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Medical Ethics and Law > Sexual Health > Flashcards

Sexual Health Flashcards

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1
Q

Case 1:

  • 62yr old man presents to Sex Health Clinic with rash on trunk
  • Diagnosed secondary syphilis
  • Sex with two people in last 3 months - A Kazakh sex worker and His wife
  • What needs to be done?
A
  • Both women should be tested for syphilis
  • The Kazakh woman is untraceable.
  • He agrees to tell his wife but then changes his mind - “It would destroy our marriage!”
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2
Q

______ is relevant for many parts of sexual health

A

Ethics

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3
Q

what are the 4 principles?

A
  • Respect for Autonomy
  • Non-maleficence
  • Beneficence
  • Justice
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4
Q

Case 1:

what needs to be thought about in the first case in relation to respect for autonomy?

A

Promote the right to self determination

Should we do what he is asking us to do?

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5
Q

Case 1:

what needs to be thought about in the first case in relation to non-maleficence?

A

the avoidance of harm

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6
Q

Case 1:

what needs to be thought about in the first case in relation to beneficence?

A

to do good

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7
Q

Case 1:

what needs to be thought about in the first case in relation to justice?

A

Fairness/equity

Individual vs population

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8
Q

case 1:

what are the relevant duties of a doctor registered with the GMC in relation to this case?

A

Useful list of our duties and highlighted ones are relevant in this case

Care of our patient is your first concern

This is about the bigger picture

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9
Q

GMC Confidentiality guidance on Serious Communicable Diseases 2017:

You may disclose information to a person who has close contact with a patient who has a serious communicable disease if you have reason to think what:

A
  1. the person is at risk of infection that is likely to result in serious harm
  2. the patient has not informed them and cannot be persuaded to do so

Both 1 and 2 have to apply to be able to disclose the information

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10
Q

Case 1:

• The man is told again that his wife needs to be tested:

  • If he won’t tell her himself then we will tell her
  • He reiterates his wish that she isn’t told by us. He will tell her when he’s ready
A

3 weeks pass, she’s not been tested

We wrote to the man giving him written notice that we will be contacting his wife

He was offshore at the time and his wife opened the letter

She tested negative

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11
Q

Case 2:

  • 41yr old man asks for an STI screen – he’d heard that his ex had ‘something’.
  • Tests positive for HIV
  • He’s a dentist
  • What are the issues?
A
  • His wellbeing
  • His privacy - Privacy important as could really harm his life
  • The wellbeing of his patients
  • His future employment - Unable to work then would be bad
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12
Q

Case 2:

what needs to be thought about in the second case in relation to respect for autonomy?

A

Promote the right to self determination

But can he do whatever he likes with all the other people involved?

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13
Q

Case 2:

what needs to be thought about in the second case in relation to non-maleficence?

A

The avoidance of harm

Harm to him or other people?

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14
Q

Case 2:

what needs to be thought about in the fsecond case in relation to beneficence?

A

to do good

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15
Q

Case 2:

what needs to be thought about in the second case in relation to justice?

A

Fairness/equity

Individual vs population

Want to be fair to him, his partner, his patients and the wider population

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16
Q

case 2:

what are the relevant duties of a doctor registered with the GMC in relation to this case?

A

Particularly this one think about the patients dignity and privacy

Where possible involve patients in decisions about their care

Coming to a joint arrangement is the best way

17
Q

Case 2:

what should the outcome be?

A
  • His wellbeing - Started on ART (Start on treatment to get viral load down - but this is treating for occupational benefit, HIV not harming him to significant degree). Not in a conventional Rx group
  • His privacy - A challenge
  • The wellbeing of his patients - Patient list reviewed for known HIV infected patients (check through his patients and see if any of them has HIV and some did and check to see if there is anything surprises to see if they had it e.g. not by sexual transmission). Look-back exercise sometimes recommended (look at previous patients and invite them for testing but this didn’t need to be done)
  • His future employment - If treatment effective, he can resume work under new guidance
18
Q

Case 3:

  • 26yr old woman named as contact of chlamydia
  • We contact her and explain situation - “Contact of treatable bacterial infection.” Gets angry, feels insulted, wants to know who named her
  • What are the issues?
A
  • Her dignity - Caused harm by affecting dignity and making her upset
  • Public health - may have sex with others
  • Is she really a contact of chlamydia? (She may not even have it)
19
Q

Case 3:

what needs to be thought about in the third case in relation to respect for autonomy?

A

Promote the right to self determination

20
Q

Case 3:

what needs to be thought about in the third case in relation to non-maleficence?

A

The avoidance of harm

21
Q

Case 3:

what needs to be thought about in the third case in relation to beneficence?

A

To do good

22
Q

Case 3:

what needs to be thought about in the third case in relation to respect for autonomy?

A

Fairness/equity

Individual vs population

23
Q

case 3:

what are the relevant duties of a doctor registered with the GMC in relation to this case?

A

Respect and protect confidential information

Cant give her the name of the person who named her

24
Q

Case 3:

  • Woman attended clinic
  • Tested for chlamydia
  • Offered treatment for chlamydia as a precaution
  • Accepted that we had a duty to protect her contact’s confidentiality; we wouldn’t give her name to her contacts should the test be positive
A

Assure her they we wouldn’t give her name to others that she would maybe name

25
Q

Case 4:

  • A 30yr old woman moves from Kent to Aberdeen. Victim of domestic violence
  • Starts seeing a local man (known by us to have HIV). Uses condoms
  • She gets a call about her ex husband - HIV positive
  • She gets tested - tests positive
  • Emerges that her new partner hasn’t told her about his HIV - speaking to them it is clear the man hasn’t told the women about his HIV but she told him about hers
  • But she has told him about her HIV - Deal with her concerns and tests
  • What are the issues?
A

• Should she be told about his HIV?

  • He says he’s told her
  • But she talks about protecting him from her infection and doesn’t mention his HIV
  • She doesn’t want her GP to know about her HIV. The GP knows about the man’s HIV
  • GP is concerned about risk to the woman of her partner’s HIV. Considering informing the woman – asks us for our advice
26
Q

Case 4:

what needs to be thought about in the fourth case in relation to respect for autonomy?

A

Promote the right to self determination

Both got right to self determination

27
Q

Case 4:

what needs to be thought about in the fourth case in relation to non-maleficence?

A

The avoidance of harm

28
Q

Case 4:

what needs to be thought about in the fourth case in relation to beneficence?

A

to do good

29
Q

Case 4:

what needs to be thought about in the fourth case in relation to justice?

A

Fairness/equity

Individual vs population

Not so much population justice as it is down to the couple

Treat everyone equally

30
Q

case 4:

what are the relevant duties of a doctor registered with the GMC in relation to this case?

A

Personal beliefs is important as maybe there is a sense that she should know about her partners HIV

31
Q

GMC Confidentiality guidance on Serious Communicable Diseases 2017:

You may disclose information to a person who has close contact with a patient who has a serious communicable disease if you have reason to think what?

A
  1. the person is at risk of infection that is likely to result in serious harm
  2. the patient has not informed them and cannot be persuaded to do so

Is the person at risk of infection anyway – using condoms and both on treatment

Not an ongoing risk of infection

32
Q

Case 4:

Should she be told about her partner’s HIV?

What would you tell the GP?

A

The couple are still together. She’s impressed by his understanding of her situation

Didn’t tell her about his station as no benefit

Suggested to GP not to be concerned about her and suggested to the women to tell her GP to get the benefits of integrated health care

33
Q

Summary:

Ethical decisions are common when dealing with contagious diseases:

  • STIs involve more than one person – some known and some unknown.
  • Individual vs population
  • Privacy vs sharing
  • Why do we treat someone?
A

Other areas to consider

Also consider ethical aspects of:

  • Abortion
  • Contraception in adolescents
  • Contraception for payment
  • Sex and consent
  • Gender incongruence
  • Sex lives of adults with cognitive impairment

Medical Ethics and Law (14 decks)

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