Ethics / law

Question 1

what are the four ethical principles / pillars?

Answer 1

• Autonomy: the patient has the right to make their own decisions and act upon them
• Beneficence: act in the patient’s best interest
• Non-maleficence: do no harm
• Justice: ensure fairness (distribute resources, including your time and skill, equitably)

Question 2

Describe what questions you would ask yourself in each of the 4 ethical principles?

Answer 2

• Autonomy: does the patient lack capacity? can the decision be deferred? the patient has the right to refuse treatment?
• Beneficence: think both medical for the patient and also for others around them, family? friends?
• Non-maleficence: should treatment be forced upon a patient if it is the “right” thing to do? does this lose trust in doctors?
• Justice: bear in mind other patients and staff?

Question 3

What is paternalism?

Answer 3

• the idea that “the doctor knows best”

Question 4

Species used in biomedical research…

Answer 4

Question 5

What are some of the arguments FOR vaccines?

Answer 5

Question 6

What are some of the arguments AGAINST vaccines?

Answer 6

Question 7

Describe sources that a doctor could use to get information on the different medications that a patient may be taking

Answer 7

• Ask relatives
• Contact the GP
• Contact their local pharmacist
• Check patient’s own list of medication
• Examine previous hospital notes if applicable

Question 8

Describe act certainty vs omission possibility in the case of using animals in biomedical research.

Answer 8

• Act certainty vs omission possibilty: animals will surely suffer by the act, humans might suffer without the research

Question 9

What are the 5 rules of ethical (human) research?

Answer 9

Question 10

Mother worried about vaccine, she asks “is it 100% safe?”, how should a doctor answer this truthfully?

Answer 10

• All vaccines carry some degree of risk, but evidence for this vaccine suggests that it is safe

Question 11

Describe four ways in which Wakefield’s paper was ethically problematic.

Answer 11

• He falsified information claiming it had been approved by a research ethics committee
• The procedures involved were invasive and not clearly justified
• The justification for the research was not clear
• Wakefield had an undisclosed conflict of interest

Question 12

Describe the legal elements of capacity

Answer 12

• Being able to understand information
• Retain information
• Process information
• Communicate one’s decision
• (Relate to a specific moment in time)

Question 13

A patient is not deemed to have capacity, a family member phones the doctor and wishes to be given information about the patient, how should the doctor address the patient’s confidentiality in this scenario?

Answer 13

• If the patient lacks capacity, then the doctor must act in the patient’s best interest (beneficence)
• In determining the patient’s best interest, the doctor is under a duty to consult with the patient’s next of kin

Question 14

When addressing concerns about safeguarding, describe four ethical issues that clinical teams should consider when sharing clinical or personal information

Answer 14

• The patient’s consent to disclose
• The patient’s capacity
• The patient’s autonomy
• The relationship between the patient and their carer
• Consequences of disclosure (best interest of patient)

Question 15

Describe three key principles of a palliative care approach

Answer 15

• Provides relief from pain
• Intends neither to hasten or postpone death
• Integrates the physical, psychological, and spiritual aspects of patient care (holistic)
• Offers a support system to help the family cope

Question 16

Name four of the most common symptoms associated with the late stage of dying

Answer 16

• Pain
• Restlessness
• Increased respiratory secretions
• Drowsiness
• Skin colour changes

Question 17

Which group of drugs is most commonly used for the management of severe pain in palliative care?

Answer 17

• Opioids

Question 18

In law, how is a child defined by the children act 1989?

Answer 18

• A child is an individual under 18 years old

Question 19

Discuss the principles of consent to treatment in an individual who is not an adult

Answer 19

• Gillick competence
• If child is deemed to have capacity then can give consent without parents/guardian
• Although, child would be unable to refuse treatment

Question 20

How would a doctor assess whether a patient is competent to consent?

Answer 20

• Test ability to retain and comprehend information
• Test ability to make a decision
• Test ability to communicate a decision

Question 21

Explain two principles of confidentiality that the doctor needs to practice, in order to respect the patient’s right to confidentiality

Answer 21

• The doctor owes the patient a legal and professional duty of confidentiality
• Information held in confidence should not be released to a third party without the patient’s consent (except in exceptional circumstances)

Question 22

The GP wants to speak to the girl alone, outline two legal principles that underpin the GPs ability to do this, in spite of her age (15 years old)

Answer 22

• The young person’s best interest allows them to receive treatment without parental consent
• The young person has to be able to understand the professional advice
• The young person cannot be persuaded to inform their parents

Question 23

List the people who are able to verify that death has occurred

Answer 23

• Any medical practitioner with a license to practice

Question 24

An 87 year old man is confused. He urgently requires a urinary catheter, the patient does not appear to understand the doctors explanation. Explain the legal considerations that allow the doctor to proceed with the task

Answer 24

• Capacity: a patient is presumed to have capacity to consent to treatment under the Mental Capacity Act 2005 (MCA)
• Under the MCA: a patient lacks capacity if they are unable to understand the information, retain it, process it, and communicate the decision
• Consent: this patient lacks capacity as he is unable to understand the explanation and therefore cannot consent to the procedure
• Best interests: as this patient lacks capacity, the doctor is under duty to act in the patient’s best interests. The doctor is under duty to consult with family to determine the best interests
• Emergency: if urgent treatment is required, the doctor can provide treatment proportionate to achieving the aim (ie. Preventing the patient from coming to harm)

Question 25

Describe virtue ethics, deontology, and consequentialism-utilitarianism and how they might be used in medical context.

Answer 25

- **Virtue ethics:** considers what a virtuous person (honesty, compassion, integrity) would do in a given situation to make sure the patient has the best possible outcome - **Deontology:** places importance on the ethical codes, professional guidelines, and respecting the autonomy of the patient (actions are based on their alignment with moral principles rather than their outcomes) - **Consequentialism-Utilitarianism:** focuses on maximising overall utility or happiness and minimising harm or suffering. utilitarianism seeks to achieve the greatest good for the greatest number of people (eg. a doctor might allocate limited resources to those who will benefit the most from them)

Question 26

Confidentiality (Hippocratic oath and department of health definition)

Answer 26

Question 27

Describe the process of registering a birth

Answer 27

- birth must be registered within 6 weeks of birth (42 days) Notes... **Opposite sex**: - married at time of birth or conception either mother or father can register - unmarried - both parents details if sign register together, statutory declaration of parentage or court order giving father - PR (Parental responsibility), mother can choose not to put father on certificate **Same-sex female** - married - either can register if born by donor insemination or fertility treatment - unmarried - partner is seen as a second parent if treated together by licensed clinic and made parenthood order but same criteria as opposite-sex unmarried couples **Same-sex male couples** - must get parental order which you cannot get in 6 weeks so birth mother must register **Surrogacy** - birth mother is legal mother unless/until parenthood transferred - husband of surrogate has PR - surrogate has legal right to keep child

Question 28

Define live Birth, premature birth, still birth, miscarriage, and surrogacy, and abortion

Answer 28

- Live Birth: a fetus, whatever it's gestational age, that exits the maternal body and shows any sign of life (voluntary movement, heartbeat or pulsation of the umbilical cord) for however brief a time and regardless of whether the umblical cord or placenta are intact - Prematurity: born alive before 37 completed weeks of pregnancy - Miscarriage: spontaneous loss of pregnancy before 24 weeks gestation - Stillbirth: born after 24 completed weeks of pregnancy and no sign of life after exiting the mother's body - Surrogacy - an arragement made where a woman carries a child agreed before she began to carry the child and made with a view to handing over the child to another person or persons - note: not legally enforceable even if contract or payment - note: not regulated by HFEA (Human Fertilisation and Embryology Act) 2008 - Abortion laws: in UK can have abortion before 24 weeks, unless baby is found to have a very high risk/fatal condition then any time during pregnancy abortion can occur - consent for treatment usualy needed by someone with PR - mother automatically has PR - father married to mothe at tme of birth - ongoing even if divorce - can acquire PR - father marrying mother, court orders, adoption

Question 29

Describe the legal status of the fetus in English law and under the human rights act

Answer 29

- The fetus does not acquire any legal rights until it is capable of surviving independently from it's mother

Question 30

Key legal principles relevant to the care of individuals at the end of life (what is death?)

Answer 30

- **Death** = the irreversible loss of capacity for consciousness combined with the irreversible loss of capacity to breathe - note: brain stem death - irreversible cessation of the integrative function of the brainstem equates with death and allows the diagnosis of death - a registered medical practitioner signs a certificate in the prescribed form stating to the best of their knowledge and belief the cause of death - **Certifying death**: statutory duty of doctor looking after person in last illness to complete (rules on duration etc) and if unable to do must refer to Coroner - Medical Examiner (Senior Doctor) or Coroner to review cause of death on certificate

Question 31

Describe the process of certifying and registering a death and the role of HM Coroner and the inquest process

Answer 31

- the doctor attending patient in last illness to complete certificate giving cause of death - note: if unable to do refer to HM Coroner (all new Coroners are lawyers) - certain categories: eg. undergoing treatment, possible suicide, death in prison/custody, related to employment eg. asbestos - note: Cause of death should be a disease process or condition not eg organ failure - post-mortem if HM Coroner requests to ascertain cause of death or family and hospital agree to gain a fuller understanding of illness/death - note: Coroner's PM does not need family to agree, must be completed within 28 days - if post-mortem confirms natural cause no inquest needed more notes... - Inquest - public hearing, Coroner calls witnesses, family may have legal representation, Trust solicitor if Hospital Team involved - to answer who is the deceased, medical cause of death, how , when and where they died - conclusions include eg. natural causes, accident/misadventure, killing themselves, drug dependence, open verdict if not enough evidence, narrative verdict where describes death - adverse findings Neglect or Regulation 28 (report on action to prevent future deaths - may be a trust action) - can refer doctor to GMC

Question 32

Discuss the professional and legal duties of confidentiality; the role of GDPR and the situations where disclosure is appropriate.

Answer 32

- GDPR = General Data Protection Regulation

Question 33

Access to notes of deceased patients (principles)...

Answer 33

Question 34

Caldicott principles 1-8...

Answer 34

- 'the Caldicott guardian is responsible for safeguarding and governing the uses of patient information within the Trust and acting as the "conscience" of the Trust