PPD - Medical Law and Ethics Flashcards
Outline the principles of conducting an ethical analysis of a medico-moral case. - WHAT ARE THE FOUR MODELS?
The ‘four principles approach’
The paradigm case process / 4 quadrants
Structured case analysis model
Ethical grid
What is the ‘four principles approach’?
Method of conducting an ethical analysis of a medico-moral case
Non-maleficence, beneficence, autonomy, justice
What is the paradigm case process / 4 quadrants?
Method of conducting an ethical analysis of a medico-moral case
medical indications, patient preferences, quality of life, contextual features
What is the Structured case analysis model?
Method of conducting an ethical analysis of a medico-moral case
SUMMARISE, STATE the more assumption, state assumptions beting made, ANALYSE the case in terms of ethics, consequences, ‘virtuous HCP’, law, IDENTIFY justifyable solutions, state preferred approach
What is the ethical grid?
Method of conducting an ethical analysis of a medico-moral case
Complex grid incorporating respect, honesty, outcome analysis and all peripheral considerations such as law, evidence
What are the benefits of being ethical?
better patient care, happier employees, maintains reputation, lack of moral distress, more productive, inclusive and effective teams
What are the challenges of doing ethics?
limited resources, integrating into habits so it is part of every clinical process, ethics constructed or treated like ‘jumping through hoops’
Explain the ethical and legal significance of the concepts of consent in clinical practice.
Consent - voluntary agreement, permission to examine/investigate/treat, waiving of right to bodily integrity
Key principles are INFORMED, VOLUNTARY, COMPETENCE (and patient can change mind at any time!)
PARQ
procedure, alternative, risks, questions
Components of competence
Competence incorporates ability to UNDERSTAND, RETAIN, WEIGH UP and COMMUNICATE DECISION
What are the theories/models regarding how much information patients should be given?
Professional practice standard, reasonable / prudent person standard, subjective standard (what does this patient likely care about)
What is the Bolam test
opinion of a responsible body of medical opinion
Requirements of a decision being ‘voluntary’
Voluntary means patients must be able to refuse, know they can refuse, and must be free from undue pressure
What is the information-giving standard following the Montgomery case
Patient must be aware of any ‘material’ risks that a REASONABLE person would be concerned about (or the specific patient if the doctor is aware of any specific concerns)
Potential issues with getting consent
must be SPECIFIC, can be delegated but only if rules are followed, signed consent does not mean you have sufficient evidence
How did you present the information?
What is the complexity of the information?
What are the effects of fear, social status, embarrassment, etc. on decisions?
Time consuming
When is consent NOT required?
patient not competent (what is in their best interests or reflects their most recent wishes?), do they pose a serious risk to others if not treated?, they decline all information
Discuss medical error in relation to professional competence - discuss likely causes and potential impact on work culture
Rarely due to poor performance
Usually systemic problems
Best solution is: systemic improvement (e.g. clinical governance, reporting to agencies etc.)
Rarely “one offs”
Everyone makes mistakes (and that includes you!)
Do not blame yourselves for every mistake
The “blame culture” is not healthy
Principles to avoid professional competence issues following mistakes
ALWAYS COMMUNICATE OPENLY, EXPLAIN ISSUES/MISTAKES
ALWAYS APOLOGISE
BUILD RAPPORT WITH PATIENTS
Explain the potential legal and professional ramifications of medical errors and negligence - how can patients hold HCPs accountable?
NHS Complaints Procedure - very convoluted
General Medical Council - Fitness to practise panel
The Law - Criminal or civil (tort of negligence, breach of contract - private only)
What elements are required to prove negligence?
The doctor had DUTY OF CARE, which was BREACHED, this breach CAUSED HARM
What is the principle of candour in medical error?
patients must be told if there was an error made which caused them to suffer OR COULD HAVE
What is defensive medicine? and discuss the various issues that may come up
“the practice of performing tests as a safeguard against possible malpractice liability rather than to ensure the health of patients”
Defensive medicine is also…
rarely a sustainable explanation for action
makes litigation more likely (unnecessary investigations/treatment)
very expensive
violates the trust that patients have in doctors
Describe a systematic approach to the analysis of the causes of medical error and threats to patient safety.
NHS Redress Act 2006 - Alternative to litigation, no court system involvement, goal is to move away from blame culture, reduce costs and prevent harm by allowing doctors to learn from mistakes
Should NHS have a no fault scheme?
Explain the ethical and legal significance of the concepts of confidentiality in clinical practice. Why is confidentiality important?
Autonomy
Rights to privacy
Welfare/beneficence
Trust depends upon it
Argument from utility
Common law duty to keep confidences (not contractual)
Ethical emphasis on confidentiality (e.g. see GMC Confidentiality (September 2000))
Outline requirements for public disclosure
in the public interest AND not competent to consent OR obtaining consent would put others at risk OR obtaining consent would undermine the purpose OR time is of the essence.
Describe the ethico-legal issues relevant to the prescription of pain relief.
Doctrine of double effect - ie the pain relief may kill them more quickly, but the express purpose is pain relief - FOCUS ON INTENTIONS (but does that matter if the consequences are the same?)
Law states that doctors can prescribe pain relief even if there is a risk of abbreviating life (with proper consent, understanding, etc.)
Explain the distinctions between active, passive, voluntary, non-voluntary and in-voluntary euthanasia
Discuss difference
Explain and ethically evaluate the law relating to suicide and assisted suicide with particular reference to the guidance issued by the Director of Public Prosecution in relation to assisted suicide.
Assisted suicide is illegal and there is not immunity from prosecution but they have determined factors that weigh in favour or against prosecution
In favour:
Person who dies is under 18, may lack capacity, has no clear / settled wish to die, questioning their decision, they did not initiate the process, they do not have a terminal illness
The person helping them is not motivated by compassion / long term relations, or there is evidence of persuasion or coercion
(against is opposite)
