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arguments for the use of assisted reproductive technology
procreative autonomy and welfare interests
ethical objections to the use of IVF
1) involves the destruction of embryos
2) harmful to those trying to conceive
3) unnatural
what is the right to an open future
ensuring that a child will have a maximally open future ie will enjoy the widest possible range of opportunities
describe the human fertilisation and embryology act 1990
a women shall not be provided with fertility treatment unless account has been taken of the welfare of any child who may be born as result of the treatment
criticisms of the human fertilisation and embryology act
fertile couples dont have to meet this criteria
purpose of pre-implantation genetic diagnosis
to avoid genetic disease. more contentious uses include sex selection and saviour siblings
what is mitochondrial replacement techniques
works by creating an IVF embryo that replaces the faulty mitochondria with healthy ones form a donor
ethical issues with mitochondrial replacement techniques
health benefits to the future child, benefit to parents, concerns regarding health risks to child, germ line modification
up to what week is abortion legal in the UK
24 weeks
what are the criteria for an abortion to be legal
1) the pregnancy has not exceeded the 24th week
2) termination is necessary to prevent injury to the pregnant woman
3) continuation of the pregnancy would involve risk to the life of the pregnant woman
4) there is a risk that if the child was born, it would suffer physically or mentally
describe conscientious objection in healthcare
you may practice in accordance with your beliefs provided it is legal and:
- you do not treat patients unfairly
- you do not deny patients access to appropriate medical treatment
- you do not cause patients distress
what should you do if you object to treating a patient
make sure the patient has enough information to arrange to see another medical professional who does not hold the same opinion as you
arguments for deaf people being able to choose to have a deaf baby
1) deafness is a societal problem
2) autonomy of the parents
3) the child can still have a worthwhile life
arguments against deaf parents being able to choose a deaf child
1) the child will be disadvantaged
2) right to an open future argument
3) it wouldnt be morally permissible to deliberately deafen a child so its the same thing
should the rights of women be accorded greater weight than that of an unborn foetus
yes - foetus doesnt have moral status of a person, could put womens life at risk
no - foetus does have moral status of a person, equal
why are children of particular concern when making decisions
- may have underdeveloped decision making abilities
- may possess undeveloped value systems
- may have limited capacity to defend their rights
- can be vulnerable to abuse or exploitation
What is Gillick competence?
children under 16 may consent to medical treatment providing they are deemed to fully understand its implications
why is parental consent used if a patient is not competent
-parents should act under the best interest of the child
-parents know their child well
what happens for young people aged 16-17 who wish to refuse treatment
treatment can still be given if approved by the parents or the court
key piece of legislation for treating children
children act 1989
what does the children act of 1989 say
allocates duties to local authorities, courts and parents to ensure children are safeguarded and their welfare is promoted
responsibilities of doctors in child protection
- all children have a right to be protected from abuse
- doctors must consider the needs and wellbeing of the child
- children are individuals with rights
- children have a right to be involved with their care
- children have a right to confidentiality
what does it mean for a doctor to be competent when working with children
- has the knowledge to recognise signs of abuse
- has the skills to work closely with the family
- know when to ask colleagues for advice
- taking appropriate and prompt action
what are fraiser guidelines
gillick competency for sexual health
what is stated in the fraiser guidelinbes
you can provide contraception and advice to young people under 16 if:
- they understand all aspects of the advice
- you can not persuade the person to tell their parents
- the person is likely to have sex regardless
- their physical or mental health will suffer without
- it is in their best interests
principles of the mental capscity act
- presumption of capacity
- best interests
- ability to make unwise or eccentric decisions
-least restrictive options
-supported to make their own decisions
when does a person have capacity
if they can understand, retain, weigh up and communicate a decision at that particular time
what is an ADRT
advance decision refusing treatment - legally binding
are advance statement of wishes legally binding
no
purpose of advance decisions to refuse treatment
empower patients to refuse, autonomy
arguments for the use of advance decisions to refuse treatment
- autonomy
-openness
- encourages forward planning
- reduces anxiety of unwanted care
arguments against the use of advance decisions
- patients dont know what it is like to be in that position
- patients may change their mind
- coercion
conditions for an advance decision refusing treatment to be valid
- must be over 18
- must have capacity
- must not be cooerced
- you specify clearly what you refuse
what is the personal identity argument for advance decisions in dementia
advance directives should only be valid if the person making it is identical to the person with dementia. the author and the person with dementia are not identical because their psychologies are radically different
equation for the absolute risk
number with the disease/ total exposed
equation for relative risk
risk in exposed/ risk in unexposed
equation for absolute risk reduction
risk in exposed - risk in unexposed
equation for relative risk reduction
1- relative risk
equation for number needed to treat
1/absolute risk reduction
equation for odds
number with the outcome / number without the outcome
equation for odds ratio
odds in exposed / odds in unexposed
what makes up an evidence based decision
evidence from research, patient preferences, available research and clinical exertise
what study is used when looking for prognosis or cause
cohort
when is a case control used
cause
what study is used when looking at treatment interventions
RCT
what study is used when looking at peoples perspectives or understanding
qualitative approaches
how do you truncate a work on medline
*
how to use an american spelling of a word on medline
add in a ?
purpose of truncating a word on medline
to search for numerous word endings at once
why do we need evidence based decision making
increasing medical knowledge, limited time to read, inadequacy of traditional sources, disparity between diagnostic skills and clinical performance
process of evidence based decision making
-converting the need for information into a question
- identify the best evidence
- critically appraise the evidence
- integrate the evidence into guidelines
what is a background question
general knowledge about a disorder
what are the two essential components of a background question
a question root and an aspect of a disorder
what are foreground questions
specific knowledge about managing patients with a disorder
what does PICO stand for
population, intervention, comparison and outcome
most common causes of death
ischaemic heart disease, neonatal disorders and stroke
what is the double burden of disease
when countries are moving from developing to developed status, they have an increasing number of non-communicable disease with still high numbers of communicable diseases
what is epidemiologic polarization
mixed pattern of deaths within the same country
commericial determinents of health
- weak regulations
- policy gaps
- poor implementation
- predatory advertising
why are global pandemics increasing
- increased global travel
- urbanisation
- climate change
- increased human to animal contact
- weak health systems
define global health
an area for study that places priority on improving health and achieving equity in health for all people worldwide
why do we vaccinate
prevent disease
eradicate disease
protection of vulnerable groups
prevent transmission
what diseases have we eradicated
rinderpest and smallpox
define transmissability
refers to the ability of a disease to be passed from one person to the next
what is the potential for transmission indicated by
basic reporduction number
what is the basic reproduction number
the average number of new infections produced by one infected individual introduced into a population where all individuals are susceptible
what is the effective reproduction number
the average number of secondary infections produced when one infected individual is introduced into a real population containing a mix od susceptible and immune individuals
what happens if Re is greater than 1
prevalence of the infection increases: epidemic
what happens if Re is 1
system at equilibrium: endemic
what happens if Re is less than 1
infection fades out of the population
what is an endemic
the disease is stable in the population, independent of the prevalence
what is herd immunity
a point exists where transmission is not expected to occur
what is the usual range for herd immunity
between 70-90%
what is the equation for transmission
R= R0(1-v) where V is the proportion protected
what is the equation for the herd immunity threshold
1-1/R0
what happens if the coverage of vaccines is too low
increased risk of outbreak, average age of infection can increase
who sets the vaccine policy
set by the department of the health and social care with guidance from the joint committe of vaccination and immunisation
what proportion of children should be immunised
95%
what are the vaccines are given at 8 weeks
6 in 1, rotavirus and men B
what is included in the 6 in 1 vaccine
diptheria, polio, tetanus, pertussis, hep b and HIB
what vaccines are given at 12 weeks
6 in 1, pneumococcal and rotavirus
what vaccines are given at 16 weeks
6 in 1 and men B
what vaccines are given at 1 year
HIB, Menc, MMR, pneumococcal and Men B
what vaccines are given at 3 years 4 months
MMR and 4 in 1 booster
what is involved in the 4 in 1 booster
diptheria, polio, tetanus and pertussis
what vaccines are given at 12 years
HPV
what vaccines are given at 14 years old
3 in 1 teenage booster and men ACWY
what is the 3 in 1 teenage booster
tetanus, diptheria and polio
who monitors vaccines
MHRA
what strains of HPV cause most cancers
16 and 18
two things needed for a successful vaccination campaign
effective deployment and impact on health
what is the extended project of immunisation
aims to make immunisation against dtp available for children worldwide
what are examples of worldwide vaccine projects
extended project of immunisation, global alliance for vaccination and immunisation
describe the vaccination act
made vaccination free and compulsory
what do anti-vax aguments focus on
vaccines are ineffective and cause harm
difference between anti-vax and vaccine hesitant
mis-informed vs under-informed
which countries have the highest trust in vaccines
Rwanda and ethiopia
describe how individual and community interests diverge in vaccines
people may choose to rely on herd immunity. however if enough people do this, coverage will be too low
what is happening to the prevalence of cancer
increasing due to an ageing population
what is prevalence
the burden of a disease in a population