1. Some additional PINK questions… Up to week 4…

2. PLEASE NOTE These questions are to help you learn key lists, they have been taken from lecture 1-5 (of pink material – so ethics, values, perspectives, epidemiology types lectures)… This is NOT EVERYTHING you may need to know, so add to it, build on it. GOOD LUCK

3. Values In MedicinePeer Support: Week 4 What is the difference between a factual statement and an evaluative statement? -Factual statement: -Verifiable by empirical measurement / research -Evaluative statement: -Expresses an attitude or value judgement

4. Values In MedicinePeer Support: Week 4 What are the three approaches to ethical reasoning? The 3 P’s: -PRINCIPLES -PARTICULARS -PERSPECTIVES

5. Values In MedicinePeer Support: Week 4 What are principles? -Moral theories -Deontology (duty) -Utilitarianism (consequences) -Virtue Ethics (character) -Professional codes -Hippocratic oath -Declaration of Geneva -Declaration of Helsinki -Duties of a doctor

6. Values In MedicinePeer Support: Week 4 What are particulars? Attention to cases: -Importance of context -Case comparison -Consistency of judgement

7. Values In MedicinePeer Support: Week 4 What are Perspectives? Whose perspective is important? Whose perspective is important? -Patient -HCP -Family -Society These can be thought of as the different perspectives of all people involved… family, friends, doctors etc.

8. Values In MedicinePeer Support: Week 4 What are values? -Principles -Needs -Wishes -Preferences -Hopes -Ambitions -Concerns -Virtues -Etc

9. Values In MedicinePeer Support: Week 4 What is values based practise? -A skills based approach to individual clinical decision making where complex and conflicting values are involved… -10 Key Elements -4 Clinical skills -2 Aspects of model of service delivery -3 links between values based practise and evidence based practise -Partnership in decision-making

10. Values In MedicinePeer Support: Week 4 What is evidence based practise? -Integration of…. -Research evidence -Clinical experience -Patient values (unique preferences, concerns and expectations)

11. Values In MedicinePeer Support: Week 4 What is a medical students responsibility to a patient? -Respect their autonomy -Consideration of their vulnerability (vulnerable adults / vulnerable children) -Consent -Confidentiality

12. Values In MedicinePeer Support: Week 4 What is confidentiality? [GMC definition] ‘Confidentiality is central to trust between doctors and patients. Without assurance about confidentiality patients may be reluctant to seek medical attention or give doctors the information they need in order to provide good care. But appropriate information sharing is essential to the efficient provision of safe effective care both for the individual patient and for the wider community of patients.’

13. Values In MedicinePeer Support: Week 4 What circumstance are you able to disclose information? -Patient has capacity – you have their consent -Patient lacks capacity (adult) – best interests -Patient lacks capacity (child) – parental consent -Legally required -Public interest -Can you give an example???

14. Values In MedicinePeer Support: Week 4 What is Battery? -In simplest terms, touching without permission

15. Values In MedicinePeer Support: Week 4 Types of consent? When is consent valid? Types: -Explicit -Written -Verbal -Implicit Requirements: -Capacity -Information -Voluntariness

16. Values In MedicinePeer Support: Week 4 What is meant by capacity? To have capacity a person must be: - Be able to understand the information relevant to decision -Be able to retain that information -Be able to use or weigh up the information as part of the decision making process -Be able to communicate his decision

17. Values In MedicinePeer Support: Week 4 What is meant by information? Information must: -Broadly outline the treatment (defence against battery) -Information about risk, benefits, alternatives (nb. level of information relationship to negligence)

18. Values In MedicinePeer Support: Week 4 What is meant by voluntariness? Must be able to show there is not: -Explicit coercion -Implicit coercion -Power differentials in the pt/dr relationship -Pressure from family

19. Values In MedicinePeer Support: Week 4 How do you prove consent in children? Competence is not assumed in a child U16, it must be demonstrated. Competent consent must be respected.

20. Values In MedicinePeer Support: Week 4 What is meant by proxy consent? Consent in children: -Proxy consent (patents / courts / authority) -Must act in childs best interest

21. Values In MedicinePeer Support: Week 4 Outline the Gillick competences… Gillick competency (must prove young person can):  -understands the problem and implications  -understands the risks and benefits of treatment  -understands the consequences if not treated  -understands the alternative options  -understands the implications on the family  -is able to retain (remember) the information  -is able to weigh the pros and cons  -is able to make and communicate a reasoned decision about what their wishes are.

22. Values In MedicinePeer Support: Week 4 What is person-centred care? There are many definitions, however in its simplest form: -‘treating patients as they want to be treated’ -Holistic… Not patient but whole person

23. Values In MedicinePeer Support: Week 4 Name 4 ways to work in partnership with patients 1.Listen to and respond to, their concerns and preferences 1.Give patients the information they want or need in a way they can understand 1.Respect patients right to reach decisions with you about their treatment and care 1.Support patients in caring for themselves to improve and maintain their health

24. Values In MedicinePeer Support: Week 4 Name 5 ways to work in partnership with patients to ensure good care a.Listen to patients and respect their views about their health a.Discuss with patients what their diagnosis, prognosis, treatment and care involve a.Share with patients the information they want or need in order to make decisions a.Maximise patients opportunities, and their ability, to make decisions for themselves a.Respect patients decisions

25. Values In MedicinePeer Support: Week 4 What is respect? Recognising the moral value of a person as an autonomous being

26. Values In MedicinePeer Support: Week 4 List some challenges to person-centred care… One size fits all targets focused on easily measurable quantitative outcomes e.g. 4hr limit in A&E; bed occupancy; patient throughput Increasing sub-specialisation in 2ary care Increasing practice sizes in 1ary care Increasing healthcare complexity of individual patients Increasing geographical mobility of individual patients

27. Values In MedicinePeer Support: Week 4 What is meant by autonomy? Name the 3 common conditions of autonomy. Autonomy is the idea that is generally understood to refer to the capacity to be one’s own person, to live one’s life according to reasons and motives that are taken as one’s own and not the product of manipulative or distorting external forces. Three common conditions: -Capacity (age 16 and over assume capacity) -Freedom (requires freedom from interference and opportunities for choices) -Authenticity (consistent with personal identity and values)

28. Values In MedicinePeer Support: Week 4 What is meant by dignity? Name the elements of dignity. A state, quality or manner worthy of estem of respect, and by extension, self respect. Elements of dignity: -Respect -Privacy -Self-Esteem -Freedom from unnecessary pain -Autonomy

29. Values In MedicinePeer Support: Week 4 What is meant by care? -Beneficence (doing good) -Best Interests Treat the condition, care for the person…

30. Values In MedicinePeer Support: Week 4 What is meant by Consequences? -Better patient outcomes -Less complaints -Less risk of litigation -Increased trust in medical profession

31. Values In MedicinePeer Support: Week 4 Use of human tissues: Who owns a body? -A property right in a body is not recognised in law -There is a right to bodily integrity (law on battery) -There is a right to possession of a dead body: -Anyone with a duty to bury the person -A hospital in which the person has died -A coroner in cases where an inquest takes place

32. Values In MedicinePeer Support: Week 4 Outline the Human Tissue Act (2004) -A framework for regulating the storage and use of human organs and tissue from the living, and the removal, storage and use of tissue and organs form the deceased, for specified health-related purposes and public display.

33. Values In MedicinePeer Support: Week 4 Human Tissue Act (2004): Outline purposes that general require consent where the tissue is from the living or the deceased 1.Anatomical exmination – requires witnessed consent in writing before death 2.Determining the cause of death 3.Establishing the efficacy of any drug or other treatment administered to him (eg. Hospital post mortem) 4.Obtaining scientific or medical information about a living or deceased person which may be relevant to any other person 5.Public display – requires witnessed consent in writing before death 6.Research in connectin with disorders or the functioning of the human body 7.Transplantation – includes all bodily material such as blood bone marrow, skin, tissue and organs

34. Values In MedicinePeer Support: Week 4 Human Tissue Act (2004): Outline purposes that general require consent where the tissue is from the living or the deceased continued… 8.Clinical Audit 9.Education or training relating to human health – includes training in research techniques 10.Performance assessment – eg. Testing medical devices 11.Public health monitoring 12.Quality assurance

35. Values In MedicinePeer Support: Week 4 Who can give consent for a Deceased Adult i.His / Her consent before death i.If no prior consent, consent of a nominated representative i.If no representative, the consent of a qualifying relative

36. Values In MedicinePeer Support: Week 4 List of qualifying relative (order of priority) i.Spouse or partner ii.Parent or child iii.Brother or sister iv.Grandparent or grandchild v.Child of a brother or sister vi.Stepfather or stepmother vii.Half brother or half sister viii.Friend of longstanding

37. Values In MedicinePeer Support: Week 4 The Human Tissue Authority issues licenses for what? i.Use, storage, and disposal of deceased human body or human tissue for scheduled purposes other than transplantation ii.Carrying out of anatomical examination iii.Post mortem examination iv.Each establishment (NHS/University) has a nominated person. v.Failure to comply = loss of license vi.Failure to obtain consent = up to 3 years imprisonment or fine