Ethics & Confidentiality - PowerPoint Presentation

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Ethics & Confidentiality

Mark Tehan

Consultant in Emergency Medicine

Ethics

Hippocratic Oath

I swear by Apollo Healer, by Asclepius, by

Hygieia

, by Panacea, and by all the gods and goddesses, making them my witnesses, that I will carry out, according to my ability and judgment, this oath and this indenture.

To hold my teacher in this art equal to my own parents; to make him partner in my livelihood; when he is in need of money to share mine with him; to consider his family as my own brothers, and to teach them this art, if they want to learn it, without fee or indenture; to impart precept, oral instruction, and all other instruction to my own sons, the sons of my teacher, and to indentured pupils who have taken the Healer’s oath, but to nobody else.

I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment, and I will do no harm or injustice to them. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly I will not give to a woman a pessary to cause abortion. But I will keep pure and holy both my life and my art. I will not use the knife, not even, verily, on sufferers from stone, but I will give place to such as are craftsmen therein.

Into whatsoever houses I enter, I will enter to help the sick, and I will abstain from all intentional wrong-doing and harm, especially from abusing the bodies of man or woman, bond or free. And whatsoever I shall see or hear in the course of my profession, as well as outside my profession in my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets.

Now if I carry out this oath, and break it not, may I gain for ever reputation among all men for my life and for my art; but if I break it and forswear myself, may the opposite befall me. – Translation by W.H.S. Jones.

Ethics

New Hippocratic Oath

AS A MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;

THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;

I WILL RESPECT the autonomy and dignity of my patient;

I WILL MAINTAIN the utmost respect for human life;

I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;

I WILL RESPECT the secrets that are confided in me, even after the patient has died;

I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;

I WILL FOSTER the honour and noble traditions of the medical profession;

I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;

I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;

I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

I MAKE THESE PROMISES solemnly, freely, and upon my honour.

Ethics

GMC Duties of a Doctor

make the care of your patient your first concern

be competent and keep your professional knowledge and skills up to date

take prompt action if you think patient safety is being compromised

establish and maintain good partnerships with your patients and colleagues

maintain trust in you and the profession by being open, honest and acting with integrity.

Ethics

Balance of;

Non-maleficence

Beneficence

Autonomy

Human Rights

Ethics

Cultural Concerns

Conflicts of Interest

Financial

Family

Sexual

Ethics

Cultural Concerns

Conflicts of Interest

Financial

Family

Sexual

Data Protection Act

Personal data shall be processed fairly and lawfully and, in particular, shall not be processed unless:

at least one of the conditions in Schedule 2 is met, and

in the case of sensitive personal data, at least one of the conditions in Schedule 3 is also met.

Personal data shall be obtained only for one or more specified and lawful purposes, and shall not be further processed in any manner incompatible with that purpose or those purposes.

Personal data shall be adequate, relevant and not excessive in relation to the purpose or purposes for which they are processed.

Personal data shall be accurate and, where necessary, kept up to date.

Personal data processed for any purpose or purposes shall not be kept for longer than is necessary for that purpose or those purposes.

About the rights of individuals e.g.[13] personal data shall be processed in accordance with the rights of data subjects (individuals).

Appropriate technical and organisational measures shall be taken against unauthorised or unlawful processing of personal data and against accidental loss or destruction of, or damage to, personal data.

Personal data shall not be transferred to a country or territory outside the European Economic Area unless that country or territory ensures an adequate level of protection for the rights and freedoms of data subjects in relation to the processing of personal data.

Caldicott Guardian

A Caldicott Guardian is a senior person within a health or social care organisation who makes sure that the personal information about those who use its services is used legally, ethically and appropriately, and that confidentiality is maintained. Caldicott Guardians should be able to provide leadership and informed guidance on complex matters involving confidentiality and information sharing.

Confidentiality Law

Common Law

Medical Act 1983

Data Protection Act 2018 (including GDPR)

National Health Service Act 2006

Health & Social Care Act 2012

Children Act 1989

Police and Criminal Evidence Act 1984

Confidentiality Guidelines

GMC Duties of a Doctor

GMC Confidentiality Guidelines

Defence Union Publications

Confidentiality

Legal basis in Common Law

Can disclose if;

a. the patient consents

b. it is required by law, or in response to a court order

c. it is justified in the public interest.

Disclosure must be proportionate

Consent to Disclose

Must be

capacitous

Must be informed consent

Patients who lack capacity – can disclose in best interests

Don’t ask for consent if you

must

disclose

Inform the patient that you

will

disclose

Unless this undermines the purpose of disclosure (i.e. serious crime)

Disclosure to Protect Others

You must disclose information if it is required by statute, or if you are ordered to do so by a judge

Child & Adult Safeguarding

Capacitous

adults can withhold consent for information sharing

Prevent duty

Disclosure is likely to help in the prevention, detection or prosecution of a serious crime

Failure to disclose information may put someone other than the patient at risk of death or serious harm

Gunshot & Knife Injury

All gunshot injury (including accidental for licencing purposes)

Knife injury (except where self-inflicted)

The patient can refuse to speak to the police

Consent to disclose personal information to police

Unless;

Failure to disclose information may put someone other than the patient at risk of death or serious harm (you should not usually disclose information against the wishes of an adult patient who has capacity if they are the only person at risk of harm)

Disclosure is likely to help in the prevention, detection or prosecution of a serious crime.

Notifications of infectious diseases (NOIDs)

Public Health (Control of Disease) Act 1984

Health Protection (Notification) Regulations 2010

Registered Medical Practitioner

See poster

PHE East of England Health Protection Team

https://www.gov.uk/health-protection-team

Driving

Neurological

Seizure

Syncope

Stroke & TIA

Dizziness

Cardiovascular

Angina

AAA

LBBB

Must record your advice

Confidentiality & Death

Duty of confidentiality continues

New exceptions;

Death certificates

Coroners & coroners inquests

When necessary to meet the duty of candour

When someone close asks for information about the patient’s death, and you have no reason to believe the patient would have objected

Consider whether disclosing information is likely to cause distress to, or be of benefit to, the patient’s partner or family

Help & Advice

Caldicott Guardian

Data Protection Manager

Defence Union

Record your decision making

End of Life Decisions

Balance of;

Non-maleficence

Beneficence

Autonomy

Human Rights

Involve patient & those close to them. Be open about uncertainty

Understand the scope & limits of your role

Presumption towards prolonging life.

No absolute obligation to do so irrespective of patient views

End of Life Decisions

Legally binding advanced refusals

Made by an adult, had capacity, was informed, signed, witnessed, not withdrawn, not appointed an attorney since

Not-legally binding ADs indicate patient preference and should be used to weigh-up

Requests for futile treatment (inc. advance directives)

No right to demand treatment

Give weight to patient wishes when weighing up

Nutrition & hydration

Last hours or days; clinically assisted nutrition is not usually appropriate

Not last days; more significant decision, second opinion usually required