Medical Ethics And Law Flashcards
Medical ethics
the application of ethical reasoning to medical decision making’
Medical law
sets down minimum acceptable standards, provides clarity for guidance on rules (better for Doctors in an emergency)
Ethical standards
may set down the reasons as to how one ought to behave, no right or wrong answers
Consequentialism - definition
An action is right or wrong based upon its consequences, rather than the feature of the act itself
• It is ok to do something unethical as long as the ends justify the means
E.G. Organ donation = Presumed Consent (2020)
Consequentialism - problem
- Can something be justified based on the ‘good’ of the many, how does this affect the minorities
- Can all actions be based off the consequence
Deontology - definition
→ It is the intention behind an action, rather than the consequences, that make the action ‘good’ value of the action
• Nothing should impede autonomy of our free will, no lies/ cohesion
Categorical imperatives
- how would it be (good/bad) if everyone did that action
- treat the patient best
- act as a community
BEAUCHAMP AND CHILDRESS MODEL
A 'common morality' - principles that are respected within societies generally around the world 1. Respect for autonomy 2. Non maleficence 3. Beneficence Justice
Autonomy
- Patients make informed choices, decisions made together with the patient, must respect patient
- ‘first among equals’
Non-maleficence
- One person should not harm another
* All procedures harm in one way but short term harm = long term benefits
Beneficence
- do good for the patient
* Problem = can become paternalistic, who is it beneficial for (finite resources)
Justice
- Equal access to treatment
- Equitable in treating people, some people may need more explaining than others
- Problems of equal access to treatment and resources
Grace framework
Get the whole story
Recognize obligation
Accept responsibilities
Consider consequences
Evaluate character
Consent
- Permission for something to happen, agreement
- Involves patient permission for treatment and investigation
- Doctors are legally and ethically required to gain consent
3 forms of consent
- Written consent = most legally substantiated
- Oral consent = less legally substantiated (ensure it is written in notes)
- Implied consent = least legally substantiated, best avoided
Issues in consent
- To consent/ refused to treatment they must be INFORMED of the risks involved
- Patient must not be coerced, consent must be freely given by patient (issue in power dynamic may want doctor guidance)
- Someone must have the mental capacity to consent (children)
4 groups that can consent
- Adults with capacity = competent adult only can consent for themself
- Adults lacking capacity = they can be provided with treatment in their best interest
- Children lacing capacity = if they don’t have capacity only those with parental responsibility can give consent
- Children with capacity = mature enough to consent (Gillick competence) then they can consent,
Test for capacity
set out in section 2(1) of the Mental Capacity Act 2005:
• person is unable to make a decision for himself if he is unable—
• to understand the information relevant to the decision,
• to retain that information,
• to use or weigh that information as part of the process of making the decision, or
• to communicate his decision (whether by talking, using sign language or any other means).
Refusing treatment
- Competent adult can refuse a lifesaving treatment
- Doctors must respect patient view
- Even after providing consent patients can withdraw consent at any time – they can refuse one treatment but can’t insist on another treatment
Criminal law and med
- Any person who intentionally or recklessly touches a patient without their consent = a crime
- Only a few instance where consent of the victim negates the criminal offence of battery e.g. proper medical treatment
- Policy reasons why criminal law only tends to be used in the medical profession in rare occasions
Civil law and med
• Tort of battery/ tort of negligence
• Battery sounds more like a criminal offence
• Negligence give judges better control of scope with Bolam test (determine if the act was reasonable)
1. Did patient consent
2. Was info provided considered appropriate by a respectable body of medical opinion
3 parts of valid consent
- Patient must be fully informed
- Patient must be competent to provide consent
- Consent must be provided voluntarily (without coercion)
Informed consent
To give valid consent patient must be fully informed about:
1. Nature of treatment/investigation being proposed 2. Why it is needed 3. How the procedure will be performed 4. Risks and benefits of procedure – including side effects 5. Alternative treatments available 6. Likely success
3 situations When treatment can be given without consent
- Emergency situations with an incompetent adult
- In patients who are mentally ill
- Children less than 16 years
Confidentiality
the principle of keeping secure and secret from others, information given by or about an individual in the course of a professional relationship,
3 data categories of confidential info
- Demographic – name, address, contact details and NHS number
- Administrative – details of appointments, whether they are waiting for a place in a health care setting (care home/ hospital)
- Medical – info on symptoms, diagnosis, weight, medicines, treatments and allergies
Anonymised
clinical/administrative info is separated from details that can be used to identify patient (name, dob etc.)
But even where identifiers are missing, when a disease is rare or only occurs in small numbers within a population individuals may still be identified. A combination of items increases the chances of patient identification
Pseudoymised
patient identifiers are substituted with a pseudonym code or other references so the data is only identifiable to the people who know the code/ reference. People who are just using the data have no way to identify individual from the data they have
Medical records
are owned by the doctor, property of the doctor, sometimes record can be kept from patients for their best interests e,g to avoid test results or child trauma.
