Medical Ethics and Law 1 Flashcards
Four domains of the GMC’s Good Medical Practice
Knowledge, skills and performance
Safety and quality
Communication, partnership and teamwork
Maintaining trust
GDPR
New General Data Protection Regulations
Based around 6 data protection principles and provides a range of rights for individuals
Personal data is defined by the GDPR as…
any information related to an identified or identifiable natural person
The data protection principles of GDPR state that personal data must…
Be processed lawfully, fairly and in a transparent manner
Be processed for specified, explicit and legitimate purposes and not in any manner incompatible with those purposes
Be adequate, relevant and limited to what is necessary in relation to the purposes
Be accurate and up to date
Must not be kept for longer than is necessary
Be secure
Situations in which confidentiality can be breached
With the patient’s consent With other medical practitioners in the patient’s interest Statutory requirements* (e.g. in court) Protection of other persons** In the public interest*** Child abuse
- prevention, detection and prosecution of serious crime
- *e.g. if someone has been assaulted, the attacker may assault someone else so the police should be told
- **terrorism, murder, culpable homicide, rape
The GMC is regulated by…
The Professional Standards Authority
Responsibilities of the GMC
To produce the medical register (its membership)
To oversee and certify the appropriateness of medical education
To ensure doctors are fit to practice (by publishing Good Medical Practice - its ethical and professional guidance)
Medical negligence
A lack of reasonable skill and care as a result of which the patient suffers
Consequentialism teaches that…
The moral worth of an action is determined by its outcome
Deontology
The opposite of consequentialism
The morality of an action is based on weather the action itself is right or wrong
Utilitarianism
A type of consequentialism
Aims to maximise pleasure/ happiness and minimise pain/ unhappiness for the individual and society as a whole
“the greatest good for the greatest number”
Autonomy
definition and concepts based on it
Promotes the right to self determination
the basis for confidentiality, informed consent and capacity
Considerations within the principle of justice
Fairness/equity (e.g. non-discrimination)
Individual vs. population (e.g. rationing, there are finite resources in the NHS)
The law
When does life begin according to the HFEA (human fertilisation and embryology authority) act?
At 14 days when the primitive streak appears
Before this point the embryo could divide to form twins so cannot be considered ONE life
After this point embryo testing cannot be performed
UK age of viability
24 weeks
birth before = miscarriage
birth after = preterm birth (so must resuscitate)
Euthanasia definition
the deliberate taking of another person’s life to relieve their suffering
Assisted suicide definition
the situation where a competent person ends their own life but with the assistance of another person to perform the act, for example by providing the means to do so
advanced decision
details treatment refusal where it would not be possible to communicate wishes
Treatments being refused and the situation must be named
Legally binding
Advanced statement
explains wishes by talking or writing about them to anyone involved in your care or family
Not legally binding
a secret agreement made between clinicians and family members to hide the diagnosis of a serious or life-threatening illness from the patient.
Collusion
DNACPR forms are…
aND THEIR PURPOSE
Not a legal document
A record of a decision
Provide guidance for clinicians who may not know the patient
(patients must be aware or relatives if patient lacks capacity)
Legality of withdrawal of treatment
Patient’s decision IF THEY HAVE CAPACITY
(continuing unwanted treatment is a criminal offence)
IF NO CAPACITY - it is the doctor’s duty to treat in the patient’s best interests
(this can mean withdrawing treatment if it is not able to provide a quality of life the patient would find acceptable)
When is “letting die” medically acceptable?
- Medical technology is USELESS
- treatment would be futile/ unnecessarily burdensome - Patient validly REFUSES medical technology
* If neither of the above is satisfied = medical negligence
the act of deliberately ending a person’s life to relieve suffering
Euthanasia
the act of deliberately assisting or encouraging another person to kill themselves.
Assisted suicide
- physician assisted suicide involves a doctor prescribing lethal drugs
The mental health (care & treatment) (Scotland) act 2003 provides…
Civil compulsory powers to…
- detain
- assess
- treat
What ages can be detained under The mental health (care & treatment) (Scotland) act 2003?
Anyone but if <18…
need child/adolescent specialist
An emergency detention certificate (EDC)
Authorises detention for up to 72 hours
A short-term detention certificate (STDC)
Authorises detention for up to 28 days
Compulsory Treatment Order (CTO)
Authorises detention for up to six months
Nurses holding power
Authorises detention for up to two hours
Criteria for detention under The mental health (care & treatment) (Scotland) act 2003.
All must apply to legally detain a patient
(there is some variation btw the orders but in general…)
Mental disorder
Significant impairment of Decision making ability (SIDMA) for medical treatment about mental disorder
Significant risk to health, safety or welfare of the person or safety of any other person
Treatment available
Order necessary
Does The mental health (care & treatment) (Scotland) act 2003 cover treatment for physical disorders?
Medical treatment for an unrelated physical disorder is not authorised by the Act.
Treatment for a physical disorder (e.g. head injury, chest infection) that is directly causing the mental disorder would be authorised
(Otherwise, consider use of Adults with Incapacity (Scotland) Act 2000)
Criteria for clinical assessment of capacity
Communication - can they communicate through any means? Understanding - can they weigh the evidence? Retention of information - "what did I tell you?" Decision - is the decision clear and consistent?
The Adults with Incapacity (Scotland) Act 2000 allows intervention in what areas?
Welfare
Financial and property
Physical illness
a way to understand whether a service is meeting defined standards of best practice
A clinical audit
“does this service reach a predetermined standard?”
a way to define or measure current practice within a service
A service evaluation
“what standard does this service achieve?”
The role of the Research Governance Framework is to…
improve research quality and safeguard the public
by:
enhancing ethical and scientific quality
promoting good practice
reducing adverse incidents and ensuring lessons are learned
forestalling poor performance and misconduct
What must you do before you begin a study?
Find a research sponsor
Get ethics approval through an ethics review by NRES research ethics committees
Apply through the integrated research application system (IRAS)
Get research and development (R&D) approval
Examination of a victim or accused of sexual assault
Retain clothing from incident
Establish points of contact
Swab for saliva, semen, blood
Comb head hair and pubic hair
fingernail swabs +/- clippings
Document injuries (may be defensive injuries e.g. scratches)
Samples for toxicology (e.g. drugs/alcohol)
Examine skin around genitalia and anus
Sexual swabs (of vulva, vagina, cervix, penis, buttocks, anus, rectum)
Document and photograph
Sexual Offences (Scotland) Act 2009 introduces the offences of…
“Sexual assault by penetration”
- If a person with any part of their body or anything else without consent penetrates the vagina or anus.
and
“Other sexual offences”
(both are centred around lack of consent)
“Other sexual offences include…
Sexual assault
Sexual coercion
Coercing a person into being present during a sexual activity
Coercing a person into looking at a sexual image
Communicating indecently
Sexual exposure
Voyeurism
How to protect yourself against complaints
Join a defence organisation
Be aware of the local complaints procedure
Be aware of the GMC’s advice in “Good Medical Practice”
Always try to act in the patient’s best interests
Do not be judgemental
Clinical audit
Peer review
Act responsibly
Do not break the law
The New Scottish Complaints Procedure from 1st April 2017
The complaints officer decides if a complaint can be dealt with informally
If so it should be dealt with successful (as far as the complainer is concerned) within 5 days
If using a formal procedure, must acknowledge within 3 working days
Then give a full response (written, verbal or meeting) within 20 days
Note that if they are dissatisfied they can contact the complaints officer again or go to the Public Services Ombudsman
*Must comply with the Patients Rights Act
Patient’s rights under the Patient’s Rights Act.
Patient’s have the right to…
Have any complaint dealt with and properly investigated
To know the outcome of any investigation into their complaint.
To take their complaint to the independent Health Service Ombudsman if they are not satisfied with the way their complaint has been dealt with by the NHS.
To make a claim for judicial review if they think they have been directly affected by an unlawful act or decision of an NHS body or individual
compensation where they have been harmed by negligent treatment
What do NRES Research Ethics Committees (NRES RECs) review?
Relevance of trial Trial design Risks and benefits Protocol Suitability of the investigator and supporting staff Quality of the facilities Subject information Consent procedure Justification for including minors or adults unable to give informed consent Insurance/ indemnity Rewards or compensation for investigators and subjects Subject recruitment
