MEDICAL ETHICS I: Confidentiality; Negligence; PASuicide; Principles of Ethics & Law; End of Life

Question 1

The definition and meaning of medical confidentiality

Answer 1

• state of keeping or being kept secret or private

Question 2

The moral and ethical obligations of medical confidentiality

Answer 2

• if pt percieves lack of confidentiality: avoid getting help or under-report or omit symptoms/aspects of complaints

Question 3

The legal requirements and restrictions of medical confidentiality

Answer 3

• GMC defined
• legal duty to protect info. from imporper disclosure
• even dead patients
  The moral obligation is clear (and not restricted to medical practitioners), and it extends to children, and indeed to the dead whose medical affairs may only be discussed with appropriate authorities (e.g. next of kin, executor)

*GDPR
- transparent manner of processing personal data. explicit consent
- minimum amount of info
- kept secure and no longer than is necessary
- only share relevant information for direct care, support pt in accessing

*GDPR = pt data is special category data
- explicit consent, processing necessary for public interest, public health, and to protect vital interest of patient
- process necessary for archiving purposes +sci, historical, statistical

Question 4

The circumstances in which medical confidentiality can be breached and their consequences.

Answer 4

• medical certificate of cause of death
• common law:
• no disclosure unless there is legal basis for doing so

-With the patient’s consent
-With other medical practitioners in the patient’s interest
-Protection of other persons
-Child abuse
-In the public interest (terrorism, murder, culpable homicide, rape)
-In the doctors own defence
-Statutory requirements – prevention, detection and prosecution of serious crime
-When directed to by a court of law

Question 5

Understand the way in which the medical profession is regulated

Answer 5

GMC = professions regulator
- responsible for membership (register)
- responsible for appropriateness of medical education = ensure right skills etc.
- ensure fit to practice = good medical practice pub.

Question 6

Understand the legislation that affects doctors

Answer 6

Hunter v Hanley 1955 in Scotland
- test for establishing negligence
- a mistake made by the practitioner must be an error which no competent doctor in that field would have made.

followed simiilarly by Bolam V Friern 1957 England

Question 7

Understand the legal definitions of medical negligence

Answer 7

Medical Negligence can be defined as “ a lack of reasonable care and skill as a result of which the patient suffers”
- monetary award to paatient will reflect financial loss suffered by patient

• actual dmg must have occured

Question 8

Understand the rights of the parties involved in a medical negligence claim, including the doctor and patient

Answer 8

• patients have a right to complain
• legal/professsional responsibiliity to reply

Question 9

Learn how to minimise the risk of negligence and how to deal with such claims and the associated legislation

Answer 9

A

Question 10

Pathway of a complaint

Answer 10

Local Complaints
- respone & apology

Disciplinary action - employer
- appraisal, job planning (, time keeping, absence

Civil claim
- UK NHS Complaints Procedures permit interaction and explanation for patients without need to sue
- no jury in UK thus no blamee culture vs US

• most claims come from non-negligence outcomes or no adverse outcome

Medical Council
- case workers manage complaints
- then case examiners
- cases heard by the tribunaal

Criminal prosecution
-Indecent assault
-Prescription fraud
-Manslaughter
-Murder
-Deception offences

• often medical and clinical negligence and slips are encompassed in civil law, not prison but compensatory fees

Question 11

Civil Vs Criminal Courts

Answer 11

Criminal law essentially relates to offences and breaches that negatively affect society as a whole, rather than just one person

If a person breaches criminal law, they’re subject to criminal prosecution by the state.

Question 12

Examples of losses leading to compensation:

Answer 12

Loss of earnings
Expenses incurred
Impaired enjoyment of life
Permanent incapacity
Procreative incapacity
Pain and suffering endured
Death

Question 13

Vicarious liability

Answer 13

where a person can be heldliablefor the actions of another person (e.g. Health Board can be held responsible for the actions of the docto

Question 14

Contributory Negligence

Answer 14

claimant’s own negligence contributed to their loss or damage

Question 15

Gross negligence manslaughter - Considerations

Answer 15

Involuntary manslaughter - nil intent to kill

(Scotland) Involuntary culpable homicide - homicide in the course of lawful conduct

Mens rea - recklessness: cannot be deemed reckless based on the outcome

Question 16

Schools of Thoughts for Ethics & Morals

Answer 16

CONSEQUENTIALISM
The moral worth of an action is determined by its outcome

UTILITARIANISM
Look at benefits and harms to individuals but also society as a whole; look at the consequences.

DEONTOLOGY
Duties, “right” & “wrong” actions, absolute values

Question 16

Schools of Thoughts for Ethics & Morals

Answer 16

CONSEQUENTIALISM
The moral worth of an action is determined by its outcome

UTILITARIANISM
Look at benefits and harms to individuals but also society as a whole; look at the consequences.

DEONTOLOGY
Duties, “right” & “wrong” actions, absolute values

Question 17

Collusion & considr why?

Answer 17

Collusionrefers to a secret agreement made between clinicians and family members to hide the diagnosis of a serious or life-threatening illness from the patient.
=> COMPROMISES PATINT AUTONOMY AND SELF-DTERMINTION

revealing information to family before patient => COMPROMISES CONFIDENTIALITY

=> compromises beneficence by preventing parties access to care needed later

disclosure may mentally affect pt.

Question 18

DNACPR

Answer 18

• not a legal document
• record of a decision
• DOCUMENT DECISION IN NOTES and RATIONALE for speaking/not speaking w/ pt.