Medical Ethics Today The BMA's handbook of ethics and law -- Contents -- Medical Ethics Today CD Rom -- Features -- Medical Ethics Today PDF eBook -- BMJ Books catalogue -- Instructions for use -- Tips -- Troubleshooting -- List of statutes and regulations -- United Kingdom -- Non-United Kingdom -- List of cases -- United Kingdom -- Non-United Kingdom -- Where to find legal references online -- Medical Ethics Committee -- Acknowledgements -- Bridging the gap between theory and practice: the BMA's approach to medical ethics -- The BMA and medical ethics -- What is medical ethics? -- The transition from "traditional" to "analytical" medical ethics -- Medical ethics and human rights -- Practical approaches to medical ethics -- Approaching an ethical issue or dilemma -- 1. Recognise the situation as one that raises an ethical issue or dilemma -- 2. Break the dilemma down into its component parts -- 3. Seek additional information, including the patient's viewpoint -- 4. Identify any relevant legal or professional guidance -- 5. Subject the dilemma to critical analysis -- 6. Be able to justify the decision with sound arguments -- The relationship between ethics and law -- The Human Rights Act 1998 -- The General Medical Council -- Philosophical approaches to medical ethics -- Bridging the gap between theory and practice -- The approach taken in this book -- References -- 1: The doctor-patient relationship -- Themes for discussion -- General principles -- Changing expectations of the doctor-patient relationship -- Historical context -- Types of relationships in modern medicine -- The therapeutic relationship and duties to the patient -- Independent assessors and duties to the commissioning agent -- Choice and duty -- Can patients choose their doctor? -- Can doctors choose their patients? -- Who has a duty of care? -- Summary - the changing relationship.

The search for balance -- Patient autonomy -- Doctors' autonomy -- The importance of communication -- Can patients refuse to receive information? -- Truth telling by doctors -- Doctors' duty to acknowledge mistakes -- Should doctors tell patients about unfunded treatments? -- Being open about employment disputes -- Truth telling by patients -- Communication and intimate examinations -- Communication, interpretation, and translation -- Summary - the importance of communication -- Trust and reciprocity -- Covert medication -- Trust and covert surveillance -- Trust and declaring a financial interest -- Receiving payment for referrals or recommendations -- Need for a chaperone -- Ensuring that staff are safe and reliable -- Requests for a second opinion -- Recording of consultations by patients -- Recording of consultations by doctors -- Patients who fail to attend appointments -- Breakdown of the doctor-patient relationship -- Complaints -- Summary - trust and reciprocity -- Recognising responsibilities and boundaries -- Boundaries in treatment -- Self diagnosis and treatment -- Treating family, friends, or colleagues -- Staff who are also patients -- Managing patient expectations -- Managing relatives' expectations -- Managing personal relationships -- Abusive behaviour by doctors -- Patients' duty to treat health professionals reasonably -- Payment for services -- Can violent people expect to receive medical care? -- Patient confidentiality and violent patient markers -- Stalkers -- Gifts and bequests -- Doctors as witnesses to wills and legal documents -- Responsibilities of doctors: a "duty to pursue"? -- Responsibilities of patients to safeguard health -- Reciprocity: do doctors still owe duties when patients refuse medical advice? -- Refusal of advice and hospital treatment -- Summary - recognising responsibilities and boundaries.

The doctor-patient relationship of the future -- Continuity of care -- Multidisciplinary practice -- Telemedicine and other forms of care at a distance -- Better informed patients -- The overlap between medicine and politics -- Rights-based expectations -- References -- 2: Consent and refusal: competent adults -- The nature and purpose of consent -- General principles -- Standards and good practice guidance -- The process of seeking consent -- Capacity to give valid consent -- Who should seek consent? -- Providing information -- Accessibility of information -- Type of information to be given -- Amount of information to be given -- Withholding information -- Refusing to receive information -- Summary - providing information -- Documenting consent -- The scope of consent -- Duration -- Exceeding consent -- Summary - the scope of consent -- Pressures on consent -- Refusal of treatment -- The right to refuse -- Informed refusal -- Continuing care -- Documenting refusal -- Refusal of blood products by Jehovah's Witnesses -- Summary - refusal of treatment -- Are there limits to an individual's consent? -- Consent to procedures carried out for the benefit of others -- Organ donation from live donors -- Risks and benefits -- What level of risk is acceptable? -- Safeguards for living organ donation -- Live donation from strangers -- Requests for amputation of healthy limbs -- Legal issues -- Ethical issues -- Summary - are there limits to an individual's consent? -- From the everyday to the extreme -- References -- 3: Treatment without consent: incapacitated adults and compulsory treatment -- Consent and the alternatives -- General principles -- When can treatment be given to adults who lack capacity? -- Best interests, benefit, and necessity -- Emergencies -- Compulsory treatment -- What constitutes capacity? -- Capacity to refuse -- Assessing capacity.

Factors affecting capacity and how to enhance capacity -- Summary - capacity: defining, assessing, enhancing -- Best interests and benefiting patients -- Screening and preventive measures -- Involving people close to the patient -- The role of people close to the patient -- Adults with Incapacity (Scotland) Act -- Proxy consent -- Disputes -- Summary - proxy decision making in Scotland -- England, Wales, and Northern Ireland -- Patient advocates -- Advance statements -- The legal position -- Scope of advance statements -- Provision of information -- Format of advance statements -- Storage of advance statements -- Summary - advance statements -- Treatment safeguards and procedures -- Clinical review and second opinions -- Court review -- Physical restraints and other measures of control -- Summary - restraint -- Treatment in hospital -- Summary - detention -- Compulsion: mental health -- Ethical principles governing treatment -- Summary - mental health care -- Compulsion: public health -- Proposals for law reform -- Mental incapacity -- Mental health -- Mental Health (Care and Treatment) (Scotland) Act 2003 -- References -- 4: Consent and refusal: children and young people -- Combining respect for autonomy with best interests -- Has human rights changed things for children? -- Scope of this chapter -- General principles -- Communication -- Involving children -- Competence to make decisions -- Growth of competence -- Confidentiality and involving parents -- Best interests -- Preventing harm -- Emergencies -- Consent for examination and treatment -- Consent from competent young people -- Refusal by competent young people -- England, Wales and Northern Ireland -- Refusal of blood products by Jehovah's Witnesses -- Scotland -- Advance decision making -- Summary - consent and refusal by competent young people.

Decision making by people with parental responsibility -- Parental responsibility -- Consent from people with parental responsibility -- Refusal by people with parental responsibility -- Disagreements between people with parental responsibility -- Summary - consent and refusal by people with parental responsibility -- The courts -- Summary - the courts -- Providing treatment against a child's wishes -- Using restraint or detention -- Cultural practices -- Circumcision -- Summary - male circumcision -- Female genital mutilation -- Withdrawing or withholding life prolonging treatment -- Conjoined twins -- Child protection -- Refusal of medical or psychiatric examination under the Children Act -- Confidentiality and disclosure of information about abuse or neglect -- Summary - action in cases of child protection46 -- References -- 5: Confidentiality -- The ethos of confidentiality -- General principles -- What is confidential? -- Regulation -- The common law -- Data Protection Act 1998 -- Human Rights Act 1998 -- Health and Social Care Act 2001 -- Anonymous information -- Pseudonymised data -- Disclosures required by law -- Disclosure in connection with litigation -- Laws affecting all citizens -- Need for clarity in the law -- Summary - what is confidential? -- Consent for disclosure of information -- Information -- Choice -- Evidence: express or implied consent? -- When the patient cannot give consent -- Deceased persons -- Summary - consent -- Disclosures necessary to provide effective health care -- Implied consent for disclosure as part of the direct provision of health care -- Clinical audit -- Summary - disclosures necessary to provide effective care -- Disclosure for purposes associated with providing health care -- Disclosures under Section 60 of the Health and Social Care Act 2001 -- Social care -- Public health -- Research -- Teaching.

Financial audit.