dr.abedalrahman shqaidef. introduction negligence risks encountered as a clinician ethical decision...
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Dr.Abedalrahman Shqaidef
Ethics and Risk management
Introduction
Negligence
Risks Encountered as a Clinician
Ethical Decision Making
A large variety of ethical questions (debate euthanasia and abortion).
Developments in high technology medicine present us with many difficult medico-moral questions (defining death, withdrawing life-support, obtaining consent).
The maintenance of standards of care and competence,
Introduction
Risk management is about how to avoid being sued. It involves:
Risk identification, Assessment of the severity of the
consequences of that risk and Formulation of a policy to minimize
the risk
Risk management
Patients may bring a case against a clinician under the law of tort up to four years after the date of knowledge of the injury. A tort is a civil wrong rather than a criminal matter,
Negligence
Types
Intent, e.g. assault.
Negligence. in diagnosis & in
the delivery of treatment.
Strict liability, e.g. problems
arising from the use of dental
products.
In order to prove Negligence a pt must prove
A legal duty of care A breach of that dutyResultant loss or damage
Negligence
Three need to be satisfied:
A duty of care existed between the defendant (clinician) and the plaintiff (patient).
That duty was breached.
There is a close causal link between the breach of duty and injury
Elements
Used to to provide evidence of proper standard of care
RCS England Management of the removal of wisdom teeth
Management Of palataly ectopic canines
Management Unerupted maxillary incisors
Guidelines:
Risks Encountered as a Clinician
ConsentConfidentialityRecord keeping and storageDiagnosisRisks of treatmentDelivery of careTermination of treatmentRisks encountered as an employer or a
selfemployed person
Gillick Competent The case of West Norfolk and Wisbech AHA
(1985) concerned a directive from the Department of Health to general medical practitioners that they were able to prescribe oral contraceptives to girls beneath the age of 16 years without parental knowledge and consent.
Mrs Gillick objected strongly to this and the case was finally decided by the House of Lords.
Consent. . . parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed.
ConsentThus, a child could be competent at as young an age as 12 or 13 years, but the complexity/seriousness of the procedure/ operation proposed will obviously have an influence in assessing competence in such a minor.
Record Keeping & Storage
Clinical records should be thorough, legible and complete.
They should be contemporaneous and may be handwritten or recorded on a computer.
a minimum of 11 years following the date of the last entry for adults and,
in the case of minors, for 11 yrs or until the age of 25, whichever is the longer.
DiagnosisIncorrect Dx may include any
aspect of patient care.
It is important that medical
history forms are updated
regularly,
Delivery of Care
The test of negligence is the Bolam test,
Did the clinician act as a body of responsible
clinicians would have acted, and is that action
good practice?
This may be modified if the judge considers the
expert opinion illogical
Risks of Treatment
This highlights the importance of
recording in the patient’s records
every failed attendance and to co-
operate
It is prudent never to guarantee a
result!
Risk Management
Introduction
Negligence
Risks Encountered as a
Clinician
Ethical Decision Making
Solving an ethical problem
A Working ExampleThe recent document released by the National Institute for Clinical Excellence pronounces on criteria to be used when assessing whether or not a patient should have 3rd molars removed.
Such documents should be read alongside anything else of relevance and a dispassionate analysis undertaken.
Decision PrinciplesAutonomy, nonmaleficence, beneficence, and
justice are four generally accepted ethical principles.
All actions should demonstrate:Regard for self-determination (respect for
autonomy); The avoidance of doing harm (nonmaleficence); The promotion of well-being (beneficence); Fairness in the distribution of goods and the
reduction and avoidance of harms (justice).
The ACD TestFor Ethical Decisions
AssessIs it true?Is it accurate?Is it fair?Is it quality?Is it legal?
Communicate
Have you listened?
Have you informed the
patient?
Have you explained
outcomes?
Have you presented
alternatives?
Decide
Is now the best time?
Is it within your ability?
Is it in the best interests of the
patient?
Is it what you would want for
yourself?
This highlights the importance of
recording in the patient’s records every
failed attendance and to co-operate
It is prudent never to guarantee a result!
Risk of treatment
Thank you
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