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Found 56 results
  1. Event
    This course will offer an overview of the law relating to medical treatment decisions, both children and adults, and both for patients able to make a decision for themselves, and where best interests decisions must be made for those who cannot, and how to tell the difference. We will also look at how, and when, it may be necessary to involve the court to resolve disputes and – better – how to avoid disputes altogether. Decisions about medical treatment can be about life and death, such as withdrawal of treatment or (not) providing CPR. Or about quality of life, liberty and independence, which can be just as important. But the legal (and ethical) framework around these decisions is often misunderstood, leading to distress and disputes at the very worst of times, as we have seen in a few very high-profile cases. It can also cause uncertainty and doubt in clinicians, where the law is misunderstood as a stick to beat them with, rather than a shield to protect their reasonable decision-making. We will cover whether a patient should always get what they want, or does “doctor know best”? When a patient cannot make a decision for themselves, who gets to decide, and how should these decisions be made? What is the role of so-called “next of kin” (and did you know that there’s actually no such thing)? Can parents insist on treatment for a child when doctors think it futile? How are disputes in this context resolved and, better yet, how are they avoided? Throughout, we will talk in particular about the importance of good communication, and managing expectations, and how to ensure that clinicians are doing the right thing for the patient, as well as avoiding getting sued. Key learning objectives: To understand and apply in practice the fundamental legal framework around decisions about medical treatment, including: Rationing and resource allocation The limits of choice and autonomy The relationship between law and ethics The importance of good communication, and how to not get sued The law on consent Mental capacity and best interests decision for adults Decisions about children – Gillick competence, parental responsibility and disputes Restraint and deprivation of liberty Going to court Register
  2. Content Article
    The epidemic of workplace violence has prompted the use of harsh responses that include “behaviour contracts” (sometimes called “behavioural agreements”) by US healthcare organisations. The authors of this JAMA article look at how this approach can undermine a hospital’s commitment to providing evidence-based, patient-centred care and highlight other approaches to dealing with patient aggression and violence in healthcare settings.
  3. Content Article
    "Our #health system in the UK is in a mess. It has failed to modernise (by this I mean to become fully accountable to #patients and the public, and truly patient-led). Instead, the system has become more and more hierarchical, bureaucratic and crony ridden, mostly as a result of constant meddling and pointless reorganisations instigated by politicians. All political parties in government for the past 30 years have had a hand in this decline." This is my view? What is yours? A new Inquiry gives us all an opportunity to have our say. I am proud to have worked in and for the NHS for most of my working life; proud to have been trained in the #NHS and proud of the work being carried out by clinical teams today. Great work which has benefited patients, often not because of the leadership but despite of the leadership. I'm retired so I can say what I like. If I were working and said anything even vaguely like criticism, however constructive it was, I would be out of a job and my career would be blighted for life. I'm speaking from experience here, unfortunately. I urge everyone to respond to the consultation (link below). In your response think forensically and write it as a statement of truth. Acknowledge the successes and areas that have delivered safe and effective services. If you are being critical give examples and say if it is an opinion or back up what you say with evidence. If we work together across boundaries we can develop a truly patient-led NHS.
  4. Content Article
    Traditionally, recommendations regarding responding to medical errors focused mostly on whether to disclose mistakes to patients. Over time, empirical research, ethical analyses and stakeholder engagement began to inform expectations — which are now embodied in communication and resolution programmes (CRPs) — for how healthcare professionals and organisations should respond not just to errors but any time patients have been harmed by medical care (adverse events). CRPs require several steps: quickly detecting adverse events, communicating openly and empathetically with patients and families about the event, apologising and taking responsibility for errors, analysing events and redesigning processes to prevent recurrences, supporting patients and clinicians, and proactively working with patients toward reconciliation. In this modern ethical paradigm, any time harm occurs, clinicians and health care organisations are accountable for minimising suffering and promoting learning. However, implementing this ethical paradigm is challenging, especially when the harm was due to an error.
  5. Content Article
    The promise of diagnosing conditions early is an exciting one. But there are fears among some health professionals that more screening might not be entirely helpful. In this programme, the BBC's Health Correspondent Matthew Hill finds out whether screening programmes can really help us live both better and longer lives. He asks whether diagnosing conditions decades before they might affect us causes more harm than good. He also examines what lessons from the past could tell us about the current surge in screening and considers some of the dilemmas it might present us with.
  6. Content Article
    The Belmont Report was written by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Commission, created as a result of the National Research Act of 1974, was charged with identifying the basic ethical principles that should underlie the conduct of biomedical and behavioral research involving human subjects and developing guidelines to assure that such research is conducted in accordance with those principles. Informed by monthly discussions that spanned nearly four years and an intensive four days of deliberation in 1976, the Commission published the Belmont Report, which identifies basic ethical principles and guidelines that address ethical issues arising from the conduct of research with human subjects.
  7. Content Article
    Report from HSJ, in association with Allocate Software, on why patient safety should be the core business of healthcare.
  8. Content Article
    My last blog, "Forgotten heroes" – the sequel, built upon a very moving BBC Panorama programme Forgotten heroes of the Covid front line. The BBC documentary told the sad story of healthcare workers (HCWs) who had bravely and knowingly put themselves in harm's way to care for their patients during the darkest days of the pandemic. Many lost their lives, while many more were rendered so severely injured by the disease (Long Covid) that they were (and remain) unable to work and have been unceremoniously sacked by their NHS Health Trusts/Boards. The way that an organisation manages its activities is known as 'governance'. Good governance will lead to high standards of ethics, morality, care and compassion for the people who work within it and those who may be affected by its acts and omissions. Hence, when applied to a whole country, it is known as 'Government', its departments and agencies. In this blog, I propose a possible hypothetical scenario that may have led to the tragic situation revealed by the BBC documentary. I hope this will lead you to consider the standards of 'governance' that apply to the 'duty of care' which a Government owes to its HCWs during a pandemic and what, morally and ethically, should be done to support those "forgotten heroes" if the Government’s governance should be found to be severely lacking. But is the scenario I am asking you to imagine hypothetical or is it real? I shall leave that to your judgement – and that of the Covid-19 Public Inquiry. 
  9. Content Article
    Some of the same people that noted surgical masks were useless for airborne viruses also made decisions to limit the use of effective respirator masks: a decision that had devastating ramifications when the pandemic struck. In this article in the Byline Times, Josiah Mortimer delves deeper into a hub blog written by David Osborn: 'The pandemic – questions around Government governance' and questions the decisions made by the Government during the pandemic.
  10. News Article
    The government of Mexico City handed out nearly 200 000 “ivermectin based kits” last year to people who had tested positive for Covid-19, without telling them they were subjects in an experiment on the drug’s effectiveness. The results of that experiment were then written up by public officials in an article placed on popular US preprint server SocArXiv. It became one of site’s most viewed articles, claiming that ivermectin had reduced hospital admissions by 52-76%. But those officials have been under fire at home since SocArXiv withdrew the paper earlier this month, calling it “either very poor quality or else deliberately false and misleading.” Opposition deputies in Mexico City’s Congress demanded hearings and said they would bring legal action against the paper’s lead author, José Merino, head of the city’s Digital Agency for Public Innovation. Explaining the decision to withdraw the article—the first to be taken down by SocArXiv—the site’s steering committee wrote that it had responded “to a community groundswell beseeching us to act” in order “to prevent the paper from causing additional harm.” The committee wrote, “The paper is spreading misinformation, promoting an unproved medical treatment in the midst of a global pandemic. The paper is part of, and justification for, a government programme that unethically dispenses (or did dispense) unproven medication apparently without proper consent or appropriate ethical protections.” Read full story Source: BMJ, 22 February 2022
  11. News Article
    Women are being misled and manipulated about abortion by some crisis pregnancy advice centres in the UK, according to evidence from a BBC Panorama investigation. The centres operate outside the NHS and tend to be registered charities. Most say they don't refer women for abortions, but offer support and counselling for unplanned pregnancies. But the BBC's investigation reveals more than a third of these services give misleading medical information or unethical advice, and sometimes both. Pregnancy counselling is available through the NHS and regulated abortion providers, but searching online, Panorama identified 57 crisis pregnancy advice centres advertising. The BBC decided to investigate after hearing from women who had been to these centres. One said she had been "traumatised" and that the centre had tried to "manipulate" her into not having an abortion. Some 21 centres gave misleading medical information and/or unethical advice about abortion Seven centres said having a termination could lead to "post-abortion syndrome" - a mental health condition likened to post traumatic stress disorder, which is not recognised by the NHS. Eight centres linked abortion to infertility and problems carrying future pregnancies to term. Five centres linked abortion to an increased risk of breast cancer. Leading medic in the field of obstetrics, and director of an abortion provider, Dr Jonathan Lord, said women needed an "informed choice" which required "good quality unbiased information". Read full story Source: BBC News, 27 February 2023
  12. News Article
    A US government watchdog called for greater federal oversight of ethics boards that sign off on scientific studies, finding that for-profit companies have taken an outsize role in approving certain research and questioning whether financial motivations could put human subjects at risk. Federal regulations require that certain research on human subjects — including those testing the safety of new drugs — first get approval from a registered institutional research board. These boards, which are made up of at least five members and can include researchers and academics, are designed to make sure that a study poses as little risk as possible and that participants have enough information to give consent. While the majority of these boards are affiliated with universities, a small number have no affiliation with institutions conducting research. But according to a new report from the U.S. Government Accountability Office (GAO), these independent boards now account for the largest share of reviews of studies involving new drugs and biologics. The GAO found that federal agencies overseeing the ethics panels inspect relatively few of them and lack ways to evaluate how well they protect people participating in research. Read full story (paywalled) Source: The Washington Post, 16 February 2023
  13. Content Article
    Healthcare sector strikes are a relatively recent phenomenon, becoming notable only in the last half of the twentieth century. In this article, Spanish medical ethics expert Gonzalo Herranz, from the Bioethics Department at the University of Navarra, examines the ethical issues and legal implications associated with healthcare worker strikes, as well as looking at the moral duty to try and prevent strikes.
  14. Content Article
    This innovative, practical guide introduces researchers to the use of the video reflexive ethnography in health and health services research. This methodology has enjoyed increasing popularity among researchers internationally and has been inspired by developments across a range of disciplines: ethnography, visual and applied anthropology, medical sociology, health services research, medical and nursing education, adult education, community development, and qualitative research ethics.
  15. News Article
    Current scientific techniques are not yet safe or effective enough to be used to create gene-edited babies, an international committee says. The technology could one day prevent parents from passing on heritable diseases to children, but the committee says much more research is needed. The world's first gene-edited babies were born in China in November 2018. The scientist responsible was jailed, amid a fierce global backlash. The committee was set up in response. Gene-editing could potentially help avoid a range of heritable diseases by deleting or changing troublesome coding in embryos. But experts worry that modifying the genome of an embryo could cause unintended harm, not only to the individual but also future generations that inherit these same changes. It made several recommendations, including: Extensive conversations in society before a country decides whether to permit this type of gene-editing. If proven to be safe and effective, initial uses should be limited to serious, life-shortening diseases which result from the mutation of one or both copies of a single gene, such as cystic fibrosis. Rigorous checks at every stage of the process to make sure there are no unintended consequences, including biopsies and regular screening of embryos. Pregnancies and any resulting children to be followed up closely. An international scientific advisory panel should be established to constantly assess evidence on safety and effectiveness, allowing people to report concerns about any research that deviates from guidelines. Read full story Source: BBC News, 4 September 2020
  16. News Article
    Doctors have been reminded not to prioritise coronavirus patients at the expense of others in new ethical guidance backed by royal colleges. There are increasing concerns that patients are not getting treatment for serious problems, including strokes or heart attacks, because they are afraid to go to hospitals. The guidelines were drawn up by the Royal College of Physicians (RCP) amid worries that a shortage of ventilators and beds could force doctors to make difficult decisions on which patients get lifesaving treatment. Read full story (paywalled) Source: The Times, 2 April 2020
  17. Content Article
    In 2015 the Supreme Court judgement in the case of Montgomery v Lanarkshire Health Board created a significant change to the law in regard to gaining informed, or valid, consent. The case concerned Nadine Montgomery, a pregnant lady of small stature with diabetes who delivered her son vaginally in 2001. Her son experienced a hypoxic insult as a result of shoulder dystocia and consequently suffered cerebral palsy with severe disabilities. She successfully argued that had she been informed of the risk of shoulder dystocia she would have opted to have an elective caesarean section. This is part of NHS Education for Scotland's Advanced Practice Toolkit repository for credible and supportive resources.
  18. Content Article
    Two professionals who treated Jack Adcock before his death were convicted of gross negligence manslaughter, receiving 24-month suspended sentences. His nurse, Isabel Amaro, was erased from the nursing register; but after reviews in the High Court and Court of Appeal, his doctor, Hadiza Bawa-Garba, was merely suspended. Nathan Hodson explores the proposition that nurses are at greater risk of erasure than doctors after gross negligence manslaughter through a close reading of the guidance for medical and nursing tribunals informed by analysis from the High Court and Court of Appeal in the Bawa-Garba cases. 
  19. Content Article
    Catherine Villanueva Gardner, Professor of Women’s and Gender Studies and Philosophy at the University of Massachusetts Dartmouth, looks at the material effects on women with Long Covid.
  20. Content Article
    This book examines the concept of medical narcissism and how error disclosure to patients and families is often compromised by the health professional’s need to preserve his or her self-esteem at the cost of honouring the patient’s right to the unvarnished truth about what has happened. This ground-breaking book explores common psychological reactions of healthcare professionals to the commission of a serious harm-causing error and the variety of obstacles that can compromise ethically sound, truthful disclosure.
  21. Content Article
    This guidance from the General Medical Council sets out the how doctors should raise and act on concerns about patient care, dignity and safety. 
  22. Content Article
    This Clinical Audit Guide has been written to help community and hospital pharmacists prepare for and conduct clinical audits. To view this guidance you need to be a Royal Pharmaceutical Society member.
  23. Content Article
    This manual by the Healthcare Quality Improvement Partnership provides an overview of the basic clinical audit process for non-clinician members of a clinical audit team. Topics include: What is Clinical Audit? How to Set Objectives How to Select an Audit Sample Clinical Audit Confidentiality and Ethics Comparing Performance Against Criteria and Standards Writing an Audit Report Implementing Change and Action Plans
  24. Content Article
    This guide by the University Hospitals Bristol clinical audit team provides a brief summary of what clinical audit is, and what it isn't. It outlines the main stages of clinical audit and describes how it can be used, how to engage patients in the process and which staff members should be involved.
  25. Content Article
    Ethics in medical science have been borne out of practices that occurred during the second world war, with the Nuremberg code being set up to prevent unethical experimentation on humans from being carried out.  This was further supported by the Declaration of Helsinki that strengthened the protection of participants within medical research by setting out the stipulations that informed consent should be obtained before research. It ensured that data should be kept confidential so that medical research that ultimately requires input from human participants would be able to be carried out with minimal risk to the individual.  Lara Carballo continues the 'Why investigate' blog series with a cautionary tale of why within Human Factors it is necessary to ensure that ethics are in place before embarking on research.
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