Ethics: e-module questions

Question 1

S comes into A&E following a Road Traffic Accident. He is intoxicated with alcohol and admits to being the driver of a BMW that was seen to knock down a pensioner. The Police want to know his address and they want a blood alcohol sample. Can B, the Emergency Department triage nurse give the police this information and the sample without permission from S?

1. B may not give address or blood sample
2. B may give the address and the blood if it has already been taken
3. B may only give the address
4. B may only give the adress if the police have a court order requiring the disclosure of personal information
5. B may give both address + blood alcohol sample

Answer 1

3 - B may only give the address

Under the 1988 Road Traffic Act there is a statutory requirement to provide information to assist the police in the identification of a person charged with a road traffic offence. There is no statutory requirement to given any other personal information under the Act and therefore the blood sample should not be given to the police officer without express consent from the patient. See section 4

Question 2

Answer 2

Question 3

Answer 3

Question 4

Answer 4

Question 5

Answer 5

Question 6

Answer 6

Question 7

Answer 7

Question 8

Answer 8

Question 9

Answer 9

Question 10

Answer 10

Question 11

Answer 11

Question 12

Answer 12

Question 13

B is a 61 year old man who attends A+E with a history of fever and cough. He is a heavy smoker but denies any previous health problems. The on call FY2 Dr R sustains a needlestick injury whilst taking an arterial blood gas. Dr R’s consultant is informed and asks B if he would be willing to have an HIV test. B refuses. Dr R does not want to take post exposure prophylaxis unless it is necessary.

How would you advise Dr R?
1. Dr R should go back and try to persuade B to consent to the test
2. Performing the HIV test without consent would breach B’s article 8 rights
3. Dr R should ask the lab to do a CD4 count instead
4. B must consent to the test as otherwise it would be a breach of Dr R’s human rights under Article 3
5. The hospital must perform the HIV test otherwise it will contravene Dr R’s right to life under article 2

Answer 13

2: Performing the HIV test without consent would breach B’s article 8 rights

Question 14

B is brought into hospital with a headache and confusion. Dr R is now an ST3 in infectious diseases. B has a GCS of 10 (E3, M4, V3). A lumbar puncture is performed and confirms a diagnosis of cryptococcal meningitis. B’s HIV test comes back positive. The next day B’s conscious level is improved (E4, M6, V4) but he remains very confused. His consultant is optimistic that B will make a good neurological recovery. B’s wife asks Dr R what is wrong with her husband.

Q 5: How should Dr R respond regarding disclosure of B’s HIV status to his wife?

1. Disclose as she has a right to know under article 2 of the Human Rights Act
2. Disclosure is a justifiable breach of article 8 of the Human Rights Act as she may have been exposed to HIV
3. Disclosure should wait until B is able to give consent
4. Disclosure is unlawful as article 8 of the Human Rights Act grants B an absolute right to confidentiality
5. The clinical team knows B’s diagnosis of HIV so the information is no longer confidential and can be disclosed

Answer 14

3: Disclosure should wait until B is able to give consent

Question 15

in what instances should you refere a death to the coroner?

Answer 15

• Unknown cause of death
• Not seen by a Dr during last illness or last 28 days
• During or within 12 months of pregnancy
• Death in custody
• While detained under Mental Health Act

Or any of the following:

• Suicide
• Accident/trauma
• Industrial disease
• Medical/surgical treatment
• Abortion
• Anaesthetic care
• Lack of medical care
• murder
• Self-neglect

Question 16

Who can give consent for removal, use or storage of tissue after death?

Answer 16

• The person before death – if competent
• A nominated representative (nominated before death when the person was mentally competent)
• Consent from an adult in a qualifying relationship (according to the HTA hierarchy of consent)

Question 17

What is the human tissue act hierarchy of consent?

Answer 17

1. Partner/spouse
2. Parent/Child
3. Sibling
4. Grandparent/grandchild
5. Niece/Nephew
6. Step parent
7. Half sibling
8. Friend of longstanding

Question 18

A potential donor has registerd consent for organ donation prior to death. However, the family does not want organ donation to proceed. What should you do?

Answer 18

Legally, this can go ahead, but consent to organ donation does not mendate that organ donation will happen.

A CNS will speak to the family and explore more.

Question 19

What are the exceptions for confidentiality after death?

Answer 19

• to assist Coroner / officer involved with inquest
• National Confidential Inquiries
• MCCD (death certificates)
• Public health surveillance
• Parent seeking information re: child’s death
• Insurance companies (lawfully)
• Partner/close relative/friend …if you have no reason to believe the patient would have objected