How does the NHS define capacity
the ability to use and understand information to make a decision and communicate any decision made.
Mental capacity act 2005 guidelines
- Understand the information required
- Retain information for a reasonable period of time
- Weigh up different information in order to make a decision
- Relay and express their decision to another person.
What can be done if a patient does not have capacity?
- if the patient is deemed not to have capacity, the healthcare professional responsible for treating them has to make the decision that is in their best interests.
- If the patient was aware that they were going to lose their capacity, they may have made an advanced decision, or a living will where they can state how they’d like their care to proceed if they can no longer consent.
- The patient can also appoint a lasting power of attorney to make informed decisions on their behalf, this is often a close family member.
When can confidentiality be breached?
- A patient is likely to cause harm to themselves or others
- If a patient lacks capacity and it is in their best interest
- If the information is required by law
- If the information is need in prevention or detection of a serious crime
- If the information is for child protection
- If a patients fitness to drive is impaired.
What is confidentiality and why is it important?
- Involves keeping a patients records and information safe and private
- If information on a patient is being used as an example in education, the case must be anonymised as much as possible to protect the patients privacy.
- Confidentiality encourages a good doctor patient relationship
- It allows patients to trust their doctor
What is the GMC good medical practice guidelines?
• Part of the GMCs job is to maintain a list of Doctors who are safe to practise medicine on the medical register.
• The GMC set out qualities that they expect every doctor to hold in the Good Medical Practise guidelines.
• Guideline 3 states: Good Medical Practice describes what is expected of all doctors registered with the GMC. It is your responsibility to be familiar with Good Medical Practise and the explanatory guidance which supports it, and to follow the guidelines they contain.
In its initial summary it states that as a good doctor you will:
• Make the care of your patients your primary concern
• Be competent and keep professional skills up to date
• Take action if you think patient safety is compromised
• Establish and maintain good relations with patients and colleagues
• Maintain trust in yourself and the profession by being honest and acting with integrity.
The document is 80 rules that all doctors should stand by, including trust, treatment and safety.
What is euthanasia? and what are some points for and against euthanasia?
the deliberate ending of a life to relieve suffering which involves a physician administering life ending treatment
Arguments supporting euthanasia:
• It enables death with dignity
• Everyone has the right to choose how they die
• Resources and expenses could be better allocated
• It prevents long drawn out and painful deaths
• If animals can be relieved from suffering, then why can’t humans?
Arguments against euthanasia:
• It reduces respect for human life
• It plays god - the healthcare professionals would have too much power
• It could worsen care provided to the terminally ill if their death can be hastened to cut expenses
• There may be pressures from family and friends
• and the intention of healthcare could change from saving lives
What is gillicks competence and the Fraser guidelines?
- Just like adults have to be competent to have capacity and make their own decisions about their treatment, children must be Gillick competent in order to have capacity.
- Gillick competence is used in law to determine whether a child under the age of 16 is competent enough to make decisions about their health care without needing approval or consent from parents.
- While adults have assumed competence from the beginning, children must be assessed to be Gillick competent as their maturity evolves over time.
- Alongside Gillick competence, the Fraser guidelines are criteria used specifically in the circumstances of deciding whether to give advice about contraception and sexual health to children under the age of 16.
The Fraser guidelines criteria:
• The child has sufficient maturity and intelligence to understand the nature and implications of the proposed treatment
• They cannot be persuaded to tell their parents and they do not allow the doctor to inform their parents
• They are very likely to begin or continue having sexual intercourse with or without contraceptive treatment
• Their physical or mental health is likely to suffer unless they receive the advice or treatment
• The advice or treatment is in their best interests
What is the NHS constitution and what are the 7 key principles?
- Set of guidelines that outline what employees and members of the public should expect from the NHS and in turn, what the NHS expects from its employees and the members of the public who use it.
- There are 7 key principles that guide the NHS in all it does
1) Comprehensive service available to all.
• Service is available to all irrespective of age, gender, race, etc.
• The service is designed to improve, prevent, diagnose and treat both physical and mental problems with equal regard
• It has a duty to every individual it treats and must respect their human rights.
2) Access to NHS is based on clinical need, not an individual’s ability to pay.
• NHS serves are free, unless in limited circumstances sanctioned by the government.
3) NHS aspires to the highest standards of excellence and professionalism.
• The NHS provides high quality care that is safe, effective and focused on patient experience.
• Respect, dignity and compassion are all at the core of how patients and staff are treated.
4) The patient will be at the heart of everything the NHS does.
• The NHS must reflect and be tailored to the needs and preferences of patients, families and their careers.
• When appropriate, patients and their families will be consulted and involved in decisions about courses of treatment
5) The NHS works across organisational boundaries.
• It works in partnership with other organisations in the interest of patients, local communities and the wider population.
6) The NHS is committed to providing the best value for taxpayers money.
• Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves.
7) The NHS is accountable to the public, communities, and patients it serves
• The system of responsibility and accountability for making decisions in the NHS should be transparent to the public as well as patients and staff.
What are the NHS values?
- Six values that all NHS employees are expected to demonstrate
- These values encompass the principals of the NHS as an organisation as well as the employees working within it
The values (Written from the point of view of an NHS staff member)
1) Working together for patients
• Patients come first in everything we do
• We fully involve patients, staff, families, carers, communities, and the professionals inside and outside the NHS.
• We speak up when things go wrong
2) Respect and dignity
• We value every person whether patients, their families, carers or staff as an individual.
• We respect their aspirations and commitment in life.
• We take what others have to say seriously.
• We are honest and open about our point of view and what we can and cannot do.
3) Commitment to quality of care
• We earn the trust placed in us by insisting on quality and striving to uphold standards of care
• We encourage and welcome feedback from patients, families, carers, staff, and the public.
• We use this to improve the care we provide and build on our successes.
4) Compassion
• We ensure that compassion is central to the care we provide and respond with humanity and kindness to each person’s distress.
• We search for the things we can do, however small, to give comfort and relieve suffering.
• We find time for patients, their families, and carers, as well as those we work alongside.
• We do not wait to be asked because we care.
5) Improving lives
• We strive to improve health and well-being and people’s experiences of the NHS.
• We cherish excellence and professionalism wherever we find it.
6) Everyone counts
• We maximise our resources for the benefit of the whole community and make sure nobody is excluded, discriminated against, or left behind.
• We accept that some people need more help, that difficult decisions have to be taken and that when we waste resources, we waste opportunities for others.
What are the 4 pillars of medical ethics?
The 4 pillars of medical ethics
1) Justice
2) Beneficence
3) Non-maleficence
4) Autonomy
Justice
1) There should be fairness in all decisions made when it comes to treating patients
2) All patients should be treated equally with equal access to resources and treatments
3) Scarce resources and new treatments should be equally distributed
4) Individuals who practise medicine must uphold laws and legislation
Beneficence
1) Healthcare providers should always do what is best for the patient to make sure all patients attain the best possible outcome
2) To ensure beneficence, Doctors need to obtain a high level of knowledge and be equipped with the appropriate skills.
3) Medical professionals must acknowledge that what may be beneficial to one patient wont be beneficial to another, so the best treatment can be provided
Non-maleficence
1) Ties in strongly with the principal of beneficence
2) Healthcare providers must cause no physical or mental harm to patients or society.
3) Sometimes this is not always possible, as treatments can be mentally and physically uncomfortable, but are necessary for the improvement of the patient’s physical health.
Autonomy
1) Patients have the right to the final say on all decisions made about their treatments. This is true whether the decision has a positive or negative impact
2) The patient can only refuse treatment. They cannot demand any treatment that has not been suggested by the doctor.
What is the GMC?
- The GMC is a medical regulator that maintains the official medical register of clinical practitioners.
- They issue and maintain a list of all individuals that hold a medical license.
- Upholds the standard of all doctors in the UK through the Good medical practise guidelines and ensures they are safe to practise.
- The primary responsibility of the GMC is to protect and maintain the health and safety of the public by controlling entry to the register and removing or suspending members when necessary.
