Medical Legal ethics

Question 1

Ethical of DNR

Describe the ethico-legal issues surrounding a do not attempt resuscitation decision (session)

Answer 1

Autonomy:
* Competent adults have the right to refuse treatment, including life-saving treatment like CPR.
* The ethical principle of respect for autonomy supports this right, meaning patients can choose not to undergo resuscitation if they do not wish to.

Beneficence and Non-maleficence:
* Healthcare professionals have an obligation to act in the patient’s best interests
* However, CPR may cause harm (e.g., rib fractures, brain damage), and when the likelihood of success is low, it might not benefit the patient.

Informed Consent:
* For DNACPR decisions, patients must be fully informed about their condition and the implications of refusing CPR.
* This includes explaining the risks and outcomes of both CPR and not resuscitating.

Family Involvement:
* In some cases, the family’s preferences or values might conflict with the patient’s wishes.
* Balancing patient autonomy with family dynamics can be ethically complicated.

Question 2

Legal Issues with DNACPR

Describe the ethico-legal issues surrounding a do not attempt resuscitation decision (session)

Answer 2

Mental Capacity Act (2005):
In the UK, the MCA governs decisions regarding patients who lack capacity to make decisions about their own healthcare. The DNACPR decision is legally valid if the patient lacks capacity but has an advance directive that refuses CPR.
Court Involvement:
In some cases, the court may be involved if there is uncertainty about the patient’s wishes, especially if there is no advance directive or clear communication from the patient.
Duty of Care:
Healthcare providers must respect DNACPR orders, but this duty must be balanced with their legal obligation to provide appropriate care. Failure to comply with a valid DNACPR can lead to legal consequences, such as claims of assault or battery.

Question 3

Legality of Advanced decisions

Explain the legal and ethical basis of advanced decisions in the context of end of life situations (session)

Answer 3

• Under the Mental Capacity Act 2005, advance decisions are legally binding as long as they are clear, specific, and made while the person has mental capacity.
• Advance statements Difference from Advance Decisions:
  • Advance statements express a patient’s preferences for treatment in future scenarios but do not have the same legal binding force as an advance decision.
  • A living will can guide healthcare providers regarding the patient’s general wishes, but without the same legal implications as an advance decision.

Question 4

An advanced decision is not valid if:

Explain the legal and ethical basis of advanced decisions in the context of end of life situations (session)

Answer 4

• Before losing capacity the individual annuls the advanced directive
• There is evidence that the patient has changed his mind regarding the advanced directive.
• The advanced directive does not refer specifically to the situation at hand
• There are reasonable grounds for thinking that circumstances now exist, which the patient did not anticipate, & which would have affected the patients decisions had he anticipated them.
• The patient has created a lasting power of attorney since the advanced directive was written

Question 5

Ethical basis of advance directives

Explain the legal and ethical basis of advanced decisions in the context of end of life situations (session)

Answer 5

Autonomy and Precedent Autonomy:
* Advanced decisions are grounded in the principle of autonomy, as they allow individuals to express their preferences for future care, especially if they lose capacity.
* Precedent autonomy acknowledges that patients’ choices about their future care are valuable and should be respected.
Welfare:
* Advanced decisions can help ensure that patients’ wishes are met, improving their quality of life by avoiding unwanted treatments that might be distressing or lead to poor outcomes.
Conflict with Current Preferences:
* One ethical concern is that what a patient desires in a well state might differ from what they would choose if they were ill.
* This discrepancy challenges the idea that an advance directive will always align with the patient’s best interests at the time of treatment.

Question 6

Legal Basis of advance decision

Explain the legal and ethical basis of advanced decisions in the context of end of life situations (session)

Answer 6

Mental Capacity Act (2005):
In the UK, the Act makes advanced decisions legally binding if the decision was made while the person had capacity, is clear, specific, written, and has been signed and witnessed. If these criteria are met, healthcare professionals are legally obligated to follow them.
Legality of Revocation:
Patients can revoke their advance decisions while they still have capacity. Failure to honor an invalid or revoked advance decision can lead to legal consequences, including claims of battery.
Legislation Caveats:
The advanced decision is not valid if the patient’s circumstances change in ways not anticipated by the original decision (e.g., new medical conditions). This means advance decisions need to be revisited and updated regularly.

Question 7

Should lifestyle effect access to healthcare?
ETHICAL

Discuss and critically analyse moral and legal arguments about whether patient lifestyle’s should influence access to health care (session)

Answer 7

Justice and Fairness:
* From a moral standpoint, it is argued that healthcare should be based on need rather than behavior.
* Punishing individuals for lifestyle choices could be seen as unjust, especially when considering the social determinants of health and the role of individual agency.

Responsibility
* On the other hand, some argue that individuals should take responsibility for their own health and that those who engage in harmful behaviors (e.g., smoking, excessive alcohol consumption) should bear some responsibility for the costs of their care.
* This would incentivize healthier behavior.

Equality
* An ethical argument against lifestyle-based discrimination is that it creates inequalities, as some people may have more access to healthcare based on their lifestyle choices, while others may be penalized unfairly.

Respect for Autonomy:
* Respecting patient autonomy is key, but autonomy can be complicated by the influence of societal norms and personal choices.
* This creates tensions when determining how lifestyle choices should affect healthcare access.

Question 8

Should lifestyle effect access to healthcare?
LEGAL

Discuss and critically analyse moral and legal arguments about whether patient lifestyle’s should influence access to health care (session)

Answer 8

Equality Act (2010):
* In the UK, laws like the Equality Act prevent discrimination based on characteristics such as age, disability, and race.
* Applying a moral argument against lifestyle-related
discrimination could conflict with legal protections.

Resource Allocation:
* The law must balance fairness in resource distribution with the practical realities of limited healthcare resources
* This might lead to the legal question of whether lifestyle choices should factor into how resources are allocated.

Public Health Laws:
* Some laws may support limiting healthcare access for those whose lifestyle choices contribute to higher health risks, particularly in cases where those choices have an economic impact on the healthcare system.

Question 9

What are treatment contracts

Describe how treatment contracts are used and evaluate the ethical arguments for and against their application (session)

Answer 9

• Treatment contracts are agreements between healthcare professionals and patients regarding the expectations and responsibilities of both parties during the course of treatment. These contracts often cover issues such as consent, confidentiality, and the patient’s responsibility to adhere to treatment regimens.

Question 10

Ethical arguements for treatment contracts

Describe how treatment contracts are used and evaluate the ethical arguments for and against their application (session)

Answer 10

• Clear Expectations: Treatment contracts can clarify the rights and responsibilities of both the patient and the healthcare provider, which can reduce misunderstandings and improve communication.
  
  • Patient Empowerment: These contracts can help patients feel more involved in their own care, as they are given a clear framework for their treatment, making it easier to make informed decisions.
  • Protection of Healthcare Providers: These contracts provide legal protection for healthcare providers by clearly stating the conditions under which care will be provided and what happens if the patient does not adhere to agreed-upon terms.

Question 11

• Ethical Arguments Against Treatment Contracts:

Describe how treatment contracts are used and evaluate the ethical arguments for and against their application (session)

Answer 11

• Autonomy and Coercion: Critics argue that treatment contracts can feel coercive, especially when patients feel they have no choice but to sign in order to receive care. This can undermine the principle of autonomy.
  
  • Risk of Discrimination: Treatment contracts could potentially discriminate against vulnerable populations who may struggle to meet certain conditions outlined in the contract, such as those with mental health issues or cognitive impairments.
  • Patient Trust: The imposition of treatment contracts might negatively impact the trust between healthcare providers and patients, as patients may feel that their providers are more concerned with legal protection than with compassionate care.

Question 12

Consent

Discuss the ethical and logistical issues relating to consent (PBL 2)

Answer 12

• Autonomy:
  
  • The core ethical principle in consent is respecting patient autonomy—the right of individuals to make decisions about their own bodies and treatment.
  • Informed consent requires that patients fully understand the nature, risks, benefits, and alternatives of the proposed treatment. This respects their right to choose.
• Capacity:
  
  • A patient must have the mental capacity to give valid consent. This means they must understand the information presented, retain that information long enough to make a decision, and communicate their decision.
  • For those who lack capacity (due to age, illness, or mental state), substitute decision-makers (e.g., legal guardians or family members) may be required, in accordance with legal frameworks like the Mental Capacity Act 2005.
• Voluntariness:
  
  • Consent must be given freely, without coercion, manipulation, or undue pressure. This is vital for maintaining the patient’s dignity and trust in the medical system.
• Disclosure and Understanding:
  
  • Healthcare providers have an ethical duty to disclose enough information in a way that patients can understand. Over-simplification or omission of critical details can undermine the patient’s decision-making ability.
• Cultural Sensitivity: It’s also important to consider the patient’s background, values, and language to ensure they fully understand their choices.
• Competence vs. Coercion:
  
  • Ethical dilemmas arise when patients face external pressures (e.g., family, financial concerns) that could undermine the authenticity of their consent.
  • In cases of vulnerable populations (e.g., children, mentally ill patients), extra caution is needed to ensure decisions are made in the patient’s best interest.
• Communication Barriers:
  
  • Effective communication is key to obtaining consent. Language barriers, literacy levels, or cultural differences can hinder understanding, making it challenging to ensure informed consent.
  • Use of interpreters and plain language are often necessary to ensure clarity.
• Documentation:
  
  • Ensuring that consent is properly documented is crucial for both ethical and legal reasons. This includes confirming that the patient has been informed and has voluntarily agreed to the proposed treatment or procedure.
  • Electronic records or paper forms must be clear and easily accessible for future reference.
• Emergency Situations:
  
  • In emergency situations, it may be impossible to obtain consent beforehand (e.g., in cases of unconscious patients). In such cases, treatment may be given under the doctrine of necessity to preserve life, but this must be consistent with what the patient would likely want or in their best interest.
• Ongoing Consent:
  
  • Consent is not a one-time event but must be ongoing throughout the treatment. Patients have the right to withdraw consent at any point, even after initially agreeing to a procedure or treatment plan.
  • It can be logistically challenging to monitor and document the ongoing process of consent, particularly in long-term care settings.
• Parental and Legal Guardianship Consent:
  
  • For minors or those who are legally unable to provide consent themselves, consent must be obtained from parents or legal guardians. This can be complicated in situations where parents disagree, or the child is old enough to express their own wishes.

Question 13

Health Records

Outline medical duties in keeping good medical records; and explain the UK law on access to health records (session)

Answer 13

• Accuracy:
  
  • Medical records must be accurate, complete, and timely.
  • Mistakes or omissions can compromise care and can be used as evidence in legal proceedings.
• Legibility:
  
  • Records should be legible, whether handwritten or electronic.
  • Use clear, precise language that accurately reflects the patient’s condition and the clinical decisions made.
• Confidentiality:
  
  • Medical records must be stored and accessed in accordance with confidentiality laws and ethical standards. Patient information should only be shared with those who are directly involved in the patient’s care.
• Up-to-date:
  
  • Medical records should be regularly updated to reflect ongoing changes in the patient’s health status, treatment plan, and progress.
• Legal and Ethical Compliance:
  
  • Medical records are both a legal document and a clinical tool. They must comply with medical ethics, laws, and regulations (e.g., Data Protection Act 2018, General Data Protection Regulation (GDPR)).
  • Professionals must ensure that records are maintained in a way that allows them to be defensible in legal and regulatory reviews.
• Clear Documentation of Decisions:
  
  • Document all clinical decisions, discussions with the patient, and informed consent. It is important to record the rationale for decisions made, particularly in complex cases.
  • Record any discussions about treatment options, risks, benefits, and patient preferences.
• Retention of Records:
  
  • Healthcare professionals have a duty to keep medical records for a specific period, typically eight years for adults and until the patient’s 25th birthday for minors. However, different specialties or settings might have specific retention policies.
  • Records must be destroyed securely when they are no longer needed, to maintain confidentiality and comply with data protection laws.

Question 14

UK Law on Access to Health Records

Outline medical duties in keeping good medical records; and explain the UK law on access to health records (session)

Answer 14

• In the UK, the law governing access to health records is primarily found in the Data Protection Act 2018 and Access to Health Records Act 1990, as well as the General Data Protection Regulation (GDPR).
• Patient’s Right of Access:
  
  • Under the Data Protection Act 2018 and GDPR, patients have the right to access their medical records. This is often referred to as a subject access request (SAR).
  • Patients can request access to their health records at any time, and this request must be responded to within one month.
  • The patient can request records in electronic or paper format, depending on the way the records are held by the healthcare provider.

Question 15

Exceptions to Access to Health Records

Outline medical duties in keeping good medical records; and explain the UK law on access to health records (session)

Answer 15

• While patients generally have the right to access their medical records, there are certain exceptions:
  - Third-party information: If accessing the record would reveal information about another person (e.g., another patient or a healthcare professional), and that person has not consented to sharing this information, access may be restricted.
  - Harmful information: If disclosure of the records would be likely to cause serious harm to the physical or mental health of the patient or someone else, access may be withheld.

Question 16

Access to Records by Others:

Outline medical duties in keeping good medical records; and explain the UK law on access to health records (session)

Answer 16

• In the case of minors, parents or legal guardians may access a child’s health records if the child is not competent to consent to their release (e.g., due to age or mental capacity).
• However, if the child is deemed competent, they must consent to the release.
• Legal representatives (e.g., in cases where a patient lacks capacity to make decisions) can also request access to health records on the patient’s behalf.
• The healthcare provider must verify the legal authority of the representative to access the records.

Question 17

Fees for Access to Health Records

Outline medical duties in keeping good medical records; and explain the UK law on access to health records (session)

Answer 17

• In most cases, patients can access their health records free of charge.
  
  • However, if the request is excessive or repeated, healthcare providers may charge a fee.
  • The amount of the fee must be reasonable and transparent.

Question 18

Corrections and Amendments
to Health Records

Outline medical duties in keeping good medical records; and explain the UK law on access to health records (session)

Answer 18

• If a patient believes there is an error in their health records, they have the right to request corrections or amendments.
  
  • The healthcare provider must consider and respond to such requests, and if the amendment is accepted, they must update the records accordingly. If the request is denied, the patient can request that a note is added to the record explaining their disagreement.

Question 19

Retention of Records to Health Records

Outline medical duties in keeping good medical records; and explain the UK law on access to health records (session)

Answer 19

The Access to Health Records Act 1990 outlines how long health records should be kept.
Generally, records for adults should be kept for eight years after the last treatment or consultation, and for children, the records should be retained until their 25th birthday.
The retention period may vary for different types of records (e.g., mental health records or records related to certain treatments).

Question 21

What does the Animals (Scientific Procedures) Act 1986 regulate?

Answer 21

The use of animals in scientific research that may cause pain, suffering, distress, or lasting harm.

This act is specific to the UK and mandates ethical principles in animal testing.

Question 22

What are the ethical principles mandated by the Animals (Scientific Procedures) Act 1986?

Answer 22

Researchers must ensure a balance between scientific necessity and the harm inflicted on the animal.

This includes the establishment of an ethics committee in research institutions.

Question 23

Which animals receive special protection under the Animals (Scientific Procedures) Act 1986?

Answer 23

• Primates
• Cats
• Dogs
• Horses

These animals are given additional protections due to their cognitive and emotional capacities.

Question 24

What are the 3Rs in the context of animal research?

Answer 24

• Replacement
• Reduction
• Refinement

These principles aim to minimize animal use and suffering in research.

Question 25

What does 'Replacement' mean in the context of the 3Rs?

Answer 25

Encouraging the use of non-animal methods when possible, such as cell cultures or computer models. ## Footnote This principle seeks alternatives to animal testing.

Question 26

What does 'Reduction' entail in animal research?

Answer 26

Minimizing the number of animals used in experiments to ensure that only the necessary number is involved for reliable results. ## Footnote This aims to decrease animal suffering while maintaining research validity.

Question 27

What does 'Refinement' refer to in the 3Rs?

Answer 27

Ensuring that the pain and distress caused to animals are minimized, and any suffering is justifiable based on the scientific value of the research. ## Footnote This principle focuses on improving animal welfare in research settings.

Question 28

What is Directive 2010/63/EU?

Answer 28

A European directive on the protection of animals used for scientific purposes that complements national laws like the UK's Animals (Scientific Procedures) Act. ## Footnote It emphasizes the 3Rs and requires strict licensing for animal experiments.

Question 29

What is the moral status argument regarding animals in research?

Answer 29

Whether animals possess moral status equal to humans, making it ethically wrong to subject them to experiments for human benefit. ## Footnote This argument is central to discussions on animal rights and ethics.

Question 30

What is the significance of sentience in the ethical debate about animal research?

Answer 30

The ability of animals to experience pain and suffering complicates the ethical justification for research on them. ## Footnote There is a growing consensus that many animals are sentient beings.

Question 31

What is a key justification for animal testing?

Answer 31

It may lead to advancements in human health and medical breakthroughs. ## Footnote The justification hinges on whether the benefits to humans outweigh the suffering caused to animals.

Question 32

What does utilitarianism support in the context of animal testing?

Answer 32

Animal testing if the benefits outweigh the harm caused to the animals. ## Footnote This perspective values the overall good produced by the research.

Question 33

What do animal rights perspectives argue against?

Answer 33

Using animals as tools for human benefit, emphasizing their intrinsic rights to live free from suffering. ## Footnote This view prioritizes animal welfare over potential human benefits.

Question 34

What is the Nuremberg Code?

Answer 34

A set of ethical principles for human experimentation developed after World War II emphasizing voluntary and informed consent. ## Footnote Established in 1947, the Nuremberg Code was a response to the atrocities committed during the war.

Question 35

What does the Declaration of Helsinki state about human subjects?

Answer 35

Human subjects should participate only if they give voluntary, informed consent and that risks should be minimized. ## Footnote Issued by the World Medical Association in 1964.

Question 36

What is Good Clinical Practice (GCP)?

Answer 36

An international quality standard that ensures ethical conduct and quality in clinical trials. ## Footnote Provided by the International Conference on Harmonisation (ICH).

Question 37

What does the Data Protection Act 2018 (UK) ensure?

Answer 37

It ensures that the personal data of research participants is protected. ## Footnote This legislation is crucial for maintaining confidentiality in research.

Question 38

What is the purpose of the Mental Capacity Act 2005 (MCA)?

Answer 38

Provides guidelines on conducting research on individuals who lack mental capacity, ensuring their best interests are considered. ## Footnote This act safeguards the rights of vulnerable individuals in research.

Question 39

What do the Medicines for Human Use (Clinical Trials) Regulations 2004 govern?

Answer 39

They govern clinical trials in the UK, requiring adherence to ethical standards to ensure safety and validity. ## Footnote This regulation is aimed at protecting participants in clinical research.

Question 40

What is the role of Research Ethics Committees (RECs)?

Answer 40

They review the ethical implications, risks, and benefits of proposed research studies to ensure adherence to ethical guidelines. ## Footnote RECs are essential for protecting participants' rights.

Question 41

True or False: Research on humans does not require approval from an ethics committee.

Answer 41

False ## Footnote Research must be approved by a Research Ethics Committee (REC) to ensure ethical standards are met.

Question 42

Fill in the blank: The _______ emphasizes the need for voluntary and informed consent in human experimentation.

Answer 42

Nuremberg Code ## Footnote This code was established in response to unethical experiments during WWII.

Question 43

REsearch legislation

Answer 43

- Data Protection Act 2018 (UK): This act ensures that the personal data of research participants is protected. - Mental Capacity Act 2005 (MCA): Provides guidelines on how to conduct research on individuals who lack mental capacity, ensuring that their best interests are considered. - Medicines for Human Use (Clinical Trials) Regulations 2004: Governs clinical trials in the UK, requiring that they be conducted according to ethical standards to ensure safety and validity.

Question 44

Ethics Committees:

Answer 44

- Research on humans must be approved by an Research Ethics Committee (REC), which reviews the ethical implications, risks, and benefits of proposed research studies. - RECs ensure that the study meets ethical guidelines, protects participants' rights, and ensures that the risks are minimized.

Question 45

Discuss the main ethical arguments in relation to research on humans (session)

Answer 45

- Informed Consent: - Central to human research ethics is the requirement for informed consent. Participants must be given all necessary information to make a voluntary and informed decision about their involvement in research. - Ethical concerns arise if participants are coerced or manipulated into consenting, or if they do not fully understand the nature of the research. - Risk vs. Benefit: - Research on humans must ensure that the potential benefits outweigh the risks involved. The ethical challenge is to balance these factors, especially in high-risk research. - Clinical trials often carry risks to participants, so ethical research must minimize harm and ensure that the benefits to society are significant. - Vulnerable Populations: - Special ethical consideration is required when conducting research involving vulnerable populations such as children, the elderly, prisoners, or individuals with cognitive impairments. - For these groups, additional safeguards are necessary to ensure that their participation is voluntary and informed and that they are not exploited or unduly influenced. - Equity and Justice: - There is an ethical concern over who participates in research. Research should not disproportionately involve disadvantaged or vulnerable populations unless the research directly benefits them. - Discriminating in who is included in studies can lead to social injustice, especially when these groups bear more than their fair share of the risks. - Privacy and Confidentiality: - Researchers must ensure that the privacy and confidentiality of participants are maintained. This includes safeguarding personal and sensitive data and ensuring that it is only used for the purpose for which consent was given. - Placebo Use: - The use of placebos in research, especially in trials where effective treatment exists, raises ethical concerns about withholding treatment from participants. - While placebos can be ethically acceptable in certain contexts (e.g., when no proven effective treatment exists), their use must be carefully justified, and participants must be aware that they may receive a placebo.

Question 46

Notifiable disease ## Footnote Describe the legal requirements relating to the reporting of notifiable diseases with specific reference to the public health (control of disease) act 1984 (session)

Answer 46

- Mandatory Reporting: - Healthcare professionals must notify the proper authorities (typically local public health authorities or the NHS) when they encounter a case of a notifiable disease. This is to facilitate timely public health responses, prevent the spread of infectious diseases, and monitor public health risks. - List of Notifiable Diseases: - A list of diseases that are considered notifiable is regularly updated and includes conditions such as tuberculosis, cholera, measles, rubella, and more recently, diseases like COVID-19. The specific diseases subject to reporting can be amended by the government as new risks emerge. - Penalties for Non-Compliance: - Healthcare professionals who fail to report a notifiable disease as required may face legal consequences, including fines or disciplinary action. The goal is to protect public health by ensuring that potentially dangerous diseases are promptly identified and addressed.

Question 47

Ethico legal of disclosing ## Footnote Discuss the ethico-legal dilemmas that occur when balancing the needs of individual patients with the wider interests of the public;

Answer 47

- Public Health vs. Personal Autonomy: - A key dilemma occurs when an individual's right to autonomy (e.g., refusing treatment or disclosure of health information) conflicts with the public interest, such as controlling the spread of infectious diseases. - For example, if a person refuses to be isolated or report a contagious disease, their autonomy may need to be overridden for the sake of public health, which raises questions about the extent of state intervention. - Confidentiality vs. Duty to Protect Others: - Healthcare professionals face the challenge of respecting patient confidentiality while also protecting public health. - For instance, if a patient with a highly infectious disease refuses to disclose their condition, there is a legal and ethical obligation to inform public health authorities to prevent a wider outbreak, even though it breaches patient confidentiality. - Individual Rights vs. Collective Safety: - In pandemics or widespread health emergencies, there may be a conflict between the individual’s rights to refuse certain medical interventions (such as quarantine or vaccination) and the need to safeguard the community. - In these cases, the ethical principle of beneficence (acting for the well-being of others) may justify limiting individual freedoms to protect the public.

Question 48

Coronavirus act 2020 ## Footnote and outline the main provisions of the coronavirus act 2020 (session)

Answer 48

- **Temporary Provisions for Public Health:** - The act grants the government emergency powers to impose public health measures such as closing schools, enforcing quarantines, or shutting down public spaces to prevent the spread of the virus. - It also allows for the temporary suspension of certain civil liberties and rights for the public good. - **Health and Social Care Staffing:** - To ensure adequate healthcare staffing during the pandemic, the act gives the government powers to alter employment laws, allowing more flexible arrangements for healthcare workers, such as suspending certain regulations regarding training and supervision. - **Emergency Registration of Healthcare Workers:** - The act allows for the expedited registration of healthcare workers (e.g., retired professionals or those with expired qualifications) to meet the surge in demand for healthcare services during the crisis. - **Powers of Detention and Quarantine:** - The act gives the authorities the ability to detain and isolate individuals suspected of being infected with COVID-19, overriding their personal consent to ensure the disease does not spread further.

Question 49

Global health ## Footnote Outline the global imbalance in the distribution of health and health care (session)

Answer 49

- **Global Income Disparities:** - A significant portion lives on less than $10 per day, - and (over 10%) lives on less than $1.90 per day, - impacts access to health care services and resources - **Access to Health Care:** - Health care availability is unevenly distributed worldwide, with low- and middle-income countries (LMICs) having significantly fewer healthcare resources, - including physicians and essential medicines - limited access to medical care in poorer regions - **Prevalence of Diseases:** - In poorer regions like sub-Saharan Africa, health challenges such as high HIV prevalence and maternal mortality rates are prominent. - **Physician Distribution:** - A disproportionate number of healthcare professionals are concentrated in wealthier nations - **Essential Medicines:** - Approximately 1.9 billion people lack access to essential medicines, exacerbating health inequalities - **Global Health Financing:** - The 10/90 gap refers to the finding that only 10% of health R&D funding addresses the health needs of the poorest 90% of the world’s population.

Question 50

Issues of global imbalance ## Footnote Discuss the ethical issues raised by the global imbalance in the distribution of health and health care (session)

Answer 50

- **Utilitarianism vs. Charity:** - Do wealthier nations and individuals have a duty to help those in poorer region? - is it merely an act of charity.? - Utilitarianism suggests that we should prioritize helping those with the greatest need, while some may argue that it is a voluntary charitable act, not a moral obligation. - **Global Justice**: - Ethical theories of justice, such as Pogge’s perspective, argue that the global economic system (e.g., unjust trade policies and tariffs) harms the poor - wealthier nations have an obligation to rectify this harm. - Those that benefit from global inequalities should be held responsible for addressing health disparities. - **Rights-based Ethics:** - The Universal Declaration of Human Rights (UDHR) asserts that everyone has the right to adequate health care.

Question 51

Who should fix global imbalance? ## Footnote Discuss the ethical issues raised by the global imbalance in the distribution of health and health care (session)

Answer 51

- **Pharmaceutical Industry Ethics:** - Pharmaceutical companies "10/90 gap. - do companies have a special duty to ensure equitable access to essential medicines in poorer regions, - they have global market influence and profit-driven motives. - **Global Health Inequities and Humanitarian Obligations:** - Many ethical perspectives argue that global health inequities are unacceptable and that wealthy nations have a moral duty to rectify this imbalance by investing in the health systems of poorer nations. - **Duty to Act in the Face of Global Suffering:** - Peter Singer's challenge asks whether, apart from geographical location, there is a moral obligation to help others suffering from avoidable health issues, as we would if we saw a child drowning in a pond. This analogy raises the ethical issue of whether proximity should determine our moral duty, and whether wealthy countries, due to their resources, are morally compelled to address global health disparities. - **Reciprocity in Global Health:** - The idea of reciprocity suggests that nations and individuals who benefit from global health systems and development have an obligation to contribute to the improvement of health in poorer regions. The ethical question is whether the global community should share responsibility for improving health outcomes world

Question 52

Policy solutions to Global inequity ## Footnote Discuss the ethical issues raised by the global imbalance in the distribution of health and health care (session)

Answer 52

- Encourage bio-pharm companies to make voluntary agreements to increase availability of drugs - Use taxation to encourage a change - Use legislation to force bio-pharm to research and produce different kinds of drugs - Use government market force to bargain with companies - Pogge’s solution (Health Impact Fund)

Question 53

Ethical Basis for duties ## Footnote Discuss the ethical issues raised by the global imbalance in the distribution of health and health care (session)

Answer 53

- **Utility**: - Poor, sick, people have a greater need for health care and thus should gain greater access - **Rights**: - Everyone has a right to basic health care and so there is a duty to provide basic heath care - **Justice**: - The wealthy of the world harm the poor and thus owe health care as a form of rectification

Question 54

What is duty of candour ## Footnote Explain duty of candour

Answer 54

- **Honesty and Transparency**: Healthcare professionals are required to inform patients when a mistake has been made in their care that has caused harm or could potentially cause harm. They must communicate this in a clear and understandable way. - **Apology**: An apology must be given for any harm caused. However, it’s important to note that an apology doesn’t imply admission of liability but acknowledges that something went wrong. - **Who Is Responsible:** - The Duty of Candour applies to individual healthcare providers (such as doctors, nurses, and other staff) and healthcare organizations (such as hospitals, clinics, and care homes). - Organizations are responsible for creating systems that ensure transparency and reporting mechanisms are in place. - In the **UK, the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 includes a requirement for healthcare providers to follow the Duty of Candour.** - The **GMC** (General Medical Council), Nursing and Midwifery Council (**NMC**), and other professional bodies also require practitioners to be **open and honest** with patients about any mistakes. - For organizations, t**he Care Quality Commission (CQC) monitors compliance with the Duty of Candour.**

Question 55

What is child protection and safeguarding? ## Footnote Define the principles of child protection and safeguarding and describe responsibilities of medical students and doctors with regards to this (session)

Answer 55

In the UK, child safeguarding is a broader concept that involves promoting children's welfare and preventing harm before it occurs. Child protection is a subset of safeguarding focused on responding to specific concerns when a child is at risk of or suffering from abuse or neglect. **Safeguarding is proactive; child protection is reactive.**

Question 56

Child protection and safeguarding ## Footnote Define the principles of child protection and safeguarding and describe responsibilities of medical students and doctors with regards to this (session)

Answer 56

- prevention - promotion of wellbeing - protection - partnership working - transparency - Doctors and medical students are legally and ethically obligated to report concerns of abuse or neglect. If there is suspicion that a child is at risk of harm, they must follow the appropriate safeguarding protocols and notify child protection agencies or social services. - In the UK, the Children Act 1989 and Working Together to Safeguard Children guidance provide the framework for reporting and acting upon concerns about child welfare.

Question 57

Approaches and arguements to organ donation ## Footnote Describe main approaches to deceased organ donation and explain ethical arguments for and against each of the approaches (session)

Answer 57

Question 58

Approaches and arguements to organ donation ## Footnote Define and critically examine ‘opt-in,’ ‘opt-out’, ‘soft’ and ‘hard’ organ donation systems and list arguments for and against their adoption (session)

Answer 58

Question 59

Human Tissue Act 2004 ## Footnote Outline main provisions of the human tissue act (2004) and organ donation (deemed consent) act (2019) (session)

Answer 59

- Consent as Fundamental: - Establishes that valid consent is the cornerstone for the lawful retention and use of human tissue. - Establishment of the Human Tissue Authority (HTA): - Regulates and monitors the use of human tissues and organs. - Offences and Prohibitions: - Makes it an offence to transplant organs or engage in the sale of organs without adhering to strict regulatory standards.

Question 60

- Organ Donation (Deemed Consent) Act (2019) ## Footnote Outline main provisions of the human tissue act (2004) and organ donation (deemed consent) act (2019) (session)

Answer 60

- Transition to an Opt-Out System in England: - Introduces a system where individuals are presumed to consent to organ donation after death unless they have opted out. - Soft Opt-Out Approach: - Although consent is presumed, the views of the deceased’s family are consulted. - Revised Code of Practice: - Updates protocols for the donation of solid organs and tissues, aligning with the changes in legislation. - Exclusions: - Specifies that certain groups (e.g., individuals under 18, those lacking capacity, visitors, or those not resident for 12 months) are not covered under the deemed consent provisions.

Question 62

What does generic healthcare ethics primarily emphasize?

Answer 62

Patient autonomy and informed consent in most treatments.

Question 63

How does psychiatric ethics differ from generic healthcare ethics regarding patient capacity?

Answer 63

Psychiatric ethics frequently grapples with impaired capacity and fluctuating insight, leading to complex issues around voluntary versus involuntary treatment.

Question 64

What is a key focus of generic ethics in healthcare?

Answer 64

Individual rights and beneficence.

Question 65

What balance does psychiatric ethics often require?

Answer 65

Balancing individual autonomy and protecting both the patient and society.

Question 66

In what situations is compulsory treatment common in generic healthcare?

Answer 66

Rare and usually confined to emergency situations.

Question 67

What ethical dilemmas arise in mental health regarding patient refusal?

Answer 67

The necessity to sometimes override patient refusal to ensure safety and provide treatment for serious mental disorders.

Question 68

What does the Mental Capacity Act 2005 presume about adults?

Answer 68

Every adult is assumed to have capacity unless proven otherwise.

Question 69

List the criteria for assessing capacity according to the Mental Capacity Act.

Answer 69

* Ability to understand relevant information * Ability to retain relevant information * Ability to use or weigh relevant information * Ability to communicate the decision

Question 70

What principle must be followed when making decisions for individuals who lack capacity?

Answer 70

Best Interests Principle.

Question 71

What does the Best Interests Principle entail?

Answer 71

Any decision made on behalf of individuals lacking capacity must be in their best interests, considering all circumstances.

Question 72

What is emphasized for individuals lacking capacity in the decision-making process?

Answer 72

Provision of support to help individuals make their own decisions wherever possible.

Question 73

What do advance decisions and lasting powers of attorney allow individuals to do?

Answer 73

Document their treatment preferences and appoint someone to make decisions on their behalf when they might lack capacity.

Question 74

What safeguards does the Mental Capacity Act 2005 establish?

Answer 74

Mechanisms such as independent reviews to protect the rights of those who lack capacity.

Question 75

What is the primary legal framework for mental health in the UK?

Answer 75

Mental Health Act 1983 (amended 2007).

Question 76

What does Section 2 of the Mental Health Act allow?

Answer 76

Detention for assessment for up to 28 days when a mental disorder is suspected.

Question 77

What is the purpose of Section 3 of the Mental Health Act?

Answer 77

Compulsory admission for treatment when necessary for the health or safety of the patient or others.

Question 78

What is the detention period for Section 3 of the Mental Health Act?

Answer 78

Typically 6 months, reviewed at 6 months, then annually.

Question 79

What does Section 4 of the Mental Health Act allow?

Answer 79

Emergency detention for up to 72 hours in urgent situations.

Question 80

What is the doctrine of necessity in mental health treatment?

Answer 80

Allows for treatment to protect the patient’s life and wellbeing in emergencies, provided it is in their best interests.

Question 81

What role do Independent Mental Capacity Advocates (IMCAs) play?

Answer 81

Provide independent support and representation for individuals who lack capacity and have no appropriate representatives.

Question 82

When is an IMCA appointed?

Answer 82

When a person lacking capacity is involved in a decision that may result in a deprivation of liberty and has no available representative.

Question 83

What framework does the Mental Capacity Act 2005 provide for individuals with intellectual disabilities?

Answer 83

Ensures they are not unjustly deprived of autonomy or subjected to decisions without appropriate safeguards.

Question 84

What is required for a patient to be detained under Section 2?

Answer 84

Application by an AMHP and support from two doctors (one specialist).

Question 85

What safeguards are in place for Section 3 admissions?

Answer 85

Application by an AMHP and support from two doctors, regular reviews, and right to appeal via the Mental Health Tribunal.

Question 86

What initiates an emergency detention under Section 4?

Answer 86

Established urgent necessity by one doctor familiar with the patient.

Question 87

MHA 1973 ## Footnote Outline the key legal provisions of the mental health act 1983 (as amended 2007) as they apply to the practice of psychiatry with particular reference to the basic aspects of sections 2, 3 and 4 (PBL 1 + 2 + session)

Answer 87