Medical Ethics Today The BMA's handbook of ethics and law -- Contents -- List of statues and regulations -- Directives and conventions -- List of cases -- Where to find legal references online -- Medical Ethics Committee -- Acknowledgements -- Preface to the third edition -- Bridging the gap between theory and practice: the BMA's approach to medical ethics -- What is medical ethics? -- The framework of good practice -- The theoretical and philosophical background -- The BMA's approach -- A hypothetical case on refusal of life-prolonging treatment -- 1 The doctor-patient relationship -- General principles -- Changing expectations of the doctor-patient relationship -- Types of relationships in modern medicine -- Choice and duty -- Maintaining a balanced relationship -- Importance of good communication -- Trust and reciprocity -- Breakdown of the doctor-patient relationship -- Recognising responsibilities and boundaries -- Patients' responsibilities -- 2 Consent, choice and refusal: adults with capacity -- The nature and purpose of consent -- General principles -- Standards and good practice guidance -- The process of seeking consent -- The scope of consent -- Pressures on consent -- Refusal of treatment -- Are there limits to an individual's choices? -- 3 Treating adults who lack capacity -- Consent and the alternatives -- General principles -- Assessing an individual's decision-making capacity -- Research and innovative treatment involving adults lacking the capacity to consent -- Providing treatment to adults lacking capacity - England and Wales -- Providing treatment to adults lacking capacity - Scotland -- Providing treatment to adults lacking capacity - Northern Ireland -- 4 Children and young people -- Combining respect for autonomy with best interests -- Has human rights legislation changed things for children? -- Scope of this chapter.

General principles -- Emergencies -- Consent and refusal by competent young people -- Consent and refusal by people with parental responsibility -- The courts -- Refusal of blood products by Jehovah's Witnesses -- Providing treatment against a child or young person's wishes -- Cultural practices -- Conjoined twins -- Child protection -- 5 Confidentiality -- The duty of confidentiality -- General principles -- What data are confidential? -- Contacting patients -- Implied consent for disclosure of information as part of the direct provision of healthcare -- The law -- GMC guidance -- NHS Care Record Guarantee -- Anonymous information -- Pseudonymised data -- Statutory and legal disclosures -- Statutory restrictions on disclosure -- Disclosures in the public interest -- Secondary uses of patient information -- Adults who lack capacity to consent -- Children and young people -- Deceased patients -- 6 Health records -- The importance of health information -- Records and record keeping -- General principles -- Content of health records -- Omitting information from health records -- Removing information from health records -- Tagging records -- Electronic records -- Security -- Transmission -- Recordings -- Ownership -- Retention of records -- Disposal -- Private records -- Access to health records -- Access to medical reports -- Looking towards the future -- 7 Contraception, abortion and birth -- The nature of reproductive ethics -- General principles -- Autonomy, rights and duties -- Contraception -- Sterilisation -- Abortion -- Prenatal screening and diagnosis -- Pregnancy -- Childbirth -- Reproductive ethics: a continuing dilemma -- 8 Assisted reproduction -- New reproductive technologies, new dilemmas? -- General principles -- Regulation of assisted reproduction -- Monitoring the outcome of fertility treatment.

What, if any duties, are owed to 'hypothetical' people? -- Access to treatment -- Consent to the storage and use of gametes and embryos -- Use of donated gametes or embryos -- Preimplantation genetic testing -- Sex selection -- Surrogacy -- Seeking treatment in other countries -- A law for the twenty-first century? -- 9 Genetics -- The impact of developments in genetics -- General principles -- Does genetics raise different ethical issues? -- Genetic testing of those with a family history of genetic disease -- Consent for genetic testing -- Confidentiality within families -- Diagnostic testing -- Carrier testing for recessive or X-linked disorders -- Predictive or presymptomatic testing -- Susceptibility testing -- Incidental findings -- Population genetic screening -- Genetic tests supplied direct to consumers -- Controversial uses of genetic information -- Other developments -- Law and regulation -- 10 Caring for patients at the end of life -- Issues covered in this chapter -- General principles -- Communication when patients are approaching death -- Diagnosing the dying patient and preparing for death -- Decisions to withhold or withdraw life-prolonging treatment -- Cardio-pulmonary resuscitation -- Caring for children and young people -- After the patient's death -- Training -- 11 Euthanasia and physician assisted suicide -- General principles -- Terms and definitions -- Public and professional views on assisted dying -- The law -- Moral, legal and pragmatic arguments -- 12 Responsibilities after a patient's death -- Scope of this chapter -- General principles -- Terminology -- Society's and individuals' attitudes to deceased people -- The impetus for law reform -- Duties and responsibilities after death -- Confidentiality after death -- Certifying and confirming death -- Post-mortem examinations -- Organ and tissue transplantation.

Organ and tissue donation for research and teaching -- Anatomical examination -- Use of bodies or body parts for public display -- Use of skeletons for private study -- Testing for communicable diseases -- Post-mortem DNA testing -- Practising procedures on newly deceased people -- Dealing with unusual requests -- Ownership and trade in human bodies, body parts and tissue -- The law -- 13 Prescribing and administering medication -- The challenges and dilemmas -- General principles -- Responsibility for prescribing -- Providing information to patients about medication -- Prescribing for different patient groups -- Pressure from patients -- Pressure from employers -- Clinical freedom and official guidance -- Conflicts of interest in prescribing matters -- Shared prescribing -- Referrals and discharge summaries -- Doctors who prescribe complementary and alternative medicine -- Prescribing placebos -- Controlled drugs -- Self-prescribing and prescribing for family members -- Prescribing at a distance -- Drug administration -- Reporting adverse drug reactions -- Generic prescribing -- Supply of drugs into the UK -- Pharmacogenetics -- 14 Research and innovative treatment -- Definitions -- General principles -- People who cannot consent to research or innovative therapy -- Confidentiality -- Research governance -- Law and regulation -- Specialised areas of research -- Fraud and misconduct in research and innovative treatment -- Summary -- 15 Emergency situations -- General principles -- Consent and refusal -- Confidentiality -- Duties to families -- Treating the victims or perpetrators of crime or abuse -- Recognising skill and competence levels -- Emergency care outside healthcare establishments -- 16 Doctors with dual obligations -- When do dual obligations arise? -- General principles -- Providing reports for third parties.

Medical reports for insurance -- Expert witnesses -- Refereeing firearms licences -- Doctors examining asylum seekers -- Pre-employment reports and testing -- Occupational health physicians -- Doctors in the armed forces -- Sports doctors -- Media doctors -- Doctors with business interests -- 17 Providing treatment and care in detention settings -- Doctors' duties in detention settings -- General principles -- General issues of consent, confidentiality and choice within detention settings -- Practical issues common to various detention settings -- Healthcare in prisons -- Facilities accommodating young adult offenders, children and young people -- Immigration removal centres (IRCs) -- Police stations and forensic physicians -- 18 Education and training -- The ethical practice of medicine -- General principles -- Medical education: the changing landscape -- The teaching of medical ethics and law -- Ethical issues raised in teaching medical students -- Particular dilemmas of medical students -- The teaching of ethics and the ethics of teaching -- 19 Teamwork, shared care, referral and delegation -- General principles -- Working in multi-disciplinary teams -- Coordination and information sharing among care providers -- Delegation, referral and second opinions -- Administrative issues in working with others -- 20 Public health dimensions of medical practice -- General principles -- The public health perspective -- Legal aspects of public health -- Public health threats - tackling diseases, changing lives -- Public health tools -- Commissioning services - tackling inequities -- Processing health data for public health management -- Looking towards the future -- 21 Reducing risk, clinical error and poor performance -- The duty to protect patients -- General principles -- Standard setting -- Duties of doctors to monitor quality and performance.

Poorly performing systems and poor management.