Ethics

Moral compass

-Your own personal standards

-Internal set of rules that your follow

-Your ability to distinguish between right and wrong

Ethical Principle- beneficence

-To 'do good’

-We must promotes actions that benefit our patients

-We should support patients throughout their illness and recovery

Beneficence-Application to medicine management

-Safe administration medication (protocols)

-Providing patients with info and education re: benefits, managing patient expectations

-Explaining material risks/side effects to patients

-Maintaining and updating knowledge re: changes in law/treatment options/efficacy

-Examples of interventions; vaccinations, smoking cessation, HRT, anti-depressants, statins 

Ethical Principle- Non maleficence

-You must ‘Do No Harm’.

-This principle involves weighing potential benefits against potential harms to ensure the benefit outweighs the harm

Example of non maleficence

-Side-effects of antipsychotics / antidepressants

-Surgical wounds / complications

-Anaphylaxis

-Chemotherapy

-Vaccines / cannulation / IV

-Medication errors

-A lot of healthcare involves some aspect of harm. It must therefore be justified, and the patient needs to consent in an informed way. We must not cause unnecessary harm / suffering

Iatrogenic harm

An illness, injury, or complication that is unintentionally caused by a healthcare provider or by a medical treatment/diagnostic procedure.

Ethical Principle- Autonomy

Respecting patient autonomy is the  cornerstone of law and ethics in healthcare:

-Fundamental right of the competent adult to refuse treatment

-Even if that refusal results in death, despite communicating potential outcomes of not having treatment

-The patient has the right to determine what investigations / treatment they wish to undergo.

Conditions Compromising Valid Consent- Coercion

Coercion nullifies most legal framework and agreement and can be found in practices such as restraint. Or it can be latent, unspoken and implied threat. Force, deprivation, encroachments on dignity and autonomy.

Conditions Compromising Valid Consent- Under influence

An act of persuasion that overcomes free will and the judgment of another. Insinuation, flattery, trickery and deception all constitute undue influence. Presents in unequal relationships more frequently especially for people who are dependant care givers

Conditions Compromising Valid Consent- Power imbalance

Societal structures, environments and values assign power to those with knowledge and responsibility, even when patients are well educated and informed they feel it is difficult to participate in meaningful discussions about their healthcare. Imbalances in power can be actual or perceived and people can feel pressure to be compliant or passive

Autonomy and MHA

-MHA trumps autonomy, while many people detained under the MHA will lack capacity – many detained patients will have general capacity to make decisions.

-This is where the MHA has slightly more reach than the MCA.

Conditions Compromising Valid Consent- Justice

Fair equitable and appropriate treatment of the person as well as the fair equitable and appropriate access to care and treatment.