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Phase 1: SocPop and VLE > VLE > Flashcards

VLE Flashcards

1
Q

List 6 factors affecting values.

A

Morals, Beliefs, Empathy, Probity, Respect and Culture

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2
Q

Define ‘facts’.

A

Claims about the world that have been, or can be, verified by empirical methods.

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3
Q

What is meant by the term ‘values’?

A 
Values are claims about, or expressions of, things like: 
• Preferences
• Attitudes
• Emotions
• Aesthetic appreciation
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4
Q

What are ‘thick concepts’?

A

Claims that have both factual and evaluative content.

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5
Q

How can value claims be assessed?

A

Using moral theory.

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6
Q

What is ‘consequentialism’?

A

‘[C]onsequentialist theories assess the moral value of anything in terms of that thing’s outcomes or impact upon the world’

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7
Q

Consequentialist theories need to provide and defend…

A
  • An account of the relevant good(s)
  • An account and method of quantification (e.g., who counts? Can we aggregate? If so, how?)
  • An explanation of how rightness is to be determined
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8
Q

What is the principal aim of utilitarianism?

A
  • Aim for the best balance between benefit and harm

* This makes for the most effective use of resources

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9
Q

What are the principles of deontology?

A
  • Rules govern actions and we have a duty to abide by them regardless of cost
  • This is contrasted with emphasis on outcomes (as is the case with consequentialism)
  • “The right is prior to the good”
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10
Q

What ethical principle is respected by deontology?

A

Autonomy - it is the only way of respecting an individual’s right to determine their own life.

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11
Q

What are the principles of virtue ethics?

A
  • Focuses on the character of the person (the doctor/professional), not their actions
  • A right act is the action a virtuous person would do in the same circumstances
  • Not “what should I do?”, but “what kind of person should I be?”
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12
Q

What are the key concepts in virtue ethics?

A
  • A move away from universal principles
  • Virtue “lies in a mean”
  • Eudaimonia – happiness or welfare
  • Phronesis – wisdom or intelligence associated with practical action, implying good judgement or practical value
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13
Q

What 3 Ps are used in ethical reasoning in clinical practice?

A
  • Principles
  • Particulars (context/facts of the case)
  • Perspectives (of all those involved in or affected by the case)
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14
Q

Define ‘autonomy’.

A

“Personal autonomy encompasses, at a minimum, self-rule that is free from both controlling interference by others and from certain limitations, such as an inadequate understanding that prevents meaningful choice”

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15
Q

What ethical principle underpins informed consent?

A

Autonomy.

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16
Q

Give 5 ethical justifications to support the duty to maintain confidentiality.

A
  1. Respect for patient autonomy means that they should be able to say what happens to their information
  2. The consequences of breaching confidentiality could harm the patient
  3. The consequences of breaching confidentiality could result in lost of trust in the medical profession
  4. There is an implied promise in the patient-doctor relationship that confidentiality will be maintained
  5. Trustworthiness is seen as a virtue that doctors should have and a trustworthy doctor would maintain confidentiality
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17
Q

When is it permissible to disclose information about a patient without their explicit consent?

A
  1. When required to by law
  2. If the patient lacks capacity
  3. When it is in the public interest due to the patient posing a public threat
  4. If there is a significant risk of serious harm to another person
  5. If the patient is a child and you have parental consent
  6. Sharing information in the healthcare team for the benefit of the patient’s care
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18
Q

In what areas of healthcare is consent required?

A
  • Treatment
  • Investigation
  • Examination
  • Disclosure of information
  • Research
  • Education
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19
Q

If a doctor were to perform a procedure without appropriate informed consent, what charge would they face?

A

Battery.

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20
Q

Valid consent comprises which 3 basic elements?

A
  • Competence/capacity
  • Information
  • Voluntariness
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21
Q

A person is unable to make a decision if they cannot…

A
  • Understand the information given to them that is relevant to the decision
  • Retain that information long enough to be able to make the decision
  • Use or weigh up the information as part of the decision-making process
  • Communicate their decision (by any means)
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22
Q

What should be considered when providing patients with appropriate information?

A

The patient’s needs and wishes, their existing knowledge of the condition and treatment, the nature of their condition, complexity/nature of treatment and the associated risks.

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23
Q

How can coercion be avoided in patients giving consent?

A

Speaking to the patient alone to determine if there is any coercion.

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24
Q

When is oral consent appropriate?

A

For low-risk procedures and treatments.

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25
Q

When is written consent required?

A
  • For high-risk procedures and treatments
  • If there are significant consequences for the patient’s employment, social or personal life
  • If clinical care is not the primary aim of investigation/treatment
  • If treatment is part of a research study
  • Specific treatments, such as fertility treatment
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26
Q

In what situations can written consent forms be invalidated?

A

If the patient lacked capacity, was not provided with sufficient information, or did not give consent voluntarily.

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27
Q

List 4 potential obstacles to informed consent.

A
  1. Poor information/time pressure during information being given
  2. Being rushed into making a decision
  3. Being pressured into making specific decisions by third parties
  4. Language barriers
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28
Q

Which act regulates the removal, storage and use of human tissue in England, Wales and Northern Ireland?

A

The Human Tissue Act (HTAct) 2004.

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29
Q

What are the 3 principal functions of the Human Tissue Authority?

A
  • To issue Codes of Practice
  • To issue licenses and inspect establishments
  • To approve living organ and bone marrow donations
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30
Q

What ‘scheduled purposes’ are covered by the HTAct?

A
  • Anatomical examination
  • Determining cause of death
  • Public display
  • Transplantation
  • Education or training relating to human health
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31
Q

On what 4 principles is the HTAct founded?

A
  • Consent
  • Dignity
  • Quality
  • Honesty and openness
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32
Q

What is criminal law?

A
  • Offences usually against individuals but brought on behalf of the Crown (state/society) (e.g., R v Jones)
  • Prosecution of a ‘defendant’
  • Two elements mens rea (intention) and actus rea (act) – unless ‘strict liability’
  • Innocent until proven guilty
  • Standard of proof: ‘beyond reasonable doubt’
  • Outcome: guilty or not guilty
  • Remedy: punishment (fines, imprisonment etc.)
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33
Q

What is civil law?

A
  • Protects rights of individuals against each other/the state
  • ‘Claimant’ sues ‘defendant’
  • Types of cases include breach of contract, employment rights, personal injury, breach of copyright and liability
  • Standard of proof: balance of probabilities
  • Outcome: court finds defendant liable (or not)
  • Remedy: damages (or injunction)
  • Also includes family law matters (divorce, arrangements for children etc.) and other kinds of non-adversarial hearings such as those concerning arrangements for adults without capacity
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34
Q

What type of law do medical negligence cases come under?

A

Civil.

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35
Q

What are the 3 elements of negligence actions?

A
  • Duty of Care
  • Breach of the duty
  • Breach causes injury or loss (causation)
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36
Q

How is ‘criminal negligence’ defined?

A

Criminal negligence refers to gross negligence showing ‘such a disregard for the life and safety of others as to amount to a crime…deserving of punishment’.

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37
Q

What is common law?

A

Common law is made by judges, using the principles that are binding for all other like cases (precedence).

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38
Q

What is statutory law?

A

Statutes are made by government. A new statute trumps existing common law. They may reflect the political agenda of the current government, or responses to strong public opinion or scandal; statutes change to reflect EU law. New statutes are made to reflect changing moral views and technological advances.

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39
Q

What are the actions of the EU based on?

A

Treaties approved voluntarily and democratically by EU Member States.

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40
Q

What is ‘primary legislation’ under EU law?

A

The EU Treaties, which give the EU power to legislate in Member States.

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41
Q

What is ‘secondary legislation’ under EU law?

A

EU Decisions, Directives and Regulations (do not automatically become law in member states).

42
Q

Which human rights are particularly important to medicine?

A
  • Article 2 – the right to life
  • Article 3 – freedom from torture and degrading or inhuman treatment
  • Article 8 – respect for your private and family life
  • Article 9 – freedom of thought, belief and religion
43
Q

What ethical principle underpins the ‘paternalistic’ model of doctor-patient relationships?

A

Beneficence - acting in a patient’s best interests.

44
Q

Describe the ‘paternalistic’ model of doctor-patient relationships.

A
  • Doctor makes a systematic enquiry
  • Patient is passive; answers the doctor’s questions
  • Information flow is largely from doctor to patient; often with minimal information given
  • Doctor makes the decision about what is best for the patient: underlying assumption is that the doctor is best placed to make it
  • Expectation that patient will agree
45
Q

What ethical principle underpins the ‘informed’ model of doctor-patient relationships?

A

Autonomy.

46
Q

Describe the ‘informed’ model of doctor-patient relationships?

A
  • Doctor communicates sufficient information (relevant to the patient, their values and preferences) for the patient to make an informed treatment decision
  • Decision-making is the sole prerogative of the patient – autonomous decision-making involves responsibility (for consequences of decision).
47
Q

What are the benefits of the ‘shared’ model of doctor-patient relationships?

A
  • Facilitates autonomy
  • Shares responsibility
  • Includes patient and doctor perspective more explicitly
48
Q

Describe the ‘shared’ model of doctor-patient relationships.

A

Two-way exchange of information between patient and doctor at all stages, as both participants are seen as bringing expertise:
• Doctors bring medical expertise about diseases and treatments
• Patients bring personal expertise (but have some knowledge about their condition and treatment)
• Each participant is seen as having limitations to their knowledge

49
Q

What are the challenges to the ‘shared’ model of doctor-patient relationships?

A
  • Patient access to information
  • Patient ability to process complex information
  • Communication difficulties
  • Challenge for doctors is to create an environment in which patient feels able to express treatment preferences. If there is disagreement, the process becomes one of negotiation.
50
Q

What is confidentiality?

A

“A duty of confidence arises when one person discloses information to another in circumstances where it is reasonable to expect the information will be held in confidence”.

51
Q

Why is confidentiality important?

A

“Trust is an essential part of the doctor-patient relationship and confidentiality is central to this. Patients may avoid seeking medical help, or may under-report symptoms, if they think their personal information will be disclosed by doctors without consent, or without the chance to have some control over the timing or amount of information shared.”

52
Q

What are the 4 main ethical principles underpinning confidentiality?

A
  • Autonomy
  • Privacy
  • Identity
  • Promise keeping/dishonesty/trust
53
Q

What are the benefits of confidentiality?

A
  • Encourages patients to seek medical treatment
  • Good for individuals and good for society at large
  • A confidential medical service is in the public interest
54
Q

What are the consequentialist arguments for maintaining confidentiality?

A
  • Impact on the patient (breach may upset them; may affect trust and make them less likely to share info in future)
  • Impact on others generally (loss of public trust and therefore less effective care for many)
  • Impact on specific others (harm of non-disclosure)
55
Q

In what way is respect for autonomy a reason to maintain confidentiality?

A

Self-determination includes determining how information about oneself is used and how or whether this is shared.

56
Q

How can ‘reasonable expectation’ be used to determine when consent is required?

A

‘If you suspect a patient would be surprised to learn about how you are accessing or disclosing their personal information, you should ask for explicit consent unless it is not practicable to do so.’

57
Q

Data is considered anonymised if…

A
  • It does not itself directly identify any individual

* It is unlikely to allow any individual to be identified through its combination with other data

58
Q

When deciding whether the public interest in disclosing information outweighs the patient’s and the public interest in keeping the information confidential, you must consider…

A

a) the potential harm or distress to the patient arising from the disclosure – for example, in terms of their future engagement with treatment and their overall health
b) the potential harm to trust in doctors generally – for example, if it is widely perceived that doctors will readily disclose information about patients without consent
c) the potential harm to others (whether to a specific person or people, or to the public more broadly) if the information is not disclosed
d) the potential benefits to an individual or to society arising from the release of the information
e) the nature of the information to be disclosed, and any views expressed by the patient
f) whether the harms can be avoided or benefits gained without breaching the patient’s privacy or, if not, what is the minimum intrusion.

59
Q

According to the GMC, when disclosing information about a patient, you must…

A

• use anonymised or coded information if practicable and if it will serve the purpose
• be satisfied that the patient:
o has ready access to information that explains that their personal information might be disclosed for the sake of their own care, or for local clinical audit, and that they can object, and
o has not objected
• get the patient’s express consent if identifiable information is to be disclosed for purposes other than their care or local clinical audit, unless the disclosure is required by law or can be justified in the public interest
• keep disclosures to the minimum necessary for the purpose, and
• keep up to date with, and observe, all relevant legal requirements, including the common law and data protection law.

60
Q

What are the GDPR 6 principles?

A

Data must be:

  1. Processed fairly, lawfully and in a transparent manner in relation to the data subject.
  2. Collected for specified, explicit and legitimate purposes and not further processed for other purposes incompatible with those purposes.
  3. Adequate, relevant and limited to what is necessary in relation to the purposes for which data is processed.
  4. Accurate and, where necessary, kept up to date.
  5. Kept in a form that permits identification of data subjects for no longer than is necessary for the purposes for which the personal data is processed.
  6. Processed in a way that ensures appropriate security of the personal data including protection against unauthorised or unlawful processing and against accidental loss, destruction or damage, using appropriate technical or organisational measures.
61
Q

Describe the legal framework governing data protection in the UK.

A
  • The General Data Protection Regulation is a data protection framework that applies in all EU member states.
  • The GMC guidance on confidentiality has been updated to reflect GDPR.
  • A new Data Protection Act (2018) was enacted to supplement some sections of the GDPR. The two laws should generally be considered together.
62
Q

What are the current legal frameworks governing access to health records in the UK?

A

GDPR
• Allows access to health records for all living individuals
• NHS Trusts have 1 month to respond to request

Access to Health Records Act 1990
• Allows access to health records of deceased people

63
Q

Who may access health records?

A
  • Patients
  • Person with parental responsibility can access child’s records (if not contrary to competent child’s wishes)
  • Power of attorney if patient lacks capacity
  • Executor of Will/dependants for deceased patients’ records
  • Independent Mental Health Advocates (IMHAs)
  • Independent Mental Capacity Advocates (IMCAs)
  • Police – by court order
  • Solicitors – with consent of data subject
64
Q

When is access to health records denied?

A
  • When access is likely to cause serious harm to the physical or mental health or condition of the data subject or any other person
  • When the data would reveal the identity of another person – Does not apply to health professionals involved in the care of the data subject (unless disclosure would cause them serious harm)
65
Q

What 3 factors are required for consent to be valid?

A
  • Capacity
  • Information
  • Voluntariness (freedom from coercion)
66
Q

Who can provide proxy consent when a patient lacks capacity?

A
  • Lasting power of attorney (LPA) (appointed by patient in advance)
  • Court-appointed deputy (appointed when patient lacks capacity)
67
Q

In what circumstances can patients be treated without consent?

A
  • When emergencies are life-threatening, meaning that there is reduced time for assessing capacity (Doctrine of necessity; common law) - treatment must be in the patient’s best interests.
  • Patient detained under MHA – whether or not they have capacity (but only under very specific conditions).
68
Q

Define ‘necessity’.

RE: Consent

A

“When an emergency arises in a clinical settingand it is not possible to find out a patient’s wishes, you can treat them without their consent, provided the treatment is immediately necessary to save their life or to prevent a serious deterioration of their condition. The treatment you provide must be the least restrictive of the patient’s future choices.”

69
Q

What 4 things must a patient be able to do to have capacity?

A
  • Understand the information necessary to make a decision
  • Retain the information long enough to make a decision
  • Weigh the information
  • Communicate their decision
70
Q

What factors should be considered to determine what is in a patient’s best interests?

A
  • The person’s past and present wishes and feelings (and, in particular, any relevant written statement made by him when he had capacity)
  • The beliefs and values that would be likely to influence his decision if he had capacity
  • The other factors that he would be likely to consider if he were able to do so.
71
Q

What factors should not affect decision-making regarding what is in a patient’s best interests?

A
  • The person’s age or appearance
  • A condition of his, or an aspect of his behaviour, which might lead others to make unjustified assumptions about what might be in his best interests.
72
Q

When can ‘D’ restrain ‘P’?

A

If ‘D’:

(a) uses, or threatens to use, force to secure the doing of an act which P resists, or
(b) restricts P’s liberty of movement, whether or not P resists.’

The first condition is that D reasonably believes that it is necessary to do the act in order to prevent harm to P.
The second is that the act is a proportionate response to—
(a) the likelihood of P’s suffering harm, and
(b) the seriousness of that harm.’ (MCA)

73
Q

Who should provide consent for children?

A

The (competent) child
Parents - Parental responsibility (under Children Act 1989) is with:
- Mother
- Father if married to mother at time of child’s birth, or
if registered on birth certificate, or
- by Parental Responsibility Agreement with mother, or
by various kinds of court order

74
Q

Name 3 conceptions of autonomy.

A
  • Principled/moral autonomy (having authority over one’s actions, according to one’s will and ability to reason/impose one’s own moral laws)
  • First- and second-order desires (to want something or to want to want something)
  • Relational autonomy (embeds agency and autonomy within social context, and rejects overly-idealised aspects of autonomy)
75
Q

Name 3 conceptions of best interests.

A
  • Mental state (happiness; experiential, what brings about the most happiness for this person)
  • Desire fulfilment (best interests tied to the person’s autonomous choices)
  • Objective list (set of agreed criteria for achieving well-being, e.g., independence, ability to have meaningful relationships, knowledge)
76
Q

What is stated in the Ulysses contract?

A
  • Short-term restrictions on autonomy may enhance autonomy in the longer term
  • (Consequentialism versus deontology)
77
Q

What are the 3 main legal requirements to respect autonomy?

A
  • Treatment without consent is battery (common law)
  • A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success (MCA s1.3).
  • Negligence: Standard of care for provision of information – what that person would want to know
78
Q

How should a patient be treated if they have capacity?

A
  • If an adult has capacity, their autonomous decision must be respected
  • This is the case even if this results in harm to that person (e.g., refusal of life-sustaining treatment)
  • If a person lacks capacity, a doctor must treat them according to the principle of best interests and must protect them from harm
79
Q

What questions should be asked when an adult patient refuses treatment thought by the clinical team to be in their best interests.

A
  • Do you have reason to think that they lack capacity? (MCA criteria for capacity)
  • Is their decision properly informed?
  • Are they being coerced/unduly influenced?
  • To what extent can you detain or restrain them to treat them in their best interests?
80
Q

What must be considered by the person making the determination of best interests?

A

(a) The person’s past and present wishes and feelings (and, in particular, any relevant written statement made by him when he had capacity)
(b) The beliefs and values that would be likely to influence his decision if he had capacity
(c) The other factors that he would be likely to consider if he were able to do so

81
Q

In considering whether to restrain a person or to deprive them of their liberty in order to treat them in their best interests, what needs to be considered?

A
  • The harm that will occur to the person if you do not restrain and treat them
  • The harm of restraining them (physical and psychological)
  • The minimum level of restraint required
  • The proportionality of the restraint to the benefit of the treatment
82
Q

What is the legal framework for deprivation of liberty?

A
  • Restraint (short term): Mental Capacity Act
  • Restraint or detaining a person so that they are not at liberty to leave (longer than necessary for immediately necessary treatment): Deprivation of Liberty Safeguards (DOLS)
  • DOLS: formal process at an organisational level with independent oversight
83
Q

Safeguarding duties apply to any adult who meets the following criteria:

A
  • Has care and support needs
  • and
  • Is experiencing or is at risk of abuse or neglect
  • and
  • Is unable to protect themselves because of their care and support needs
84
Q

With regards to safeguarding adults, who might be at risk?

A
  • An older person who is particularly frail
  • An individual with a mental disorder, including dementia or a personality disorder
  • A person with a significant and impairing physical or sensory disability
  • Someone with a learning disability
  • A person with a severe physical illness
  • An unpaid carer who may be overburdened, under severe stress or isolated
  • A homeless person
  • Any person living with someone who abuses drugs or alcohol
  • Women who may be particularly at risk as a result of isolating cultural factors
85
Q

What should you do if you suspect a patient has safeguarding needs?

A
  1. Identify adults who have safeguarding needs
  2. Respond to immediate risks
  3. Assess the individual’s ongoing needs
  4. Assess capacity
  5. Identify relevant services
  6. Seek consent
  7. Review
86
Q

State a benefit and limitation to the consequentialist approach to someone assisting in an RTC.

A

Benefit - may save/prolong life, or avert harm/suffering

Limitation - doesn’t take account of acts/omissions

87
Q

Describe the deontological (duty-based) approach to someone assisting in an RTC.

A
  • Duty derived from relationship as a fellow citizen

- You would want others to help if it were you

88
Q

Describe the virtue ethics approach to someone assisting in an RTC.

A

Compassion/kindness.

89
Q

Describe the consequentialist argument for a doctor assisting in an RTC.

A

Doctors have a greater ability to help due to more knowledge/skill/experience.

90
Q

Describe the deontological argument for a doctor assisting in an RTC.

A

Professional duty of care.

91
Q

Describe the virtue ethics argument for a doctor assisting in an RTC.

A

Values particularly expected of a doctor.

92
Q

In what situation does a doctor have a legal obligation to assist?

A

When there is an established professional duty of care, e.g. the situation arises in a hospital setting.

  • Normal standard of care test applies (though dependent on context) when it comes to negligence claims
  • Must only act within your clinical competence
93
Q

When may a GP be contractually obliged to assist?

A

a) During core hours

b) Emergency is within their practice area

94
Q

What is the purpose of the Social Action, Responsibility, and Heroism Act 2015?

A

Applies when a court is determining the steps that a person was required to take to meet a standard of care.
Court must consider:
Was the person acting for the benefit of society?
Did the person demonstrate a ‘predominantly responsible approach’?
Was the person ‘acting heroically’?

95
Q

What is not covered by the indemnity provided by the NHS Litigation Authority?

A
  • Disciplinary issues by employer
  • Referrals to GMC
  • GP contractors, locum GPs, salaried GPs
  • Contract work for any other agency
  • Voluntary/charity work
  • Overseas work
96
Q

Name 5 things that you should remember when offering to help in an emergency.
[HINT: 5 Cs]

A
  • (Your) clinical competence
  • Consent
  • Case notes
  • Communication
  • Clinical negligence
97
Q

Define ‘informal medicine’.

A

Treatment or consultation given without the usual record-keeping or follow-up.

98
Q

What is the GMC guidance regarding providing help to yourself or other people close to you?

A

‘[W]herever possible, avoid providing medical care to yourself or anyone with whom you have a close personal relationship’.
‘Wherever possible you must avoid prescribing for yourself or anyone with whom you have a close personal relationship.’

99
Q

List 4 arguments for treating acquaintances, friends and family.

A
  • Relationship of trust between doctor and patient;
  • Greater understanding of the person and the context by doctor;
  • Leads to a better standard of care;
  • Reduced burden on NHS.
100
Q

List 6 arguments against treating acquaintances, friends and family.

A
  • Emotional involvement may lead to lack of objectivity;
  • Assessment at home not as good as in the clinical setting. The standard of care may be lower;
  • Impaired relationship with own GP;
  • Confidentiality;
  • The doctor may not wish to explore sensitive topics;
  • Patient may feel unable to refuse treatment/seek alternatives.
101
Q

Personal relationships with former patients may also be inappropriate depending on factors such as:

A

a. The length of time since the professional relationship ended
b. The nature of the previous professional relationship
c. Whether the patient was particularly vulnerable at the time of the professional relationship, and whether they are still vulnerable
d. Whether you will be caring for other members of the patient’s family.’

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