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