L3 ethical decision making in prescribing

What is the purpose of the Human Medicines Regulations 2012?

to consolidate most of the legislation regulating the authorisation, sale, and supply of medicinal products for human use, originally made under the Medicines Act 1968.

Which legislation did the Human Medicines Regulations 2012 consolidate?

The Medicines Act 1968

Why is the Human Rights Act 1998 relevant to healthcare providers?

Because it regulates the relationship between individuals and public authorities, making it unlawful for public authorities to act in ways that are incompatible with a person’s Convention rights.

What is a key requirement for healthcare practitioners under the Human Rights Act 1998?

They must make decisions that respect patients' wishes and interests and ensure that any interference with human rights is legitimate.

What is the principle of presumption of capacity under the Mental Capacity Act 2005?

: Every adult must be assumed to have the capacity to make their own decisions unless it is proven otherwise.

What does the Mental Capacity Act 2005 say about supporting individuals to make decisions?

Individuals must be given all appropriate help and support to make their own decisions before anyone decides they lack capacity.

Can a person under the Mental Capacity Act 2005 make decisions that others view as eccentric or unwise?

Yes, people retain the right to make decisions that may seem eccentric or unwise to others.

What must be considered when acting on behalf of someone who lacks capacity under the Mental Capacity Act 2005?

Any action or decision must be made in the person’s best interests.

What does the principle of least restrictive intervention mean under the Mental Capacity Act 2005?

any action taken or decision made for someone who lacks capacity should interfere as little as possible with their basic rights and freedoms

What is the purpose of the Mental Health Act 1983, as amended by the Mental Health Act 2007?

It gives health professionals the authority, in certain situations, to detain, assess, and treat individuals with mental disorders to protect their health, safety, or the safety of the public.

Can someone be treated against their will under the Mental Health Act?

Yes, if they are detained under the Act, they can receive treatment even without their consent. in the interest of their health and safety or for public safety. 

Why can individuals be treated without consent under the Mental Health Act?

Because they are considered to lack the capacity to make an informed decision about their treatment at that time.

What happens if a detained patient refuses treatment but the medical team believes it is necessary?

The patient can still be treated if the team determines that treatment is in their best interest and justified under the Act.

What role do pharmacists play in mental health settings under the Mental Health Act?

Pharmacists help safeguard the rights of patients who are detained and treated under the Act.

What does the principle of beneficence mean in healthcare?

It means that healthcare professionals should aim to do good by balancing the benefits of treatment against the risks and costs in a way that benefits the patient.

What does the principle of nonmaleficence require from healthcare professionals?

it requires them to avoid causing harm to the patient, ensuring that any harm from treatment is not greater than the potential benefits.

What is meant by respect for autonomy in healthcare ethics?

It means acknowledging and supporting a patient’s right to make their own informed and reasoned decisions about their care.

What does the principle of justice involve in a healthcare context?

It involves treating all patients in similar situations equally and ensuring that the benefits, risks, and costs of treatment are distributed fairly.

What should always be the top priority in remote prescribing?

Patient safety must be the first priority, and concerns should be raised if necessary.

What must a healthcare professional do when identifying vulnerable patients during remote prescribing?

They must know how to recognise vulnerability and take appropriate steps to protect those patients.

What information should a healthcare professional provide to the patient at the start of a remote consultation?

Their name, role, professional registration (if online), and a clear explanation of how the remote consultation will work.

Under what condition can a healthcare professional prescribe during a remote consultation?

Only if it is safe to do so, based on adequate information and suitability of remote care for the patient’s needs.

When is it not safe to prescribe remotely?

When the healthcare professional lacks sufficient information about the patient's health or if remote care is unsuitable.

Why might remote prescribing be unsafe even if the consultation goes well?

Because it may be unsafe if relevant health information is not shared with other healthcare providers involved in the patient’s care.

What should a prescriber do if they cannot safely prescribe remotely?

They should signpost the patient to another appropriate service.

What legal and ethical steps must be followed before prescribing remotely?

Informed consent must be obtained, and relevant mental capacity laws and codes of practice must be followed.

What should a clinical assessment include in a remote context?

Accessing medical records and verifying key information through examination or testing where necessary

: What should patients be told about treatment options during a remote consultation?

They should be informed of all available options, including the option to decline treatment, in a way they understand.

What follow-up responsibilities does a remote prescriber have after treatment?

Make arrangements for aftercare and, unless the patient objects, share relevant information with others involved in their care to support monitoring and treatment.

What should be documented after a remote prescribing consultation?

Clear notes that fully explain and justify all decisions made.

What should remote prescribers do to maintain competence?

Stay up to date with training, support, and guidance for providing healthcare remotely.

: What event led to increased scrutiny of online prescribing by the GPhC?

Cases where patients died after overdosing on opiate medications prescribed online.

What does the GPhC guidance say about prescribing certain categories of medicine remotely?

: Some medicines should not be prescribed or supplied at a distance unless additional safeguards are in place to ensure they are clinically appropriate.

what types of medicines are considered unsuitable for remote prescribing without safeguards?

Medicines prone to abuse, overuse, or addiction, and those requiring ongoing monitoring.

Can you name examples of medicines that require extra caution when prescribing remotely?

Yes — opioids, sedatives, laxatives, and gabapentinoids.

What is Gillick competence?

It is a legal standard used to determine if a child under 16 can consent to medical treatment without parental permission, based on their understanding, intelligence, and maturity.

When is a child considered Gillick competent?

When they can fully understand the proposed treatment, including its nature, benefits, risks, and long-term consequences, and make an informed decision.

Who can consent on behalf of a child who is not Gillick competent?

Someone with parental responsibility, such as:

• A parent

• A legally appointed guardian

• A designated local authority

What key factors should be assessed when determining Gillick competence?

• Age and maturity

• Mental capacity

• Understanding of the treatment, including pros, cons, and risks

• Awareness of consequences

• Ability to explain reasoning

• Understanding of available alternatives

Can a child's Gillick competence change over time?

Yes. Understanding can vary, and capacity can fluctuate—so assessments must be made on a case-by-case basis.

What are the Fraser Guidelines used for?

To determine when a healthcare professional can give contraception or sexual health advice to a person under 16 without parental consent.

what are the Fraser Guidelines?

1. The child must be mature and intelligent enough to understand the nature and implications of the proposed treatment.

2. It must be clear that the child cannot be persuaded to involve their parents or allow the doctor to do so.

3. The child is likely to continue or begin sexual activity with or without contraception.

4. The child’s physical or mental health would likely suffer without the advice or treatment.

5. The advice or treatment must be in the child’s best interest.