Semester 1 - Lecture Revision Flashcards

Question

Can a adult with capacity refuse treatment?

Answer 1

Yes, adults can refuse treatments that are in is in their best interest

Answer 2

- Consequentialism – Negative impact on the doctor-patient relationship & contribute to a negative public outlook on the medical profession - Virtue – what would a good doctor do? - Deontology – Duty to respect the laws/guidelines - Autonomy - Patient’s autonomy over their own personal/private information - Beneficence - Is it in the patient’s best interest to breach confidentiality? - Non-maleficence - Are you doing the patient harm? - Justice - Societal implications?

Answer 3

The duty of confidentiality requires Doctors, and other healthcare professionals, to keep their patients’ information private within the healthcare team, apart from some very specific circumstances. Doctors may breach confidentiality when… a) Sharing with the medical team is in the patient’s best interest b) Required by law e.g. communicable diseases c) Justified in the public interest d) If ordered to by a judge/presiding officer of a court e) If the patient consents to it

Answer 4

When you do breach confidentiality ensure that it is… a) Necessary b) Proportionate – breaking confidentiality to the right people c) Justifiable d) Patient should be informed – some exception apply

Answer 5

1. Three cycles of IVF/ICSI where there is a reasonable expectation of a live birth 2. Both partners non-smoking for 3 months before treatment and during treatment 3. Both partners must abstain from illegal and abusive substances 4. Neither partner should drink alcohol prior to or during the period of treatment 5. BMI of female partner must be above 18.5 and below 30 6. Neither partner to have undergone voluntary sterilisation (even if reversed) 7. Treatment must be initiated by the date of the female partner's 40th birthday, frozen transfers must be complete before 41st birthday 8. Couples must have been co-habiting in a stable relationship for a minimum of 2 years 9. One partner does not have a biological child

Answer 6

Human Fertilisation and Embryology Act (2008) 1. Research - 14 day limit on embryos used in research 2. Research - cloning of embryos is illegal 2. IVF - Embryos can be stored for up to five years 3. IVF - Both parties have to consent to implantation, either party can veto implantation 4. IVF - sex selection for non-medical reasons is prohibited. Sex selection is allowed for medical reasons—for example to avoid sex chromosome-linked disease

Answer 7

1. Abstention 2. Coitus interruptus (avoid sex during peak ovulation) 3. Rhythm aka ‘Natural Family Planning’ (Avoiding sex during peak ovulation) 4. Barrier (Condom, cervical cap) 5. Pharmaceutical (before sex) – preventing ovulation (The pill + long acting hormone releasing implants) 6. Sterilisation 7. Intra-uterine device (IUD – coil +/- hormone release) 8. Pharmaceutical (morning after pill) – preventing implantation Both IUDs and morning after pills can be controversial - should an embryo be considered human?

Answer 8

a) The continuance of the pregnancy would involve **risk to the life of the pregnant woman** greater than if the pregnancy were terminated b) The termination is necessary to prevent grave permanent injury to the physical or mental health of the pregnant woman c) the pregnancy has not exceeded its **twenty-fourth week** and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of **injury to the physical or mental health of the pregnant woman** - most abortions carried out under this act (97.7%) d) The pregnancy has not exceeded its twenty-fourth week and that the continuance of the pregnancy would involve risk, greater than if the pregnancy were termonated, of injury to the physical or mental health of any existing child(ren) of the family of the pregnant woman e) There is a **substantial risk that if the child** were born it would suffer from such physical or mental abnormalities as to be seriously handicapped 1.6% 2018 England & Wales - accounts for 1.6% of abortions

Answer 9

Key points of 1967 Abortion Act (ammended 1990) 1. Abortions on approved premises only 2. Must be approved by two doctors (except in emergency) 3. Prior to 24 weeks if risk to the physical or mental health of the woman. 4. After 24 weeks only if ‘serious handicap’ of the child, or ‘risk to life’ to the pregnant woman or ‘grave permanent injury to the woman’s physical or mental health.

Answer 10

Yes, clinicians have a right to conscientious objection and do not have a duty to participate in terminations, save for emergencies. But if you do decided to object you must... a) Tell patients that they have a right to see another doctor b) Make sure they have enough information to exercise this right c) When providing this information you must not imply or express disapproval of the patient’s lifestyle, choices or beliefs d) If it is not practical for your patient to see another doctor – you must make sure that the arrangement are made for a colleague to take over your role

Answer 11

The courts have indicated that a woman with capacity has the right to refuse treatment even where the life of the foetus is at grave risk. The interests of the foetus are not taken into consideration by the court. However, judges have often (in cases that reached the court) judged the woman to lack capacity to make a decision – perhaps, to justify saving the fetus Court ruled that compensation cannot not be obtained by the child from the mother – e.g. alcoholism leading to disability

Answer 12

Yes, they are able if they are deemed competent. If not competent, people with parental responsibility can consent.

Answer 13

Surrogacy - ask a third party to carry ang give birth to a baby Commercialisation of surrogacy is illegal but individual parties are given immunity Also no surrogacy arrangements are enforceable by or against any of the people involved, so the surrogate mother will remain the child’s mother until you obtain a parental order from the courts.

Answer 14

The state of having limits or bounds

Answer 15

In assisted suicide/dying most interpretations involve the patient making final act (pressing button on machine, taking tablets) - the doctor assists in the process Whereas, in voluntary (active) euthanasia the doctor would complete task

Answer 16

Definition - Advance care planning has been defined as a process of formal decision making that aims to help patients establish decisions about future care that take effect when they lose capacity Originally called “living wills” and “advance directives”

Answer 17

These are statements about what the patient would or would not want to happen in the future, their goals of care, or their personal values; they are sometimes known as a statement of preferences and wishes. They can be about medical treatment or about social aspects of care They are not legally binding but must be taken into account when best interest decisions are made about the person after capacity has been lost

Answer 18

Valid and applicable advance decisions to refuse treatment (box 4) are legally binding statements (usually written documents) that allow patients to refuse specific medical treatments if they lose capacity in the future. Patients can refuse only medical and nursing treatments in advance and not basic care (such as the offer of food and drink by mouth and repositioning in bed).

Answer 19

These are legal documents that replace the previous enduring power of attorney. They allow patients (donors) to nominate someone (attorney) to whom they want to give decision making powers (if they lose capacity in the future). There are two types of lasting power of attorney: 1. Property and financial affairs 2. Health and welfare

Answer 20

When life support is switched off or life-prolonging medical treatment is stopped, the person dies from their underlying illness, from natural causes. When euthanasia is performed, a person dies from a lethal overdose deliberately given to cause death. Not too sure about this one...

Answer 21

1. The Children Act 1989 is the principal statute concerning children in England, Wales and Northern Ireland. 2. The Children (Scotland) Act 1995 applies to Scotland. This Act has similar general principles to the Children Act 1989 3. The Family Law Reform Act 1969 is relevant to consent to treatment for patients aged 16 and 17 years in England and Wales 4. The Age of Legal Capacity (Scotland) Act 1991 gives statutory power to mature minors under the age of 16 years to consent to treatment - equivalent (in Scotland) of Gillick competence (see below)

Answer 22

There are some general points about parental responsibility (PR): a) More than one person may have PR for a child (typically both parents will have PR). b) Many actions or decisions, including consent to medical examination or treatment, can be carried out by just one person with PR – do not need to consult other person. c) PR cannot normally be transferred or surrendered – except in adoption

Answer 23

Note - there are other circumstances such as adoption, court appointment PR, loca authority, etc.

Answer 24

If parents (with PR) refuse consent to medical treatment that would be in a child's best interests to receive, then a court can authorize the treatment. The most commonly cited example of this is where parents who are Jehovah's Witnesses decline consent for a blood transfusion for a child a) Short time frame – emergency - treatment should be provided b) Longer time frame - doctors should apply to the court for authorization to provide treatment in the child's best interests.

Answer 25

A young person below the age of 16 may consent to medical treatment if they are deemed to be able to fully understand the decision. In Scotland, this is set out in the Age of Capacity (Scotland) Act. In the rest of the UK, this is based on a case known as ‘Gillick’ A child is said to be ‘Gillick competent’ if they have sufficient maturity and intelligence to understand and consider the nature and risks of the proposed treatment, as well as any alternatives available If they are not gillick competent - consent can be obtained from a parent or the courts.

Answer 26

The Fraser guidelines outline the scenario in which advice can be given to an under 16 about contraception and sexual health without parental consent. The five points are 1. Is the child mature and intelligent enough to understand the nature and implications of her actions and the treatment? 2. Is it impossible to persuade the child to tell their parents, or let the Doctor tell them? 3. Are they likely to begin or continue having sexual intercourse with or without contraception? 4. Are their physical or mental health likely to suffer unless they get the advice or treatment? 5. Is the advice or treatment in their best interest?

Answer 27

Basically – below 18 – can consent (if they are deemed to have capacity) Note - in Scotland, a person aged 16 years and above is presumed to have the ability to make medical decisions (capacity) and consent to procedures. But they cannot refuse treatment that is their best interest - e.g. life saving treatment

Answer 28

Freedom to (positive liberty) – e.g. access certain services - Requires involvement of the state Freedom from (negative liberty) - Freedom from interference/restraint by other people - Absence of (interference by) the state

Answer 29

The Patient Rights (Scotland) Act 2011 Yes, health care staff and patients should make sure that resources are used as efficiently as possible.

Answer 30

Rationing, targeting, increasing efficiency and reducing waste are important tools in resource distribution