Ethics Flashcards
(43 cards)
What are the key steps in breaking bad news?
Setting up the interview
Assess the patients perception
Obtain the patients invitation for information
Giving Knowledge and information to the patient
Adressing the patients Emotions and providing Empathic responses
Strategy and Summary
Also: Gradual breaking of news
Titrate the amount of information to the response.
Can a person with intellectual disability consent to treatment?
NB: In many cases consent is implied. Consent is also not required in an emergency.
It should not be assumed that every person with intellectual disability does not have the capacity to consent.
Capacity is present if the patient can fulfill the following criteria:
a) an ability to comprehend and retain information
b) an ability to weight that information in balance to arrive at a choice.
In every state there is specific guardianship legislation regarding substitute decision makers
these may be a) a court or tribunal appointed guardian b) enduring attorney or enduring guardian c) spouse d) unpaid care giver e)close friend or relative
What are the mandatory reporting guidelines for child abuse?
Legislation is unique to each state
In Victoria
Children Youth and Families Act 2005
Report MUST be made if NAI or sexual abuse is believed to be occurring for children under age of 17 in victoria
REPORT to Department of Human Services, child protection and family services.
If a GP is uncertain - contact your local child protection unit for further advice
What constitutes child sexual abuse?
Involvement of a child (under 18) in sexual activity that violates the laws/taboos of society that they
a) cannot comprehend
b) does not consent to or cannot consent to
c) is not developmentally prepared for and cannot give consent to
Goals of an initial encounter re: child sexual abuse?
- be therapeutic for the child in regards to mental and physical well being.
- explore whether abuse has occurred in regards to our role as mandated notifier of child abuse
- meet the needs of other parties such as the police
History of child sexual abuse patient?
What happened
When?
Current symptoms - injuries, pain, bleeding, dysuria
History of involvement with child protection agencies or polices, any orders in place
Do a HEEEADSSS screen
Housing, Education and Employment, Eating and Exercise, Activities, Drugs and Alcohol, Sexuality and gender, Suicidality, Safety, screen
Who is caring for her/him becomes a priority
Examination of a patient with child sexual abuse?
Abide by locol protocols regarding sensitive examination
Forensic medical examination should be offered to the child either by GP or by a local forensic specialist ( avoid two examinations if possible and contamination of specimens)
Investigations in child sexual abuse?
Pregnancy testing in all girls subject to assault
STI screening - First pass urine for chlamydia, gonnhorea, trichomonas vaginalis and mycoplasma genitalium
Serology for Hep B, C, HIV, Syphillis
Refer to forensic examiner for collection of swabs from genital area
Management of a child with sexual assualt
- Medical Management
- Pregnancy prevention - emergency contraception
- Antibiotic prophylaxis against chlamydia - Azithromycin (due high prevalence)
- Hep B immunisation (if not done)
- HPV immunisation (if not done)
- Consider post exposure HIV prophylaxis based on protocols from Royal Childrens Hospital
Psychological management - refer to local sexual assault counselling service
Notify Local Child protection unit if abuse is suspected or for advice
Follow up - repeat pregnancy testing in 2 weeks if Menses has not occurred.
- repeat STI testing at 2 weeks, 6 weeks, 3 months and 6 months
Do you need to notify police about abuse?
NO. but you can encourage child to do so
Age of consent?
Non consensual sex - always illegal
Consensual - in Victoria is 16 (unless its a person in power then its 18)
if less than 16 its statutory rape
if the child is between 12 and 16 - and consented to sex with someone two years above or below - its not a criminal offence
Professional misconduct for doctors and patients
Cannot have a sexual relationship with a former patient.
Even over 18
This is considered professional misconduct and could affect registration
If a patient can’t speak ENglish?
Use a telephone interpreter. Free interpreting service available for doctors.
If the issue is minor and the patient wishes a family member to interpret this may be acceptable but in general the use of family and friends to interpret is discouraged.
What are the requirements for medicolegal report?
- Only required if requested by AHPRA, the courts or by Work Cover.
Stick to facts as documented in the history.
Do not need to provide an opinion on these facts.
List these systematically.
Ensure you have the permission of the patient to write the report.
Understand clearly the purpose of the report
If asked to give evidence as a witness ask for a copy of the code.
Consent for procedures when the patient is a minor?
In general a patient under the age of 18 requires consent from a a parent or guardian for procedures unless they are ‘minor’.
There is however the provision for the developing capacity of an adolescent to provide informed consent - this is known as ‘Mature minor’ or Gillick competency. In this case the teenager and guardian can hold concurrent right to consent.
Seek legal advice if needed
What does Gillick competency allow?
Allows a child under the age of 18 to give consent or maintain confidentiality if deemed A MATURE MINOR (Gillick competent)
- UNDERSTANDS all aspects of advice and follow up
- the doctor cannot persuade the patient to inform the parents
- in sexual matters - the young person is at risk and will likely continue to engage in behaviours that put them at risk
- that its in the best interest of the young person (physicala and mental well being)
IF UNSURE seek advice from a senior colleague or from medical defence organisation
Who can complete a death certificate?
- The doctor responsible for looking after the patient
- The doctor who examined the body
- Another doctor who is fully satisfied about the cause of death from the medical notes
A Death Certificate should not be completed if the cause of death is reportable
In which cases should a death be reported to the coroner
- Cause of death was violent, unnatural, suspicious
- Death related directly from an accident or injury
- Death occurred whilst in custody (eg police)
- Death occurred in 24 hours of a medical or surgical procedure
Where should a death certificate be sent?
Register of Births, Deaths and Marriages
Perinatal death certificate?
Separate form for a child after 20 weeks gestation or before 28 days post partum
Things to do when filling out a death certificate
Write legibly
Block letters suggested
Avoid abbreviations
Neoplasms should be classified according to HISTOLOGY and PRIMARY site
the SITE and CAUSATIVE organism for an infection should be included on a death certificate
What are the key aspects of open disclosure of errors in general practice?
- An apology or expression of regret including the words ‘Im sorry’ or ‘we are sorry’
- A factual explanation of what happened
- An opportunity for the patient to relate their experience
- A discussion of the potential consequences of the adverse event
- An explanation of the steps taken to manage the event and prevent recurrence
The ethical principles here are: Non maleficence (Do no harm) and patient autonomy
What is an advance care directive?
This is a written or oral statement made by a capable adult in regards to wishes, preferences, values and beliefs about future treatment decisions.
It may include a) a treatment directive (about treatment preferences or potential RESTRICITON of treatment)
b) Proxy directive ( a subsitute decision maker)
ITS ONLY USED when a patient loses capacity to make their own medical decisions.
What is a plan of care?
A consensus based discussion between patient, carer and medical staff about BEST INTERESTS, because of the patient no longer having capacity to make their own decisions.
