1
Q
What is moral accountability?
A
the readiness or preparedness to give an explanation or justification to relevant others for one’s judgements, intentions, acts and omissions
- individuals are accountable for the effects of their actions so far as they are reasonably forseeable
2
Q
Moral accountability of organisations/government examples?
A
- To articulate and communicate clearly with workers the moral values and principles which it believes to be embedded in its accountability relationships
- To develop procedures and advice to support and guide the applications of these values and principles
- To search out and review inconsistencies between explicit values and organisational practice
- To develop the competence of all its workers in the application of those values, principles and procedures which are relevant to their jobs
3
Q
Definition of values?
A
concepts or ideals that give meaning to an individual’s life and provide a framework for decisions and actions
4
Q
Definition of morals?
A
the standards of right and wrong associated with individuals, groups, and society in general - practical application
5
Q
Definition of ethics?
A
- the branch of philosophy that deals with the moral dimensions of human life;
- what should we do and why should we do it
- Science of morals in human conduct
6
Q
What does ethics help us to do?
A
- Appreciate the choices of others and to evaluate the justification they give for their choice
- Enable a conscious examination of our own values and choices and how they can be used in making future decisions
7
Q
What are some of the domains of values in society?
A
individual, legal, organisation, occupation
8
Q
What are occupational values?
A
Occupational standards – e.g. principles of pharmacy ethics
Codes of ethics & “Standards of conduct, ethics & performance”
9
Q
What are individual values?
A
- Based on sense of right and wrong
- May be based on political or religious beliefs
10
Q
What are legal values?
A
- Values in common and contractual law
- Generally explicit
- Interpretations may be necessary
11
Q
What are organisational values?
A
- Explicit in mission statements, codes of practice, etc
- Implicit in working norms
12
Q
When do ethical dilemmas arise?
A
- There are difficulties in deciding how to apply moral/ethical values
- Moral/ethical values come into conflict with each other
13
Q
What are the main principles of utilitarianism?
A
- concerned with ends and not means
- should act in a way that will produce most good and least harm
- can it justify doing harm or injustice to a few, if society as a whole benefits ?
14
Q
What are the main principles of deontology?
A
- concerned with actions not outcomes
- unirversal morals to follow duty, regardless of consequences
- always treat human beings as ‘ends in themselves’ and never merely as ‘means to someone else’s end’
15
Q
What are the core princples of ethics?
A
- autonomy
- beneficence
- non-malificence
- justice
(- fidelity)
16
Q
Definition of autonomy?
A
Freedom to exist, to think, to act and to communicate
- respect decisions that someone makes
17
Q
Issues that can arise as a result of autonomy?
A
Does everyone have it? young children, mentally ill etc
18
Q
What is paternalism?
A
ignoring autonomy - deciding you know best for someone else and removing their ability and right to make their own decisions
19
Q
Definition of beneficence?
A
principle of doing what is best for the patient
20
Q
Principles of beneficence?
A
- protect and defend rights of others
- prevent harm occurring to others
- remove conditions that will cause harm to others
- help people with disabilities
- rescue people in danger
promotion of patients best wishes
21
Q
Definition of non-malificence>?
A
One ought not to inflict evil or harm (to the patient)
In other words, do not do something that you know will cause harm to the patients
22
Q
What are acts with double effect?
A
acts that have both benefits and harmful effects
23
Q
Conditions for acts with double effect to be okay?
A
- act must be good or at least morally neutral
- you only intend the good effect, not the bad one
- bad effect must not be a means to the good effect
- good effect must outweigh the bad
24
Q
Definition of justice?
A
being fair - not necessarily equal
awarding what is due
25
Principles of fidelity?
- trust and truthfulness
- keeping promises
- honouring commitments and obligations
- loyalty
26
General principles of ethics?
- “What is right and good with respect to conduct and character”
- A detailed, explicit, operational blueprint of the norms of professional conduct
- A public recital of desirable and undesirable actions having impact upon the character of a profession and its functional reliability
- Helps prevent exploitation of clients
- Regulates professional relationships
- Such rules are usually the result of reasoning and analysis
27
WHat are the standards for Pharmacy Professionals?
- Encapsulate what it means to be a registered pharmacist or pharmacy technicians – your obligations
- Describe how safe and effective care is delivered through ‘person-centred’ professionalism
- Standards grounded in timeless principles: Serving the public, Lifelong learning and Professional accountability
- Pharmacy professionals are personally accountable for meeting the standards and must be able to justify the decisions they make
28
What are the nine standards for pharmacy professionals?
1. person centred care
2. work in partnership with others
3. communicate effectively
4. maintain, develop and use professional knowledge and skills
5. use professional judgement
6. behave in a professional manner
7. respect and maintain the person’s confidentiality and privacy
8. speak up when they have concerns or when things go wrong
9. demonstrate leadership
29
Definition of consent?
to express willingness, give permission or agree
30
What is the purpose of consent to treatment?
moral, clinical, legal and professional purpose
31
What is valid consent?
- capacity to give consent for this decision
- acting voluntarily
- sufficient, balanced information to allow them to make an informed decision
- capable of using and weighing up the information provided
32
Principles of consent?
- ongoing process
- can be withdrawn at any time
- responsibility of the professional to ensure valud consent has been given
33
What are the types of consent?
explicit (written, or verbal). written is preferred for significant procedures. evidence of consent if it was valid, if invalid a signature means nothing
implied e.g. holds out arm for blood pressure to be taken
34
Criteria for capacity?
- understand information provided
- retain and believe it
- weight it in the balance to make a choice
- communicate the decision
35
Importance of consent?
Civil laws about battery and negligence
36
Application of battery laws relating to consent?
patient must be informed of nature and purpose of treatment in broad terms, so consent is real and no liability in battery
37
Application of negligence laws relating to consent?
Higher standard than for battery
- material and significant risks must be disclosed
- sufficiency of information defined by bolam principle
38
5 key principles of capacity?
- presumption of capacity
- individuals being supported to make their own decisions
- unwise decisions
- best interests
- least restrictive option
39
What is doctrine of necessity?
Can be invoked for emergency treatment - best interest when no alternative
40
Examples of when court involvement may be required when patient lacks capacity?
- sterilisation or contraceptive purposes
- donation of regenerative tissue such as bone marrow
- withdrawal of nutrition and hydration from an individual in a persistent vegetative state
- where there is doubt as to the individual's capacity or best interests
41
Who can consent in the case of children?
- child (under 16) or young person (16-17)
- parent or guardian
- court
42
Are children presumed to have consent?
No, must demonstrate it
43
Are young people presumed to have consent?
yes unless evidence otherwise
44
What is Gillick Competence?
child capable of understanding and who has the intelligence to understand fully what is proposed
45
Where do parents/guardians come in with Gillick Competence?
- can act for a child who is not Gillick Competent
- cannot override a Gillick competent child's consent
- can overrule refusal by a Gillick Competent adolescent to receive treatment in their best interests
46
When is Gillick competence flexible?
depends on seriousness of the decision taken as well as cognitive powers and maturity
courts adopt a paternalistic approach when adolescents are afflicted with life-threatening situations
47
What is the rationale of distinguishing between consent and refusal in children and young people?
consent is accepting a greater knowledge of the medical profession
refusal asks more of the child. courts reluctant to empower children to refuse treatment against medical opinion
48
What are advance decisions?
- permitted under the mental capacity act
- made when the person still has capacity
- used later if theyre not able to make a decision themselves
- clear statement specifying treatment to be refused and circumstances in which will trigger particular course of action
- cannot refuse compulsory treatment under mental health laws
- cannot refuse care such as food, water, warmth
49
Examples of services that may be affected by religion, personal values and beliefs
contraception, EHC, sexual health, advanced decisions, end of life care, pharmacogenetics
50
Pharmacists right to practice within their beliefs?
- have right to practise in line with religion, personal values or beliefs as long as act in accordance with equalities and human rights law and make sure that person-centred care is not compromised
- Think in advance about areas of practice which may be affected and make necessary arrangements, so are not in position where person’s care could be compromised
- Referral to another health professional may be an appropriate option but may not be appropriate in every situation
51
Factors to consider when a pharmacist has strong personal beliefs?
- Work location and range of services
- Openness between pharmacy professional and their employer
- Making the care of the person the priority
- Handling requests sensitively
52
Justification for confidentiality according to utilitarian argument?
Keeping confidences maximises happiness
53
Autonomy argument for patient confidentiality?
control over personal information
54
Privacy argument for patient confidentiality?
Universal Declaration of Human Rights
| European Convention for the Protection of Human Rights and Fundamental Freedoms (ECHR)
55
Efficiency argument for patient confidentiality?
healthcare system requires patients to be open and honest - public health benefit
56
Trust argument for patient confidentiality?
nature of relationship out of which confidentiality arise - patients must trust their doctors
57
What is the duty of confidentiality to a pharmacy professional?
Maintaining confidentiality is a vital part of the relationship between a pharmacy professional and a person under their care.
A person may be reluctant to ask for advice, or give a pharmacy professional the information they need to provide proper care, if they believe that the pharmacy professional may not keep the information confidential. ”
- professional and legal duty to keep information confidential that they obtain in the course of their practice
58
What types of confidential information may a pharmacy professional obtain?
- electronic and hard copy data
- personal details
- information about a persons medication
- other information about a person’s medical history, treatment or care that could identify them
- any other information shared that is not strictly medical but they would expect you to keep confidential
59
Principles of the data protection act?
```
Fairly and lawfully processed
Processed for limited purposes
Adequate, relevant and not excessive
Accurate
Not kept longer than necessary
Secure
Processed in accordance with data subjects rights
```
replaced with GDPR in 2018
60
Definition of sensitive personal data?
```
Racial or ethnic origin
Political opinions
Religious beliefs
Trade union membership
Physical or mental health or condition
Sexual life
Proceedings of, or alleged offences or committed offences
```
61
Steps to take to protect information?
Store information securely
Do not leave confidential information where it may be seen or accessed
Do not discuss information that can identify patients where discussions can be overheard
Do not disclose identifiable information on e.g. social media
Continue to protect a person’s confidentiality after they have died
62
Principles on disclosing information for individual care?
- explicit consent
- implicit consent - Consent to the use of confidential patient data for the purposes of delivering safe and effective care is implied by a consent given to care and treatment. Reasonable expectation of the person
63
Under what conditions can implied consent be used to share information on individual care?
Is the person sharing the information a registered and regulated professional or one of their direct care team?
Is the activity a type of direct care within the scope specified by the professional’s regulatory body?
Does the professional have a legitimate relationship with the person or persons concerned?
64
What should you do if you decide to disclose confidential information about a patient?
Use codes or make the information anonymous if you do not need to identify the patient
Get the patient’s consent if possible
Disclose the minimum amount of information
Make sure the recipient knows it is confidential information
Make records
Be prepared to justify your actions
65
How to disclose confidential information with consent?
This is always the preferred option
Make sure that it is informed consent
Decide whether explicit or implied consent is appropriate
If you are unsure if you have consent, ask
66
What if a patient with capacity refuses to give consent to share information?
- Respect their decision (unless required to disclose the information)
- inform of the potential implications
67
How to disclose confidential information without consent?
Make every effort to get consent
Be satisfied that you are required to by law
Get the request in writing
Disclose the minimum amount required
68
Who can legally request confidential information?
- police
- healthcare regulator - GPhC, GMC
- NHS counter fraud officer
- coroner, judge, relevant court
they do not have an automatic right to all of the information, and require a legitimate reason for the information
69
Examples of when you can disclose information in public interest?
To prevent a serious crime
To prevent serious injury or damage to the health of the patient, third-party or public health
For the protection of children or vulnerable adults
70
What must be considered before disclosing information in public interests?
Maintaining confidentiality versus Public interest benefit in disclosing
Harm by not disclosing versus Consequences of disclosing
The Pharmacist
flashcards
Decks in class (9)
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