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Legal and Ethical aspects of medicine management.                                                    Agweddau Cyfreithiol a Moesegol ar reoli meddyginiaeth.           

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Legal and Ethical aspects of medicine management.                                                    Agweddau Cyfreithiol a Moesegol ar reoli meddyginiaeth.           

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Aims of the session:                  Nodau’r sesiwn:    

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Aims of the session:                  Nodau’r sesiwn:    

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1. Explore some of the legal aspects related to medicines management.
2. Explore some of the ethical considerations related to Medicine Management and healthcare practice generally.

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Why is this relevant:                         Pam mae hyn yn berthnasol: 

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Why is this relevant:                         Pam mae hyn yn berthnasol: 

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Often patients find themselves in a relationship with a nurse or other medical professional at a very vulnerable and powerless time in their lives.
often in our role there is a power imbalance.
With power comes responsibility.
Responsibility to act ethically and legally.

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LEGISLATION:                                    DEDDFWRIAETH:         

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LEGISLATION:                                    DEDDFWRIAETH:         

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The belief that everyone, by virtue of her or his humanity, is entitled to certain human rights is fairly new. Its roots, however, lie in earlier tradition and documents of many cultures; it took the catalyst of World War II to propel human rights onto the global stage and into the global conscience.

Throughout much of history, people acquired rights and responsibilities through their membership in a group – a family, indigenous nation, religion, class, community, or state. Most societies have had traditions similar to the "golden rule" of "Do unto others as you would have them do unto you." The Hindu Vedas, the Babylonian Code of Hammurabi, the Bible, the Quran (Koran), and the Analects of Confucius are five of the oldest written sources which address questions of people's duties, rights, and responsibilities. In addition, the Inca and Aztec codes of conduct and justice and an Iroquois Constitution were Native American sources that existed well before the 18th century. In fact, all societies, whether in oral or written tradition, have had systems of propriety and justice as well as ways of tending to the health and welfare of their members.

Precursors of 20th Century Human Rights Documents

Documents asserting individual rights, such the Magna Carta (1215), the English Bill of Rights (1689), the French Declaration on the Rights of Man and Citizen (1789), and the US Constitution and Bill of Rights (1791) are the written precursors to many of today's human rights documents. Yet many of these documents, when originally translated into policy, excluded women, people of color, and members of certain social, religious, economic, and political groups. Nevertheless, oppressed people throughout the world have drawn on the principles these documents express to support revolutions that assert the right to self-determination.

Contemporary international human rights law and the establishment of the United Nations (UN) have important historical antecedents. Efforts in the 19th century to prohibit the slave trade and to limit the horrors of war are prime examples. In 1919, countries established the International Labor Organization (ILO) to oversee treaties protecting workers with respect to their rights, including their health and safety. Concern over the protection of certain minority groups was raised by the League of Nations at the end of the First World War. However, this organization for international peace and cooperation, created by the victorious European allies, never achieved its goals. The League floundered because the United States refused to join and because the League failed to prevent Japan's invasion of China and Manchuria (1931) and Italy's attack on Ethiopia (1935). It finally died with the onset of the Second World War (1939).

The Birth of the United Nations

The idea of human rights emerged stronger after World War II. The extermination by Nazi Germany of over six million Jews, Sinti and Romani (gypsies), homosexuals, and persons with disabilities horrified the world. Trials were held in Nuremberg and Tokyo after World War II, and officials from the defeated countries were punished for committing war crimes, "crimes against peace," and "crimes against humanity."

Governments then committed themselves to establishing the United Nations, with the primary goal of bolstering international peace and preventing conflict. People wanted to ensure that never again would anyone be unjustly denied life, freedom, food, shelter, and nationality. The essence of these emerging human rights principles was captured in President Franklin Delano Roosevelt's 1941 State of the Union Address when he spoke of a world founded on four essential freedoms: freedom of speech and religion and freedom from want and fear (See Using Human Rights Here & Now). The calls came from across the globe for human rights standards to protect citizens from abuses by their governments, standards against which nations could be held accountable for the treatment of those living within their borders. These voices played a critical role in the San Francisco meeting that drafted theUnited Nations Charter in 1945.

The Universal Declaration of Human Rights

of the United Nations pledged to promote respect for the human rights of all. To advance this goal, the UN established a Commission on Human Rights and charged it with the task of drafting a document spelling out the meaning of the fundamental rights and freedoms proclaimed in the Charter. The Commission, guided by Eleanor Roosevelt's forceful leadership, captured the world's attention.

On December 10, 1948, the Universal Declaration of Human Rights (UDHR) was adopted by the 56 members of the United Nations. The vote was unanimous, although eight nations chose to abstain.

The UDHR, commonly referred to as the international Magna Carta, extended the revolution in international law ushered in by the United Nations Charter – namely, that how a government treats its own citizens is now a matter of legitimate international concern, and not simply a domestic issue. It claims that all rights are interdependent andindivisible. Its Preamble eloquently asserts that:

[R]ecognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice, and peace in the world.

The influence of the UDHR has been substantial. Its principles have been incorporated into the constitutions of most of the more than 185 nations now in the UN. Although a declaration is not a legally binding document, the Universal Declaration has achieved the status ofcustomary international law because people regard it "as a common standard of achievement for all people and all nations."

The Human Rights Covenants

With the goal of establishing mechanisms for enforcing the UDHR, the UN Commission on Human Rights proceeded to draft two treaties: the International Covenant on Civil and Political Rights (ICCPR) and itsoptionalProtocol and the International Covenant on Economic, Social and Cultural Rights (ICESCR). Together with the Universal Declaration, they are commonly referred to as theInternational Bill of Human Rights. The ICCPR focuses on such issues as the right to life, freedom of speech, religion, and voting. The ICESCR focuses on such issues as food, education, health, and shelter. Bothcovenants trumpet the extension of rights to all persons and prohibit discrimination.

As of 1997, over 130 nations have ratified these covenants. The United States, however, has ratified only the ICCPR, and even that with many reservations, or formal exceptions, to its full compliance. (See From Concept to Convention: How Human Rights Law Evolves).

Subsequent Human Rights Documents

In addition to the covenants in the International Bill of Human Rights, the United Nations has adopted more than 20 principal treaties further elaborating human rights. These include conventions to prevent and prohibit specific abuses like torture and genocide and to protect especially vulnerable populations, such as refugees (Convention Relating to the Status of Refugees, 1951), women (Convention on the Elimination of All Forms of Discrimination against Women, 1979), and children (Convention on the Rights of the Child, 1989). As of 1997 the United States has ratified only these conventions:

The Convention on the Elimination of All Forms of Racial Discrimination

The Convention on the Prevention and Punishment of the Crime of Genocide

The Convention on the Political Rights of Women

The Slavery Convention of 1926

The Convention against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment

In Europe, the Americas, and Africa, regional documents for the protection and promotion of human rights extend the International Bill of Human Rights. For example, African states have created their own Charter of Human and People's Rights (1981), and Muslim states have created the Cairo Declaration on Human Rights in Islam (1990). The dramatic changes in Eastern Europe, Africa, and Latin America since 1989 have powerfully demonstrated a surge in demand for respect of human rights. Popular movements in China, Korea, and other Asian nations reveal a similar commitment to these principles.

The Role of Nongovernmental Organizations

Globally the champions of human rights have most often been citizens, not government officials. In particular, nongovernmental organizations (NGOs) have played a cardinal role in focusing the international community on human rights issues. For example, NGO activities surrounding the 1995 United Nations Fourth World Conference on Women in Beijing, China, drew unprecedented attention to serious violations of the human rights of women. NGOs such as Amnesty International, the Antislavery Society, the International Commission of Jurists, the International Working Group on Indigenous Affairs, Human Rights Watch, Minnesota Advocates for Human Rights, and Survivors International monitor the actions of governments and pressure them to act according to human rights principles.

Government officials who understand the human rights framework can also effect far reaching change for freedom. Many United States Presidents such as Abraham Lincoln, Franklin Roosevelt, Lyndon B. Johnson, and Jimmy Carter have taken strong stands for human rights. In other countries leaders like Nelson Mandela and Vaclev Havel have brought about great changes under the banner of human rights.

Human rights is an idea whose time has come. The Universal Declaration of Human Rights is a call to freedom and justice for people throughout the world. Every day governments that violate the rights of their citizens are challenged and called to task. Every day human beings worldwide mobilize and confront injustice and inhumanity. Like drops of water falling on a rock, they wear down the forces of oppression and move the world closer to achieving the principles expressed in the Universal Declaration of Human Rights.

Source: Adapted from David Shiman, Teaching Human Rights, (Denver: Center for Teaching International Relations Publications, U of Denver, 1993): 6-7.

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The belief that everyone, by virtue of her or his humanity, is entitled to certain human rights is fairly new. Its roots, however, lie in earlier tradition and documents of many cultures; it took the catalyst of World War II to propel human rights onto the global stage and into the global conscience.

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In The UK, Human rights are enshrined in the Human Rights act 1998, which has its basis in the European convention on human rights (ECHR). All public authorities (including NHS) have a legal duty to be compatible.

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For medicine management and prescribing 3 articles of the ECHR appear relevant, article 2,3 and 8.

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1. Everyone’s right to life shall be protected by law. No one shall be deprived of his life intentionally save in the execution of a sentence of a court following his conviction of a crime for which the penalty is provided by law.

2. Deprivation of life shall not be regarded as inflicted in contravention of this Article when it results from the use of force which is no more than absolutely necessary:

in defence of any person from unlawful violence

in order to effect a lawful arrest or to prevent the escape of a person lawfully detained, and

in action lawfully taken for the purpose of quelling a riot or insurrection.

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Most obvious example of the application of Article 2 would be where a member of staff deliberately kills a patient, such as Harold Shipman cases.
But article 2 extends beyond, as it is not necessary for the victim to die to be in breach of article 2, it is enough to put the person at material risk.

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Article 3 - the right not to be tortured or treated in an inhuman or degrading way.
Although Article 3 is an absolute right and is stated in very simple terms, the problem is that its interpretation can vary.
In practice most are associated with complaints related to conditions of detention, seclusion, forced medication and control and restraint.

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Article 8: Right to privacy

1. Everyone has the right to respect for his private and family life, his home and his correspondence.

2. There shall be no interference by a public authority with the exercise of this right except such as is in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others.

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Could a bed bath performed by a different gender be considered a breach of Article 8? What about male and female prisons when you have a transgender person.
Can you think of any examples where Healthcare may infringe Article 8?

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This Important Act, with which nurses must comply, deals with the prescribing, supply, storage and administration of medicines, and defines three categories of medicines:
1 Prescription only medicines.
2 Pharmacy Medicines
3 General sales list.

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Purpose of the Act is to prevent the non medical use of certain medicines or drugs.
Bans the possession, supply and manufacture of controlled drugs. (unless licensed to do so)
It is an offence to use or allow usage on premises.
Three different classes with different severity of punishment. A, B and C class. Class A having the greatest penalty.
also includes the the classification of controlled drugs into different schedules. Schedule 1 is the most stringent and drugs such as LSD and Cannabis needs special home office licence to be used (generally for research).

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Mental Health Act Brief Overview for Students

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ETHICS:                                                                MOESEG:       

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ETHICS:                                                                MOESEG:       

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what are ethics?
Is concerned with human action what is right and wrong.

Can also be viewed as the basis for choosing what kind of professional life we believe we should lead.

Ethical problems are said to arise when moral principles conflict in a given situation, Eg dementia patient being told her husband has died causing distress over and over again.

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Medical Ethics 2 - The Four Principles - Prima Facie Autonomy, Beneficence, NonMaleficence & Justice

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Patients autonomy is always respected and in most cases patients listen to the doctors and nurses and accept their expertise and adhere to the suggestions for treatment made.
However When a patient with capacity disagrees with the treatment options presented, how much additional information and possible 'persuasion' should a clinician provide? How would this conflict with the principle of beneficence? (medical paternalism)

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Utilitarianism proposes that a morally correct decision is the one that has the most likelihood of a favourable outcome and the greatest pleasure for the person.
In that case would you be justified telling a lie to a patient if it involved providing bad news, as otherwise you will upset the individual. any thoughts?

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HCP must work within the law, national guidelines, standards and policies of various regulatory and registration bodies such as the NMC ,MHRA, NICE,RFS among others.

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The legal and ethical issues in healthcare

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The legal and ethical issues in healthcare

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Our care sector is governed by multitudes of rules, regulations, laws, and ethical standards. Which are designed to protect patients when making decisions about their healthcare. In addition, governing bodies set out the responsibilities of healthcare professionals.

Ethical issues -

1) Accountable Care Organisations (ACOs)

2) False claims and whistle-blower lawsuits

3) Malpractice within the care sector

4) Patient confidentiality

5) Informed consent

6) Assisted Suicide (PAS) and euthanasia

(These to pinpoint a few).

Overall, patients, families, and healthcare professionals face ethical and legal decisions daily, and other matters that arise in the healthcare industry.

References

Dam, D. (2019). St.Patrick’s College London. StPatrick. https://www.st-patricks.ac.uk/blog/posts/2019/october/an-overview-of-the-legal-and-ethical-issues-in-healthcare/

Published by - J.Bond