Four principles
AUTONOMY: right own decision
• patient must have patient competence
•accept or refuse procedure offered by doctor
BENEFICENCE: do good, act in best interest
NON- MALEFICENCE: do no harm
JUSTICE: fairness- benefits, risks, costs
RIGHT TO CONFIDENTIALITY: linked to autonomy- right to control info
Non- mal- harming if info released
Eg. Increase morphine relieves pain doing good but brings closer to death so doing harm
Informed consent
What is it
What needs to be explained (8)
=consented to procedure, given and considered all facts necessary
- Options for treatment or management
- Aim of plan, consequences, side effects
- Details of plan, benefits, success rate, risks
- Consequences of providing treatment / not
- Secondary interventions? Consent
- Who performs and if doctor in training involved
- Remind change mind anytime
- Costs
Competence of patient
Consent only taken from ‘competent patients’
=legal judgement
Capacity is medical judgement
Competence in adults if not competence two options:
- If has advance directive then must abide by decision
2. If none, doctor decides for best interest - involve relatives
Competence in children below 16
If mature enough to understand info. Duty to discuss with parents (can against will if not competent)
- Competence assessed in relation to procedure
- Cannot refuse if deemed in best interest- decision made by parents
- If both parents refuse consent doctors must act in best interest (follow up in court)
Confidentiality duty
When can be breached (3)
All doctors must protect at all costs
- Implied consent given by the patient - e.g. Nurse, if patient discusses openly in front of relative but if bad news must check with patient
- Info required by court
- In public interest and to protect patient/ others - notifiable diseases , child abuse, driving, Terrorism
Euthanasia
Active
Passive
=someone ends another’s life intentional act to alleviate pain
Active: practical action
Passive: lack of action
Voluntary: person gave consent
Non- voluntary- person not able to give consent
Involuntary: did not wish to die
Assisted suicide
Someone commits suicide with help
Swiss: patients injected
Euthanasia and assisted suicide for (4) and against (6)
- Patients allowed to choose best
- Avoid suffering
- Die with dignity when they choose
- Free up beds
- Religious : playing god
- May change mind later
- Times when they’ve recovered
- Difficult to verbalise specific criteria
- Not clear cut- murder charges
- Relatives abuse situation or pressure them
UK both illegal, even booking flights to Switzerland
Doctors may withdraw treatment for best interest, not effective
