MLE

Question 1

Describe the ethics surrounding prescription pain relief (5pts)

Answer 1

Doctrine of double effect- the nature of the act is not bad, and one of the consequences is good (the patient feels pain relief) although there is a risk of toxicity
Non maleficence- avoid leaving the patent in pain
Theologians would argue that the intention is the moral guidance- the intention to relieve pain is inheritantly good.
However, consequentialists would argue that the consequences are the same regardless of intention.

Question 2

Discuss four aims of palliative care (5pts)

Answer 2

Pain and symptoms management
Clear decision making
Preparation for death
Affirmation of the whole

Question 3

Distinguish Assisted Suicide from Euthanasia (2pts)

Answer 3

Deliberately assisting or encouraging a lethal injection
Euthanasia involves deliberately ending a person’s life to relieve suffering, typically by a third party.

Question 4

Distinguish active euthanasia from passive euthanasia (2pts)

Answer 4

Active- delivering a fatal injection of encouraging end of life
Passive euthanasia involves withholding or withdrawing life-sustaining treatment to allow the patient to die.”

Question 5

Discuss the differences between voluntary, involuntary and non-voluntary active and passive euthanias (5pts)

Answer 5

INVOLUNTARY - killed against wishes
NON VOLUNTARY- unable to consent such as coma and withdrawal of treatment
ACTIVE- deliberate such as delivering a fatal injection
PASSIVE- withholding treatment
VOLUNTARY- a person makes a conscious decision

Question 6

Describe the double doctrine effect (DDE)

Answer 6

`The act is permissible if the following occur:
the nature of the act is not bad
at least one of the act’s consequences is good
at least one of the act’s consequences is bad
there is a sufficiently serious reason for allowing the bad consequence to occur
the bad consequence is not a means to the good consequence
the agent foresees the bad consequence but intends the good consequence

Question 7

Define Consent (1pt)

Answer 7

the patient’s voluntary agreement to treatment, examination, or other healthcare aspects and permission to examine, investigate, or treat, and the waiving of the right to bodily integrity.
Understand and voluntarily agree

Question 8

Discuss the ethics surrounding consent (4pts)

Answer 8

Autonomy - the right to make a decision as an individual
Do no harm- but sometimes a patient will not consent to an option that is lifesaving, providing they have a capacity. This is a decision that must be respected
Do good- allowing a patient to have all information and understanding to be able to consent allows for their decision to be voluntary. And therefore to do goo, a patient must know they are free to refuse without pressure to do so.

Question 9

Discuss the professional guidance surrounding consent and the information necessary to recieve informed consent (5pts)

Answer 9

A doctors omission to warn a patent of risks is a breach of duty of care under the Bolam test- was the omission accepted as proper by a responsible body of medical opinion
The doctor is under a duty to take reasonable care to ensure the patient is aware of material risks and the reasonable alternatives
A risk is material if a reasonable person would likely to attach significance to it.
The doctor must uphold trust in the profession and therefore not withheld information that may be used as decision making for consent.
Doctors must start from the presumption that all adult patients have capacity to make decisions about their treatment and care
Doctors must try to find out what matters to patients so they can share relevant information about the benefits and harms of proposed options and reasonable alternatives, including the option to take no action.
INFORMATION: Procedure, Alternatives, Risks, Questions

Question 10

Discuss with examples, the legal aspects of obtaining consent (5pts)

Answer 10

it must be voluntary - the patient must know they can refuse, are able to refuse and are free from undue pressure
informed- there must be options for procedure, alternative, risk, questions and doctors should not withhold information
the person consenting must have the capacity to make the decision- a bad decision does not mean no capacity but they must able to understand, weigh up, retain and communicate their decision.

Question 11

Explain the meaning of valid consent, and the key conditions needed to obtain it (5pts)

Answer 11

it must be voluntary - the patient must know they can refuse, are able to refuse and are free from undue pressure
informed- there must be options for procedure, alternative, risk, questions and doctors should not withhold information
the person consenting must have the capacity to make the decision- a bad decision does not mean no capacity but they must able to understand, weigh up, retain and communicate their decision.

Question 12

Discuss the importance of relaying risks to a patient prior to a procedure (3pts)

Answer 12

it must be voluntary - the patient must know they can refuse, are able to refuse and are free from undue pressure
informed- there must be options for procedure, alternative, risk, questions and doctors should not withhold information
the person consenting must have the capacity to make the decision- a bad decision does not mean no capacity but they must able to understand, weigh up, retain and communicate their decision.

Question 13

Discuss voluntariness with regards to consent (3pts)

Answer 13

Patients must be able to refuse
Patients must know that they are able to refuse
Patients must be free from undue pressure (i.e. free from coercion and perceived coercion)

Question 14

Using ethical theory and principles, justify the importance of maintaining patient confidentiality (5pts)

Answer 14

Autonomy: control their personal health information
“Virtuous behaviour” should specify which virtues, such as honesty and trustworthiness.
Consequentialist Justifications: leads to positive outcomes for patients and fosters trust.
Trust is fundamental for building and maintaining trust between healthcare professionals and patients.
Beneficence: contributes to the overall well-being of patients.

Question 15

Using examples from common and statute law, discuss the legal aspects of maintaining patient confidentiality (5pts)

Answer 15

“Common Law: Balancing the protection of individual privacy against potential harm to society or individuals.” Therefore a breach of confidentiality would be harming an individuals respect of privacy and legal consequences come under tort of negligence
Stature Law: The Human Rights Act 1998 requires balancing the right to respect for private and family life, the right to life, and the right to freedom of expression. Data Protection Act 2018: Adds legal provisions related to data protection and confidentiality.

Question 16

Discuss justifiable breaches of confidence from a legal perspective (5pts)

Answer 16

Disclosure may be justified in cases of patient consent, research with anonymized data, protection of patient or others, detection of serious crime, legal defense, and statistical obligations.
Breaching confidentiality is allowed only in the ‘most compelling circumstances,’ with a real and serious risk of physical harm to identifiable individuals.
such as imminent danger or mandatory reporting laws.

Question 17

Explain a scenario of when health information can be disclosed without consent (4pts)

Answer 17

Certain situations mandate disclosure by law, such as notification of births, stillbirths, deaths, fertility treatment, communicable diseases, termination of pregnancy, serious workplace accidents, terrorism, road traffic accidents, and court orders.

Tricky: Genetic diseases diseases affecting driving, sexually transmitted infections, domestic abuse, child abuse, sexually active children, crimes, immigration issues, diseases, driving, and the DVLA pose particular challenges.

Question 18

List five topics that must be disclosed according to statute law (5pts)

Answer 18

Certain situations mandate disclosure by law, such as notification of births, stillbirths, deaths, fertility treatment, communicable diseases, termination of pregnancy, serious workplace accidents, terrorism, road traffic accidents, and court orders.

Question 19

Define ageism (1pt)

Answer 19

Age a protected characteristic, prohibiting discrimination based on age. Ageism is the discrimination based on age.

Question 20

Using legislation, discuss aspects of ageism from a legal perspective (2pts)

Answer 20

The equality act considers age a protected characteristic.
The mental health act is crucial in assessing capacity and legal provisions exist for compelling treatment
Elderly people have rights to choose accommodation in the National Assistance Act

Question 21

Describe 5 key issues individuals from the ageing population may experience (5pts)

Answer 21

more likely to be deferential to doctors
have impaired capacity
rely on social support
face discrimination
And have complex healthcare needs such as polypharmacy

Question 22

List the criterias for having capacity (4pts)

Answer 22

based on the ability to understand, retain, use, and communicate information relevant to decision-making.

Question 23

Define a Deprivation of Liberty (DoL) (1pt)

Answer 23

ensures people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty.

Question 24

List five factors that can impact capacity (5pts)

Answer 24

Capacity can change over time, and patients may be capacitous for some decisions but not others.
Previous assessments should not be overemphasized,
doctors can influence capacity through various factors.
Various factors, such as pain, medication, infection, fear, illness, injury, and fatigue, can affect capacity.

Question 25

Define quality of adjusted life years (1pt)

Answer 25

a generic measure of disease burden, including both the quality and the quantity of life lived.

Question 26

List 5 potential causes of medical error (5pts)

Answer 26

Rarely due to poor performance
Usually systemic problems
incorrect patient name and drug name
incorrect dose and directions are given
Poor teamwork leading to near misses. (expand this!)

Question 27

List 1 breach of care that can result in criminal action (1pt)

Answer 27

“if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art” BOLAM. For example, creating a new technique / treatment with no discussion.

Question 28

Define and explain gross negligent manslaughter (4pts)

Answer 28

where the death is a result of a grossly negligent (though otherwise lawful) act or omission on the part of the defendant
The doctor had a duty of care
The doctor breached the duty of care by not acting in a proper way that the responsible body would say medical person would.
The act of breaching the duty caused harm to the patient. (omission does not count)

Question 29

List two breaches that can result in civil action (2pts)

Answer 29

GP can be sued for damages if they caused harm.
Your case may concern a failure to obtain informed consent (also sometimes referred to as a ‘Montgomery’ case)

Question 30

Define negligence (1pt)

Answer 30

breach of a duty of care which results in damage.

Question 31

Explain three conditions that must be proven in order to sue for Tort of Negligence (3pts)

Answer 31

Dr had a duty of care
Duty of care was breached
Breach cause harm

Question 32

Explain two ways of describing standard of care (3pts)

Answer 32

Reasonable Person Standard: whether a person’s actions were what a typical, reasonable person would have done under similar circumstances.
Professional Standard: This standard assesses whether a professional has acted in accordance with the skills, knowledge, and practices that are commonly accepted by their peers in the same field

Question 33

Compare Legal Standard and ‘duty of care’ (1pt)

Answer 33

Legal standard of care is a legal obligation that is imposed on an individual, requiring adherence to a standard of reasonable care to avoid careless acts that could foreseeably harm others, and lead to claim in negligence

Conceptual Difference:
Duty of Care: It is the obligation to avoid acts or omissions that could foreseeably harm others. It is the threshold question in negligence cases.
Legal Standard of Care: It is the benchmark against which the defendant’s conduct is measured to determine if the duty of care has been breached.
Function in Negligence Claims:
Duty of Care: Establishes whether the defendant owed a duty to the plaintiff.
Legal Standard of Care: Evaluates whether the defendant’s actions met the required level of care to fulfill that duty.
Establishment:
Duty of Care: Determined by law, based on the relationship and circumstances (e.g., a doctor has a duty of care to their patient).
Legal Standard of Care: Involves an assessment of what a reasonable person or professional would have done in similar circumstances.
Role in Legal Proceedings:
Duty of Care: Its existence must be proven first in a negligence claim.
Legal Standard of Care: Once a duty of care is established, the plaintiff must show that the defendant breached this duty by not meeting the legal standard of care.

Question 34

List two examples of areas surrounding duty of care (2pts)

Answer 34

There is no duty of care to every stranger in the world, only DOC when Dr Pt relationship is established.
Doctors can prescribe against guidelines (NOT RULES) but must be able to justify decision.
The examples given could be clearer by specifying that guidelines are not legally binding but must be justified if deviated from.

Question 35

Define resource allocation (1pt)

Answer 35

process of assigning and managing assets in a manner that supports an organization’s strategic goals.

Question 36

Using ethical principles, discuss who you would allocate the liver to (4pts)

Answer 36

Need: The need requirements of both individuals is the same.
Lottery: The randomisation of resources would not take into account need, cost effectiveness
Consequentialism: Using QALYs to determine how many years of perfect health is available. (For this reason, the 2 year old is prioritised)
Responsibility: Neither scenario has a responsibility that would effect choices to be maximised (hints at cirrhosis but doesn’t suggest lifestyle influenced)
Social Worth: Danger of corruption, and prejudice, would not be a good determinant
Democracy: Government mandated decision making which would enact discrimination
Pluralism: Considering all of the above.

Overall, prioritising consequentialism and pluralism the 2- year old has the greatest chance of survival and therefor allocation would be appropriate. This is without bias to the individuals social worth/ experience.

Question 37

Discuss the pros and cons of allocating limited resources based on lottery (3pts)

Answer 37

Lottery ensures everyone is treated equally, removed discrimination of age, gender and ethnicity. But, it fails to account Need, cost effectiveness and social responsibility.

Question 38

Discuss three factors to consider when allocating limited resources based on need (3pts)

Answer 38

Need is too simple to define: how is need compared within groups and between groups?
Takes no account of cost-effectiveness or responsibility
Bias and discrimination could be determined as “need”

Question 39

List 3 disadvantages to allocating limited resources based on personal responsibility (3pts)

Answer 39

Not all choices are free: addiction
Overly moralistic approach
Judgemental medics might violate a right to life.

Question 40

Discuss, using ethical principles, the allocation of limited resources based on social worth (3pts)

Answer 40

Danger of discrimination/prejudice/corruption. Who decides? Ignoring need?
Social Contract / Reasonability / Rationality.

Question 41

Define ‘transgender’ (1pt)

Answer 41

Someone whose gender identity differs from the sex they were assigned at birth.

Question 43

Define what it means to have a gender identity as ‘non-binary’ (1pt)

Answer 43

A gender identity that does not subscribe to the western view of 2 facets: man and woman. (male and female are sex)

Question 44

Describe 2 aspects of the conservative approach to supporting a transgender person (2pts)

Answer 44

Harm reduction- counselling to cope with the discrimination of being trans
Voice coaching
Social support groups
Affirming behaviour- updating name and pronouns.

Question 45

List 2 therapies, medical or surgical, available to a transgender person (2pts)

Answer 45

Hormone therapy- Oestrodiol
Testosterone
Top Surgery

Question 46

List the conditions needed for a GRC (3pts)

Answer 46

Diagnosis of gender dysphoria.
Proof of living in the acquired gender for at least two years.
Intention to live permanently in the acquired gender.

Question 47

List the conditions for safeguarding under the Care Act 2014 (3pts)

Answer 47

Protecting an adult’s right to live in safety, free from abuse and neglect.

Question 48

Define ‘Adult Safeguarding’ (1pt)

Answer 48

Apply to adults with care and support needs who are at risk of abuse or neglect and unable to protect themselves due to those needs.

Question 49

List five symptoms of abuse or neglect that may warrant adult safeguarding (5pts)

Answer 49

Physical, domestic violence/abuse, sexual, psychological/emotional, financial/material, modern slavery, discriminatory, organizational/institutional, neglect/acts of omission, self-neglect.
Physical, Behavioural, Neglect, Financial

Question 50

Describe how you might respond and report to noticing symptoms of abuse and neglect (3pts)

Answer 50

Listen and reassure.
Assess immediate risk.
Discuss with the person what they would like to happen.
Consider mental capacity.
Explain confidentiality limits and potential for overriding wishes if risks to self or others are present.
Recording all concerns and actions taken is vital.

Question 51

List three examples of self-neglect (3pts)

Answer 51

Recognized as a form of abuse or neglect if the person has care and support needs.
Balancing respect for autonomy with duty to protect health and wellbeing is crucial.
Often addressed through assessment, planning, advice, and prevention under the Care Act.

Question 52

How may you approach a situation of self neglect ethically and legally? (3pts)

Answer 52

Autuonomy- reporting without pt consent
Non maleficence- not reporting will cause pt harm
Do good- reporting will stop abuse