PVB bits Flashcards by rachael a

approaches to child decisions

child paternalistic approach

child liberationist approach

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what are the types of best interests for children

basic interests - physical/emotional wellbeing
developmental interests - promote child development/emotional maturity/education/confidence/socialisation
autonomy interests - respecting and promoting autonomy

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when do basic and developmental interests take precedence in children

if the autonomous decision will result in death or serious harm

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should 18 be a cut off for legal protection from bad decisions?

development continues after 18
values and beliefs change as an adult
+ if we value autonomy, yes
+ practically there must be a legal cut off
+ there if more than just law to protect from bad decisions
+ autonomy should be respected especially as children start to be able to be exposed to risk factors for ill health at their own choice - drinking alcohol, smoking, extreme sports without adult supervision

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how should decisions be made for children without autonomy (babies, infants etc)

best interests - basic and developmental

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approaches to parental autonomy

parental rights

best interests

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pros and cons of parental rights argument

+ parents share values/beliefs with children

dont have a right to impose beliefs on others
parents have duty to ensure child reaches autonomous adulthood

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parental autonomy best interests argument

+ parents know child more than anyone else, family welfare is relevant to child

parents may be too emotionally involved, lack of objective weighing up
personal values/beliefs may mean they consider effective treatment as unacceptable

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risks and benefits of tissue donation as a child

risks - physical harm to child donor, transplant fails for recipient and causes grief and guilt
benefits - altruisim, saving a life, if sibling dies without transplant, guilt and grief

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professional guidance for children participation in research

minimal risk of harm
not possible to do in adults
condition specific to children
parental consent

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age of consent for children

16+

court approval for major decisions with parental disagreement over 16

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what are the requirements for Gillick competency

ask child if you can tell parents - if they say no, respect it
assess child maturity - understanding etc
likely to suffer harm without treatment given

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what is utalitarianism

consequence based approach - whatever decision brings greatest happiness is right (benefit is measured by overall happiness from consequences)

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pros and cons of utalitarianism decisions

+ democratixc, each persons happiness has value
+ intuitively 10 lives better than 1

certain actions always wrong
not all consequences can be forgiven
may justify heinous acts for greater good

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rights based approach to decisions

moral obligation placed on people to uphold rights of others

negative rights - may not harm us, may not steal from us may not kill us etc
positive rights - autonomy, education, healthcare (things that must be provided)

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pros and cons of rights based approach decisions

+ protects all individuals, incl marginalised and lacking power
- no power shifting possible

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what is the concept of justice

reciprocal relationship between individuals + society - all humans valued equally

if human life valued equally - justice means ensuring equal capability to flourish - access to healthcare

requires that societal structures value people equally

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is justice equity?

no, instead removing barriers and engaging with priorities instead of helping those with barriers overcome them

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how does listening and enagaging with those affected by conditions help (co-production)

informs understanding of health inequalities
identifies meaningful needs
informs sustainable and effective interventions

what is the concept of equity

recognising that people have different needs to achieve the same outcomes

what is the mental capacity act

decisions made on behalf of a person lacking mental capacity must be in individuals best interests

what is best interests

physical and emotional interests (values, aspirations, likes/dislikes)
autonomy interests

interaction of best interests and mental disability

previous best interests should be considered

health vs wellbeing

medical interests dont always = best interests
bad health decision may be in someones best interests/medical interest may not align with best interests (therefore their wellbeing)

importance of free will

being free to make ones own choices helps us flourish as humans

what do autonomous choices require

ability to understand information ability to form values ability to make decisions based on values and understanding

how does one enable autonomy to patients

``` provide adequate information clearly explain give time to consider options don't pressure patient non-judgmental approach provide reasonable choices ```

positive impacts of autonomy on care

``` helps drs give better advice enable better decision making improve mutual understanding improve trust improve adherence ```

how can doctors go against their moral instincts in treatment?

by talking to the patient and understand each others perspective

what is paternalism

overriding/undermining patients autonomy based on healthcare professionals view of patients best interests

what falls under paternalism

presenting one side of the argument withholding information coercion lying

arguments for/against withholding information being lying

for - intention is the same then lying = withholding morally. wrong to assume patients dont want to know. esp if you know the patient would be influenced by the information against - withholding restricts autonomy less. patients may actively collude in withholding. impossible to tell patients everything. less likely to cause mistrust

what offenses may be committed if a doctor acts without consent

criminal - assault and battery | civil - claim for damages

situations where consent is not required

emergency - obtaining consent may lead to damage to the patient implied - llifting top after asking if they can be examined, not good for invasive treatment waiver - decision given to someone else best interests - unconscious, dementia etc

what is expressed consent

oral or written permission

what is consent

a competent person that understands the nature of the treatment based on information in broad terms without coercion who then gives permission

what is competency

understand information retain information use information to make a decision communicate the decision

arguments for paternalism

patients may be depressed if given bad news | patients are laymen so may put undue weight to certain side effects

what is duty

certain actions are right or wrong in themselves irrespective of consequences e.g to not kill, not torture etc but how is it decided?

what are the conflicting duties of abortion

duty to respect autonomy | duty to not end life

what is virtue

a character trait a human being needs to flourish/live well

foetal rights

no legal rights til birth | being pregnant doesnt take your rights away - can engage in harmful behaviours, refuse medical treatment

paternal rights over foetuses/pregnant women

once born | none during pregnancy - no say in abortions, no legal right to be consulted/informed of one

legal grounds for abortion

pregnancy under 24wks or necessary to prevent gradve/permanent injury to mother or continued preg would be greater risk than termination or substantial risk of serious physical/mental handicap

what is consequentialism

actions ethically right/wrong determined by overall consequences of the action

problems with consequentialism

certain actions always wrong consequences aren't always clear could justify heinous actions for greater good doesnt take rights into account