PPS Flashcards
HUMAN RIGHTS ACT 1998
What is the WHO definition of health?
How does this link to the HRA?
- The state of complete physical, mental + social wellbeing + not merely the absence of disease or infirmity.
- The highest attainable level of health is the fundamental right of every human being.
HUMAN RIGHTS ACT 1998
When did the HRA come into force?
What is the importance of it?
- 2000 + is set out in the European Convention on Human Rights.
- (Should) form part of an organisations decision-making process to ensure people’s rights are respected + is part of all policy making.
HUMAN RIGHTS ACT 1998
What are the underlying assumptions with the HRA?
- State/organisations have a duty to uphold these rights + they’re universal.
- All basic rights are claim rights i.e. others wanting things.
- The irreducible moral status of individuals demands that people are treated in ways that are compatible with that moral status.
HUMAN RIGHTS ACT 1998
What are some issues with the HRA?
- ?Universal or Western concept (FGM, judicial executions).
- Which interests are significant enough to justify it being a human right?
- Can absolute claims conflict? All rights are interdependent + inter-related.
HUMAN RIGHTS ACT 1998
What are the 5 articles that are frequently engaged in healthcare?
Art 2 – the right to life.
Art 3 – the right to be free from inhumane + degrading treatment.
Art 8 – the right to respect for privacy + family life.
Art 12 – the right to marry + found a family.
Art 14 – the protection from discrimination (sex, race, sexuality etc).
HUMAN RIGHTS ACT 1998
What is meant by absolute rights?
Give some examples
They’re never limited i.e. they hold under ALL circumstances.
- Art 3, Art 4 (prohibition on slavery + enforced labour), Art 7 (protection from retrospective criminal punishments).
HUMAN RIGHTS ACT 1998
What is meant by limited/qualified rights?
Give some examples
They are limited under explicit + finite circumstances.
- Art 2 (limited), Art 5 (the right to liberty), Art 8 (qualified).
HUMAN RIGHTS ACT 1998
Explain why some rights may be limited/qualified.
- Art 5 – if your freedom affects other’s safety.
- Art 2 – medical Tx a pt requests is not a right. Obligation upon state to take appropriate steps to safeguard life but cannot impose a disproportionate burden on the authorities to provide unlimited resources.
HUMAN RIGHTS ACT 1998
What is the exceptionality criteria with the HRA?
Applicable to public bodies like NHS trust where they adopt a general policy for the exercise of ‘administrative discretion’, to allow for exceptions from it in ‘exceptional circumstances + leave those circumstances undefined’.
HUMAN RIGHTS ACT 1998
What are some topics in individual rights vs. collective groups?
- Should vaccines or blood/organ donation become compulsory?
- Is screening a form of collectivism?
- Wearing a face mask to prevent spread of disease despite disagreement.
RESOURCE ALLOCATION
What is rationing?
Where resource is refused because of lack of affordability rather than clinical ineffectiveness.
RESOURCE ALLOCATION
Why have rationing needs increased in terms of resource allocation?
- Shift from acute>chronic complex conditions.
- Increase in choice + availability of more expensive drugs.
- Medicalising what used to be ‘normal’ physiology (childbirth, menstruation).
- Ageing population with increasing demand on services.
- Funding has barely increased.
RESOURCE ALLOCATION
What are the 3 ethical theories in context of resource allocation?
- Egalitarianism.
- Maximising/Utilitarianism.
- Libertarian.
RESOURCE ALLOCATION
What is the concept of egalitarianism?
What are the pros/cons?
- Provide all care that is necessary + required to everyone.
Pros: equal for everyone (supports belief people deserve equal rights/opportunities)
Cons: economically restricted, tension between egalitarian aspirations + finite resources.
RESOURCE ALLOCATION
What is the concept of maximising?
What are the pros/cons?
- Healthcare should be distributed to bring about the best possible outcome (criteria that maximises public utility).
Pros: resources allocated to those most likely to receive most benefit.
Cons: those with ‘less need’ receive nothing.
RESOURCE ALLOCATION
What is the concept of libertarian?
What are the pros/cons?
- Each individual is responsible for their own health, wellbeing + flourishment i.e. incentives for behaviour change, screening participation paid (all paid with savings made from better health outcomes).
Pros: onus on pt therefore may be more engaged.
Cons: not all diseases are self-inflicted, should people be held accountable for their current/future health?
RESOURCE ALLOCATION
What is the harm principle in relation to Libertarian theory?
What is the con to this principle?
- People should have autonomy in life so long as it doesn’t affect anyone else, even if others see actions as being wrong
- BUT doesn’t appreciate the impact choices has on others
RESOURCE ALLOCATION
What is Johnson’s rule of rescue?
A tension sometimes arises between the injunction to do as much good as possible with scarce resources + the injunction to rescue identifiable individuals in immediate peril, regardless of the cost.
RESOURCE ALLOCATION
Give an example of Johnson’s rule of rescue.
It’s a perceived duty to save endangered life through disproportionate efforts regardless of cost + usually seen in vulnerable groups like children.
- E.g. treat rare cancer in child with experimental drug that may be effective.
RESOURCE ALLOCATION
What is meant by a sustainable process?
One that meets the needs of the present without compromising the ability of future generations to meet their own needs.
RESOURCE ALLOCATION
What are the aspects of sustainability
- Economic factors.
- Social factors.
- Environmental factors.
RESOURCE ALLOCATION
Explain how the NHS can contribute to unsustainable practice
- NHS emissions come directly from everyday clinical practice.
- E.g. inefficient use of resources which can lead to clinical waste (over investigating, overprescribing, over intervention).
RESOURCE ALLOCATION
How can we respond to the unsustainable practices in the NHS?
- Reduce clinical waste via appropriate prescribing, pt education to improve adherence.
- Requires system-level action i.e. changes through legislation.
- Encourage active travel (improved air quality + reduced risk of CVD).
RESOURCE ALLOCATION
What is the ladder of interventions?
- Starts at doing nothing/monitoring.
- Next steps are education or enabling choice (can be via changing the default).
- Ends with incentives, disincentives + then restricting/eliminating choice.
MEDICAL NEGLIGENCE
Define negligence
A breach of duty of care which results in damage.
- There is failure to take proper care over something.
MEDICAL NEGLIGENCE
What 4 questions should be asked when negligence is suspected?
- Was there a duty of care?
- Was there a breach in that duty?
- Did the patient come to any harm?
- Did the breach cause the harm?
MEDICAL NEGLIGENCE
What 2 tests can be used to decide if there was a breach in a duty of care?
- Bolam test = would a group of responsible doctors do the same?
- Bolitho test = would it be reasonable of them to do so?
MEDICAL NEGLIGENCE
What factors influence how much money a patient may get from a successful negligence claim?
- Loss of income.
- Cost of extra care.
- Pain + suffering.
MEDICAL NEGLIGENCE
What are 6 broad factors which contribute to negligence?
- System failure.
- Human factors.
- Judgement failure.
- Neglect.
- Poor performance.
- Misconduct.
MEDICAL NEGLIGENCE
Explain what is meant by system failure.
- Computer system may shutdown > losing notes.
- Pt may be unconscious + unable to communicate so important info lost at critical moment.
- Hackers could access computer systems = remove confidential information.
– Confidentiality breaking in this way could be negligent.
MEDICAL NEGLIGENCE
Explain what is meant by human factors?
- Personal factors (having a bad day>mistakes).
- Teamwork problems (miscommunication, tensions between staff).
- Working environment (lighting, space).
- Decision density (leaving one person to make all decisions = pressure so more likely to make a mistake).
MEDICAL NEGLIGENCE
Explain what is meant by judgement failure?
- Defective decision making, bias.
- Analytical or intuitive.
- Wrong amount or type of information, wrong decision making strategy.
MEDICAL NEGLIGENCE
Explain what is meant by neglect.
- Not showing enough care.
- Falling below expected standard.
- Often chain of minor failures which may/may not lead to harm.
- Can be multidisciplinary (communication + assumptions).
MEDICAL NEGLIGENCE
Explain what is meant by poor performance.
- Repeated minor mistakes or not learning from mistakes.
- Usually extends beyond attitude to pt care (timekeeping, reliability, illness).
MEDICAL NEGLIGENCE
Explain what is meant by misconduct.
- Deliberate harm, covering up errors, improper relationships (staff/pts).
- Fraud/theft/abuse i.e. falsely claiming sickness, substance misuse.
ERROR
Define error?
What can medical error lead to?
What should you do in the event of a Patient Safety Event?
- A preventable event that can cause or lead to an unintended outcome.
- Medical error is a preventable event that can lead to pt harm.
- Notify, inform patient, explain + apologise under the Duty of Candour policy
ERROR
What are 2 types of medical error?
- Adverse event = incident that results in pt harm.
- Near miss = event which had potential to cause harm but didn’t develop further thereby avoiding harm.
ERROR
What are some examples of human (individual errors)?
- Omission (required action delayed/not taken).
- Commission (wrong action taken).
- Sequence (action taken in wrong order).
- Fixation (regular act so don’t recognise if something goes wrong).
- Negligence (actions/omissions do not meet standard of an ordinary, skilled person).
ERROR
What are 4 broad classifications of errors?
- Intention.
- Action.
- Outcome.
- Context.
ERROR
What is meant by intention?
- Failure of planned actions to achieve desired outcome.
ERROR
What are 3 types of intention error?
- Skill-based (action made is not what was intended i.e. performing well-known task>little attention>error if distracted).
- Rule-based (incorrect application of a rule/incorrect plan or course of action taken i.e. in emergencies).
- Knowledge based (lack of knowledge in a certain situation.
ERROR
What are the issues with knowledge based errors?
- Automatically make us prone to actions not as planned.
- Memory may contain mini-theories rather than facts (liable to confirmation bias).
- Limited attentional resources.
ERROR
What is meant by action?
- Generic factors (omission, intrusion, sequence).
- Task-specific factors (wrong blood vessel/organ/side, bad knots in surgery).
ERROR
What is meant by outcome?
- Near miss.
- Death/injury/loss of function.
- Successful detection + recovery.
- Prolonged intubation/stay in ICU.
ERROR
What is meant by context?
- Equipment + staffing issues.
- Accumulation of stressors.
- Interruptions + distractions.
- Team/organisation factors.
- Nature of procedure.
ERROR
What are some red flags for errors?
- Anomalies.
- Broken communication, missing information or confusion.
- Departures from normal practice.
- Stress.
ERROR
What are the 10 types of basic error?
- Sloth.
- Fixation + loss of perspective.
- Communication breakdown.
- Poor team working.
- Playing the odds.
- Bravado + timidity.
- Ignorance.
- Mis-triage.
- Lack of skill.
- System error.
ERROR Give an example of... i) sloth. ii) fixation + loss of perspective. iii) communication breakdown. iv) poor team working v) playing the odds.
i) not bothering to check results accurately, inadequate documentation.
ii) early unshakable focus on Dx, inability to see bigger picture.
iii) unclear instruction of plans, not listening to/considering other’s opinions.
iv) some out of depth, some under-utilised.
v) choosing the common + dismissing rare.