law and ethics

ethical principles

• beneficence

• non-maleficence

• autonomy

• justice

beneficence

• to do good

• We must promote actions that benefit patients and support them

• safe administration

• providing info, education and explaining risk and side effects

• maintaining and updating knowledge - changes in laws, treatment options/efficacy

• Example of interventions - vaccinations, smoking cessation, HRT, antidepressants, statins

Non- maleficence

• to do no harm

• harm or adverse events which occur as a result of healthcare

  • side effects,

  • surgical wounds/complications

  • anaphylaxis

  • chemo

  • vaccines/cannulation/IV

  • medication errors

Autonomy

• The right of patients to make informed choices regarding their own healthcare.

• right to refuse treatment

• right to determine what investigations/treatment they wish to undergo

• capacity and consent

• conditions compromising valid consent - coercion, undue influence, power imbalance

Justice

• fair equitable, and appropriate treatment of the person as well as equitable and appropriate access to care and treatment

• Model of social determinants of health - Dahlgreen and whitehead model - looks at:

  • general socio-economic, cultural and environmental conditions

  • living and working conditions - work, education, housing, food

  • social and community networks

  • individual lifestyle factors

  • age, sex and constitutional factors

treatment refusal

• Does the patient have all the info to make an informed decision?

• Is there evidence that the patient is experiencing a mental disorders - MCA and MHA?

Mental health act (1983)

• Patient must be experiencing a mental illness which is severe enough to warrant inpatient treatment - must be a significant risk of harm to self, to others or a significant degree of vulnerability

• People may lack capacity, not always

best interest

•  principle that requires decisions to be made on their behalf that are in their best interest, taking into account their wishes and feelings, and their past and present circumstance

• lack of capacity determined

• Do not make assumptions about what is in the best interests of the person - deal with facts and 'known knowledge'

• Understand all relevant circumstances

• Can the decisions be put off until they regain capacity??

common law

• Allows anyone to take reasonable proportionate action to prevent immediate significant harm to themselves or others, whether capacity or not

• If behaviour suggests a lack of capacity, then you should act in the individual’s best interest

• Aggression/ violence in A&E is an example - common law is used

consent laws - the human rights act (1998)

• Article 3 - right to freedom from torture or inhuman or degrading treatment

• Article 5 - right to liberty and security

• Article 8 - right to respect for private and family life

• Article 9 - right to freedom of religious expression

consent laws - health and social care act (2008)

• Part 3, section 2 (11) - care and treatment of service users must only be provided with the consent of the relevant person

triggers for capacity assessment

• The person has substantial difficulty retaining info

• The person has substantial difficulty weighing up info

• The person has substantial difficulty communicating their view, wishes or feeling

• the person has substantial difficulty understanding info

MCA 2 stage test

1. s the person unable to make a particular decision (the functional test)?

2. Is the inability to make a decision caused by an impairment of, or disturbance in the functioning of, a person’s mind or brain?

assessing capacity

1. Can the patient understand the decision? - including what will happen with or without the intervention?

2. Can they retain info?

3. Can they weigh up relevant info?

4. Can they communication their decisions (by any mean)?

5 principles of MCA

1. presume capacity

2. The individual must be supported to make their own decisions

3. People are able to make unwise decisions

4. Everything should be done in the patient’s best interest

5. least restrictive option should be considered

Consent

• the validity of consent does not depend on the form in which is given

• Written consent merely serves as evidence of consent - if elements of voluntariness, appropriate info and capacity

• Duration of consent

• Consent remains valid for an indefinite duration - unless withdrawn by the person - if new info becomes available between when consent is sought and when intervention is undertake, you can reconfirm consent

 

convert medication- who is it essential for?

CQC guidance - necessary or appropriate when:

• A person actively refuses their medicines

• That person is assessed and not to have capacity to understand the consequences of their refusal

• The medicine is deemed essential to the persons health and wellbeing

• Always done under the MCA framework

• It requires a best interest meeting and should involve family and people who know the patient

• Remember 2 stage test

• Consult with a pharmacist

• If changes - another best interest is required as its decision specific

key things to consider when converting medicines

• Altering characterises of a medicine can change the drug and how someone responses to it:

• Crushing a tablet - release slowly over 24 hours which could increase adverse effects due to the who dose being released too quickly

• Some medicines can become ineffective when mixed with certain foods or drink

iatrogenic harm - non maleficence

harm or damage caused by medical intervention, treatment or diagnosis procedure

what should you do prior to assessing capacity?

• What is the decision?

• What are the problems or difficulties the person is experiencing relating to the decision?

• What support do they need?

conditions comprimising valid consent

• coercion - nullifies most legal frameworks, can be an unspoken, implied threat, force or deprivation

• undue influence - act of persuasion that overcomes free will and judgement of another

• power imbalance - societal structure, environments and values that assign power to those with responsibility whereby other feel its difficult to participate in discussions about their healthcare

moral compass - Elephants In Trunks Run Slowly

• Your own personal standards

• Internal set of rules that your follow

• Your ability to distinguish between right and wrong

values -

•Empathy

•Integrity

•Trustworthy

•Responsibility

•Social Conscience