PPP Flashcards
(207 cards)
1
Q
WHO Health definition
A
Complete physical mental and social well-being
No disease or infirmity
2
Q
Sociology health definition (blaxter 1990)
A
Negative -absences of illness and not be able to cope with everyday activities
Positive- fitness and well-being
3
Q
Symptoms define
A
Those feeling states patient experience to alert them they are not well
4
Q
Signs define
A
The pointers that doctors identify which signify the existence of the underlying pathological lesio
5
Q
Stages of illness
A
Experience symptoms
Advice from friends/family
Advice from doctor
Doctor confirms sick
Sick role
Recovery
6
Q
5 triggers that may cause people to think their ill (zola’s 1973)
A
Interference with work/physical activity (can’t play sport etc)
Interference with social/personal relations (if someone notices and points out)
Occurrence of an interpersonal crisis (losing jobs etc will make symptoms feel worse)
Timings (more than a week I’ll go and see)
Sanctioning (apologising for seeing doctor/someone else asked him to go)
7
Q
Mechanics (1978) influences to illness behaviour
A
Visibility
Other’s perception to see serious
Disruption if causes
Frequency/persistence
Threshold of those exposed
Knowledge of symptoms/culture pressures
Basic needs that lead to denial/working to get money
Needs competing
Possible interpretation of what symptoms are
Availability of treatment (time, money, effort, stigma)
8
Q
Parsons and the sick role
A
Patient-
Want to get well quickly
Cooperate and seek medical help
Allow to shed normal activities/responsibilities
Unable to get better on their own
Doctor-
High degree of skills/knowledge
Act for welfare of patient/community
Objective and emotionally detached
Guided by rules of professional practice
Rights:
Allowed to examine physical and personal
Considerable autonomy
Occupies position of authority
9
Q
Kleinman’s model of healthcare systems
A
Professional- doctors
Popular-self cafe
Folk- alternative medicine
10
Q
Ethics definition
A
Branch of philosophy
Study of how human beings should behave
Related not to just individual but whole system and society
11
Q
Sociology definition
A
Social science that seeks to understand all aspects of human behaviour
12
Q
Biopsychosocial model
A
Look holistically at the person
Bio/psycho/social factors
Criticisms-
Doesn’t look for single factor
Doesn’t focus on illness
13
Q
Biomedical model
A
Reductionist (simplest process to explain)
Single factor causes
Focus on illness
14
Q
Stigma model
A
Erving Goffman early 1960s
Set people apart from normal people
15
Q
Courtesy stigma
A
Members of family stigmatised for affiliation
16
Q
Managing stigma
A
Depend on how visible
Withdraw
17
Q
Public health
A
The Art and science of preventing disease prolonging life and promoting health through the organised efforts of society
1988 Acheson WHO
18
Q
Epidemiology
A
The quantitative study of the distribution, determinants and control of disease in populations
19
Q
3 types of research studies
A
Cohort design
Case control
Random sized control trial
20
Q
Definition of clinical communication
A
Any communication that is in a clinical setting
What leads to better outcomes
The means you represent yourself as competently, caring professional
21
Q
Marx health definition
A
The capacity to do productive work
22
Q
Parsons health definition
A
A state of optimum capacity for the effective performance of valued tasks
23
Q
WHO health definition
A
A state of complete physical mental and social well-being
Not merely the a sense of disease or infirmity
24
Q
Criticism of WHO health definition
A
Pros- emphasis on all three, positive dimensions of health
Cons- is well-being= good health
Utopian
25
What determines health?
Biology
Lifestyle
Environment
Health service
26
Role of clinical medicine
Prevent death
Improve length and quality of survival
Improve quality of life
Preventing and treating genetic disorders
Care
27
Stigma dictionary definition
Mark/spot on skin
Mark of disgrace or infamy
Visible sign/characteristic of disease
28
Goffman 1963 definition of stigma
An attribution that is deeply discrediting
reduces from a whole and usual person to a tainted discounted one
29
Stigma
Social interaction
Focus on individual
Visible or known difference
Negative
30
Prejudice
Social cognition
Focus on group
Attitudes or emtotions
Negative
31
Stereotype
Social cognition
Focus on group
Social expectations
Positive negative or neutral
32
Causes stigma
Undesirable characteristics decided by society
33
Effects of stigma
Will cause labels to spread faster (especially when people in power will say them)
Emotional reactions to people (fear, repulsion)
People who are stigmatised- shame, status lost, discrimination
34
How to help people who are stigmatised?
Special care for those with visible health conditions (changing faces)
May delay seeking help as stigma
35
Examples of stigmatised conditions
Visible differences
Mental health
Infectious disease
Feared conditions (contagion)
36
Why is there stigma about cancer?
Incurable
Unclear -> more frightening
Can lead to visible differences (hair loss etc)
Potentially embarrassing outcomes (colostomy bag etc)
37
Three types of stigma from Goffman
**Abomination of the body** - physical disfigurement/deviation from social norm
**Blemishes of character** - a known record (eg alcoholism) seen as a character flaw
**Tribal identities** - negative evaluation of people due to association with particular group
38
Impact of physical stigma
Heightened social anxiety
Embarrassment
Depression
Low self esteem
Social withdrawal
Isolation
39
Stigmatised activities eg
(Linked to a person character)
Drug/alcohol addiction
Time spent in prison
Long term unemployment
Sex workers
Mental illness
Sexuality
40
Scambler 2009 -> shame or blame
Seen as innate or genetic and as in control
Is something predetermined or is it a choice
41
Types of tribal identities
Religious groups
Radical groups
Ethnic groups
Chosen ie -> clothing, symbols (goths)
42
Impacts of stigma (Goffman)
Change social identity
A person is discredited -> sign that cannot be disguised
Discreditable -> when possible to conceal but showing
43
Discredited individuals effects
**Enacted stigma** -> staring, avoidance
Effects on earning potential/employment
Isolation -> **felt stigma**
44
Discreditable individual effects
Concealment stratgies
Passing as normal
45
Spoiled identity (goffman)
An individuals social identity is dominated by the stigmatised illness/attribute
46
Response to spoiled behaviour
Pass as normal
Information control
Avoiding social contact
Trying to avoid blame
Refusing to be ashamed
47
Stigma vs stereotype
Both viewed differently to what they are
Stereotype:
Group identity
Stigma:
Individual and effect on them
48
Prejudice vs stigma
Prejudice: attitudes/negative emotions towards groups
Focuses on the person holding the prejudice
Can lead to discrimination
49
Examples of prejudice (2)
Race
Ethnicity
Mental health
Self harm
50
Three phases of decision making (to make the best possible)
Gather info
Recalling and pooling that info
Weighing things up
51
Decision making is adversely affected by
You weren’t competent
You were coerced or under pressure to make it quickly
You were deceived or had info concealed from you
52
Decision making is a…
Joint enterprise between doctor and patient
53
Autonomy (bullet points)
Takes roots from humanism
-ownership of the self
-person has right to determine their experiences
-persons should not be made to do things against their will/interests
-a person should not trepass on the person of another
Patient centered
54
Autonomy basics
self determination
Personhood
Identity
Integrity
55
Battery
Treating with no consent
56
Self determination theory
With human motivation links with well being, satisfaction and performance autonomy, competence, relatedness
57
The best decisions possible (gmc)
All patients have the right to be involved in decisions about treatment, care and be supported to make informed decisions
Decision making in an ongoing process on meaningful dialogue- the exchange of relevant info
All patients have the right to be listened to and given info they need/time and support to understand it
Doctors must try to find out what matters and give relevant info and alternatives that are reasonable (including doing nothing)
Presumption that all adult patients have the capacity to make decisions
Choice of treatment or care for patients who lack capacity must be of overall benefit
Someone’s who’s right to consent is affected by law should be supported and involved
58
Law around consent
Based around case law. What previous judges in similar cases
Not enacted through parliament (legislation)
59
Sidaway vs Bethlehem 1985
A doctor who operates without the consent of his patient save in cases of emergency or mental disability, is guilty of the civil wrong of trespass to the person, he is also guilty of the criminal offence of assault
To provide enough info for the patient to make a balanced judgement
Provide alternatives
Inform of common/serious consequences
60
How much info to give?
Depends what you’re proposing (abdo exams very little etc)
How much info your patient wants
61
Montgomery vs Lanarkshire (2015)
Chose not to tell the patient about the risk of shoulder dystocia in large baby, small diabetic mum
Baby did suffer oxygen deprivation causing cerebral palsy
Supreme Court ruled the doctor should have informed
Have to tell any material risks and any reasonable alternatives
62
What is a material risk?
Whether a reasonable person in the patients position would attach significance to the risk
If the doctor knows (or should know) that this particular patient would attach significant risk to
63
GMC material risks
Clear accurate and up to date info
About the potential benefits and risks of each option including nothing
No reasonable to share every possible risk- instead tailor to patient guided by what matters to them
1. Recognise risks of harm that anyone in their position would want to know
2. Effect of individual circumstances of the probability of a benefit or harm
3. Risk of harm that this patient would consider significant
4. Any risks of serious harm- death etc
5. Expected harms, common side effects and what to do if they occur
64
Is consent always necessary?
Can use implied consent
Must not assume the patient understands what you are about to do
Best practice to ask
Sometimes cannot consent (emergency etc) in these situations act in best interests
Use info about what they would want if available (advanced directive)
65
Is consent always valid?
Can expire-prolonged time or situation changes
If conditions not met then not valid
Must be: voluntary, informed, competence
66
Onus on doctor to ensure consent valid
Make sure:
Voluntariness- free will (pressure or vulnerability)
67
Beauchamp and Childress 1994
Coercion occurs if and only if one person intentionally uses a credible and server threat of harm or force to control another
68
Coercion
Depends on accuracy of information
It is exaggeration to persuade
69
Parental consent
Those with parental responsibility can consent on behalf of children who have not yet achieved competence
Mothers have parental responsibility for any child given birth to
Fathers have pr if named on birth certificate or if are married to the child’s mother
Can apply for pr through courts
Adoptive parents gain legal pr
Social care can also have pr
Only need one parent to say okay
70
Parental refusal
One parent cannot veto a treatment of other parent agrees
If one parent doesn’t want and one gives consent- best to work in best interest
If both disagree- can apply to court of law if needed treatment, will consider parents belief but to safeguard child
71
Children’s act 1989
Duty to maintain the child’s welfare as paramount
72
Why measure the health of the population?
Prevalence
Incidence
Identify longitudinal trends
Interventions or policies helping?
Disease patterns
Service planning
73
Prevalence
How common a disease is at one point in time
good for: ascertaining burden of long term conditions
74
Incidence
How many new cases occur
over a period of time
75
Data sources for measuring health status
Death certificate
Census
Health survey for England
Hospital episode statistics
General practice research databases (CPRD, THIN)
Health protection reports of notifiable infectious diseases
Cancer registration
National/local/regional audits
76
Death certificates, what info?
Legal requirement to register
Age
Sex
Occupation
Cause of death and contributing diseases
77
Census, what info?
Every 10 years
Counts everyone in household
Age
Gender
Migration
Education
Marital
Health
Housing conditions
Family
Employment
Travelling habits
78
Hospital episode statistics, what info?
All outpatient appointments/admissions
Diagnoses and operation
Age
Gender
Ethnicity
Time waited
Date of admission
Geographical info of where treated
Outcome of treatment
79
Clinical practice research datalink used for…
Clinical research planning
Drug utilisation
Studies of treatment patterns
Clinical epidemiology
Drug safety
Health outcomes
Health service planning
80
Health survey for England includes
Questionnaire answers on- smoking, demographic, self reported info on health, illness, treatment, health service usage
Blood+saliva sample analysis
Height
Weight
Key theme each year: asthma etc
Freely available online
81
General lifestyle surgery includes
Whole of GB
Demographic info of families
Housing tenure and household accommodation
Access to vehicles
Employment
Education
Health and use of health services
Smoking and drinking
Family info- marriage, fertility
82
Notifiable diseases used for
Can be by doctors or lab results
Cancers registered in cancer registries and linked to data
83
Methods to measure health and disease
Birth and fertility rates
Incidence
Prevalence
Mortality
84
mortality data advantages
legal requirement
little delay
ensures comparability (international classification of diseases)
cheap sources of data
85
mortality data disadvantages
potential for error
death may be from a conjunction of diseases
some diseases have high mortality rate and death occurs quickly- others long term and resources intensive
86
why we use mortality and morbidity rates?
compare areas
-areas with poor health
-if need preventative services
-may raise a cause of disease
look at change over time
87
what is the international classification of disease?
providing a format for reporting causes of death on the death certificate
88
direct standardisation definition (Age)
**age specific death rates from a study population are applied to a standard population structure**
google: the rate that we would expect to find in the populations under study if they all had the same composition according to the variable which effect we wish to adjust or control (age)
89
direct standardisation advantages
used to compare disease rates across areas and time
assess relative burden of disease in a population
90
direct standardisation disadvantages
requires age specific rates (not always available)
rates may not be stable if a small population
91
indirect standardisation definition
age specific rates from a **standard population** are applied to a **study population** =standardised mortality ratio
92
standardised mortality ratio equation
observed number of deaths for study population/expected number of deaths for study population
93
indirect standardised advantages
no local rates needed
easier to interpret rates
94
disadvantages of indirect standardisation
areas cannot be directly compared (only within the UK for example)
does not give an idea of actual burden of disease (no 1 in 100)
95
what goes wrong in interpreting?
different criteria for the symptoms of a disease
not all cases have been identified
use of hospital data for disease/death, omits those in gp or community
96
people living in high deprivation have...
lowest life expectancy at birth
highest death rates
highest teenage pregnancy
higher levels of unhealthy lifestyles
97
5 theories why health associated with deprivation
an artefact of measurement error
social selection (health determines socioeconomic status, not the other way round)
behavioural/cultural
psychosocial (stress of low status job causes biological changes)
material/structural conditions (direct effects)
98
more recent theories of health and deprivation
importance of area context- availability of goods, facilities, social availability
role of lifecourse- pathways between childhood and adulthood that accumulate risk for health
99
karl marx definition of health
a commodity
the capacity to do work
100
talcott parsons definition of health
the state of optimum capacity of an individual for the effective performance of the roles and tasks for which they have been socialised
capacity to do productive work
101
what uses the deficit based model for health?
the traditional medical model
the body is a machine to be fixed
opposite= asset based model
102
criticisms of WHO model
is it realistic? are we unhealthy most of the time?
temporal changes in the burden on illness? acute>chronic
temporal changes in spells of ill health?
those with chronic or disabilities?
culturally applicable?
how is it even measured?
103
objective wellbeing measured based on...
assumptions about basic human needs and rights
-food, physical health, education, safety
through self report or objective measures like mortality rates etc
104
subjective wellbeing measure by...
asking people directly how they feels about their own wellbeing
-about life satisfaction, meaningful, positive emotions
105
biological factors that effect health
age
sex
genetics
ethnicity (bio differences, social inequities- racism= effects on health care, cultural- family, diet)
106
lifestyle factors that affect health
smoking
nutrition
alcohol
physical activity
risky behaviours
obesity
107
environmental factors that effect health
more fast food chains in deprived areas
housing- poor quality, overcrowded
access to good green space
air pollution
transport- road accidents
education
unemployment
108
role of clinical medicine in health
preventing disease
improving length and quality of survival in fatal conditions
improving quality of life in non fatal conditions
preventing and treating genetic disorders
care
(not always medicine- evidence for lifestyle decreasing diseases dramatically before vaccines even introduced)
109
how are disease classified?
international classification of diseases
diagnostic and statistical manual of mental disorders
diagnoses on electronic patient records
draws on medical consensus building
110
who classifies disease?
WHO
American psychiatric association
read codes- GPs
111
what is a social construct?
an idea that has been created and accepted by the people in a society
112
define medicalisation (conrad 2007)
the expansion of medicine into areas that are considered non-medical
can be:
conceptual- use of medical terms
institutional- doctors used as gate keepers, eg legitimising sickness
interactional- direct interaction, eg prescribing for a social problem
113
define iatrogenesis
doctor caused disease
medical iatrogenesis- illness caused or made worse through treatment, eg cascade prescribing
social iatrogenesis- medicalisation
cultural iatrogenesis- ability to cope with illness and death is eroded by handing over to professionals
114
examples of behaviours that have been medicalised?
use of medical terms in the media
doctors signing off people from work
being prescribed medication for a social issue
115
examples of conditions where construction plays a major role
effects of diagnosis/labelling
116
marinker's definitions of:
disease
sickness
illness
disease- deviation from biological norm, viewed objectively, individuals experience in the background
illness- experience of unhealth which is entirely personal
often felt together
sickness- social position of a sick person, different social status
117
WHO health definition pros
emphasis on all three facets
positive dimensions of health
118
WHO health definition cons
is well-being good heath?
utopian
119
incidence rate equation
(number of new cases of a disease arising over a period of time)/(person-years at risk)
120
person years at risk equation
total population x time period
121
point prevalence equation
number of people with a disease at a point in time/ total population at risk of the disease at the time point
122
birth rate is...
number of live births per 1000 population
123
general fertility rate is...
number of live births per 1000 women aged 15-44
124
why is total fertility rate better than general fertility rate?
takes into account age structure between populations, so allows for comparison
125
total fertility rate is...
the average number of children that a woman would bear if they experienced the age specific fertility rates at that point in time
126
infant mortality rate equation
number of deaths in children ages <1 year x 1000
_________________________________________
all live births
127
why measure infant mortality rate?
correlated to life expectancy
amenable to change through public health measures
128
crude mortality rate equation
total number of deaths in 1 year
-----------------------------------------------
total mid year population
129
disease specific death rate equation (per 1000)
number of deaths from disease x 1000
------------------------------------------------------------------
total mid year population
130
standardisation define
enables us to compare rates of disease or death in populations with different structures
131
describe culturally based differences in approaches to death
Hindu patient- sleeping near to floor when dying
Muslim funeral- buried never cremated, funeral as soon as possible, body is washed
Sikh- as soon as possible, cremation, coffin first to family home, duty of heir to light (here press button)
132
discuss how social sciences approaches can explain why and how people engage in death rituals
Group com my together
Remembering the dead
Tradition
Comforting
Gives an important role to dead’s family
Can be linked to religion
133
give examples for situations where medical professionals engage with culturally diverse death rituals
Allowing to be close to floor
Trying to make the process as quick as possible
134
What is culture?
Groups and their customs/traditions
Learnt or taught but often unspoken
Overlap with ethnicity, nationality and religion
135
Medicalised death
Interrupt natural death
Negotiation between family and doctor about what is desirable
Palliative care
136
Cultural competence training is…
Being culturally sensitive
But focuses on one individual while this is embedded in the system
137
The asked model of cultural competence stands for? (Campinha-bacote 2003)
Awareness
Knowledge
Skill
Encounters
Desire
138
Discuss the ways people define health and illness (Boyd 2000)
Disease- pathological process
Illness- patients experience
Sickness- role played in society
Healing and wholeness- whatever process results in the experience of greater wholeness of the human spirit
139
Recognise the different ways in which people seek and interpret medical advice and information through formal healthcare settings and lay sources
professional sector
Folk sector (alternative)
Popular (media)
140
Understand how people make decisions about approaching the formal healthcare system and the factors which influence this
Symptoms
More visible or impact on daily life
Family member pointed out
Personal Crisis
Effecting hobbies
141
Discuss the factors which influence peoples use and experiences of health care
142
Kleinmans model of healthcare systems includes…
Professional sector
Popular sector
Folk sector
143
Utilitarianism define…
Maximise happiness for the most people possible
Reduce suffering
Depends on **outcome** not act itself
144
Would a utilitarian tell the truth?
If it would lead to a good outcome
Should lie if not
145
Advantages and disadvantages of utilitarianism
✅Initiative
Distribution of Justice
Flexible-no rigid rules
❌consequences hard to predict
Can be hard to measure consequences/far reaching
No intrinsic value in the system
Can be unfair to favour majority
One person may be more valuable
146
Deontology define…
Rational beings so are capable of deciding what our moral duties are
Not about outcomes
Actions are either wrong or right
Can generate rules to always be right
147
Deontology advantages and disadvantages
✅humans are not expendable so should not be sacrificed for the majority
Reflect on how people perceive mortality
Places value on intention
Offer certainty that you are right
❌ too rigid
Can cause immense suffering just to stick to a principle
Often conflict of duty
Not that rational as humans (have emotions and pre-existing morals)
148
Beau champ and childress (1979) four principles are…
Beneficence
Non-maleficence
Justice
Autonomy
149
What does objective or rational mean?
Without emotion
150
Virtue ethics (Aristotle)
Based on a mentor role
Cultivate a good moral character
Phronesis - experience/practical wisdom
151
Virtue ethics pros and cons
✅pretty accurate to what most people currently do
acknowledge complexity
Most people have role models
Developmental model- doesn’t expect perfect but imperative to improve
❌nebulous (doesn’t help with decision making as vague)
Often pick role models who are like yourself
Virtuous character can take years to develop
Self-centred, what about the patient?
Encourages perfectionism
Role-model based
152
Different views of telling truth
(Utilitarian, deontology, 4 principlism, virtue, communitarian)
U: if increases happiness
D: because it’s your duty
P: enables autonomy
V: what a good person would do
C: allows us to trust each other
153
Communitarianism define
Need all the building blocks to complete a successful society
Ethics- trust- needs- well-being- collaboration
154
NHS guidelines for truth telling
NHS: Probity means being honest and trustworthy, acting with integrity
GMC: act with honesty and integrity
155
Every day deception- Micheal Lewis
Total honest would pose a significant Dias advantage
Being about to conceal feelings and stimulate others is considered a key part
156
The truth that is due- Hugo grotois 1625
Only owe the truth that is due
A lie is not wrong if someone had no right to the truth
157
Types of deception
Lie of commission
Lie of omission
Lie of embellishment
158
Lie of commission define…
A direct statement of an untruth
159
Lies of omission define..
Omitting to tell someone something that would materially effect their understanding of the situation
Grey area
Eg Not telling someone that their partner has a communicable disease
160
Nocebo effect
Experience a side effect of it has been told to them
161
Lies of embellishment define…
An exaggeration or misrepresentation to generate a misleading interpretation of a situation
162
The last resort (Sissela Bok 1978)
Truth has value
Lies do not
So to outweigh the trust, you need multiple other factors to be sufficient
163
What caused the duty of candour?
The mid staffs scandal
164
What is the duty of candour?
Be honest with your patients about mistakes or errors that have happened in their care
Volunteered info not requested for
Have duty to:
-inform people about the incident
-provide reasonable support
-provide truthful info
-provide an apology
165
Patient priorities are…
Humaneness
Competence/accuracy
Patient involvement In decisions
Time for care
166
What is Clinical communication?
The means through which you represent yourself as a competent, caring health care professional
Any communication in a clinical setting
167
What under pins competence in clinical communication?
Knowledge
Character
Skills
168
Why is reflective practice good?
Prepares you for ill-defined and complex issues
Think about past actions
Create and clarify meaning in terms of self but examining responses and emotions
Informs your actions for future experiences
169
Gibbs model for reflection
Description
Feelings
Evaluation
Analysis
Conclusion
Action plan
170
Define stigma
A mark of disgrace or infamy (dictionary)
Goffman- 1963: an attribute that is deeply discrediting, dedicated the bearer from a whole and usual person to a trained and discounted one
171
Explain goffman’s formulation of stigma
?
Impact of label
Causes shame, status loss, discrimination
3 types: abominations of the body
Blemishes of character
Tribal identities
172
Give examples of how specific medical conditions can be stigmatised in different ways
Mental health
Infectious disease
Feared conditions
Visible differences
173
The effects of living with a stigmatised condition
Enacted stigma- staring
Effects on employment
Isolation
174
Roles of hcp in dealing with the effects of stigma
May prevent people from seeking help earlier
175
Re T situation
Refusal of a blood transfusion, but then deteriorates- new situation so refusal was different and so best interests
Judge said about undue influence:
Doctors must consider whether the decision is really that if the patient
176
Consent must be…
Informed voluntary and capacitous
177
Why is autonomy a spectrum?
Material or social conditions - ie jobs can effect what decision you make
Must have a stable sense of self and value
178
Individualism
The role of a society is to maximally endow its citizens with the ability to make autonomous decisions
Cons- the wishes can be conflicting, so it may be unfair to others, constantly competing
179
If capacity is lost, then which of the four principles is gone?
Autonomy
180
To have capacity, a patient must be able to…
Understand the presented info
Retain the info
Weigh up the decision
Communicate that decision
181
Is capacity variable? Does it change for each decision?
Yes
Never assume someone doesn’t have capacity
For each decision, it should be assessed
Provide all possible help and support
182
What are the signs that someone doesn’t have capacity?
Erratic decision making
A conditions that could affect their ability
183
The two stage test of capacity
Stage 1-
Is there an impairment of/disturbance in the functioning of a persons mind or brain?
Stage 2-
Is the impairment sufficient that the person lacks capacity?
184
What are the different types of impairment that can stop capacity?
Disorders of the brain- strokes/brain damage/learning difficulties
Temporary- shock, fatigue, pain, drugs, panic
185
Capacity is…
Dynamic
Independent of whether you agree
To chose between, or refuse offered treatments
Cannot just ask for a treatment
186
The mental capacity act (2005)
Who is it for?
Over 16
Lack capacity to make some or all decision for themselves
187
What are the 5 principles of the mental capacity act?
Presumption of capacity
Support of individuals to make decisions
Unwise decisions
Best interests
Least restrictive option
188
What to do if your patient doesn’t have capacity? Who to talk to?
Decide what is overall benefit
Consult with those close to the patient
Or those in the health care team
Get an agreement of those people
Consider which option aligns closely with patients needs
Consider options would be least restrictive of the patients future options
189
What to consider when deciding options with no capacity?
Can it wait? Will the regain capacity?
What is best in general?
What is best for this specific person?
Can you get any more info?
190
Advanced statement, what is it?
Any info which the patient feels is relevant to their future care, should they lose capacity to make their decisions
191
Advanced decision, what is it?
Only to the advanced decisions to refuse certain treatment in specified circumstances
192
What makes an advanced decision legally binding?
In writing
Signed by the patient
Signed by a witness
Only circumstances and treatments specified
193
What are the two types of lasting power attorney?
Health and welfare
Property and financial affairs
194
How’s does a lasting power of attorney work?
Legal doc
Allow named person to make certain decisions
Next of kin does not have right without LPA
195
What happens if you have no friends or family and no capacity? Who can you turn to?
Independent mental capacity advocates
196
What are the guidelines for the independent mental capacity advocate?
Over 16 years old
Long term change in accom or serious medical treatment
Lacks capacity
No on independent of services who is appropriate to consult (friends of family)
197
What do the court of protection do?
Make decisions on whether someone has mental capacity
Handling best interest disputes
Ruling on questions about deprivation of liberty
Can apoint deputies (longstanding of lack of capacity and no LPA)
198
Competence
Minors under age of 16
Whether they have ability to make autonomous decisions about their health
Not interchangeable with capacity
Don’t use incompetent
199
Gillick v West Norfolk & Wisbeck Area Health Authority (1986)
Led to Gilick competence
Children under 16
Can consent if they have sufficient maturity and intelligence
To fully understand proposed treatment, purpose, nature, likely effects, risk, chances of success
200
How to determine the maturity of a child?
Child’s experiences and ability to manage influences in their decision
Ie peer pressure, family pressure, fear and misgivings
201
How to measure a child’s intelligence?
Child’s understanding
Ability to weigh risk and benefits
Consideration of long term effects
202
Fraser guidelines apply to?
Contraception
Or termination of pregnancy
And treatment of STIs
203
What are the Fraser guidelines?
Sufficient maturity and intelligence
Understand nature and implications
Cannot persuade to tell parents or allow doctor to tell parents
Very likely to continue sex
Physical or mental health could suffer without treatment
Advice is in best interest
204
If they are not gillick competent?
Seek parents consent
Usually on parents consent is enough
If parents cannot agree then seek legal advice
205
Scope of parental responsibility (2015)
1. Is this a decision that a parent should reasonably be expected to make?
2. Are there any factors that might undermine the validity of this particular persons parental consent?
206
Can a parent override the competent consent of a young person?
No
207
Can a competent refusal be overruled by a parent?
Yes
Technically A parent but is now a dwindling right, courts Will hesitate to enforce so always seek legal advice
But yes court
