Quesmed Flashcards
What is the bolam test
The standard of care is based on an ordinary standard of care, from a doctor with that level of experience, in those circumstances. “The test is the standard of the ordinary skilled man exercising and professing to have that special skill” (Bolam [1957]) - i.e. what can be expected of an ordinary doctor in that situation.
The Bolam Test used to be the standard test used in court for doctors to justify their actions. However, this has since been added to by the Bolitho Test. This is because it is no longer seen as enough for a doctor to potentially find just one body of opinion that supports their actions - the court has the right to scrutinise these actions and decide if they are logical or not.
What is the bolitho test
used to scrutinise if the actions undertaken by the doctor and supported by the medical opinion are logical.
If they are not, then there has been a breach in the duty of care.
If they are, then the duty of care has not been breached.
What is a lasting POA
If an individual wants to legally appoint someone they trust to make decisions on their behalf in the future if they lose capacity, they can do this by making a lasting power of attorney (LPA). Usually an individual chooses a close relative or friend to be their “attorney”, who is given legal power to make decisions about their health and care if they lose capacity at some point in the future.
What is an independent mental capacity advocate
used when an individual lacks the capacity to make a specific important decision, when there is no-one independent of services (e.g. a family member or friend) appropriate to represent the individual lacking capacity.
IMCAs support and represent the individual who lacks capacity, ensuring the Mental Capacity Act, 2005 is followed.
What is a court of protection
court that if applied to, can make decisions about an individual’s health, welfare, finances and property under the Mental Capacity Act 2005.
There are three requirements for a successful negligence claim. In order for a claim to be successful, a “Yes” answer is needed to all three of these questions:
Duty of Care - Was a duty of care owed?
Breach of Duty - Was this duty of care breached?
Causation - Was the harm caused by the breach?
What would make doctors not be found guilty of negligence
They act with ordinary care
and
Their actions are sanctioned by a responsible body of medical opinion (from the Bolam Test) which stands up to logical scrutiny in court (from the Bolitho Test).
The General Medical Council (GMC) gives two reasons for which information may be withheld from a patient:
If a patient with capacity does not want to know.
If giving this information would cause serious harm - it is important to note the GMC guidance that “serious harm” means more than the patient becoming upset or deciding to refuse treatment.
Five key principles underpin the MCA.
Capacity is assumed; it needs to be proven otherwise
Enabling people to make their own decisions
Unwise decisions
Best interests
Less restrictive option
There are four criteria used when assessing capacity in adults
The individual must be able to understand the information relating to the decision
The individual must be able to retain that information
The individual must be able to weigh up the information and reach a conclusion
The individual must be able to communicate the decision they have made.
According to guidance from the General Medical Council, it is important to respond constructively when things go wrong. It is important to establish open and honest communication, and do the following:
Apologise (this is not an admission of liability)
Explain what has happened
Notify a senior clinician
Direct the patient and their family to the Patient Advice and Liaison Service, and advise them on the complaints procedure
Explain to them what investigations will be carried out
What is a ceiling of care
This means that doctors should engage with the patient, those close to them and the healthcare team in order to determine what level of treatment is appropriate to give to a specific patient towards the end of their life.
What is euthanasia
Euthanasia, a type of assisted dying, is when the death of another person is intentionally hastened for their own benefit. The word ‘euthanasia’ itself means ‘good death’. There are different types of euthanasia, but all forms are illegal in the UK. There is no legal distinction between euthanasia and murder.
What is acitve euthanasia
Death is hastened by an act. For example, being given a medication to cause death.
What is passive euthanasia
death is hastened by not doing something and allowing the person to die. For example, withholding or withdrawing treatment that would prolong life.
