VLE phase2 Flashcards
what is important for informed consent?
- Clear information on benefits and risks
o Important but rare risks
o Unimportant but common risks - Tailor information to individual patient
- Take into account patient’s views preferences and concerns about adverse outcomes
- Provide supplementary material to facilitate discussion
- Consent should be undertaken by doctor doing procedure
o Or delegate who is suitably trained & qualified, has knowledge and understand risks, and knows guidance
o If you delegate you are still responsible for making sure informed consent has happened. - explore with patient
What are three elements that need to be proven for negligence?
- duty of care
- breach of duty
- causation
what is the GMC guidance on treating a child who lacks capacity to consent?
- If child lacks capacity to consent, you should ask for parent’s consent (one is sufficient). If parents cannot agree, seek legal advice about whether you should apply to court.
- A child’s best interest assessment, consider:
o Views of child including past views
o Views of parents
o Views of others close
o Cultural, religious beliefs & values
o Views of other HCPs providing care
o Which choice will least restrict child future options
what is Gillick competence?
competence to consent for treatment, for children under 16
depends on “maturity and understanding and nature of consent required”
GMC says child must understand, retain, weigh up and communicate their decision, based on understanding of nature and benefits and risks of treatment. All relevant information must be provided. Capacity depends more on child’s ability to understand rather than age. Capacity can be present with simple decisions but not complex decisions. Capacity can be affected by child development and by changes in health/treatment
what are Fraser guidelines?
o Specific to contraception, abortion and STIs
o Doctor can give advice and treatment if criteria are met:
♣ Girl will understand advice
♣ Doctor cannot persuade her to inform parents
♣ Girl will likely continue to have sex
♣ That without advice/treatment her health is likely to suffer
♣ That her best interests require doctor to give advice/treatment
can 16/17 yo in England decide on their treatment?
- 16/17 year olds in England o competent child can consent o parent can consent o court can consent o court appointee can consent o doctor needs
- 16/17 year old refusal of treatment
o can be overridden by parent or court
o “legal flak jacket”
Can an adult refuse treatment?
- An adult with capacity to consent can refuse any treatment, except when MHA criteria is fulfilled.
If an adult has no capacity, what happens regarding treatment?
o Is there an advance directive?
o Is there a Welfare Lasting Power of Attorney?
o Look at Best Interests criteria
o Court of Protection final arbiter of best interests
what is the MHA legal definition of a mental disorder?
o “any disorder or disability of the mind”, includes:
♣ any mental health problem normally diagnosed in psychiatry
♣ learning disability ONLY when “associated with abnormally aggressive or seriously irresponsible conduct”
♣ substance misuse ONLY when it exists in association with another psychiatric diagnosis
what are the criteria for assessment under section 2?
patient is suffering from mental disorder of a nature or degree which warrants the detention of the patient in a hospital for assessment (or for assessment followed by medical treatment) and ought to be so detained in the interests of his own health or safety or with a view to the protection of other persons
what are the criteria for treatment under section 3?
o the patient is suffering from mental disorder of a nature or degree which makes it appropriate for him to receive medical treatment in a hospital; and treatment is necessary for the health or safety of the patient or for the protection of other persons; and treatment cannot be provided unless the patient is detained; and appropriate medical treatment is available
what is advanced care planning?
o Structured discussion with patients & families about wishes
o Allows for continuity of care
o Avoids conflicts
o Can help determine action if capacity is lost
o Record of discussion made, plan can be updated
o Discussion may result in Advance Care Decisions
Calculate cost utility (cost/QALY) for asthma drug:
- £600 for one patient
- reduces admissions and saves £100
- net cost is thus £500
- QALY gain for one patient over one year is 0.02
what is cost utility?
cost/QALY = 500/0.02=£25,000 ie within threshold
what is health inequality and health inequity?
- Health inequality describes differences in health outcomes between different population groups
- Health inequity describes differences in opportunity for different population groups, ie different access to health services, nutritious food, adequate housing. These can lead to health inequalities.
what is progressive universalism?
- population-wide approach that aims to level up all groups and reduce the social gradient in health. Reducing health inequalities may require unequal distribution of HC resources to, eg, socially disadvantaged groups, people with rare disease.
