VLE Flashcards
Describe the Fraser Guidelines (5)
Advice and treatment may be given to a child provided:
- She will understand the advice
- She cannot be persuaded to tell her parents
- She is very likely to continue having sexual intercourse regardless
- Without the treatment, her physical or mental health are likely to suffer
- That her best interests require the advice or treatment
At what age is a person assumed to possess capacity unless otherwise indicated?
16 years + (the MCA 2005 applies from 16)
a child may be found to have Gillick competence <16, but this must be proven rather than assumed
Does a child who lacks capacity, have autonomy?
No - therefore disregarding their preferences is not overriding their autonomy, as they have none
Which factors determine Gillick competence? (3)
- The child’s maturity
- The child’s understanding
- The nature of the consent required
When can confidentiality be broken (in adults)? (3)
If the patient consents
If it is required by Law (notification of infectious diseases, if ordered by a Judge)
If it is justified in the public interest (i.e. public at risk of serious harm; gunshot/knife wound, DVLA)
When determining best interests, 3 things should be considered (MCA 2005):
- The past and present wishes and feelings of the patient
- The beliefs and values likely to influence their decision if they had capacity
- Any other factors they would likely consider
When do professionals have a legal responsibility to refer a child to Children’s Social Services?
If it is suspected or believed that the child:
- Has suffered significant harm
- Is likely to suffer significant harm
(Children’s Act 1989)
When may health records not be accessed (by those who legally could)?
When access is likely to cause serious harm to the physical or mental condition of the data subject or any other person
When the data would reveal the identity of another person
Which 2 legal frameworks apply to restraint? (Short/Long term)
Short term - Mental Capacity Act
Long term - Deprivation of Liberty Safeguards
Which 3 provisions allow an adult to be treated without consent, and in what circumstance?
Doctrine of Necessity (allows ‘least restrictive’ treatment for life-threatening conditions when unable to assess capacity and gain valid consent)
Mental Capacity Act 2005 (allows treatment of patient without capacity, provided deemed within best interests)
Mental Health Act (allows treatment given while sectioned/detained within first 3 months, under very specific conditions)
Which 4 criteria must be met for implicit consent to be sufficient for the sharing of information?
You have no reason to believe they would object
The information is being accessed to support a patient’s direct care
Information is available to patients on how it will be used, and how they may object
You are satisfied that those disclosed to will understand it is in confidence, and treat it accordingly
Which 4 principles is the Human Tissue Act founded upon?
Consent
Dignity
Quality (of processes involved)
Honesty and Openness
Which Act is used to consider best interests of a patient?
Mental Capacity Act 2005
Which activities are regulated by the Human Tissue Act 2004?
Anatomical Examination
Determining cause of death
Public display
Transplantation (living or desceased)
Education/training relating to human health
Which legal statute regulates the testing of embryos?
Human Fertilisation & Embryology Act 1990
Which statute outlines the duty of candour?
Health and Social Care Act 2008
What are the differing types of consent?
Written (Vital for whole body donation - may only be given by patient, not relatives)
Verbal
Implicit
(Broad and Enduring - used for medical research, to prevent further seeking of consent at a later date)
What 3 basic elements are required for valid consent?
Sufficient Information
Capacity
Freedom from coercion/Voluntariness
What 3 things should be included as part of an apology to a patient?
What happened
What will be done to mitigate/deal with the harm caused to the patient
What will be done to prevent future harm to others
A medical student comes across a man in respiratory distress on his way back from lectures. Is he legally obliged to stop and help?
No, but he does have a moral obligation.
BMA advises: “..if no other qualified HCP available, and patient at risk of serious harm, provided they reasonably believe they can improve outcomes”
If a patient is found to have HIV, is it legally permissable to break confidentiality if they request it kept strictly between you both?
Yes, if they refuse to inform their sexual partners - they are considered at risk of serious harm
However, you may not inform other members of the medical team, as in theory normal handwashing and infection control proceedures should be sufficient to prevent an increased risk of spread.
Outline the ethical principles for maintaining confidentiality
Consequentialism - impact on patient (upset), impact on other generally (loss of trust), impact on specific others (N.B. possible harm of non-disclosure)
Respect for Autonomy
Virtue Ethics - promise keeping & trustworthiness are virtues!
Deontology - a duty of care; vital some information shared to ensure appropriate treatment
Define identifiable information
“Any information that could identify a patient, including when combined with other information such as their name, postcode, DOB.”
Is sex selection of an embryo permitted?
Yes, but only if there is a risk of inheriting sex-related abnormalities
Discuss the ethical considerations of in-vitro fertilisation
Maximising Benefit/Minimising Harm - Physical harm (Mother, saviour sibling, embryo), Psychological harm (Saviour sibling, infertile couples), Selective abortion (negative message? E.g. Downs)
Justice/Fair use of resources - Funding issues (postcode lottery) and criteria (BMI, etc)
Autonomy & Rights - Right to procreate? To chose method? Respect for life of embryos?
Legally, treatment without consent is..?
Battery
In considering whether to restrain a person, what 4 things must be considered?
- The harm which will occur if they are NOT restrained.
- The harm OF restraining them.
- The minimum level of restraint required.
- The proportionality of restraint required vs. amount of benefit of treatment.
What are the ethical arguements for a doctor stopping to assist someone in a “good Samaritan” situation?
Consequentialist - Doctors have a greater ability to help, due to greater knowledge/experience/skill.
Deontological - Professional duty of care (GMC). (N.B. Not established until self-identified to patient as a doctor)
Virtue ethics - Doctors seen as particularly vituous.
Is a doctor legally obliged to help a person in distress outside of the work environment?
No, however if self-identifies to patient as a doctor, the normal legal duty of care is established.
(duty of care must be established for legal obligation to occur)
What arguements exist against the medical treatment of family or friends? (6)
- Emotional involvement may cause a lack of objectivity
- Poorer standard of care in home setting vs. medical practice
- Interferes with relationship with their own GP
- Harder to maintain confidentiality?
- Doctor may not wish to explore sensitive topics
- Patient may feel unable to refuse advised treatment
What do patients need to know, when things go wrong?
What went wrong
Why it went wrong
The possible complications/implications for the patient
Where there are still uncertainties
They should also be apologised to
What does the GMC guidance say about the duty of candour when things go wrong?
“Every HCP must be open and honest with patients when something that goes wrong with their treatment or care causes or has the potential to cause, harm or distress.”
In what circumstances is embryo testing permitted? (3)
To establish if the embryo has an abnormality which will reduce the chance of a live birth
To establish if the embryo has an abnormality which may result in a serious disability or illness
To determine if the embryo is tissue compatible with a sibling who has a serious medical condition which could be treated with umbilical cord blood, bone marrow, or other tissue
Mary requires life-sustaining treatment, but refuses it. Can her decision be overriden?
No, provided she has capacity.
N.B. There is a technical difference between ‘doing harm’, and ‘not doing good’ - i.e. by withdrawing treatment
What 4 ethical principles underpin confidentiality?
Autonomy
Privacy
Identity
Trust/Promise keeping
What are the 4 criteria for an individual to have capacity?
Understand the information given
Retain information long enough to reach a decision
Weigh up the information to make a decision
Communicate that decision
(MCA 2005; Assumed from age 16+ unless demonstrated lack of)
Do written consent forms qualify as valid consent?
No - they are evidence of consent, but not that it is necessarily valid…!
In regards to disclosing information, list some uses which would not be considered to be directly relevant to a patient’s care (i.e. explicit consent required…)
Research
Financial audit
Public Health
Education
Health service planning
According to the MCA 2005, who can proxy consent be given by?
Lasting Power of Attorney
Court Appointed deputy
Which statute governs the treatment of children?
The Children Act (1989)
Until what age may a parent/the court give consent for treatment of a child who has refused treatment, overriding their wishes?
Until the age of 18 (i.e. until an adult)
However, this overriding of refusal must be in circumstances where refusal would “in all probability lead to the death, or serious permanent injury of the child.”
N.B. the Dept. of Health advises getting a “court declaration or decision” anyway, to ensure it is lawful…
When treating a child or young person, what should the doctor bear in mind?
UN Convention on the rights of a child (Article 3) -
“In all actions concerning children, …the best interests of the child shall be a primary consideration.”
UN Convention on the rights of a child (Article 12) -
“…The views of the child should be given due weight in accordance with the age and maturity of the child.”
How should a doctor facilitate the involvement of children in discussions regarding their care? (5)
GMC guidance (2007)
- Be honest and open with them (and their parents, while respecting confidentiality)
- Listen to, and respect their views and respond to their concerns
- Communicate in a way they can understand
- Give them the opportunity to ask questions, answering honestly
- Give them the same time and respect that you would adults
From what age may a child accept treatment, overriding their parents wishes?
From any age, provided the child is proved to be Gillick competent
When making a best interests decision, other than what is clinically indicated, what should be taken into account? (6)
GMC Guidance (2007)
- The views of the child (including previously expressed views)
- The views of parents
- The view of others close to the child
- The views of other healthcare professionals involved
- The cultural, religious, and other belief and values of the child or parents
- Which choice will least restrict the child’s future options
Who may give consent for treatment on behalf of a child (0-17) who lacks capacity?
- Someone with parental responsibility (provided they have capacity)
- A Court of Law
N.B. A doctor may treat without consent in an emergency
How many people die daily, while waiting for an organ transplant?
3
Who might be affected by a change in decisions/actions regarding organ donation? (4)
Dying/dead patients (potential organ donors)
Potential organ recipients
Relatives
Medical staff
What is the Dead Donor rule? (2)
1) Organ donors must be dead before retrieval of organs
2) Organ donation must not cause the death of the patient
Define the term Dying
“Irreversible changes to the brain, resulting in irreversible loss of consciousness and irreversible loss of capacity to breathe.”
What 2 ways exist of confirming death for organ donation?
Brain-stem death
Circulatory death
What is Brain-stem death?
“Death following the irreversible cessation of brain-stem function.”
What is Circulatory death?
“Death following the irreversible cessation of cardiorespiratory function.”
What implications might the type of diagnosis of death have on the organ donation process? (4)
- Which organs can be donated (DCD heart donation is controversial*)
- The ‘quality’ of the organs when they are retrieved
- Permissible actions to ‘optimise’ organs
- How relevant legislation should be applied
*DCD = Donation after Circulatory Death; if heart ‘irreversibly stopped’, how can it function for someone else?
What is required before a deceased person’s organs can be removed/transplanted?
Consent - Joining the Organ Donor Register can count
What issues could be debated regarding whether applying to the Organ Donation Register counts as consent? (~3)
Not a fully informed decision (e.g. DBD vs DCD)
Patient may have later changed their mind
Patient’s family can successfully oppose the donation
Can an organ transplant go ahead legally, if someone in a qualifying relationship objects?
Yes legally, but this does not happen in practice
Which 2 ethical principles must be weighed up when considering delaying the withdrawal of life-sustaining interventions so that organ donation can occur?
A Best interests decision must be made, to weight the balance between:
- Respect for the patient’s autonomy in choosing to be an organ donor
- Non-maleficence in the avoidance of causing unnecessary harm to the patient
According to the Human Tissue Act, who can provide consent on behalf of a patient who has not indicated one way or the other, regarding organ transplantation? (8)
Those in a qualifying relationship to the deceased person are (highest first):
- Spouse or partner (including civil or same sex partner)
- Parent or child (in this context a ‘child’ can be any age)
- Brother or sister
- Grandparent or grandchild
- Niece or nephew
- Stepfather or stepmother
- Half-brother or half-sister
- Friend of long standing
When a patient is deemed to not have capacity (assessed as per MCA), what steps should be followed in order to ensure the most appropriate treatment is undertaken? (4)
- Whether an advance refusal of treatment (ART) exists
- If no ART, is there a Lasting Power of Attorney (healthcare not financial)?
- If no ART/ LPA, Best Interests criteria (MCA) should be taken in to account
- Court of Protection is final arbiter of Best Interests
