Ethics

Question 1

when is sex selection of embryos permitted in UK

Answer 1

for medical conditions that are linked to a gender

Question 2

why would you create an embryo with 2 genetic mothers

Answer 2

to avoid mitochondrial diseases

Question 3

when can you refuse assisted reproduction treatment

Answer 3

issues with child welfare
reduced success rate (older female age etc)
increased risk of harm (obesity and smoking)
when it is not legal (e.g. sex selection not for medical conditions)

Question 4

how many cycles of IVF is funded on NHS in scotland

Answer 4

3

Question 5

how many IVF cycles is funded in patients aged 40-42

Answer 5

1

Question 6

how long is embryological research permitted for

Answer 6

14 days (when primitive stream appears)

Question 7

how late can you get an abortion

Answer 7

24 weeks

later if severely handicapped or significant risk to maternal life

Question 8

what are the rights of donors of genetic materials

Answer 8

to choose the outcome of their genetic material

to be anonymous

Question 9

is egg donation legal

Answer 9

yes

Question 10

does the child have a right to find out biological origins

Answer 10

yes at age 18

Question 11

does sexual consent have to be informed

Answer 11

no- can be free agreement

Question 12

can a child under 13 consent to any sexual activity

Answer 12

no- if you are told this by child need to inform social services

Question 13

can an older child ages 13-15 legally have sexual intercourse

Answer 13

no

but consensual touching, kissing and sexual conversations are considered part if growing up

Question 14

when can you provide contraception for a child under 16

Answer 14

when you have assessed that the child is:

• fully competent
• has sufficient maturity and intelligence to understand the implications
• has not been persuaded
• is likely to continue sexual activity without the contraception
• if their physical or mental health will suffer without the contraception/ advice

Question 15

when is a person over 16 not considered able to consent to sexual decisions

Answer 15

if lack capacity (e.g. mental disorder)
or other person is in a position of trust (teacher, family member etc)

in incapable then will need advocate to make decisions for them (adults with incapacity act)

Question 16

when would you perform a genital exam on a child/ someone who is not sexually active/ doesn’t have consent

Answer 16

always ask a senior before hand
never do smear or vaginal exam on someone who is not sexually active unless symptomatic or extenuating circumstances- again always ask someone first and have chaperone
seek consent from a responsible person, unless emergency

Question 17

what are the only times you can treat an adult (16+) without their consent

Answer 17

If is an emergency (real emergency, not just in A&E)
You can apply the Adults with Incapacity Act (form)
You can apply the Mental Health (Scotland) Act

Question 18

what is battery

Answer 18

unlawful touching

• could apple if you act without a patient’s valid consent
• person may need not be harmed by procedure

Question 19

how is consent different from a contract

Answer 19

consent can be withdrawn at anytime without penalties, this removal of consent should be respected immediately, not binding (getting valid consent is a continuous process)

contract- withdrawing can have consequences, it is binding

Question 20

can a patient refuse/ demand any treatments

Answer 20

can refuse any (inc life saving)

cannot demand treatment

Question 21

in competent patients who refuse Tx, does their reasoning have to be:
Logical
Prudent
Rational
Reflected
Justified
Communicated
Discussed
Correct according to you or your colleagues
?

Answer 21

no

Question 22

how can you improve someones capacity to consent

Answer 22

discuss anxieties, fear of pain/ other problems
written maternal, pictures, other aids
meet communications needs
use clear simple language
suggest they bring a friend/ relative/ translator
give them opportunities and time to ask questions and answer honestly- capacity may change over time
give time to reflect on their decisions (give consent forms and information in advance)

Question 23

what is included in assessment of capacity

Answer 23

check patient can:
1. Understand the treatment options and weight up potential benefits, risks, burdens and side effects of the options

2. Retain the information provided
3. Weigh up, decide and communicate their decision

Question 24

what is required for valid consent

Answer 24

capacity (competence)- ability to give/ withdraw consent
information- enough information and it is understood (both parties ask questions to ensure this)
voluntariness- not coerced

Question 25

what are the rule in an emergency

Answer 25

If the treatment is immediately necessary to save a someone’s life or to prevent a serious deterioration: - You can treat people without their consent - The treatment must be the least restrictive of the patient’s future choices

Question 26

can you assume someone is incapable of consent

Answer 26

no- in adults capacity is assumed until proven other wise

Question 27

should you inform patient of all options available to them

Answer 27

yes

Question 28

what should you do if there is uncertainty/ disagreement between yourself and colleagues/ patient/ patients family

Answer 28

Consult it with other colleagues Ask more senior colleague for advice Ask for second opinion Consider mediation or involving an independent advisor Contact your defence organisation (e.g. Medical Defence Union) Ask your professional body Find out if there is a Clinical Ethics Committee Seek legal advice Apply for independent court/statutory ruling

Question 29

what are the rules of treatment of children

Answer 29

Parent/s (or legal guardian/s) must be consulted about their child’s treatment (unless it is an absolute emergency) It is assumed that parents make decisions in the best interest of their child, and must be consulted from the moment of birth Child’s consent should ideally also be sought, even from toddlers However, the State must protect the best interests of the child, so can override parents’ (guardians’) wishes The power can be devolved to others – e.g. doctors, nurses, social workers etc.

Question 30

what is the most recent guidlines on treatment of children

Answer 30

Children and Young People (Scotland) Act 2014

Question 31

what happens if parents disagree with the healthcare team

Answer 31

Judge (courts) can assess the situation and override parents’ refusal of consent In urgent situation this can be dealt with over the phone in a matter of hours

Question 32

who has parental responsibility

Answer 32

Births registered from 4 May 2006 in Scotland: PR rests with both parents, if they are named on the birth certificate, whether married or not. Births registered before 4 May 2006 in Scotland: father automatically has PR only if he was married to the mother. If not, he needs a Parental Responsibility Agreement/Order. A step-parent or civil partner may also obtain PR in this way. If parents divorce, both retain PR for the child, no matter who the child lives with or spends most of his/her time with. PR is lost by giving the child up for adoption. When the child has been formally adopted, the adoptive parents get PR.

Question 33

can people under 16 consent

Answer 33

yes if assessed to have capacity

Question 34

when can you disclose personal information

Answer 34

if the patient consents to this if it is required by law in the public interest (infectious disease, risk of death/ serious harm/ serious crime- murder but not left)

Question 35

can police, solicitor, employer, school, relatives, insurance company get a patients information

Answer 35

have to have a judicial order or by required by an act of parliament

Question 36

what are the rules of patient information that is released

Answer 36

All released information should be protected, anonymised or coded People should be NOT IDENTIFIED, but also NOT INDENTIFIABLE People have the right to be informed about all disclosures (unless it would cause serious risks, e.g. in cases of serious abuse or child neglect)

Question 37

when can information be shared with family

Answer 37

If a person below the age of 16 is assessed as having capacity to consent to certain treatment, then the information about this treatment cannot be disclosed to his/her parents without her/his explicit consent If an adult patient has no or limited capacity (e.g. is in a coma or detained under the Mental Health Scotland Act) then certain information can be released to nearest relatives, friends or others – but the rules can be complex

Question 38

what should you do if a patient is no longer fit to drive

Answer 38

inform her/him of a legal duty to inform the DVLA or DVA about the condition If s/he continues to drive when they may not be fit to do so, you should make every reasonable effort to persuade them to stop If you discover that they are continuing to drive against your advice, you should contact the DVLA or DVA immediately and disclose any relevant medical information to the medical adviser You should then also inform the patient immediately as well as in writing once you have done so