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Flashcards in Ethics Deck (54)
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1
Q

Describe ‘ethics’

A

the body of moral principles or values governing or distinctive of a particular culture or group

2
Q

Where do ethics come from?

A

Two traditions

  1. Duties; right and wrong, actions by individuals or groups ‘absolute values’
  2. Considering the benefits and harms to individual and society, looking at consequences not just individual
3
Q

What comprises ethics?

A

Principles
Values
Honesty
Standards

4
Q

What is morality?

A

Our attitudes, behaviours and relations to one another

5
Q

Define consequentialism

A

the moral worth of an action is determined by its outcome

6
Q

What is deontology?

A

That the morality of an action should be determined by wether it is right or wrong, not by its consequences

7
Q

What is utilitarianism?

A

One type of consequentialism stating that only the consequences of an action determine if it is right or wrong

8
Q

What are the four ethical principles?

A

Autonomy
Justice
Beneficence
Non-maleficence

9
Q

Why is confidentiality important?

A

It is the basis of trust

10
Q

Describe the duty of candour

A

Must be open and honest with patients when something goes wrong with their care or treatment and causes, or has the potential to cause, harm/distress

You must apologise to the patient and offer an appropriate remedy or support to put matters right (if possible) and explain fully the short and long term effects of what has happened

11
Q

Why is confidentiality important?

A

It is the basis of trust

Patients may avoid seeking help if they think their personal info may be disclosed

12
Q

What are the four domains of the Good Medical Practice document?

A
  1. Knowledge, skills and performance
  2. Safety and quality
  3. Communication, partnership and teamwork
  4. Maintaining trust
13
Q

Describe confidentiality in legal terms

A

It is based on the law of contract and equity

Breach of confidentiality constitutes a breach of contract

14
Q

Describe the common law with regards to confidentiality

A

Information acquired by doctors in a professional capacity generally confidential under common law

This means a doctor must not disclose confidential information unless there is a legal basis for doing so

15
Q

Describe the GDPR in terms of healthcare

A

Healthcare info likely to be considered special category data, meaning in info sharing at least one Article 9 Condition needs to be met

  • data subject has given explicit consent
  • processing necessary to protect vital interests of data subject where incapable of giving consent
  • processing necessary for reasons of substantial public interest
  • processing necessary for reasons public interest in area of public health
  • processing necessary for purposes of scientific or historical research purposes/statistical purposes
16
Q

When can confidentiality be breached?

A

With patient consent

With other medical practitioner’s in patient interest

In doctor’s own defence

Statutory requirement; prevention, detection and prosecution serious crime

When directed to by a court of law

Protection of other persons

In public interest

Child abuse

17
Q

What are caldicott guardians?

A

Senior people in NHS, local authority social care and partner organisations responsible for protecting the confidentiality of patient information and enabling appropriate information sharing

18
Q

Describe regulation of doctors

A

GMC is the professions regulator

It is regulated by the Professional Standards Authority

The GMC is responsible for producing the medical register and overseeing and certifying the appropriateness of medical education

19
Q

Describe reasons for disciplinary procedures of employers

A
Terms and conditions of service
Appraisal
Job planning
Time keeping
Absence
20
Q

Describe complaints made to the GMC

A

Anyone can make a complaint

This complaint considered by case workers

May be passed onto case examiners; investigate if your “honesty and probity” are in question

Cases are heard by MPTS and various sanctions can be imposed

21
Q

What is the MPTS

A

Medical Practitioners Tribunal Service

22
Q

What do GMC cases include?

A
Manner and attitude
Dishonesty
Sexual impropriety
Criminal Convictions
Health issues - drink driving/drug abuse/mental health
Significant performance issues
23
Q

When is criminal prosecution utilised?

A

In cases of

  • indecent assault
  • prescription fraud
  • manslaughter
  • murder
  • deception offences
24
Q

Define medical negligence

A

a lack of reasonable care and skill as a result of which the patient suffers

25
Q

What is required to fulfil the definition of medical negligence?

A
  1. A legal duty to provide care and skill, either express or implied
  2. Reasonable care and skill; concept of accepted medical practice
  3. Actual damage must have occurred as a result of the lapse i.e. causation
26
Q

Lines of defence in medical negligence cases

A

Deny charge

True facts but not pursued doctor’s fault, or vicarious liability

Patient took a risk i.e. consented procedure

Contributory neglicence; claimant’s own actions contributed

27
Q

Describe dignity

A

Dignity is the person’s feeling of worth and doctors must protect this as much as they are able

28
Q

Describe limits on respect for patient autonomy

A

This is limited if a person’s capability to consent is inhibited

29
Q

Describe ageism

A

Ageism is discrimination against people due to them being old

30
Q

Describe futility in terms of treatment

A

Futility is where a treatment is no longer providing hope for a cure or benefit

31
Q

Describe sanctity of life

A

This means that life is sacred and we should do our utmost to protect it

32
Q

Describe quality of life

A

Quality of life is a person’s health, comfort and happiness

Person’s own perspective

33
Q

Describe the withdrawal of treatment and withholding treatment

A

Withdrawal or witholding treatment is legal in the UK as the person would die anyway if you did not treat them

Assuming the person consents i.e. requests for this to happen it is legal and expected

Continuing treatment is considered battery and is criminally prosecutable

34
Q

Describe DNACPR orders and when they are put in place

A

Do Not Attempt CPR orders

Put in place at patient’s request or if resuscitation is considered an inviable option by doctors as it is unlikely to be successful

It is not a legally binding document, but patients and families should have input where possible and be notified without delay

35
Q

Describe ethical and legal issues surrounding the status of the embryo and foetus

A

When is an embryo/foetus considered a person?

Different views

HFEA says 14 days as this is when primitive streak forms and thus the embryo is only developing into one person

Others say as soon as conceived and there are many other figures stated

36
Q

Describe possible maternal-foetal conflict

A

Treatment of mother outweighing treatment of baby

Mother refusing to have C-section despite baby in distress

Treatment for mother’s conditions may harm baby

37
Q

Describe the concept of personhood

A

Personhood is the quality or condition of being an individual person

38
Q

Describe artificial reproductive technologies

A
Artificial insemination
IVF
Gamete donation
Embryo donation
Use of artificial gametes (not yet mainstream)
39
Q

Describe ethical issues associated with preimplantation/prenatal testing, embryo selection, genetic testing and screening

A

Eg in sex selection, avoiding/choosing disabilities

Could be considered against nature

A slippery slope - ‘designer babies’

Parental love

Virtue of acceptance

40
Q

Describe the potential pitfalls of social media in a professional context

A

Must protect patient confidentiality

Still a med student/doctor even if not posting as such

Maintenance of professional boundaries

Informal and real-time so run risk of desiring to “rant” online to let off steam

Avoidance of giving medical advice online

Be careful about conflicts of interest

41
Q

Define rape under the law

A

If a person penetrates to any extent without consent the vagina, anus or mouth

Penetration is a continuous act from entry to withdrawal of the penis (including surgically constructed penis)

42
Q

Define sexual assault under the law

A

If a person with any part of their body or anything else without consent penetrates the vagina or anus, including penetration with a penis

43
Q

How to deal with situation regarding sexual offences

A

Recognise victims/assailants at earliest opportunity

Seek advice

Always document conversations and findings

Do not undertake examinations unless experienced to do so

Consider consultation with forensic pathologists

44
Q

How do you examine a victim/assailant of a sexual offence?

A

Establish whether clinical findings support history

Identify clinical evidence supporting acts in history

Collect physical evidence

Prophylaxis for pregnancy/UTI

Documentation and recording

45
Q

GMC information regarding confidentiality in terms of serious communicable disease

A

May disclose to person close contact with patient if think that

  • person is at risk of infection likely to result in serious harm
  • patient has not informed them and cannot be persuaded to do so
46
Q

What is a clinical audit?

A

A way to understand whether a service is meeting the defined standards of best practice

Aims to answer question “does this service reach a predetermined standard?”

47
Q

What are the steps in a clinical audit?

A
  • Identify problem or issue
  • Set criteria and standards
  • Observe practice/data collection
  • Compare performance with criteria and standards
  • Implement change
48
Q

What is a service evaluation?

A

A way to define or measure current practice within a service

Results help toward producing internal recommendations

Aims to answer the question “what standard does this service achieve?”

49
Q

What does the research governance framework do?

A

Improves research quality and safeguards the public by;

  • enhancing ethical and scientific quality
  • promoting good quality
  • reducing adverse incidents and ensuring lessons are learned
  • forestalling poor performance misconduct
50
Q

Describe the role of a research sponsor

A

Takes primary responsibility for ensuring that the design of study meets appropriate standards and that arrangements are in place to ensure appropriate conduct and reporting

Confirm everything is ready for research to begin

51
Q

How is research approved ethically?

A

Ethical review achieved through review of research within the NHS by the NRES Research Ethics Committees

Give their opinion on proposed participant involvement and whether the research is ethical

52
Q

What does an ethics committee review?

A
  • trial relevance
  • trial design
  • risks and benefits
  • protocol
  • suitability of investigator and supporting staff
  • quality of facilities
  • subject information
  • consent procedure
  • justification for minors
  • insurance/indemnity
  • subject recrutiment
53
Q

What is IRAS?

A

Integrated Research Application System

Applications can only be made through this system

54
Q

What does R&D do?

A

Ensure research is conducted to high scientific, ethical and financial standards

Provide guidance to researchers regarding processes involved in research

Direct researchers to sources for further info