MEL Flashcards

1
Q

Oath of doctors

A

Hippocratic Oath
Declaration of Tokyo (torture and cruel and inhuman procedures)
Declaration of Helsinki (for medical research)
Belmont report (for medical research)
3 core principles: respect for other, beneficence and justice
-primary areas of application: informed consent, assessment of benefits and risk, selection of subjects
Declaration of Geneva
- THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration
- I WILL RESPECT the autonomy and dignity of my patient
- I WILL MAINTAIN the utmost respect for human life

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2
Q

Utilitarianism

A

What is morally right:

  • Greatest NET utility, defined in terms of happiness
  • Greatest amount of good/happiness for greatest number of people (Best overall consequence)
  • Human welfare is most important (any everyone’s welfare is equally important)
  • ~Cost-benefit analysis

Calculation:

  • everyone is equal
  • net happiness
  • intensity
  • duration
  • fruitfulness
  • likelihood

Advantages:

  • Clear and straightforward basis for designing policies
  • Objective and attractive way of solving conflicts
  • Flexible, result-orientated approach

Disadvantages:

  • Do not consider intentions
  • Should not only take results into consideration
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3
Q

Kant’s Deontology

A

Deontological theories are NOT goal-oriented but intention-oriented

Teleological theories are goal-oriented

  • Egoism: right act bring good for SELF
  • Utilitarianism: right act bring OVERALL good

Right motive:
- should be unconditional

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4
Q

Virtue ethics

A

Trait of character manifested in habitual action

Intellectual virtue: excellence of mind
Moral virtue: act well

Aristotle’s list of Moral Virtue:

  • Courage
  • Temperance
  • Justice
  • Pride
  • Magnanimity (寬宏大量)

7 Virtues of good physicians:

  • Fidelity to traits and promise
  • Benevolence
  • Effacement of self-interest
  • Compassion and caring
  • Intellectual honesty
  • Justice
  • Prudence

Advantages:

  • Attractive account on moral motivation
  • Allow the presence of partiality (中庸之道)
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5
Q

Bioethical principles

A

Moral principles:

  • Respect for autonomy
  • Non-maleficence
  • Beneficence
  • Justice

Principle of Proportionality: balanced approach, weighing risks and benefits

Principle of Subsidiarity: action taken only when all other options not available

Principle of Veracity: tell truth

Principle of Double effect: positive and negative effects are known but still permissible to take action for the intention of positive outcome

Principle of Non-abandonment: continuous care even though nothing else could be done for patient

Principle of Necessity: Give medical treatment only when there is a medical need

Principle of Family Solidarity, Integrity or Response

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6
Q

Good Samaritan Acts

A
  • Doctor-passenger does not have a duty of care unless pre-existing doctor-patient relationship
  • Bound by physician’s pledge to render medical assistance when asked for help, otherwise misconduct
  • Bolam test: if a doctor has acted according to proper and accepted practice, he is not guilty of medical negligence, standards should be judged by own peers
  • Bolitho test: defence could not be considered reasonable if body of doctors / supporting witnesses were not capable of withstanding logical analysis, defence and body of opinion must be reasonable and responsible
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7
Q

Patient’s charter

A
Right to medical treatment
Right to information
Right to choices
Right to privacy
Right to complaint

Right of information
Right of refusal
Right of confidentiality

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8
Q

Informed decision/consent

A

3 requirements for informed consent:

  1. Competent
    - Understand the information
    - Retain the information
    - Use and weigh the information
    - Communicate the decision
  2. Patients must be provided with all necessary information
  3. Give their consent voluntarily
    - free of coercion

Steps in obtaining informed consent:

  1. Assess competence of patient
    - capable of understanding the information
    - capable of using and weighing
    - capable of communicating a decision
2. Provide sufficient information
—> information particular to patient
- nature of medical condition
- available options include option not to treat + likely outcome
- consequence
- any uncertainty of doctor in his diagnosis
—> information about procedure
- description
- common risks and complications
- uncommon risk with serious consequence
- what to expect before and after
  1. Additional questions by patient
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9
Q

Capacity / competency

A

Mental capacity - mental ability and understanding (decision specific)
Legal capacity - based on legal age
Autonomy - right to make own decision and to be assumed to have the capacity to do so

Assessment methods:

  • Understand the information
  • Retain the information
  • Use and weigh the information
  • Communicate the decision

Lack capacity:

  • doctor to assess person’s ability to consent
  • absence of proxy decision maker: due to principle of necessity —> justify treatment without consent
  • any decision should be based on patient’s best interest - Proxy decision (major ethic principle: beneficence)
  • family members DO NOT have automatic right to decision making
  • unless appointed as guardian (Guardianship order)
  • Not every mentally incapacitated adult need a guardian
  • Advanced directive, Power of attorney, Best interests decisions
  • Children (automatic parental consent unless provoked by Courts / Proxy decision is needed, unless the child is Gillick competent)
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10
Q

Gillick criteria

A
  • whether a child (under 16 years of age) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge.
  • Doctor decides whether the child is Gillick competent
  • Parents cannot overrule

Fraser guideline

  • the young person will understand the professional’s advice;
  • the young person cannot be persuaded to inform their parents;
  • the young person is likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment
  • unless the young person receives contraceptive treatment, their physical or mental health, or both, are likely to suffer
  • the young person’s best interests require them to receive contraceptive advice or treatment with or without parental consent
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11
Q

Confidentiality

A
  • Moral
  • Legal
  • Contractual

Principles:

  1. Purpose and manner of collection
    - no excessive collection
    - lawful and fair collection only to purpose of organisation
  2. Accuracy of data collected and retained
    - amend errors, check and avoid errors
    - appropriate duration of retention
  3. Use of personal data
    - only used for same purpose / related purpose of collection
    - change of purpose requires consent
  4. Safe retention of data
    - appropriate level of security
    - protocols for disposal of data
  5. Publication of policy on how to deal with personal data
  6. Ensure right of access to data stored
    - rights to request copy / demand correction of data

Exceptions:

  • Consent to publish
  • Patient’s interest
  • Public’s interest
  • Required by law
  • HIV? Not in HK yet
  • Domestic violence etc.
  • Medical research (consent from patients)
  • Medical records (clinic/institution are owners of records, but patients are entitled to unrestricted access and copies of their own records, covered by Personal Data Ordinance, only applied to living individual)
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12
Q

Physician assisted suicide, Active voluntary euthanasia, Passive euthanasia

A

Physician assisted suicide:
Prescription of lethal dose of substance in which person takes with definite intention to end life at patient’s request

Active voluntary euthanasia:
Administration of lethal dose of substance at request of patient

Passive euthanasia:
Administration of lethal dose without asking consent / against patient’s will

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13
Q

Doctor patient relationship

A
  1. Paternalistic model: doctor knows best
  2. Informative model:
    - doctors offer scientific facts and delivery technical solutions
    - patients know their own circumstances best
  3. Fiduciary model:
    - doctor act in patient’s best interest, show loyalty and inspire confidence
    - patients able to perceive that doctors are acting in good faith and trustworthy manner
  4. Legal model
    - service provider and customer relationship
    - strong sense of equality
    - degree of formal protection for patients
  5. Interpretive model
    - doctors as MENTORS
    - guide patients to clarify values and prioritising them, suggest interventions that best realise the patient’s values
    - do not judges patient’s values
    - obligated to assist
    - patients: values not fixed
    - doctor patient not assumed to be equal
  6. Deliberative model:
    - doctors as FRIENDS
    - treating each other as equals
    - sincere exchange of viewpoints (shared decision making)
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