Ethics

Question 1

Four principles

Answer 1

AUTONOMY: right own decision
• patient must have patient competence
•accept or refuse procedure offered by doctor

BENEFICENCE: do good, act in best interest

NON- MALEFICENCE: do no harm

JUSTICE: fairness- benefits, risks, costs

RIGHT TO CONFIDENTIALITY: linked to autonomy- right to control info
Non- mal- harming if info released

Eg. Increase morphine relieves pain doing good but brings closer to death so doing harm

Question 2

Informed consent
What is it
What needs to be explained (8)

Answer 2

=consented to procedure, given and considered all facts necessary

1. Options for treatment or management
2. Aim of plan, consequences, side effects
3. Details of plan, benefits, success rate, risks
4. Consequences of providing treatment / not
5. Secondary interventions? Consent
6. Who performs and if doctor in training involved
7. Remind change mind anytime
8. Costs

Question 3

Competence of patient

Answer 3

Consent only taken from ‘competent patients’
=legal judgement
Capacity is medical judgement

Question 4

Competence in adults if not competence two options:

Answer 4

1. If has advance directive then must abide by decision

2. If none, doctor decides for best interest - involve relatives

Question 5

Competence in children below 16

Answer 5

If mature enough to understand info. Duty to discuss with parents (can against will if not competent)

1. Competence assessed in relation to procedure
2. Cannot refuse if deemed in best interest- decision made by parents
3. If both parents refuse consent doctors must act in best interest (follow up in court)

Question 6

Confidentiality duty

When can be breached (3)

Answer 6

All doctors must protect at all costs

1. Implied consent given by the patient - e.g. Nurse, if patient discusses openly in front of relative but if bad news must check with patient
2. Info required by court
3. In public interest and to protect patient/ others - notifiable diseases , child abuse, driving, Terrorism

Question 7

Euthanasia
Active
Passive

Answer 7

=someone ends another’s life intentional act to alleviate pain
Active: practical action
Passive: lack of action

Voluntary: person gave consent
Non- voluntary- person not able to give consent
Involuntary: did not wish to die

Question 8

Assisted suicide

Answer 8

Someone commits suicide with help

Swiss: patients injected

Question 9

Euthanasia and assisted suicide for (4) and against (6)

Answer 9

1. Patients allowed to choose best
2. Avoid suffering
3. Die with dignity when they choose
4. Free up beds
5. Religious : playing god
6. May change mind later
7. Times when they’ve recovered
8. Difficult to verbalise specific criteria
9. Not clear cut- murder charges
10. Relatives abuse situation or pressure them

UK both illegal, even booking flights to Switzerland

Doctors may withdraw treatment for best interest, not effective