Medical Ethics & Law Principles Flashcards
What legal document governs medical law?
Medical Act 1858
Which organisation created the Medical Act 1858?
General Medical Council (GMC)
What authority regulates the GMC?
Professional Standards Authority
Which document provides doctors with ethical and professional guidance?
Good Medical Practice
Which document provides medical students with ethical and professional guidance?
Professional Behaviour & Fitness to Practise
What are the four principles of ethics?
Autonomy
Non-Maleficence
Beneficence
Justice
What is autonomy?
It means that a patient has the ultimate decision-making responsibility for their own treatment - only if they have capacity
What should you do if the patient asks for a treatment the doctor considers would not be of benefit?
They don’t have to provide the treatment
They should explain their reasons to the patient and explain other options that are available, including the option to seek a second opinion
What is non-maleficence?
It states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect
What is beneficence?
It means that all medical practitioners have a moral duty to promote the course of action that they believe is in the best interests of the patient
What is justice?
It is the principle that when weighing up if something is ethical or not, we have to think about whether it’s compatible with the law, the patient’s rights, and if it’s fair and balanced
It also means that we must ensure no one is unfairly disadvantaged when it comes to access to healthcare
What is consent?
It is when a patient gives permission before receiving any form of medical treatment, examination or test
Who obtains consent?
It must be obtained by a clinician with appropriate experience and expertise
For example, a junior doctor cannot obtain consent for a procedure that they themselves cannot conduct, or don’t know the full benefits and risks of
How do we obtain consent?
You must listen to the patient and respect their views about their health
You must discuss with patients their diagnosis, prognosis and treatment
You must share with patients the information they want or need in order to make decisions
You must maximise patients abilities to make decisions for themselves
You must respect the patients decision
In what four circumstances do we not need to obtain consent?
When an individual requires emergency treatment to save their life, however they’re unconscious
When an individual requires emergency treatment, however it would be unsafe to wait to obtain consent
Severe mental health conditions
When there is a risk to public health - rabies, TB, etc
What type of consent is obtained for non-invasive treatments (blood pressure, ECG)?
Implied consent
Verbal agreement
What type of consent is obtained for minor or routine investigations (blood letting, IV access, ABG)?
Express consent
What type of consent is obtained for high risk procedures (surgery)?
Written consent
What are the three criteria for consent?
Voluntary - which means that the decision to give consent is not influenced by pressures of relatives, friends or healthcare professionals
Informed - which means that individuals are provided with information about the benefits, risks and consequences if the treatment didn’t go ahead
Capacity
What is the most important consideration regarding the information in informed consent?
It must be understood by the patient
What is capacity?
Capacity is the ability to give consent
It relies on the patient being able to understand, believe, retain and weight the necessary information
What rights are given to the patient if they have capacity?
They can make their own decisions to refuse treatment, even if those decisions appear irrational to the doctor or may place the patient’s health or their life at risk
Is capacity situation specific?
Yes
It can fluctuate due to different decisions and timeframes
What are the five obstacles of capacity?
Mental capacity
Intoxication (alcohol, drugs)
Unconsciousness
Communication difficulties
Age
What legal document governs capacity in Scotland?
Adults with Incapacity Act 2000
What legal document governs capacity in England and Wales?
Mental Capacity Act 2005
What does the ‘Adults with Incapacity Act 2000’ outline in regards to capacity?
The legislation sets out the criteria and procedures to be followed in making decisions when patients lack capacity to make these decisions for themselves
It also grants legal authority to certain people to make decisions on behalf of patients who lack capacity
What does it mean if the ‘Adults with In capacity Act 2000’ deems an individual not to have capacity?
They are incapable of acting on/making decisions about their healthcare
What are the five principles of the ‘Adults of Incapacity Act 200’?
Principle 1 - any action or decision taken must benefit the person
Principe 2 - it must be the least restrictive option
Principle 3 - take account of the wishes of the person
Principle 4 - consult with relevant others
Principle 5 - encourage the person to use existing skills and develop new skills
What is a power of attorney?
This is a means by which individuals, whilst they have capacity, can grant someone they trust powers to act as their continuing and/or welfare attorney
How many people can be appointed as power of attorney?
More than one
What is the rights of a continuing power of attorney?
They can continue or commence on the granter’s loss of capacity
What is the rights of a welfare power of attorney?
They only come into effect in the event of the granter’s loss of capacity
Who do power of attorneys register with?
Public guardian
What happens if a person does not have capacity and they have not appointed a lasting power of attorney?
The healthcare professionals treating them can administer treatment if they believe it’s in the person’s best interests
The clinical must discuss this with the person’s relatives and friends before making this decision
If an agreement cannot be reached between family and clinicians, the case may be taken to court
An incapacity certificate which states the nature of incapacity, its expected duration and the intended treatment should be completed
How do we manage patients who lack capacity due to temporary intoxication by drugs/alcohol or unconsciousness?
If possible wait until the patient has sobered up/regained consciousness before commencing treatment
In a life-threatening situation, healthcare professionals may act on the behalf of the patient to perform a procedure in their best interest
How do we manage patients who lack capacity due to communication difficulties?
We can liaise with the next of kin
We can use braille information and consent forms
We can use sign language interpreters
We can use interpreters via telephone or in person
At what age do we assume individuals have capacity unless proven otherwise?
> 18 years old
At what age do we assume that individuals can make decisions about their health independently from their parents and are usually able to consent for themselves?
16 - 17 years old
How do we assess if individuals who are 16 have capacity?
We conduct the Gillick competency assessment
When can consent be overruled in young people? Who overrules this?
If a young person refuses treatment, which may lead to their death or a severe permanent injury
Court of Protection (parents can however it is usually best to go through the courts)
Which five individuals can consent on a child’s behalf?
The child’s parents
Legally appointed guardian
Local authority designated to care for the child
A person with a residence order concerning the child
A local authority/person with an emergency protection order for the child
What is the duty of candour?
This means that you must be open and honest with patients when something goes wrong with a patient’s treatment or care which causes, or has the potential to cause, harm or distress
It also means you are open and honest with all parties as well as any relevant organisations - such as the employer, practice principle, health authority
What is confidentiality?
It requires doctors, and other healthcare professionals, to keep their patients’ information private within the healthcare team, apart from some very specific circumstances
In what eight circumstances can doctors breach confidentiality?
When individuals have consented
With other health care professionals involves in the patient’s care
Where not sharing the patient’s information puts the patient, or others, in danger
Where the patient lacks capacity and sharing information is of overall benefit to the patient
When the clinician suspect signs of child abuse
When it is in the public’s interest (terrorism, murder, homicide, rape)
When the clinician is defending themselves against negligence claims in court
When directed to by a court of law
In terms of deceased patients, when can confidentiality be breaches?
Medical Certificate of Cause of Death
What are the eight principles of confidentiality in the GMC?
Use the minimum necessary personal information
Manage and protect information
Be aware of your responsibilities
Comply with the law
Share relevant information for direct care
Ask for explicit consent
Tell patients
Support patients to access their information
What are the five GDPR regulations which apply to confidentiality?
The data subject has given explicit consent
The processing is necessary to protect the vital interests of the data subject or another person in a case where the data subject is physically or legally incapable of giving consent
The processing is necessary for reasons of substantial public interest
The processing is necessary for reasons of public interest in the area of public health
The processing is necessary for archiving purposes in the public interest, scientific or historical research purposes or statistical purposes
Which GDPR article applies to medical practice?
Article 9
