negative experiences disclosing abuse Social isolation Lack of access to health and social services or high quality information
What are the main types of abuse?
Physical Sexual Pyschological Financial or material eg theft, fraud pressure in wills etc Neglect/act of omission Discrimatory abuse Domestic Oganisational
What are the principles for safeguarding?
Empowerment Protection (support) Prevention Proprtionality Partnership Accountability
What is an adult at risk?
Adult unable to safeguard own well-being, property, rights or other interest
At risk of harm
And because they are affected by disability, mental disorder, illness or physical/mental infirmity are more vulneral to being harmed
Who should be informed regarding concern of risk of abuse?
The local service responsible for safeguarding
England and wales have local safeguarding investigation team
What is the process if you suspect an adult at risk?
Discuss with a senior
Document concerns
Report to relevant authority
What are some examples of the lasting effects of child abuse?
Lack of trust and relationship difficulties
Feeling worthless
Trouble regulating emotions
What are the types of child abuse?
Emotional child abuse
Child neglect
Physical
Sexual abuse
What is emotional child abuse?
Constant belitting, shaming and humiliating child
“no good” “worthless” “mistake”
Frequent yelling, threatening or bulying
Ignoring or rejecting child as punishment
Limit physical contact with child
What is child neglect?
Failing to provide for a child’s basic needs
What is physical child abuse?
Physical harm
May be deliverate, but not always
What is the difference between discipline and abuse?
Abuse has unpredictability - never knowing what will set parent off
Abuse - lashing out in anger and control, not trying to teach child
Abuse - uses fear to control behaviour
What is sexual abuse?
Has layers of guilt and shame
Does not always involve body contact
Exposure to sexual situations or material
Most often at hands of someone they trust
What are the signs of emotional abuse in children?
Excessively withdrawn, fearful or ancious about doing something wrong
Shows extrmes in behaviour - compliance, demanting, passive or aggressive
Seemingly unnatached to parent/caregiver
Acts inapproriately adult like or infantile (takijng care of other children vs tantrums etc)
What are the signs for physical abuse in children?
Frequent injuries
Watchful/alter as if something is about to happen
Injuies have patterns
Child shies away from touch/sudden movements. Afraid to go home
Wears inapproriate clothing like long sleeves on hot days to ocver up
What are the signs of neglect/child abuse?
Clothes illfitting or filthy
Hygiene constantly bad (unbathed, matted/unwashed hair noticable body oder)
Untreated illness/injury
Frequently late or missing from school
What are risk factors for child abuse/neglect?
Untreated mental illness
Domestic violence
Substance abuse
Lack of parenting skillsStress and lack of support
What are the key points in reporting suspected child abuse?
Keep good, full contemporaneous records
Dsicuss concerns with colleagues
Discuss concerns with GP
Take advice from defece organisation
Report case to social services if GP doesn’t
Follow up actions by colleagues, doctors and social services
When may you discolse information about communicale diseases?
In the case of a serious disease that a patient has come in to contact with
If you believe that a peron is at risk of infection and likely to result in serious harm
AND patient has not told them nor be persuaded to do so
