Truth telling Flashcards
In the case of Nadine, where her delivery caused her son to suffer a lack of oxygen to the brain leading to cerebral palsy. What was the basis of the informed consent argument in this case?
No ordinarily competent obstetrician acting with reasonable skill and care would have failed to warn Nadine of the risks of vaginal delivery and shoulder dystocia, due to have baby being larger because of her diabetes
Why didn’t Dr McLellan mention shoulder dystocia to Nadine?
she did not consider the risk to be of such significance that she needed to raise it with nadine
What is “informed choice” predicted on?
predicted on the view that the patient is entitled to be told of risks where that is necessary for her to make an informed decision whether to incur them
When does a doctor not inform a patient about a risk?
an exception to the duty of “informed choice” is when the doctor reasonably considers that the disclosure of the risk would “be seriously detrimental to the patient’s health”
What is the test of materiality?
is whether in the circumstances, of the particular case, a reasonable person in the patient’s position would be likely to attach significance to the risk, or the doctor is or should reasonable be aware that the particular patient would be likely to attach significance to it
What does the GMC state a doctor’s duties are when a patient requests to be told the truth?
listen to the patients and respond to their concerns and preferences
give patients the information they want or need in a way they can understand
be honest and open and act with integrity
What is deontology?
ethical duty of honesty
- must tell the truth at all times and in all circumstances
- no matter what the consequences might be
- the only real way to respect autonomy
What does the consequential approach entail?
Utilitarianism:
- need to weigh up each situation to assess which action is more likely to bring about the greatest good for the greatest number of people
- at the cost of the least suffering
- could be rule based or act based
What are the 4 types of deception?
INVOLUNTARY- through mishearing or misunderstanding info
VOLUNTARY - when i know the person has misunderstood and I don’t clear it up
INTENTIONAL - when I tell you what i presume not to be true
UNINTENTIONAL- when i communicate info believing it to be true, when in fact it’s not
What should you do if a complaint is made?
- tell the truth: it not an admission of liability. Check with trust solicitors
- do not cover up facts
- do not cover up for colleagues
- seek advice from GMC/Defence union
What is the expected standard GMC S26-7)?
- Protect patients from harm by others
- report concerns honestly to appropriate person
- if unsure, contact defence union, professional organisation or GMC for advice
What is the public interest disclosure act 1998?
- legal protection if you are unfairly dismissed for disclosing information reasonably and responsibly; internal whistle blow; external whistle blow (reasonable and responsible)
- NHS have senior managers to protect staff who disclose concerns
- clinical governance depends on willingness to report concerns
