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Flashcards in framework for ethical analysis Deck (28)
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1
Q

GMC: Good medical practiceDuties of a doctor (2013, 14, 19)

A

Knowledge, skills & performance
Make the care of your patient your first concern

Safety and quality

Communication, partnership and teamwork

Maintaining trust

2
Q

Consequentialism

A

it promotes best consequences.

Most common form is utilitarianism

3
Q

deontology

A

it is in accord with a moral rule or principle. Duties and Rights based morality

4
Q

virtue ethics

A

it is what a virtuous agent would do in the circumstances.

e.g. a good doctor is one who is: Caring, Disciplined, Skilful Trustworthy

5
Q

Four Principles of Medical Ethics

A

autonomy - respecting the patient’s wishes; helping them come to their own decisions

no maleficence - do no harm

justice - fairness in the provision of care; distributive justice; rights based justice; legal justice

beneficence - doing good and acting in the patients best interests

6
Q

Four Quadrants

A

medical indications
patient preferences
quality of life
contextual features

7
Q

medical indications

A

Consider each medical condition and its proposed treatment:
Does it fulfil any of the goals of medicine?
With what likelihood?
If not, is the proposed treatment futile?

8
Q

patient preferences

A

What does the patient want? Does the patient have the capacity to decide? If not, can anyone advocate for the patient?
Do the patient’s wishes reflect a process that is: informed? understood? Voluntary? Continuing?

9
Q

quality of life

A

Describe the patient’s quality of life in the patient’s terms and from the care providers’ perspectives.

10
Q

contextual features

A

Circumstances that can either influence the decision or be influenced by the decision

11
Q

Prof Bowman’s guide to helping you think through cases (p10):

A
  • Summarise the case or problem
  • State the moral dilemma
  • State the assumptions that are being made
  • Analyse the case
  • Acknowledge other approaches and state the preferred approach with explanation
12
Q

why do basic errors happen? - Sokol & Bergson

A
  • Stress
  • Fatigue
  • Covering for colleagues (too little locum support)
  • Professional culture (unwillingness to use support structures)
  • Feeling that decisions must be made alone
  • Unable to admit to uncertainty
13
Q

bowman - why is it difficult to admit and report errors in medicine

A
  • Consequences:
  • Does error = incompetence? (after all, everyone makes mistakes…)
  • Whistle-blowing is not without risk (far from it in fact…)
  • Medicine is not an exact science
  • Some argue that there is a “norm of non-criticism”
14
Q

Francis Report

A

• Stafford Hospital
• “They (Stafford Hospital patients) were failed by a system which
ignored the warning signs and put corporate self-interest and
cost control ahead of patients and their safety.“
• 290 recommendations including:
– Duty of Candour: A statutory obligation on doctors and nurses for a duty of candour so they are open with patients about mistakes

15
Q

Duty of Candour (2015)

A

‘To place a duty of candour on health and social care organisations. This would create a legal requirement for health and social care organisations to inform people when they have been harmed as a result of the care or treatment they have received.
• To establish new criminal offences of ill-treatment or wilful neglect in
health and social care settings; one offence applying to individual health and social care workers, managers and supervisors, and another applying to organisations’

16
Q

apology

A

a statement of sorrow or regret in respect of unintended or unexpected incidence

17
Q

GMC – Duty of Candour 2015

A
  • tell the patient (or, where appropriate, the patient’s advocate, carer or family) when something has gone wrong
  • apologise to the patient (or, where appropriate, the patient’s advocate, carer or family)
  • offer an appropriate remedy or support to put matters right (if possible)
  • explain fully to the patient (or, where appropriate, the patient’s advocate, carer or family) the short and long term effects of what has happened.
18
Q

What might happen in responseto errors or inadequate care?

A
  • Negligence (legal approach): patient might take legal action
  • NHS Complaints Procedure: patient might make a complaint
  • GMC (professional body): disciplinary action or removal from register
19
Q

Four outcomes from GMC investigation:

A

Case concluded, no further action
Issue a warning
Agree undertakings
Refer to MPTS (Medical Practitioners Tribunal Service)

20
Q

Legally: Negligence

A
  1. He/she is owed a duty of care by the defendant
  2. That the defendant breached that duty by failing to provide
    reasonable care; and
  3. That the breach of duty caused the claimant’s injuries
    (causation), and that those injuries are not too remote (proximity).
21
Q

The Bolam (1957) test:

A

“A doctor is not guilty of negligence if he has acted in accordance
with a practice accepted as proper by a responsible body of
medical men skilled in that particular art.” Judge McNair (p113,
Ibid)

22
Q

The Bolitho (1997) test:

A

Modified Bolam to add: the professional opinion must be
capable of withstanding logical analysis (note: a move away from
the deferential approach of Bolam) (p115, Ibid)

23
Q

The impact of Montgomery(2015)

A

• Does the patient know about the material risks of the
treatment I’m proposing?
• Does the patient know about reasonable alternatives to this
treatment?
• Have I taken reasonable care to ensure that the patient
actually knows this?”

24
Q

causation

A

There must be a clear link between the action (or inaction) of a
doctor, and the harm the patient experienced
• a key factor is also proximity

Often causation is where a patient’s case may fail

25
Q

NHS complaints procedure(Scotland)

A

2012 Charter of Patient Rights and Responsibilities
• Stage 1: Local resolution
• Stage 2: Scottish Public Services Ombudsman
• Judicial review

26
Q

How best to learn from errors?

A

• Person-centred approach
– Focussed on the individual doctor
• Systems-based approach
– Considers the environment, and seeks to minimise opportunities for error

27
Q

How has medicine sought to address some of the failures in the current system?

A
• Dedicated centres
– Beneficial for less common and uncommon procedures
• Requirement to retrain
– New procedures and techniques
• Data collection of incidents
• Improved instrument design
• Protocols & guidelines
• Checklists
28
Q

National Patient Safety Agency

A

Established in 2001; abolished in 2012 (England & Wales)