medical ethics Flashcards
Ethics
The body of moral principles or values governing or distinctive of a particular culture or group
What are some things which compromise ethics?
principles
values
honesty
morality
our attitudes, behaviours and relations to one another
consequentialism
the moral worth of an action is determined by its outcome
deontology
duties - right and wrong actions
absolute values
utilitarianism is a type of what?
consequentialism
utilitarianism
look at benefits/harms to individual and society
look at the consequences
greatest good for greatest number of people
maximise happiness and minimise pain
Autonomy
promote the right to self determination
How can we achieve autonomy?
confidentiality
informed consent
promote capacity
Non malfeasance
the avoidance of harm
Beneficence
to do good
Justice
fairness/equity
individual and population
How can we achieve justice?
non discrimination
equal treatment for equal need
rationing
limits to autonomy
non-judgemental approach
it does not matter how the patient got his/her condition or complaint
Duty of candour
open and honest with patients when something goes wrong with treatment/care which causes or potential to cause harm or distress
What must you do in relation to the duty of candour?
apologise to patient
offer appropriate remedy to put things right
explain consequences
What is a complaint according to the NHS?
expression of dissatisfaction
that requires a response
How do you protect yourself from complaints?
join defence organisation
GMC - good medical practice
act responsibly
listen to patent and put them first
First step with a complaint
complaint officer deal with it and may interview you
5 days
If complaint dealt with formally how long do you have to acknowledge?
3 days
How long to give a FULL response to a complaint
20 days
Who can patient complain if dissatisfied with response
complaint officer again
OR public services ombudsman
Patients rights under the NHS legislation - complaints
complaint dealt with efficiently and properly investigated
know the outcome of complaint
take complaint to public services ombudsman if not satisfied
claim for judicial review
compensation
resilience
ability to withstand and bounce back from adversity
4 character traits influencing capacity for resilience
self directedness
co-operativeness
harm avoidance
persistence
character trait with strongest correlation with resilience
self directedness
self-directedness
conscientious, resourceful and goal orientated
accept responsibility for mistakes
co-operativeness
accept opinions and behaviours of colleagues even if different to own
harm avoidance
low harm avoidance - more decisive and less anxious
accept degree of risk
persistence
maintain behaviour with stamina despite frustration, fatigue or discouragement
?perfectionism
predictors of resilience
personality previous adversities coping strategies work load culture
factors contributing to resilience in doctors
female
relaxation, exercise
spirituality
mindfulness
professionalism
set of values, behaviours and relationships which underpins the trust the public has in doctors
Characteristics of professionalism
expertise standards respectability responsibility and reliable probity conduct respect integrity
Roles of GMC
setting standards for doctors overseeing doctor education and training investigate and act on concerns raise standards through revalidation managing UK medical register
What can medical student concerns lead to?
fitness to practice procedure
Examples of things in medical school which can lead to fitness to practice procedures
criminal convictions alcohol misuse sharing exam questions with others sign peers into sessions plagiarism
Forms of consent
implied expressed consent verbally expressed consent in writing informed consent - not in UK rational consent
Bolitho principle
panel of doctors on consent cases decide whether they would have done the same as the defendant
Pearce principle
where an average person would expect to be told about the risk they should be told
When do patients not have capcity?
unable to make, remember, communicate, understand of act on decisions
What should be taken into account when making decisions for someone with incapacity?
past and present wishes
views of relevant others
Who can consent?
person with capacity
parental of child with parental responsibility
court for a child
doctors - incapacity
Competency over what age?
12
public guardian
property and financial affairs within court case
mental welfare commission
welfare within court case
continuing power of attorney
finance and property
welfare attorney
welfare
Gillick competency
16 years - legal capacity - surgery, treatment
opinion of qualified medical practitioner
understand nature and possible complications
advanced directives
person’s wishes for treatment in future life if become incapacitated
English/welsh/scots law - literally or purposively
E+w = both
scots is just purposively
Can an FY1 fill out DNACPR?
no
Euthanasia and physician assisted suicide - legal or illegal?
illegal
doctrine of double effect
must not intend to hasten death
may in certain circumstances administer treatment that will hasten death
Informing about an abortion
notify chief medical officer within 14 days
adoption
legal contract - birth mother will not be able to contact child
fostering
no legal contract - may be able to take over caring responsibilities for her child
suicide act
1961 - suicide is illegal
GMC - serious communicable diseases
person is at risk of infection which will result in serious harm
patient not told them and does not want to
