Clinical Ethics and Law (CEL) Flashcards
(193 cards)
1
Q
Outline the first principle of the Mental Capacity Act (MCA)?
A
A person must be assumed to have capacity unless it is established that he/she lacks capacity
2
Q
Outline the second principle of the Mental Capacity Act (MCA)?
A
A person is not to be treated as unable to make a decision unless all practicable steps to help him/her to do so have been taken without success
3
Q
Outline the third principle of the Mental Capacity Act (MCA)?
A
A person is not to be treated as unable to make a decision merely because he/she makes an unwise decision
4
Q
Outline the fourth principle of the Mental Capacity Act (MCA)?
A
Any act done, or decision made, under the Mental Capacity Act for, or on behalf of, a person who lacks capacity must be done, or made, in his/her best interests
5
Q
Outline the fith principle of the Mental Capacity Act (MCA)?
A
Before any act is done, or any decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person’s rights and freedom of action
6
Q
What questions need to be asked of the patient as part of the functional test of decision making when assessing capacity? (4)
A
Is the patient able to;
- understand all of the relevant information
- retain that information
- use and/or weigh-up that information as part of the decision making process
- communicate a decision
7
Q
Should a patient who is refusing a treatment be treated if they are deemed to have capacity?
A
No; refusals of treatment must be respected, unless in a situation where the Mental Health Act (MHA) applies
8
Q
Should a patient who is requesting a treatment be treated if they are deemed to have capacity?
A
No; doctors are not obliged to provide treatment requested by the patient if they believe that treatment to be harmful or futile
9
Q
Should a patient who is consenting to a treatment be treated if they are deemed to have capacity?
A
Yes; treatment may proceed lawfully provided the patient is giving voluntary and informed consent
10
Q
If a patient is deemed to lack the capacity to make a decision in the first instance, what should be done before considering whether to treat or not to treat?
A
Steps to maximise their capacity; for example use of word boards in patients that cannot communicate
11
Q
Which two legal frameworks can be used to determine whether or not to treat a patient who lacks capacity? (2)
A
- Advanced Decision to Refuse Treatment (ADRT); a decision made in advance to refuse a specific type of treatment in the future
- Lasting Power of Attorney (LPA); a person nominated to make a decision regarding treatment that is in line with the patient’s own best interests
12
Q
Which additional conditions are required to be met by advanced decision (AD) documentation in order for the refusal life-saving or life-sustaining treatment to be legally-binding? (4)
A
- Must be written
- Must be signed
- Must be witnessed
- Must include a clear sentence stating that the decision is to be upheld even if the patient’s life is at risk
13
Q
How should a clinician decide on whether or not to treat a patient who lacks capacity if they do not have a Lasting Power of Attorney (LPA) or any Advanced Decisions to Refuse Treatment (ADRT)?
A
A decision on whether or not to treat should be made in line with what that clinician believes is in the best interest of that patient
14
Q
Who can clinicians consult with in order to ascertain what is in the best interests of a patient who lacks capacity to consent/refuse a treatment? (2)
A
- People who know the patient well
- Independent mental capacity advocates (IMCAs)
15
Q
Outline the aspects that need to be considered prior to making a best interest decision? (7)
A
- Likelihood of a regain of capacity
- Effort made to encourage the patient’s participation in the decision
- Past and present wishes and feelings
- Beliefs and values
- Emotional bonds, family obligations
- Consultation with anyone named by the person to
16
Q
Outline the components of legally valid consent? (3)
A
- Competent; patient has mental capacity to decide to agree to the act
- Informed; patient provided with information as to the nature and purpose of the act
- Voluntary; not coerced, obtained under duress or undue influence
17
Q
When it comes to conset for treatment, which two pillars of medical ethics need to be considered and balanced? (2)
A
- Beneficence; obligation of the physician to act so as to benefit the patient
- Respect for autonomy; ability of the patient to act deliberately and in accordance with their values
18
Q
For consent to be ‘informed’ what information must be provided to the patient? (3)
A
- All options available to them including to do nothing
- Nature of the act and the purpose including expected benefits
- Risks associated with each option
19
Q
Outline the two key components that need to be covered when discussing the risks to a patient of a particular intervention? (2)
A
- What a ‘reasonable patient’ would want to know
- Any additional information that the specific patient wants to know
20
Q
Outline the two components that make up the capacity assessment? (2)
A
- Diagnostic threshold; does the patient have a disorder or impairment in the function of their mind or brain
- Functional test; can they demonstrate the ability to make a relevant a decision for themself
21
Q
Under what circumstances would a patient fail the functional test of decision making that makes up part of the capacity assessment?
A
If they are unable to do any one or more of the four tasks that make up the functional test (understand, retain, weigh-up/use, communicate)
22
Q
In order for a patient who meets the diagnostic threshold component of the capacity assessment, what other feature must be demonstrated in order for them to be deemed to lack capacity?
A
Patients with a known disturbance in functioning of mind or brain MUST also be demonstrated to not have the ability to make a relevant decision in order for them to be deemed to lack capacity
23
Q
Outline the key assertion of the Fraser Guidelines?
A
In order to treat children under 16, the consent of a person with parental responsibility, or the prior authorisation of the Courts, is required before treatment can be given
24
Q
Outline the key exception to the Fraser Guidelines?
A
Treatment of a patient under the age of 16 years can proceed provided that they are consenting for such treatment and that they have be proven to be ‘Gillick competent’
25
Outline the law regarding consent for a procedure in patients who are 16 or 17 years of age?
Patients who are 16 or 17 years of age are presumed to be competent to consent for treatment without the need for prior consent from a person with parental responsibility
26
Outline the law regarding refusal to consent for a procedure in patients who are under the age of 18 years?
Refusal to treatment made by patients under 18 years can be overridden by consent for treatment made on their behalf by an individual with parental resonsbility, even if the patient has been deemed to be Gillick competent
27
What caveat is there to the ability of proxy consent by an individual with parental responsibility to overrule a refusal to consent to treatment made by a patient under the age of 18?
Provided this decision falls within the **'zone of parental control'** based on what is considered **normal practice in society** and that the decision being made by the individual with parental responsibility is in the **best interest** of the child/young person
28
Outline the law regarding the consent for treatment in patients who are detained under Section 2 or Section 3 of the Mental Health Act (MHA)?
**Treatment** for patients detained under Section 2 or Section 3 of the Mental Health Act (MHA) **can proceed without consent** provided it is treatment **for their mental health condition only** and not treatment of a medical condition
29
Outline the difference between capacitous refusals for treatment for a mental health illness and refusals for treatment of a physical health illness? (2)
- Capacitous refusals for treatment of a mental health illness can be overridden
- Capacitous refusals for treatment of a physical health illness cannot be overridden
30
Outline the three legitimate justifications that can be used for the provision or witholding of treatment in an adult that lacks capacity? (3)
- **Advanced Decision to Refuse Treatment (ADRT)**; a decision made in advance to refuse a specific type of treatment in the future
- **Lasting Power of Attorney (LPA)**; a person nominated to make a decision regarding treatment that is in line with the patient's own best interests
- **Best interest decision (BID)**; the person providing/witholding the treatment may do so provided they believe it to be in the patient's own best interests
31
Under what circumstance may an advanced decision to refuse treatment (ADRT) be invalidated?
If the patient has subsequently gone on to appoint a lasting power of attorney (LPA)
32
Who can you contact if you are unsure whether or not a valid advanced decision to refuse treatment (ADRT) is applicable to the treatment you are proposing exists?
Court of Protection
33
If you are awaiting clarification regarding the presence and/or validity of an advanced decision to refuse treatment (ADRT), how should you proceed with treatment?
In the meantime **treatment should be provided** necessary **to preserve life** and **prevent serious deterioration**
34
When can the Court of Protection appoint a Personal Welfare Deputy in patients with no Lasting Power of Attorney (LPA)? (2)
- If there is **doubt about** whether **decisions** made will be made in someones **best interests** (i.e. family disagreements)
- Where someone needs to make **multiple decisions regarding a specific issue over time** (i.e. choosing Where someone will live)
35
Broadly speaking, what is the difference between statutory law and common law?
- **Statutory (written) law**; specific laws proposed by the government of a country and passed into written legislation
- **Common (case) law**; laws declared by judges derived from custom and precedent that are defined when new decisions are made
36
Outline the four main conditions under which a breach of confidentiality is considered lawful? (4)
- The patient to whom the disclosure relates to **consents** to the disclosure
- Based on a **best interests** decision in a patient that lacks the capacity to consent to the disclosure
- Where there is a **legal obligation or statutory permission** to disclose the information
- On the basis that the disclosure can be justified as in the **public interest**
37
Outline the key GMC principles regarding information governance? (8)
- Use the **minimum necessary personal** information
- Manage and **protect information**
- Be **aware** of your **responsibilities**
- **Comply** with the **law**
- Share relevant information for **direct care**
- Ask for **explicit consent** to disclose identifiable information
- **Tell patients about disclosures** you make
- **Support** patients to **access** their information
38
Is it ever possible to share/disclose patient information without their consent where there is no perceived benefit to the patient/public and the disclosure is not required by law?
**Yes**; if it is **anonymised information** that **cannot foreseeably** be used to **identify a patient**, it is not considered confidential and therefore may be used for legitimate purpose(s) without consent
39
Outline the two main circumstances where you have a legal obligation to disclose information? (2)
- Statutory obligation/permission
- Specifically ordered to by a court
40
Are you legally obliged to disclose information to a police officer under all circumstances?
**No**; information can only be disclosed to police officers if that information satisfies **one or more of the principle justifications** regarding the lawful disclosure of information (i.e. consent, best interests, public interest or legal court order/statutory obligation)
41
Under what circumstances does the GMC state that disclosure of information is justifiable under the basis of public interest? (2)
- If **failure to disclose** may **put someone** other than the patient **at risk** of death or serious harm
- If the disclosure is likely to help in the **prevention, detection or prosecution** of a **serious crime**
42
Outline the two component moral claims that encompass the doctrine of double effect? (2)
- Performing a **bad act** in order to bring about a **good consequence** is **always wrong**
- Performing a **good act**, which one foresees as **potentially** leading to a **bad consequence**, is **sometimes right**
43
Outline the definition of voluntary active euthanasia?
**Intentionally killing** someone, with their **consent**, for their **benefit**
44
Outline the definition of non-voluntary active euthanasia?
**Intentionally killing** someone, who **lacks capacity** to consent, for their **benefit**
45
Outline the definition of involuntary active euthanasia?
**Intentionally killing** someone, **against** their **expressed wishes**, for their **benefit**
46
Outline the definition of voluntary passive euthanasia?
**Intentionally allowing** someone to **die**, with their **consent**, for their **benefit**
47
Outline the definition of non-voluntary passive euthanasia?
**Intentionally allowing** someone, who **lacks capacity** to consent, to **die**, for their **benefit**
48
Outline the definition of involuntary passive euthanasia?
**Intentionally allowing** someone to **die**, **against** their **expressed wishes**, for their **benefit**
49
What is the difference between physician assisted suicide and assisted dying? (2)
- **Physician assisted suicide**; providing **any patient** the means to end their own life
- **Assisted dying**; providing a **terminally ill** individual the means to end their own life
50
What should you do if a police officer intends to issue you with a caution?
Do not accept the caution without **first seeking legal advice**
51
Which individuals can refer doctors to the general medical council (GMC)? (3)
- Employers (e.g. NHS Trusts)
- Colleagues
- Members of the public
52
Outline the possible outcomes that can occur following a meeting of the Medical Practitioners Tribunal Service (MPTS) where Fitness to Practise (FtP) has been found to have been impaired? (4)
- **No action**, the doctor can continue practising
- **Conditions** on continued registration and practise
- **Suspension** from the register
- **Erasure** from the register
53
Outline the three tiers of fitness to practise assessment at the Clinical School of the University of Cambridge? (3)
- **Informal notification** of low level concerns
- Referral to a **Progress Panel**
- **Fitness for Medical Practice** Adjudication Board
54
Outline the phases that make up a Fitness for Medical Practice Adjudication Board Assessment? (3)
- Preliminary stage
- Investigation stage
- Adjudication stage
55
Outline the main outcomes of a Fitness for Medical Practice Adjudication Board? (3)
- **Outcome 1**: no action, student is **fit to continue** on the course
- **Outcome 2**; student can continue on the course **subject to conditions**
- **Outcome 3**; student is **removed from the course** and the medical student register
56
What are the five main circumstances in which the fitness of a doctor to practise may be taken into question? (5)
- Actual or potential **harm** to patients
- Disregard for **clinical responsibilities**
- **Personal health** is compromising patient safety
- **Abuse of patient trust** or disregard for autonomy
- Deliberate **dishonesty/fraudulent** behaviour
57
Outline the possible outcomes that can occur following a meeting of the Medical Practitioners Tribunal Service (MPTS) where Fitness to Practise (FtP) has been found to have not been impaired? (2)
- **Warning**; used if there has been a departure from the principles of good medical practise
- **No action**; if fitness to practise is not impaired and there was no deviation from good medical practise
58
Which circumstances are exempt from erasure from the General Medical Council (GMC) register being an outcome?
Cases where a doctor's **health** is the sole reason for referral
59
What is the difference between an audit and a service evaluation? (2)
- **Audits**; **compare** the outcomes or processes in a clinical service to a **pre-defined standard**
- **Service evaluations**; measure the outcomes or processes in a clinical service **without comparison** to a **pre-defined standard**
60
Outline the similarities between an audit and a service evaluation in terms of the information they are concerned with?
Audits and service evaluations both measure **outcomes** or **processes** in a clinical service
61
Outline the four main types of clinical research? (4)
**ASK Qs**;
- **A**udits
- **S**ervice evaluation
- **K**nowledge acquisition research
- **Q**uality improvement
62
Outline the main aim of quality improvement research?
To improve the quality of care and outcomes for patients using a particular service
63
Which types of research project do not require a Research Ethics Committee (REC) review? (4)
- Audit projects
- Service evaluation projects
- Quality improvement projects
- Public health surveillance projects
64
Which department should be notified when undertaking a clinical research project?
Research & Development (R&D) Department of the NHS Trust
65
What is meant by the term ‘**equipoise**’?
Equipoise describes the position of **not knowing** whether or not an **intervention** will provide an **overall benefit**
66
What is the main ethical problem associated with conducting clinical research?
The fact that we **do not know whether or not the intervention will be of benefit** means that the priniciple of beneficence cannot be applied to such activities
67
Which piece of legislation governs the standards that medical researchers must adhere to?
World Medical Association (WMA) Declaration of Helsinki (1964)
68
Which types of research projects require a Research Ethics Committee (REC) review?
Knowledge acquisition research projects
69
When must a Research Ethics Committee (REC) review be undertaken?
Before the project is advertised and/or participants are recruited
70
Under which circumstances is an NHS Research Ethics Committee (NHS-REC) review nedded? (3)
- Research that **recruits** NHS **patients** and/or their **relatives and carers**
- Research that **collects tissue** from NHS **patients**
- Research that involves activities that **require consent** but in **adults who lack capacity** to do so
71
Outline the main dimensional clusters that differ between different cultures? (9)
- Individualism vs collectivism
- Power distance
- Uncertainty avoidance
- Mastery vs harmony
- Traditionalism vs secularism
- Indulgence vs restraint
- Assertiveness vs tenderness
- Gender egalitarianism
- Collaborativeness
72
What is meant by the term '**ethnocentrism**'?
Imposition of ones own cultural values and beliefs upon another
73
Outline the different approaches to cultural diversity as proposed by Friedman and Berthoin-Antal? (4)
- **High-advocacy, high enquiry**; expressing and advocating your own values whilst trying to understand those of the other culture
- **High-advocacy, low enquiry**; expressing and advocating your own values whilst ignoring those of the other culture
- **Low-advocacy, high enquiry**; suppressing your own values whilst trying to understand those of the other culture
- **Low-advocacy, low-enquiry**; suppressing your own values and ignoring those of the other culture
74
Which approach to cultural diversity is thought to be the most beneficial in terms of intercultural learning?
High-advocacy, high-enquiry
75
Outine the two main types of bias against a person? (2)
- Conscious (explicit) bias
- Unconscious (implicit) bias
76
Which two opposing models have been proposed to explain the apparent shortage of facts in psychiatric medicine? (2)
- **Medical model**; psychiatric disorders are caused by dysfunction in the brain and neuroscience has not progressed enough to identify the underlying pathology
- **Anti-psychiatry model**; psychiatry is fundamentally different to physical medicine and diagnosis has no factual basis but is instead an evaluative process
77
Outline the value-based medicine (VBM) argument that attempts to explain the apparent shortage of facts in psychiatry compared to physical medicine?
**Values** at the **core** of **psychiatric medicine** are more **widely disputed** (because they involve motivation, desire, affect and belief). Whereas, the values at the core of physical medicine are largely shared (i.e. pain is bad)
78
When, in relation to issues of health, when may a person be deprived of their liberty in accordance with Article 5 of the European Court of Human Rights (ECtHR)? (5)
- Prevention of spread of infectious disease
- Person(s) of unsound mind
- Alcoholics
- Drug addicts
- Vagrants
79
Outline the limits applied to the detenion of a person on the basis of unsoundness of mind? (4)
- Objective medical **evidence** in support
- **Nature/degree** of disorder warrants confinement
- Period **review** to assess continued need
- Considered a **proportionate** response
80
Which two ways are there of detaining a person under the Mental Health Act? (2)
- Civil detention
- Criminal Justice System detention
81
What are the three possible outcomes following detention under Section 2 of the Mental Health Act? (3)
- Discharge from hospital
- Remain as voluntary/informal admission
- Detainment under Section 3 of MHA
82
Outline the Civil Detention powers granted under Section 135 of the Mental Health Act?
**Section 135**; allows the **police to enter a persons home** and take them to a place of safety, lasting upto 24 hours
83
Outline the Criminal Justice System Detention powers granted under Section 35 of the Mental Health Act?
**Section 35**; allows a patient **awaiting trial or sentencing** to be remanded to hospital to be **detained** for **upto 28 days at a time** for **upto 12 weeks** in total for **assessment** purposes
84
Outline the Criminal Justice System Detention powers granted under Section 36 of the Mental Health Act?
**Section 36**; allows a patient **awaiting trial or sentencing** to be remanded to hospital to be **detained** for **upto 28 days at a time** for **upto 12 weeks** in total for **treatment** purposes
85
Outline the Criminal Justice System Detention powers granted under Section 37 of the Mental Health Act?
**Section 37**; allows a patient who has **already been convicted** of a crime to be remanded to hospital to be **detained** for **upto 28 days at a time** for **upto 12 weeks** in total for **treatment** purposes
86
Outline the Criminal Justice System Detention powers granted under Section 41 of the Mental Health Act?
**Section 41**; **restricts** the **discharge** of an an **individual** already **under Section 37** and **gives powers** regarding leave and discharge from hospital to the **Secretary of State for Justice**
87
Outline the powers granted by Section 6 of the Mental Capacity Act?
**Allows restraint**, defined as the use or threat of force, to **restrict the movement** of a **person** who **lacks capacity** provided that it is believed to be both **necessary and proportionate** to both the magnitude and likelihood of that person coming to harm
88
Outline the definition of a deprivation of liberty?
Deprivation of liberty occurs where a **person who lacks capacity** to consent is subjected to **continuous supervision and control** and is **not free to leave** irrespective of whether they have expressed to do so or not
89
Why are patients who are deprived of their liberty and detained under the Mental Capacity Act (MCA) more vulnerable than those detained under the Mental Health Act (MHA)?
The Mental Capacity Act (MCA) does not encompass an established system of safegaurds to protect those it allows to be detained (second opinions, appeals etc.) unlike the Mental Health Act (MHA)
90
Under the Liberty Protection Safeguards (LPS), which individuals/organisations have the power to authorise deprivations of liberty? (3)
- **For NHS Trusts**; the hospital manager
- **For arrangements under Coninuing Health Care (CHC)**; local clinical commissioning group (CCG)
- **All other cases**; the local authority
91
Can you treat a patient for a medical condition without their consent if they detained under the Mental Health Act (MHA) for treatment of a psychiatric condition?
**No**; either the patient must consent, or their capacity assessed to determine if treatment can proceed under the Mental Capacity Act
92
Can you treat a patient for a psychiatric condition without their consent if they detained under the Mental Health Act (MHA) for treatment of a psychiatric condition?
**Yes**; with some exceptions, inluding for those detained under Section 5(2), 5(4), Section 4 and Section 136
93
Which treatments of psychiatric illness are subject to additional safegaurds before they can be administered to patients detained under the Mental Health Act (MCA)? (2)
- Electroconvulsive therapy (ECT)
- Psychosurgery
94
What additional safegaurds need to be invoked before a patient detained under the Mental Health Act (MCA) can be treated with psychosurgery and/or electroconvulsve therapy (ECT)?
Review by second opinion approved doctors (SOADs)
95
What options are there for the administration of medications to treat psychiatric illness beyond 12 weeks to be authorised under the Mental Health Act (MHA)? (2)
- **If patient has capacity**; consent from the patient
- **If patient lacks capacity**; authorisation by a second opinion approved doctor (SOAD)
96
When can electroconvulsive therapy (ECT) be administered to patients detained under the Mental Health Act (MHA) before prior authorisation by a Second Opinion Approved Doctor (SOAD) is obtained?
**Two sessions** can be administered if it is immediately necessary to **save** the patient's **life** and/or **prevent serious deterioration** of their condition
97
What three clauses must be satisfied before a pyschotropic medication can be administered to patients detained under the Mental Health Act (MHA) before prior authorisation by a Second Opinion Approved Doctor (SOAD) is obtained? (3)
- If it is **immediately necessary** to **alleviate** serious **suffering**
- Represents the **minimum interference necessary** to prevent the patient from behaving violently and/or **being a danger** to themselves or others
- Provided the medication is '**non-hazardous**'
98
What is a community treatment order (CTO) and what is its purpose? (2)
- A community treatment order (CTO) allows a **consultant psychiatrist** to **recall a patient to hospital** for administration of a **psychotropic medication if they have refused it** in the community
- CTOs are **used to faciliatate the discharge** of a **patient** detained under **Section 3** of the Mental Health Act (MHA) where there are **concerns regarding compliance** with medication
99
If a patient subject to a community treatment order (CTO) refuses medication in the community, should it still be given?
**No**; refusal of, for example, depot intramuscular injections, outside of hopsital must be respected
100
Which groups are covered under the adult safegaurding framework? (3)
- Those that have **needs** for **care and/or support**
- Those **experiencing and/or at risk** of **abuse and/or neglect**
- Those who are **unable to protect themselves** from actual or increased risk of abuse and/or neglect
101
Outline the six principles of safeguarding? (6)
- Empowerment
- Prevention
- Proportionality
- Protection
- Partnership
- Accountability
102
From what age does the Mental Capacity Act (2005) apply?
Individuals over 16 years of age
103
Outline the difference regarding assumed capacity to consent in children younger than 16 compared to those aged 16 or 17 years? (2)
- **< 16 years of age**; presumed **NOT** to have capacity to consent
- **16 - 17 years**; presumed to **HAVE** capacity to consent
104
Under what circumstances can an individual with parental responsibility for a child aged 16 or 17 override the child's capacity?
If the child is 16 or 17 and is **refusing to provide consent** for treatment, then individuals with parental responsibility can overrule that refusal and provide proxy consent for treatment to be administered
105
Under what circumstances can doctors overrule decisions made by individuals with parental responsibility for an individual under the age of 18 years?
If the individual(s) with parental responsibility appear to be making decisions that are not in the best interests of the child
106
Outline the difference in terms of providing emergency and non-emergency treatment for an individual under the age of 18 years (minor) where those with parental responsibility have been deemed to not be able to act in the best interests of that minor? (2)
- **Emergency treatment**; can be administered without parental consent regardless
- **Non-emergency treatment**; may be administered following authorisation from the court
107
Which individuals have automatic and presumed parental responsibility for a child? (2)
- **Biological mother**; under all circumstances, **except where** a child has been **adopted**
- **Fathers**; **only** if **currently married** to the **mother** of the child
108
Can an individual with parental responsibility surrender or transfer that responsibility?
**No**; unless the child is formally adopted
109
Outline the guidance regarding confidentiality in individuals under the age of 18 years? (2)
- Confidentiality must be respected unless there's a legal obligation or the public interest defence applies
- However, good practice is to suggest that the individual discusses this treatment with their parents
110
Outline the three circumstances that the Royal College of Paediatrics and Child Health (RCPCH) guidance states that treatment limitation can be considered in paediatric patients where it is not in their best interests? (3)
- Where life is limited in quantity
- Where life is limited in quality
- Where there is informed and competent refusal of treatment
111
Who should be the first port-of-call in cases where you identify perceive actual or potential child protection concerns?
The Local Child Safegaurding Lead
112
Outline the measures one can take in cases of perceived immediate risk to child safety and in cases where there is not immediate risk to child safety but there are perceived child protection concerns? (2)
- **Immediate risk to child safety**; refer to social services for a Section 47 assessment
- **Non-immediate perceived child protection concerns**; complete a Common Assessment Framework (CAF) form
113
Outline Section 4 of the Human Fertilisation and Embryology Act (1990)? (2)
- **No** person shall **store** any **gametes** except in pursuance of a licence
- **No** person shall **use** the **gametes** of a person **unless** the **service provided** is for the **individuals** from which both derive, except in pursuance of a licence
114
What happens if one or more partner from which stored gametes/embryos are derived withdraws their consent for storage?
Treatment providers can **no longer lawfully store** those gametes/embryos
115
What is the main difference between ethical decisions surrounding reproduction and pregnancy compared to all other areas of medical practice?
Doctors must consider the interests of any child brought about as a result of assisted reproductive technology. This is the only example of where **consideration of the interests of someone other than the patient themself should be taken into account** and included in decision making
116
Outline the responsbility of treatment providers regarding the information given to their patients prior to the use of assisted reproductive technologies (ARTs)?
Treatment providers have a legal obligation to provide information about the potential implications of treatment and must offer counselling on this
117
What happens if the partner of a woman due to undergo artificial insemination or embryo implantation changes their mind regarding their williingness to co-parent any child born as a result of the treatment?
The treatment provider is **legally obliged to inform the woman before insemination/implantation** of embryos
118
What happens if a woman due to undergo artificial insemination or embryo implantation changes their mind regarding their willingness to allow the partner from whom the embryo/gametes are also derived from, to co-parent any child born as a result of the treatment?
The treatment provider is legally obliged to inform the partner before treating/continuing to treat the woman
119
Outline the legality of implanting embryos that have undergone pre-implantation genetic diagnosis? (2)
- It is **legal to implant embryos** that have undergone pre-implantation genetic diagnosis and have been proven as being **unaffected** by the genetic condition
- It is **illegal to implant embryos** that have undergone pre-implantation genetic diagnosis and have been proven as being **affected** by the genetic condition
120
Outline the legal position regarding the selection of embryos based on sex where there is a history of sex-linked genetic disease in the family? (2)
- It is **legal to select embryos** of the **unaffected sex** for implantation in preference to embryos of the affected sex
- It is **illegal to select embryos** of the **affected sex** for implantation in preference to embryos of the unaffected sex
121
Outline the main schools of thought regarding the ethics of termination of pregnancy that revolve around the moral significance of the fetus? (4)
- **Sanctity of life**; all life is sacred and must be preserved
- **Gradualist**; at a point in development the fetus' right to life outweighs the pregnant woman's right to bodily self-determination
- **Viability argument**; termination is morally wrong beyond the point at which the fetus is viable outside of the uterus and without the mother's support
- **Personhood argument**; termination is morally wrong beyond a point at which the fetus has developed qualities shared by most other human beings
122
Outline the legal standpoint on personhood in the England?
English Law is clear in defining personhood as beginning at birth and hence this is the point at which human rights apply
123
Outline the legal standpoint regarding interventions that involve maternal-fetal conflict? (2)
- A pregnant woman **with capacity** has the **right** to **refuse treatment** regardless of the consequences
- **Decisions** made in the **best interest** of pregnant women who lack capacity must be made in the best interests of the **mother** and **not the unborn child**
124
Under what circumstances could a caesarian section deemed to not be in the best interests of a pregnant woman who lacks capacity be justified?
If performing the caesarian section would acheive a live birth that without the intervention would not occur and that such live birth would sway the balance of best interest sufficiently that the intervention could be justified on that basis
125
Which two acts of legislation make for a general prohibition on abortion? (2)
- The Offences Against the Person Act (1861)
- The Infant Life Preservation Act (1929)
126
Which act of legislation makes an exception for the use of abortion under certain circumstances?
The Abortion Act (1967)
127
Under section 1A of the Abortion Act, what is the legal gestation at which abortion after is considered unlawful
Abortion is lawful upto 24 weeks of gestation
128
Outline the Bourne Defence regarding abortion?
Doctors cannot be sucessfully prosecuted for peforming abortions in cases where the pregancy would cause actual or probable mental and/or physical ill-health
129
Outline Section 1 of The Abortion Act (1967)?
A person shall not be guilty of an offence where a pregnancy is terminated by a registered medical professional, if two registered medical professionals are of the same opinion, formed in good faith
130
Which registered medical professionals are legally allowed to perform abortion?
Only doctors; although they may be assisted by other registered medical professionals
131
Outline the clauses that legally permit abortion beyond 24 weeks of gestation? (3)
- Termination is necessary to prevent grave permanent **injury** to the **physical and/or mental health** of the pregnant **woman**
- Continuance of the pregnancy would involve **risk to the life** of the pregnant **woman** that is **greater** than the **risk** of **termination** of the pregnancy
- Substantial risk that the **child born** as a result of the pregnancy will suffer **physical or mental abnormalities** that would render it seriously handicapped
132
Outline the legal standpoint regarding the conscientious objection of a healthcare profession to abortion?
Conscientious objection allows doctors and other healthcare professionals who would be/are involved in the terimation of a pregnancy to withdraw their own participation in such procedures provided that they do not hinder the access of their patients to lawful terminations
133
Outline the statutory obligation of healthcare professionals regarding female genital mutilation (FGM)?
Health and Social Care professionals and teachers have a legal obligation to report 'known' cases of female genital mutilation (FGM) in girls under the age of 18 years to the police
134
Outline the two main ways of classifying rights? (2)
- **Positive vs negative rights**; the right to have something vs the right to not have something
- **Absolute rights vs qualified rights**; rights that cannot be overridden vs rights where exceptions can be made
135
Which types of rights are considered weaker? (2)
- **Positive rights**; as they are more difficult to enforce and prove where they have not be upheld
- **Qualified rights**; as their stance requires qualifying factors to be satisfied
136
Outline the three main ways of defining rights? (3)
- Legal rights
- Moral rights
- Human rights
137
Outline the two main theories that attempt to answer how natural (moral) rights arose? (2)
- **Interest theory**; the purpose of rights is to protect and promote essential human interests
- **Will (choice) theory**; rights are ultimately reducible to the equal human capacity for freedom and liberty
138
Broadly speaking, what rights are encompassed by Article 2 of the European Convention on Human Rights (ECHR)? (3)
- No one shalled be deprived of their life intentionally
- There is no absolute right to life-sustaining treatment
- Life-sustaining or life-extending treatment must not be held arbitrarily
139
What is significant about Article 2 of the European Convention on Human Rights (ECHR) in relation to reproductive medicine?
The European Court of Human Rights (ECtHR) decided not to extend Article 2 to cover the rights of fetuses; therefore **fetuses do not have the negative right to not be killed**
140
Outline the stance indicated by Article 2 of the European Convention on Human Rights (ECHR) on rationing of healthcare resources?
Rationing of healthcare resources is lawful provided it is not done arbitrarily and evidence can be made to support a fair system of decision making
141
Broadly speaking, what rights are encompassed by Article 3 of the European Convention on Human Rights (ECHR)? (2)
- No one has the absolute right to treatment
- There is No right to assisted suicide in order to avoid unbearable suffering
142
What type of rights are those mentioned in Article 2 and Article 3 of the European Convention on Human Rights (ECHR)?
Absolute rights
143
What type of rights are those mentioned in Article 5 and Article 8 of the European Convention on Human Rights (ECHR)?
Qualified rights
144
Broadly speaking, what right is encompassed by Article 5 of the European Convention on Human Rights (ECHR)?
The power to detain people with mental disorders is limited
145
Outline the three main qualifications for detainment to a person with a mental disorder to be considered lawful under Article 5 of the European Convention on Human Rights (ECHR)? (3)
- Objective medical evidence of a true **mental disorder**
- Of a **nature/degree** warranting confinement
- Subject to **periodic review**
146
Broadly speaking, what right is encompassed by Article 8 of the European Convention on Human Rights (ECHR)?
The right to refuse treatment, unless it is imposed in accordance with an appropriate legal framework and in pursuit of a legitimate aim
147
Outline what is stated in Articles 5 and 12 of the United Nations Convention onf the Rights of Persons with Disabilities (UN-CRPD)?
The national laws of UN member states must not allow for discrimination on the grounds of disability
148
Outline the argument that suggests that the Mental Capacity Act (MCA) and the Mental Health Act (MHA) are incompatible with the United Nations Convention onf the Rights of Persons with Disabilities (UN-CRPD)?
Both the Mental Capacity Act (MCA) and the Mental Health Act (MHA) use a diagnostic threshold to determine whether or not someone may be subject to treatment without consent and they allow for subjective substitutive decision making by healthcare professions who may then enforce treatment on those patients.
149
Legally speaking, who's responsibility is it to determine how to ration healthcare services?
**Doctors and healthcare authorities**; it is not the role of the Courts
150
Which act of legislation in the UK governs the just distribution of healthcare resources?
The Equality Act (2010)
151
What legal justification is there for rationing a healthcare resource so as to preferentially treat a younger person as opposed to an older person?
If the treatment/healthcare resource was more likely to provide benefit to the younger person as opposed to the older person
152
Outline the difference between equality and equity in relation to the allocation of healthcare resources? (2)
- **Equality**; giving everyone the same treatment
- **Equity**; giving everyone the treatment they need, in order to get the same outcome
153
Outline the main schools of thought that regarding resource allocation? (5)
- **Distribution according to merit (Aristotelian)**; based on deserve/need
- **Respect for human life (Kantian)**; prioritsation of the life-saving treatment of a few over life-improving treatment of the many
- **Principle of utility (Utilitarian)**; dependance on what will yield the greatest benefit to the greatest number of people
- **The free market (Libertarian)**; access resources based on ability to afford them but with the adjuvant of charity as a means of access
- **Rawlsian equity (Rawlsian)**; equal allocation of freedom, priorty allocation of other resources to the least privileged in society
154
What is meant by the term medical negligence?
Non-criminal wrong-doing of a healthcare professional(s)
155
What is the main outcome where medical negligence is deemed to have occured?
**Compensation**; medical negligence is not (usually) a criminal offnce
156
Outline the components of the legal test of medical negligence? (4)
- The defendant owed the plaintiff a duty of care
- The defendant was in breach of their duty of care
- The plaintiff suffered injury/loss as a result
- The injury/loss suffered by the plaintiff was reasonably foreseeable
157
What test can be used to establish what the required standard of care would have been in any given situation?
**Bolam test**; what would a responsible body of doctors do
158
Detention under the Mental Health Act (MHA) allows detention of patients in what kind(s) of institution?
Only in acute hospitals/psychiatric hospitals
159
Which legislation must be used to in order to detain a patient with a mental health condition for treatment where that treatment is not being giving in the hospital context?
The Mental Capacity Act (MCA)
160
Which specific groups of patients may be detained under the Mental Capacity Act (MCA) using a Deprivation of Liberty Safeguard (DoLS)? (3)
Patients affected by a mental health disorder who **do not meet criteria** for detetion **under** the **Mental Health Act (MHA)** but who;
- Need to be **treated in hospital** for a **medical illness**
- Need to be **treated in hospital** for a **psychiatric illness** but who **do not object** to admission and/or treatment
- Need to be **cared for and/or treated** for a medical/psychiatric illness in the **community**
161
Broadly speaking, which group of patients may be detained under the Mental Capacity Act (MCA) using a Deprivation of Liberty Safeguard (DoLS)?
Patients affected by a mental health disorder who do not meet criteria for detetion under the Mental Health Act (MHA)
162
Outline the criteria for detention under the Mental Health Act (MHA)? (3)
- Is suffering from a **known mental disorder** or is exhibiting signs and/or symptoms of a mental disorder
- Of a **nature or degree** which **warrants detention** for assessment
- In the **best interest's** of the patients health and/or safety or for the protection of
163
Outline the Beauchamp and Childress model of the four principles of medical ethics? (4)
- **Beneficence**; to act in accordance with what will benefit the patient
- **Non-maleficence**; avoid causing harm to the patient
- **Respect for autonomy**; respect for the lawful choices of competent decision-makers
- **Justice**; treating patients equitably
164
What legal framework can be used to restrain a patient for immediate treatment where a patient is combative and not in a state for a formal assessment of capacity to be carried out?
**Common (case) law**; treatment can be given despite continued objection if it is in the best interests that the treatment be given despite those objections, the extent of force of that restraint can only be judged in each individual case and by the healthcare professionals involved
165
What is the difference between public law and private law? (2)
- **Public law**; where a case is brought against the state, or an emanation of the state (e.g. an NHS Authority)
- **Private law**; where a case is brought against an individual, a group of individuals or a company (e.g. a doctor or an NHS Trust).
166
What is the difference between criminal law and civil law? (2)
- **Criminal law**; where an individual is prosecuted by the Crown (the State), with the aim of punishing wrongdoing
- **Civil law**; an individual or corporation is sued by another, who seeks compensation for a loss or harm that the wrongdoer has caused
167
What type of law is involved in most medical law cases?
Civil law
168
Outline the hierachy of civil courts in the United Kingdom (UK)? (4)
1. Supreme Court
2. Court of Appeal
3. High Court
4. Magistrates Court
169
What is meant by the term '**doctrine of judicial precedent**'?
The decision of a court will bind a court that is lower in the hierarchy
170
What is meant by the term '**doctrine of Parliamentary Supremacy**'?
Parliament can make or unmake any law it chooses and this law is binding and therefore must be followed by the courts (unless incompatible with international law)
171
Outline the approach that can be used to address medicolegal problems? (5)
- Describe the problem
- State the relevant facts
- State the relevant law
- Apply the law to the facts
- Generate a defensible plan
172
Outline the three main approaches that are widely used in the context of medical ethics in the Anglo-American world? (3)
- **Virtue ethics (Aristotle)**; one acquires good character by habitually choosing the mean between extremes
- **Utilitarianism (Bentham)**; one should maximise happiness by choosing actions producing the greatest good for the greatest number of people
- **Deontology (Kant)**; one should use reason and not desire, to determine moral duties, people should not be used as a means to achieving an end
173
Outline the seven tools of ethical reasoning proposed by Hope, Savelescu and Hendrick (2008)? (7)
- Distinguish facts from values
- Clarify the logical form of the argument
- Use conceptual analysis
- Reason from principles and theory
- Use case comparison
- Use thought experiments
- Rationalise Decision therapy
174
What types of patient information can be considered as non-confidential?
Anonymous information which cannot foreseeably be used to identify a patient
175
According to the British Medical Association (BMA) what types of patient information collected by doctors is considered to be confidential?
Any information collected by doctors working in their professional capacity is considered to be confidential
176
What is meant by the term '**paternalism**'?
Interfering with a person, against their wishes on the grounds that the interference is for the person's own good
177
Outline the three main exceptions that allow treatment of a patient without legally valid consent from that patient? (3)
- **Consent was given by proxy**; i.e. parents of children, or court authorisation
- **Statutary (written) law provides an exemption**; i.e. via mental capacity act (MCA) or mental health act (MHA)
- **Common (case) law provides an exemption**; acted out of necessity
178
What three questions have superceeded the Bolam test when gaining consent from patients for treatment? (3)
- Does the patient know the **material risks** associated
- Does the patient know the **reasonable alternatives**
- Has **reasonable care** been taken so the patient **understands** these
179
Give some examples of non-mental health disorders that can cause a patient to lack capacity to consent? (4)
- Intoxication
- Hypoglycaemia
- Hypoxia
- Post-operative confusion
180
Outline the Civil Detention powers granted under Section 136 of the Mental Health Act?
**Section 136**; allows **police to detain a person** acting suspisciously in a **public place** and take them to a place of safety, lasting upto 24 hours
181
Outline the Civil Detention powers granted under Section 5(2) of the Mental Health Act?
**Section 5(2)**; doctor's holding power, allows a patient **already admitted** to hospital to be **detained** for **upto 72 hours**
182
Outline the Civil Detention powers granted under Section 5(4) of the Mental Health Act?
**Section 5(4)**; nurse's holding power, allows a patient **already admitted** to hospital to be **detained** for **upto 6 hours**
183
Outline the Civil Detention powers granted under Section 2 of the Mental Health Act?
**Section 2**; allows **detainment** of a person for **assessment** of, and the response to treatment for, a mental health disorder, lasting **upto 28 days**
184
Outline the Civil Detention powers granted under Section 3 of the Mental Health Act?
**Section 3**; allows **detainment** of a person for **treatment** of a mental health disorder, lasting **upto 6 months**
185
Outline the Civil Detention powers granted under Section 4 of the Mental Health Act?
**Section 4**; allows **detainment** of a person **by an approved mental health practioner (AMHP)** out of **urgent necessity** for **upto 72 hours** in order for **assessment under** the **mental health act to occur**
186
Outline the '**potentiality of personhood**' argument against termination of pregnancy?
A **fetus without the moral right to life** should still be given special moral status **worthy of protection** because it has the **potential to become a person** if allowed to do so
187
Outline the consequentialist/utilitarian argument in support of termination of pregnancy?
Termination of pregnancy may be acceptable despite the fact that it ends the life of a fetus if the consequences involve saving the mother from mental and/or physical harm.
188
Outline the '**pragmatic harm reduction**' argument in support of termination of pregnancy? (2)
- Termination of pregnancy should be acceptable as, if not, it is liklely that people will still attempt to terminate pregnancies anyway.
- This would put them at risk from unlicensed and potentially dangerous treatments
189
Outline the '**slippery slope**' argument against termination of pregnancy?
Justification of termination of pregnancy is a moral gateway to justification of more heinous acts (e.g. infanticide, homicide)
190
Outline the moral arguments against termination of pregnancy? (5)
- **Sanctity of life**; all life is sacred and must be preserved
- **Gradualist**; at a point in development the fetus' right to life outweighs the pregnant woman's right to bodily self-determination
- **Viability**; termination is morally wrong beyond the point at which the fetus is viable outside of the uterus and without the mother's support
- **Personhood**; termination is morally wrong beyond a point at which the fetus has developed qualities shared by most other human beings
- **Slippery slope**; justification of termination of pregnancy is a moral gateway to justification of more heinous acts (e.g. infanticide, homicide)
191
Give examples of arguments against assisted suicide? (4)
- Assisted suicide sets a course on a ‘slippery slope’ into voluntary or even involuntary euthanasia
- Assisted suicide could allow for an erosion of the case for excellent palliative care
- Incompatible with the concept of sanctity of life.
- Kantian argument that a decision to end one’s life can never be reasonable therefore cannot be an exercise of the autonomous will.
192
If a patient with capacity refuses to provide consent for a safeguarding disclosure, can a disclosure be lawfully made?
No; a capacitous refusal to consent to a disclosure must be respected unless that individual to whom the disclosure relates is it at imminent risk of serious harm
193
Is consent required from a patient for whom you have safeguarding concerns about for a discussion to be had with the Adult Safeguarding Lead?
No; however the discussion that you have with the Adult Safeguarding Lead should refrain from mentioning confidential information that could identify the patient for whom you are asking for advice about
