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Block 2 AR > VLE > Flashcards

VLE Flashcards

1
Q

What defines expectations and obligations of participants in the doctor patient relationship?

A

Social roles which change over time

Shaped by culture

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2
Q

What are the 3 types of Doctor patient relationships?

A

Paternalistic - doctor led
Shared - partnership
Informed - patient led

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3
Q

In the paternalistic doctor patient relationship, what is the patients role?

A

Passive, answers questions and expectation that they will agree with doctors decisions as doctor knows best

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4
Q

In the paternalistic doctor patient relationship, what is the doctors role?

A

Makes systematic enquiry
Information flow from doctor to patient
Makes decision about what is best for patient
Doctor knows best

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5
Q

When is a paternalistic model appropriate?

A

In a medical emergency

If patient wants this model

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6
Q

What are the social roles in a shared doctor patient relationship?

A

Two way sharing of info at all stages
Both participants bring expertise and have limitations to knowledge
Reach decision together

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7
Q

What could be challenging for a doctor in the shared doctor patient relationship?

A

Creating environment in which patient feels able to share preferences
Negotiation if there is a disagreement in the best options for the patient
Patient access to information eg can they access the Internet?
Patient ability to process complex information
Communication difficulties

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8
Q

What is the doctors role in the informed model of the doctor patient relationship?

A

Communicate all relevant information about treatment options, risks and benefits. Must be sufficient for patient to make informed decision

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9
Q

What is the role of the patient in the informed model of the doctor patient relationship?

A

Patient is active and expects to make the decision

Sole prerogative of patient is decision making

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10
Q

When might the informed model of doctor patient relationship be most common in the UK?

A

Private healthcare

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11
Q

Which model of doctor patient relationship is key to person centred care?

A

Shared decision making

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12
Q

What may guide the choice of doctor patient relationship that you choose to adopt in a given situation?

A

Patient preference

Clinical situation

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13
Q

Why is the choice of doctor patient relationship style important?

A

Fits with ethical stance emphasising patient autonomy and respect for persons

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14
Q

What ethical principle underpins the paternalistic model of doctor patient relationship?

A

Beneficence

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15
Q

What ethical principle underpins the informed model of doctor patient relationship?

A

Respect for autonomy

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16
Q

How can information decrease autonomy?

A

Information overload

Autonomy requires that the patient is able to use the information to make a choice

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17
Q

Why is there a potential for increased psychological harm of living with poor outcome in the informed model of doctor patient relationship?

A

Responsibility for consequences of the decision rests solely on the patient

18
Q

How could the informed model of doctor patient relationship result in doctor making the decision?

A

Patient may make informed choice that the doctor should make the decision on their behalf

19
Q

How can the information presented, influence decisions made by the patient in the informed model of the doctor patient relationship?

A

Manipulation of decision by the order or way in which they are given the information. Can a decision ever be truly free from interference?
Risk of persuasion or coercion, even if accidentally

20
Q

What are the main pros of the shared model of the doctor patient relationship?

A

Facilitates autonomy
Shared responsibility for decisions
Includes both experts perspectives
Involves dialogue

21
Q

What does the ethical principle of justice say about shared decision making?

A

Must ensure it is available to everyone, even if it may be difficult

22
Q

What is contemporaneous treatment refusal and what caveats does it require?

A

Anyone aged 16 or over is assumed to have capacity to give or refuse consent and a doctor must demonstrate lack of capacity before treating without consent
An adult with capacity may refuse life sustaining treatment and continuation of life sustaining treatment without consent is unlawful

23
Q

In what circumstances may a contemporaneous refusal of treatment be overridden?

A

Mental Health Act 1983 (2007)
Children under 16 years
? Young people aged 16-18 years

24
Q

What is the legal framework for an advanced decision to refuse treatment?

A

Mental capacity act 2005

25
Q

What is advanced treatment refusal and what caveats does it require?

A

Applies to persons aged 18 years and over
An advance decision to refuse treatment (ADRT) only comes into force when a person lacks capacity
Extends autonomous decision making to hypothetical future situations
Treatment contrary to a valid and applicable ADRT is a battery
Must be valid and applicable to the given situation
Decision can be cancelled at any time
Decisions regarding life sustaining treatment must be: In writing, Signed by the person making the advance refusal and witnessed, State clearly that the decision applies even if life is at risk

26
Q

When are health care professionals protected from liability with regards to advanced decisions to refuse treatment?

A

Withhold or withdraw treatment because they reasonably believe a valid and applicable advance decision exists
Treat a person because they do not know or are not satisfied that a valid and applicable advance decision exists (having taken all practicable and appropriate steps to find out)

27
Q

What determines if an advanced decision to refuse treatment is valid?

A

Made by a person who has capacity - Adults are assumed to have capacity unless there are reasonable grounds to doubt this
There is no requirement to record an assessment of a person’s
capacity at the time of making a decision but it would be good
practice to do so
The person has not withdrawn the decision when he had capacity to do so
There is no Lasting Power of Attorney who has authority to make the relevant decisions as this would override an ADRT
The person has not done anything inconsistent with the advance decision remaining his fixed decision

28
Q

What determines whether an ADRT is applicable?

A

The treatment specified in the advance decision is that which is being considered
The circumstances specified in the advance decision are present
There are no reasonable grounds to believe that circumstances exist which the person did not anticipate at the time of the advance decision and which would have affected his decision had he anticipated them

29
Q

What are the limits of advanced decisions?

A

A Lasting Power of Attorney made after the advance decision will make the ADRT invalid if the LPA gives the attorney authority to make decisions about the same treatment
Advance decisions regarding treatment for mental disorder in persons who are detained under the Mental Health Act (MHA trumps MCA in this case)
Provision of basic or essential care

30
Q

What are the practicalities of advanced decisions?

A

It is the responsibility of the person making the ADRT to make sure that it is drawn to the attention of HCPs when it is needed
Anyone with an ADRT is advised to regularly review it. Decisions made a long time in advance are not necessarily invalid or inapplicable but they are more likely to be open to doubt about validity and
applicability if circumstances or treatments have changed

31
Q

What are the implications for health care professionals regarding advanced decisions to refused treatment?

A

Be aware that a patient may have refused treatment in advance
Raise the question of advance refusal of treatment with patients when they have capacity
If someone tells a HCP that the patient has an ADRT the HCP should make reasonable efforts to find out what the decision is
Assess whether the ADRT is valid and applicable
If the advance refusal is valid and applicable the HCP must not provide the specified treatment
If the HCP does not think it is valid and applicable they must treat the patient in his/her best interests but should make clear notes for their decision
If in doubt, apply to the Court of Protection for a declaration on the existence validity or applicability of an ADRT

32
Q

What is conscientious objection?

A

HCPs do not have to do something that is against their beliefs but they must make arrangements for the patient to be transferred to the care of another health care professional

33
Q

What is a lasting power of attorney?

A

Another way to have influence/control over future decisions
Can only be made by a person aged 18 or over
Must be written and set out in the statutory form
Must include information about the nature and effect of the LPA
Signed statement by donor
Signed statement by donee (attorney)
Signed statement by independent third party
LPA must be registered with the Office of the Public Guardian
LPA can be for decisions about property and affairsor about personal welfare
Personal welfare LPAs can only be used for decisions when the person lacks capacity
Attorneys must be over eighteen
Can be appointed jointly
Must act in the person’s best interests as set out in the MCA
Power to make decisions about life sustaining treatment must be specified in the document

34
Q

What are the limits to a patients request for treatment?u

A

Can be seen as part of shared decision making process
Limits to a patient’s options:
Treatment unavailable or not funded by NHS (nationally/locally)
Impact on others (other patients, family)
Treatment considered futile
Treatment considered not to be in patient’s interests (burden outweighs benefit) but presumption in favour of respecting patients’ wishes and in favour of life sustaining treatment

35
Q

What do you do if you do not think that a patient should receive a specific treatment that they are requesting?

A

Talk to them first to explore reasons and issues
If still a disagreement, explain to patient and explain other options including option to seek second opinion or access legal representation

36
Q

What can patients do to request treatments in advance?

A

Patients cannot require that specific treatments are provided as part of an advance decision
A statement of preferences for treatment should be taken into account as part of a best interests decision
There is a (rebuttable) presumption in favour of life sustaining treatment
In cases of conflict a second opinion is advisable

37
Q

What are the UK Resuscitation Council recommendations on DNACPR?

A

If CPR would not re-start the heart and breathing, it should not be attempted
If CPR is not in accord with a valid advance decision that is applicable in the current clinical circumstances, or with the recorded, sustained wishes of a patient with capacity, it should not be attempted
Where successful CPR may not be followed by a length and/or
quality of life that are in the best interests of the patient, the informed views of a patient with capacity are of paramount importance in
planning decisions about CPR
All healthcare organisations should have arrangements in place to
ensure that appropriate decisions about CPR are made for patients
who lack capacity. Such arrangements must comply with the law

38
Q

What factors should be considered when making a decision on DNACPR?

A

Likely clinical outcome
Patient’s known or ascertainable wishes, including information about previously expressed views, feelings, beliefs and values
Patient’s human rights, including the right to life and the right to be free from degrading treatment
Likelihood of the patient experiencing severe unmanageable pain or suffering
Level of awareness the patient has of their existence and surroundings

39
Q

Where can you palpate the transverse process/lateral mass of axis?

A

Lateral neck just deep to sternocleidomastoid

40
Q

What is a Jefferson Fracture?

A

Excess compression can shatter the ring of Atlas

41
Q

What natures of the doctor patient relationship are important?

A

Qualitative and subjective nature

Block 2 AR (9 decks)

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