what are the principles of distributive justice?
its all about fair decisio making and providing far access to quiality healthcare and fair share of healthcare resources
describe making decisions fo children
users are presumed to be competent unless there are reasonable grounds for otherwise
restrictions in decision making capacity are reasons
treatmetn provider in charge of deciding if the patient is competent
if deemed incompetent, the childs guardian is in charge of making the deicion
if guardian does not have childs best interest in making decision, best interest principle will be applied
describe procedural justice
describe competence and capacity do decide
what is the best interests principle
Working with Families
Families and doctors can have different views about what is in a patient’s best interests. Doctors should work with families to:
Understand the person’s wishes, values, or interests better. Families often have access to information that is relevant to a best interests decision
Respect whakapapa and show manaakitanga for families. Families generally have significant interests in each other’s’ wellbeing and in being involved in their care
Uphold Right 8 of the Code (The Right to Support). Patients may want their family to play a part in their medical decision making
enduring powre of attorney and welfare guadirans
Under the PPPR Act 1998, the Family Court can appoint a welfare guardian to make decisions for a person where there is no Enduring Power of Attorney. Almost anyone can apply to the Family Court for a welfare guardian to be appointed for a person who cannot make decisions for themselves, including a health professional, social worker or family member.
A welfare guardian is expected to make decisions in the best interests of the person concerned:
PPPR Act 1998 Part 2 Welfare guardians 18 Powers and duties of welfare guardian
(3) In exercising those powers, the first and paramount consideration of a welfare guardian shall be the promotion and protection of the welfare and best interests of the person for whom the welfare guardian is acting, while seeking at all times to encourage that person to develop and exercise such capacity as that person has to understand the nature and foresee the consequences of decisions relating to the personal care and welfare of that person, and to communicate such decisions.
The Court only appoints a person that they are satisfied will not have a lot of conflict with that person, and they ensure, insofar as is possible, that the order is made with the knowledge and agreement of the person concerned.
Deciding for an adult in the absence of an Enduring Power of Attorney/Welfare Guardian
When there is no appointed decision maker, medical decisions rest with the healthcare provider. In making decisions for a patient, doctors should apply the best interests principle. Families should be involved and informed, unless there are compelling reasons not to do so (evidence-based concern that a family does not have a patient’s best interests at heart).
quantiative vs qualitiative futility
sanctity of life?
pillars of medical ethics?
describe right 1
d
escribe right 2 and 3
describe right 4
describe right 7
Right 7
Right to make an informed choice and give informed consent
(1) Services may be provided to a consumer only if that consumer makes an informed choice and gives informed consent, except where any enactment, or the common law, or any other provision of this Code provides otherwise.
(2) Every consumer must be presumed competent to make an informed choice and give informed consent, unless there are reasonable grounds for believing that the consumer is not competent.
(3) Where a consumer has diminished competence, that consumer retains the right to make informed choices and give informed consent, to the extent appropriate to his or her level of competence.
(4) Where a consumer is not competent to make an informed choice and give informed consent, and no person entitled to consent on behalf of the consumer is available, the provider may provide services where—
(a) it is in the best interests of the consumer; and
(b) reasonable steps have been taken to ascertain the views of the consumer; and
(c) either,—
(i) if the consumer’s views have been ascertained, and having regard to those views, the provider believes, on reasonable grounds, that the provision of the services is consistent with the informed choice the consumer would make if he or she were competent; or
(ii) if the consumer’s views have not been ascertained, the provider takes into account the views of other suitable persons who are interested in the welfare of the consumer and available to advise the provider.
(5) Every consumer may use an advance directive in accordance with the common law.
(6) Where informed consent to a health care procedure is required, it must be in writing if—
(a) the consumer is to participate in any research; or
(b) the procedure is experimental; or
(c) the consumer will be under general anaesthetic; or
(d) there is a significant risk of adverse effects on the consumer.
(7) Every consumer has the right to refuse services and to withdraw consent to services.
(8) Every consumer has the right to express a preference as to who will provide services and have that preference met where practicable.
(9) Every consumer has the right to make a decision about the return or disposal of any body parts or bodily substances removed or obtained in the course of a health care procedure.
(10) No body part or bodily substance removed or obtained in the course of a health care procedure may be stored, preserved, or used otherwise than
(a) with the informed consent of the consumer; or
(b) for the purposes of research that has received the approval of an ethics committee; or
(c) for the purposes of 1 or more of the following activities, being activities that are each undertaken to assure or improve the quality of services:
(i) a professionally recognised quality assurance programme:
(ii) an external audit of services:
(iii) an external evaluation of services.
describe right 8
Right 8
Right to support
Every consumer has the right to have one or more support persons of his or her choice present, except where safety may be compromised or another consumer’s rights may be unreasonably infringed.
describe right 6
Right 6
Right to be fully informed
(1) Every consumer has the right to the information that a reasonable consumer, in that consumer’s circumstances, would expect to receive, including—
(a) an explanation of his or her condition; and
(b) an explanation of the options available, including an assessment of the expected risks, side effects, benefits, and costs of each option; and
(c) advice of the estimated time within which the services will be provided; and
(d) notification of any proposed participation in teaching or research, including whether the research requires and has received ethical approval; and
(e) any other information required by legal, professional, ethical, and other relevant standards; and
(f) the results of tests; and
(g) the results of procedures.
(2) Before making a choice or giving consent, every consumer has the right to the information that a reasonable consumer, in that consumer’s circumstances, needs to make an informed choice or give informed consent.
(3) Every consumer has the right to honest and accurate answers to questions relating to services, including questions about—
(a) the identity and qualifications of the provider; and
(b) the recommendation of the provider; and
(c) how to obtain an opinion from another provider; and
(d) the results of research.
(4) Every consumer has the right to receive, on request, a written summary of information provided.
