Best Interests: From 1 Different Sources
a legal and ethical standard in medical care and treatment. A doctor has both an ethical and a legal obligation to maximize a patient’s welfare or wellbeing. When cases have gone to court, the judiciary has been clear that the concept of best interests extends beyond the purely medical. The principle of *autonomy requires that a patient with *capacity is in the best position to determine what is in his or her best interests. Where a patient lacks capacity, health-care professionals must act in his or her best interests. Under the Mental Capacity Act 2005, a doctor must take account of the patient’s wishes and try to determine what he or she would have wanted, possibly with reference to an advance directive (see advance directive, decision, or statement), an appointed proxy, or an *independent mental capacity advocacy service. The interests of children are especially important, and doctors must be particularly vigilant where there is a potential conflict of interests, as when reporting cases of suspected child abuse or recruiting for paediatric research.
Hypomania is a modest manifestation of mania (see under MENTAL ILLNESS). The individual is elated to an extent that he or she may make unwise decisions, and social behaviour may become animated and uninhibited. To the casual observer individuals may, however, seem normal. Treatment is advisable to prevent them from harming their own or their family’s interests. Treatment is as for mania.... hypomania
A trained staff member who is responsible for leisure activities in a health care programme. Activity coordinators develop programmes for people based on individual abilities and interests.... activity coordinator
Services which seek to ensure that a person’s views are heard and his or her interests represented.... advocacy scheme
A lifelong personality disorder, evident from childhood and regarded as a mild form of AUTISM. Persons with the syndrome tend to have great di?culty with personal relationships. They tend to take what is said to them as literal fact and have great di?culty in understanding irony, metaphors or even jokes. They appear shy with a distant and aloof character, emotional rigidity and inability to adapt to new situations. They are often mocked and ill-treated at school by their fellows because they appear unusual. Many people with Asperger’s seem to take refuge in intense interests or hobbies, often conducted to an obsessional degree. Many become skilled in mathematics and particularly information technology. Frustration with the outside world which is so hard to comprehend may provoke aggressive outbursts when stressed.... asperger’s syndrome
Most blows to the head cause no loss of consciousness and no brain injury. If someone is knocked out for a minute or two, there has been a brief disturbance of the brain cells (concussion); usually there are no after-effects. Most patients so affected leave hospital within 1–3 days, have no organic signs, and recover and return quickly to work without further complaints.
Severe head injuries cause unconsciousness for hours or many days, followed by loss of memory before and after that period of unconsciousness. The skull may be fractured; there may be ?ts in the ?rst week; and there may develop a blood clot in the brain (intracerebral haematoma) or within the membranes covering the brain (extradural and subdural haematomata). These clots compress the brain, and the pressure inside the skull – intracranial pressure – rises with urgent, life-threatening consequences. They are identi?ed by neurologists and neurosurgeons, con?rmed by brain scans (see COMPUTED TOMOGRAPHY; MRI), and require urgent surgical removal. Recovery may be complete, or in very severe cases can be marred by physical disabilities, EPILEPSY, and by changes in intelligence, rational judgement and behaviour. Symptoms generally improve in the ?rst two years.
A minority of those with minor head injuries have complaints and disabilities which seem disproportionate to the injury sustained. Referred to as the post-traumatic syndrome, this is not a diagnostic entity. The complaints are headaches, forgetfulness, irritability, slowness, poor concentration, fatigue, dizziness (usually not vertigo), intolerance of alcohol, light and noise, loss of interests and initiative, DEPRESSION, anxiety, and impaired LIBIDO. Reassurance and return to light work help these symptoms to disappear, in most cases within three months. Psychological illness and unresolved compensation-claims feature in many with implacable complaints.
People who have had brain injuries, and their relatives, can obtain help and advice from Headwat and from www.neuro.pmr.vcu.edu and www.biausa.org... brain injuries
Relating to, or founded upon a trust or confidence. A fiduciary relationship exists where an individual or organization has an explicit or implicit obligation to act on behalf of another person’s or organization’s interests in matters which affect the other person or organization.... fiduciary
An independent agency recently set up by the UK government. The aim is for the agency to protect consumers’ interests in every aspect of food safety and nutrition. The agency advises ministers and the food industry, conducts research and surveillance, and monitors enforcement of food safety and hygiene laws.... food standards agency
Adoption was relatively uncommon until World War II, with only 6,000 adoption orders annually in the UK. This peaked at nearly 25,000 in 1968 as adoption became more socially acceptable and the numbers of babies born to lone mothers rose in a climate hostile to single parenthood.
Adoption declined as the availability of babies fell with the introduction of the Abortion Act 1968, improving contraceptive services and increasing acceptability of single parenthood.
However, with 10 per cent of couples suffering infertility, the demand continued, leading to the adoption of those previously perceived as di?cult to place – i.e. physically, intellectually and/or emotionally disabled children and adolescents, those with terminal illness, and children of ethnic-minority groups.
Recent controversies regarding homosexual couples as adoptive parents, adoption of children with or at high risk of HIV/AIDS, transcultural adoption, and the increasing use of intercountry adoption to ful?l the needs of childless couples have provoked urgent consideration of the ethical dilemmas of adoption and its consequences for the children, their adoptive and birth families and society generally.
Detailed statistics have been unavailable since 1984 but in general there has been a downward trend with relatively more older children being placed. Detailed reasons for adoption (i.e. interfamily, step-parent, intercountry, etc.) are not available but approximately one-third are adopted from local-authority care.
In the UK all adoptions (including interfamily and step-parent adoption) must take place through a registered adoption agency which may be local-authority-based or provided by a registered voluntary agency. All local authorities must act as agencies, the voluntary agencies often providing specialist services to promote and support the adoption of more di?cult-to-place children. Occasionally an adoption allowance will be awarded.
Adoption orders cannot be granted until a child has resided with its proposed adopters for 13 weeks. In the case of newborn infants the mother cannot give formal consent to placement until the baby is six weeks old, although informal arrangements can be made before this time.
In the UK the concept of responsibility of birth parents to their children and their rights to continued involvement after adoption are acknowledged by the Children Act 1989. However, in all discussions the child’s interests remain paramount. The Act also recognises adopted children’s need to have information regarding their origins.
BAAF – British Agencies for Adoption and Fostering – is the national organisation of adoptive agencies, both local authority and voluntary sector. The organisation promotes and provides training service, development and research; has several specialist professional subgroups (i.e. medical, legal, etc.); and produces a quarterly journal.
Adoption UK is an e?ective national support network of adoptive parents who o?er free information, a ‘listening ear’ and, to members, a quarterly newsletter.
National Organisation for Counselling Adoptees and their Parents (NORCAP) is concerned with adopted children and birth parents who wish to make contact.
The Registrar General operates an Adoption Contact Register for adopted persons and anyone related to that person by blood, half-blood or marriage. Information can be obtained from the O?ce of Population Censuses and Surveys. For the addresses of these organisations, see Appendix 2.... child adoption
An o?cial, responsible to the United Kingdom’s parliament, appointed to protect the interests of National Health Service patients in matters concerning the administration of the health service and the delivery of health care (excluding clinical judgements). Known colloquially as the health ombudsman, the Commissioner presents regular reports on the complaints dealt with.... health service commissioner
An oath once (but no longer) taken by doctors on quali?cation, setting out the moral precepts of their profession and binding them to a code of behaviour and practice aimed at protecting the interests of their patients. The oath is named after HIPPOCRATES (460–377 BC), the Greek ‘father of medicine’. Almost half of British medical students and 98 per cent of American ones make a ceremonial commitment to assume the responsibilities and obligations of the medical profession, but not by reciting this oath.... hippocratic oath
Within most cultures, care of the sick is seen as entailing special duties, codi?ed as a set of moral standards governing professional practice. Although these duties have been stated and interpreted in di?ering ways, a common factor is the awareness of an imbalance of power between doctor and patient and an acknowledgement of the vulnerability of the sick person. A function of medical ethics is to counteract this inevitable power imbalance by encouraging doctors to act in the best interests of their patients, refrain from taking advantage of those in their care, and use their skills in a manner which preserves the honour of their profession. It has always been accepted, however, that doctors cannot use their knowledge indiscriminately to ful?l patients’ wishes. The deliberate ending of life, for example, even at a patient’s request, has usually been seen as alien to the shared values inherent in medical ethics. It is, however, symptomatic of changing concepts of ethics and of the growing power of patient choice that legal challenges have been mounted in several countries to the prohibition of EUTHANASIA. Thus ethics can be seen as regulating individual doctor-patient relationships, integrating doctors within a moral community of their professional peers and re?ecting societal demands for change.
Medical ethics are embedded in cultural values which evolve. Acceptance of abortion within well-de?ned legal parameters in some jurisdictions is an example of how society in?uences the way in which perceptions about ethical obligations change. Because they are often linked to the moral views predominating in society, medical ethics cannot be seen as embodying uniform standards independent of cultural context. Some countries which permit capital punishment or female genital mutilation (FGM – see CIRCUMCISION), for example, expect doctors to carry out such procedures. Some doctors would argue that their ethical obligation to minimise pain and suffering obliges them to comply, whereas others would deem their ethical obligations to be the complete opposite. The medical community attempts to address such variations by establish-ing globally applicable ethical principles through debate within bodies such as the World Medical Association (WMA) or World Psychiatric Association (WPA). Norm-setting bodies increasingly re?ect accepted concepts of human rights and patient rights within professional ethical codes.
Practical changes within society may affect the perceived balance of power within the doctor-patient relationship, and therefore have an impact on ethics. In developed societies, for example, patients are increasingly well informed about treatment options: media such as the Internet provide them with access to specialised knowledge. Social measures such as a well-established complaints system, procedures for legal redress, and guarantees of rights such as those set out in the NHS’s Patient’s Charter appear to reduce the perceived imbalance in the relationship. Law as well as ethics emphasises the importance of informed patient consent and the often legally binding nature of informed patient refusal of treatment. Ethics re?ect the changing relationship by emphasising skills such as e?ective communication and generation of mutual trust within a doctor-patient partnership.
A widely known modern code is the WMA’s International Code of Medical Ethics which seeks to provide a modern restatement of the Hippocratic principles.
Traditionally, ethical codes have sought to establish absolutist positions. The WMA code, for example, imposes an apparently absolute duty of con?dentiality which extends beyond the patient’s death. Increasingly, however, ethics are perceived as a tool for making morally appropriate decisions in a sphere where there is rarely one ‘right’ answer. Many factors – such as current emphasis on autonomy and the individual values of patients; awareness of social and cultural diversity; and the phenomenal advance of new technology which has blurred some moral distinctions about what constitutes a ‘person’ – have contributed to the perception that ethical dilemmas have to be resolved on a case-by-case basis.
An approach adopted by American ethicists has been moral analysis of cases using four fundamental principles: autonomy, bene?cence, non-male?cence and justice. The ‘four principles’ provide a useful framework within which ethical dilemmas can be teased out, but they are criticised for their apparent simplicity in the face of complex problems and for the fact that the moral imperatives implicit in each principle often con?ict with some or all of the other three. As with any other approach to problem-solving, the ‘four principles’ require interpretation. Enduring ethical precepts such as the obligation to bene?t patients and avoid harm (bene?cence and non-male?cence) may be differently interpreted in cases where prolongation of life is contrary to a patient’s wishes or where sentience has been irrevocably lost. In such cases, treatment may be seen as constituting a ‘harm’ rather than a ‘bene?t’.
The importance accorded to ethics in daily practice has undergone considerable development in the latter half of the 20th century. From being seen mainly as a set of values passed on from experienced practitioners to their students at the bedside, medical ethics have increasingly become the domain of lawyers, academic philosophers and professional ethicists, although the role of experienced practitioners is still considered central. In the UK, law and medical ethics increasingly interact. Judges resolve cases on the basis of established medical ethical guidance, and new ethical guidance draws in turn on common-law judgements in individual cases. The rapid increase in specialised journals, conferences and postgraduate courses focused on ethics is testimony to the ever-increasing emphasis accorded to this area of study. Multidisciplinary practice has stimulated the growth of the new discipline of ‘health-care ethics’ which seeks to provide uniformity across long-established professional boundaries. The trend is to set common standards for a range of health professionals and others who may have a duty of care, such as hospital chaplains and ancillary workers. Since a primary function of ethics is to ?nd reasonable answers in situations where di?erent interests or priorities con?ict, managers and health-care purchasers are increasingly seen as potential partners in the e?ort to establish a common approach. Widely accepted ethical values are increasingly applied to the previously unacknowledged dilemmas of rationing scarce resources.
In modern debate about ethics, two important trends can be identi?ed. As a result of the increasingly high pro?le accorded to applied ethics, there is a trend for professions not previously subject to widely agreed standards of behaviour to adopt codes of ethical practice. Business ethics or the ethics of management are comparatively new. At the same time, there is some debate about whether professionals, such as doctors, traditionally subject to special ethical duties, should be seen as simply doing a job for payment like any other worker. As some doctors perceive their power and prestige eroded by health-care managers deciding on how and when to ration care and pressure for patients to exercise autonomy about treatment decisions, it is sometimes argued that realistic limits must be set on medical obligations. A logical implication of patient choice and rejection of medical paternalism would appear to be a concomitant reduction in the freedom of doctors to carry out their own ethical obligations. The concept of conscientious objection, incorporated to some extent in law (e.g. in relation to abortion) ensures that doctors are not obliged to act contrary to their own personal or professional values.... ethics
This term is used to de?ne the process of learning and knowledge-acquisition in the study of medicine. It also encompasses the expertise required to develop education and training for students and learners in all aspects of medical health care. Studies for undergraduate students, postgraduate students and individual health-care practitioners, from the initial stages to the ongoing development of a career in medicine or associated health ?elds, are also included in medical education. The word ‘pedagogy’ is sometimes applied to this process.
A range of research investigations has developed within medical education. These apply to course monitoring, audit, development and validation, assessment methodologies and the application of educationally appropriate principles at undergraduate and postgraduate levels. Research is undertaken by medical educationalists whose backgrounds include teaching, social sciences and medicine and related health-care specialties, and who will hold a medical or general educational diploma, degree or other appropriate postgraduate quali?cation.
Development and validation for all courses are an important part of continuing accreditation processes. The relatively conservative courses at both undergraduate and postgraduate levels, including diplomas and postgraduate quali?cations awarded by the specialist medical royal colleges (responsible for standards of specialist education) and universities, have undergone a range of reassessment and rede?nition driven by the changing needs of the individual practitioner in the last decade. The stimuli to change aspects of medical training have come from the government through the former Chief Medical O?cer, Sir Kenneth Calman, and the introduction of new approaches to specialist training (the Calman programme), from the GENERAL MEDICAL COUNCIL (GMC) and its document Tomorrow’s Doctors, as well as from the profession itself through the activities of the British Medical Association and the medical royal colleges. The evolving expectations of the public in their perception of the requirements of a doctor, and changes in education of other groups of health professionals, have also led to pressures for changes.
Consequently, many new departments and units devoted to medical education within university medical schools, royal colleges and elsewhere within higher education have been established. These developments have built upon practice developed elsewhere in the world, particularly in North America, Australia and some European countries. Undergraduate education has seen application of new educational methods, including Problem-Based Learning (PBL) in Liverpool, Glasgow and Manchester; clinical and communications skills teaching; early patient contact; and the extensive adoption of Internet (World Wide Web) support and Computer-Aided Learning (CAL). In postgraduate education – driven by European directives and practices, changes in specialist training and the needs of community medicine – new courses have developed around the membership and fellowship examinations for the royal colleges. Examples of these changes driven by medical education expertise include the STEP course for the Royal College of Surgeons of England, and distance-learning courses for diplomas in primary care and rheumatology, as well as examples of good practice as adopted by the Royal College of General Practitioners.
Continuing Professional Development (CPD) and Continuing Medical Education (CME) are also important aspects of medical education now being developed in the United Kingdom, and are evolving to meet the needs of individuals at all stages of their careers.
Bodies closely involved in medical educational developments and their review include the General Medical Council, SCOPME (the Standing Committee on Postgraduate Medical Education), all the medical royal colleges and medical schools, and the British Medical Association through its Board of Medical Education. The National Health Service (NHS) is also involved in education and is a key to facilitation of CPD/CME as the major employer of doctors within the United Kingdom.
Several learned societies embrace medical education at all levels. These include ASME (the Association for the Study of Medical Education), MADEN (the Medical and Dental Education Network) and AMEE (the Association for Medical Education in Europe). Specialist journals are devoted to research reports relating to medical educational developments
(e.g. Academic Medicine, Health Care Education, Medical Education). The more general medical journals (e.g. British Medical Journal, New England Journal of Medicine, The Lancet, Annals of the Royal College of Surgeons) also carry articles on educational matters. Finally, the World Wide Web (WWW) is a valuable source of information relating to courses and course development and other aspects of modern medical education.
The UK government, which controls the number of students entering medical training, has recently increased the quota to take account of increasing demands for trained sta? from the NHS. More than 5,700 students – 3,300 women and 2,400 men – are now entering UK medical schools annually with nearly 28,600 at medical school in any one year, and an attrition rate of about 8–10 per cent. This loss may in part be due to the changes in university-funding arrangements. Students now pay all or part of their tuition fees, and this can result in medical graduates owing several thousand pounds when they qualify at the end of their ?ve-year basic quali?cation course. Doctors wishing to specialise need to do up to ?ve years (sometimes more) of salaried ‘hands-on’ training in house or registrar (intern) posts.
Though it may be a commonly held belief that most students enter medicine for humanitarian reasons rather than for the ?nancial rewards of a successful medical career, in developed nations the prospect of status and rewards is probably one incentive. However, the cost to students of medical education along with the widespread publicity in Britain about an under-resourced, seriously overstretched health service, with sta? working long hours and dealing with a rising number of disgruntled patients, may be affecting recruitment, since the number of applicants for medical school has dropped in the past year or so. Although there is still competition for places, planners need to bear this falling trend in mind.
Another factor to be considered for the future is the nature of the medical curriculum. In Britain and western Europe, the age structure of a probably declining population will become top-heavy with senior citizens. In the ?nancial interests of the countries affected, and in the personal interests of an ageing population, it would seem sensible to raise the pro?le of preventive medicine – traditionally rather a Cinderella subject – in medical education, thus enabling people to live healthier as well as longer lives. While learning about treatments is essential, the increasing specialisation and subspecialisation of medicine in order to provide expensive, high-technology care to a population, many of whom are suffering from preventable illnesses originating in part from self-indulgent lifestyles, seems insupportable economically, unsatisfactory for patients awaiting treatment, and not necessarily professionally ful?lling for health-care sta?. To change the mix of medical education would be a di?cult long-term task but should be worthwhile for providers and recipients of medical care.... medical education
The Ottawa Charter for Health Promotion of 1986 identifies three basic strategies for health promotion. These are advocacy for health to create essential conditions for health; enabling all people to achieve their full health potential; and mediating between the different interests in society in the pursuit of health. These strategies are supported by five priority action areas: build health public policy; create supportive environments for health; strengthen community action for health; develop personal skills; and reorient health services.... ottawa charter for health promotion
Professional sta? working in health care are registered with and regulated by several statutory bodies: doctors by the GENERAL MEDICAL COUNCIL (GMC); dentists by the GENERAL DENTAL COUNCIL; nurses and midwives by the Council for Nursing and Midwifery, formerly the UK Central Council for Nursing, Midwifery and Health Visiting (see NURSING); PHARMACISTS by the Royal Pharmaceutical Society; and the professions supplementary to medicine (chiropody, dietetics, medical laboratory sciences, occupational therapy, orthoptics, physiotherapy and radiography) by the Council for Professions Supplementary to Medicine. In 2002, the Council for the Regulation of Health Care Professions was set up as a statutory body that will promote cooperation between and give advice to existing regulatory bodies, provide a quality-control mechanism, and play a part in promoting the interests of patients. The new Council is accountable to a Select Committee of Parliament and is a non-ministerial government department similar in status to the FOOD STANDARDS AGENCY. It has the right to scrutinise the decisions of its constituent bodies and can apply for judicial review if it feels that a judgement by a disciplinary committee has been too lenient.... regulation of health professions
Formerly Reader in Phytochemistry, Department of Pharmacy, University of Nottingham. Research interests: secondary metabolites of the Solanaceae and Erythroxylaceae. Principal author of Trease and Evans’ Pharmacognosy. Visiting lecturer, School of Phytotherapy (Herbal Medicine). ... evans, william c. (b.pharm., b.sc., ph.d., f.r. pharm. s)
A person whose interests are constantly directed outwards, to other people and the environment. Extroverts are active, sociable, and have many outside interests. (See also personality.)... extrovert
n. agreement to undergo medical treatment sought from an adult or child who lacks capacity to *consent. More generally, permission from patients with capacity, but whose autonomy is constrained, given to their doctor to act in their *best interests. Assent has ethical but not legal force. In medical research, particularly with children over seven years, it is difficult to justify proceeding without assent, since research is not principally and inevitably in the patient’s best interests.... assent
n. doing good: one of the *four principles of medical ethics. The obligation to act in patients’ *best interests at all times is recognized in ancient and modern codes of professional conduct, e.g. the *Hippocratic oath. Benefits in health care, and therefore beneficence, must commonly be balanced against risks or harms (i.e. *nonmaleficence). The courts have been clear that beneficence extends beyond medical interests. Respect for *autonomy requires that professionals determine what the patient considers to be doing good in any given situation.... beneficence
the use of enteral feeding tubes or cannulas to administer nutrients and fluids directly into the gastrointestinal tract or bloodstream when the oral route cannot be used owing to disability or disease. When other intensive treatments are judged *futile, artificial nutrition and hydration are considered *extraordinary means of prolonging life in patients who have no prospect of recovery. It is permissible to withdraw such treatment when it is no longer in the patient’s interests and when the primary intention is not to kill the patient, although death is foreseen (see doctrine of double effect). In cases of patients in a *persistent vegetative state in England and Wales, the matter must be referred to the courts following the case of Tony Bland. Where food and water are withdrawn it is still considered important to moisten the patient’s lips and to keep him or her comfortable until death.... artificial nutrition and hydration
(BMA) a professional body for doctors and also an independent trade union dedicated to protecting individual members and the collective interests of doctors. It has a complex structure that allows representation both by geographical area of work and through various committees, including the General Practice Committee (GPC), Central Consultants and Specialists Committee, Junior Doctors Committee, and the Medical Students Committee.... british medical association
n. an approach to ethics and politics that advocates a middle way between communism and liberalism, emphasizing family and community interests as well as individual *autonomy, social responsibilities, and personal rights.... communitarianism
(in medical ethics) the situation in which a health professional is subject to potential or actual pressures that may conflict with his or her obligation to promote the *best interests of the patient over and above all else. A conflict of interest arises from a particular context or situation and may threaten a doctor’s integrity and undermine trust between professional and patient. For example, a drug company may encourage a doctor to prescribe a particular medicine, which may not be the treatment of choice for a patient, or contractual financial disincentives may discourage a doctor from providing a more expensive treatment of choice for a patient. In medical research, there is always a potential conflict between protecting the individual and benefiting society. Particular problems of this kind occur in randomized controlled trials (see equipoise; intervention study). Doctors will always experience competing pressures and it is important for them to be able to recognize and then, where possible, disclose, resolve, or mitigate morally problematic conflicts.... conflict of interest
a relationship in which one person holds a position of trust with respect to the other and is expected to act solely in the *best interests of that person and to treat information shared as confidential. In medicine, the doctor–patient relationship is a fiduciary relationship.... fiduciary relationship
a *special health authority of the NHS established following the Health and Social Care Act 2012 to promote and protect the interests of patients in health research and to simplify the regulation of research. The Health Research Authority inherited the functions of the National Research Ethics Service, which closed in 2012.... health research authority
(IMCA) a person who must, by virtue of the *Mental Capacity Act 2005, be contacted to represent the *best interests of a patient who lacks *capacity and has no family or friends while acting as a proxy in medical decision-making. IMCAs are available via the local Independent Mental Capacity Advocacy Service.... independent mental capacity advocate
(in England) an official responsible to Parliament and appointed to protect the interests of patients in relation to administration of and provision of health care by the *National Health Service. He or she can investigate complaints about the NHS when they cannot be resolved locally. In Scotland, and in Wales, this role is undertaken by a Public Services Ombudsman.... parliamentary and health service ombudsman
n. a state of genuine and substantial uncertainty as to which of two or more courses of action will be best for a patient. Equipoise is an important ethical principle in research, specifically in the design of clinical trials. It is generally held that the random allocation of patients to one or other arm of a trial is ethically acceptable only where there is a genuine uncertainty (equipoise) as to which treatment will most benefit trial participants. Knowingly to assign an individual to inferior or ineffective treatment (such as a placebo) would offend against the principle that his or her *best interests are paramount. A distinction is sometimes made between clinical equipoise, which refers to uncertainty across the medical profession as a whole, and theoretical equipoise, which refers to the uncertainty of an individual doctor. In addition, patients may not share the state of equipoise; for example, if a patient has his or her own preferences and there are significant side-effects influencing the choice of treatment, it would be *paternalistic and counter to *beneficence not to respect that patient’s wishes.... equipoise
n. 1. (extraversion) an enduring personality trait characterized by interest in the outside world rather than the self. People high in extroversion (extroverts), as measured by questionnaires and tests, are gregarious and outgoing, prefer to change activities frequently, and are not susceptible to permanent *conditioning. Extroversion was first described by Carl Jung as a tendency to action rather than thought, to scientific rather than philosophical interests, and to emotional rather than intellectual reactions. Eysenck used it as one of the main personality traits in his widely used personality questionnaire. Compare introversion. 2. a turning inside out of a hollow organ, such as the uterus (which sometimes occurs after childbirth).... extroversion
a pattern of behaviour characterized by impaired control over digital gaming, increased priority given to gaming over other interests and activities, and continuation or escalation of gaming despite negative consequences. For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment of personal, family, social, educational, occupational, or other important areas of functioning and would normally have been evident for at least 12 months. Gaming disorder was first introduced as a diagnostic entity in ICD-11 in 2018. It is estimated that around 2% of people who regularly play digital games are affected. Treatment follows the principles of other *addiction treatments.... gaming disorder
the means by which to assess legal *capacity in children under the age of 16 years, established in the case Gillick v West Norfolk and Wisbech Area Health Authority (1985) 2 A11 ER 402. Such children are deemed to be capable of giving valid *consent to advice or treatment without parental knowledge or agreement provided they have sufficient understanding to appreciate the nature, purpose, and hazards of the proposed treatment. In the Gillick case the criteria for deciding competence, set out by Lord Fraser, related specifically to contraceptive treatment. In addition to the elements of Gillick competence, the Fraser guidelines specified that a health professional must be convinced that the child was likely to begin, or to continue having, sexual intercourse with or without contraceptive treatment, that his or her physical and/or mental health would probably suffer in the absence of treatment, and it was in his or her best interests to provide treatment. The principle of Gillick competence applies to all treatment for those under the age of 16, not just contraceptive services. —Gillick-competent adj.... gillick competence
n. a state of mind characterized by excessive cheerfulness and increased activity. The mood is euphoric and can change rapidly to irritability. Thought and speech are pressured and rapid to the point of incoherence and the connections between ideas may be impossible to follow to the point of *loosening of associations. Behaviour is overactive, extravagant, overbearing, and sometimes aggressive. Excessive drug and alcohol use can complicate the picture. Judgment is impaired, with disinhibited behaviour, and therefore the patient may damage his or her own interests. There may be grandiose delusions. *Mixed affective states (such as low mood with pressured speech and irritability) are common. Treatment is usually with medication, such as lithium, *benzodiazepines, or *antipsychotics, and hospital admission is frequently necessary. See also bipolar affective disorder. —manic adj.... mania
n. an attitude or policy that overrides a person’s own wishes (*autonomy) in pursuit of his or her *best interests. The classic argument against paternalism of the philosopher John Stuart Mill is that intervention is justified only when trying to prevent a person from causing harm to others, not to himself. However, a form of paternalism may be justified when a person lacks the capacity to make decisions for him- or herself, assuming there is no valid *advance directive, decision, or statement or a proxy with *power of attorney to represent the patient’s wishes. See also therapeutic privilege. —paternalistic adj.... paternalism
(surrogate decision) a decision made with or on behalf of a person who lacks full legal capacity to *consent to or refuse medical treatment. See best interests; Gillick competence; parental responsibility; power of attorney; substituted judgment.... proxy decision
a decision made by someone on behalf of a patient lacking capacity that is judged to reflect what the patient would have wanted had he or she had the mental capacity to decide for him- or herself. This judgment is best made by someone close to the patient who has a good knowledge of the patient’s beliefs, opinions, and character, provided that there are no potentially conflicting and partial interests at play. See also power of attorney; proxy decision.... substituted judgment
legislation for England and Wales, which came into force in October 2007, to govern the treatment of people who lack *capacity to make decisions. It gives legal force to the importance of *autonomy in health care and to *advance directives, decisions, or statements. It also provides statutory legislation for medical and social decision-makers to act in the patient’s best interests should he or she lose capacity (see Independent Mental Capacity Advocate). It allows proportionate force to implement decisions made in a patient’s best interests. For Scotland the current legislation is the Adults with Incapacity (Scotland) Act 2000.... mental capacity act 2005
an Act of Parliament to govern the treatment of people with a mental disorder, which is defined as including *mental illness, *personality disorder, and *learning disability. For England and Wales the Mental Health Act 1983 has been amended by the Mental Health Act 2007. The legislation provides for the voluntary and compulsory (involuntary) assessment and treatment of patients with a diagnosis or symptoms of a mental disorder. The purposes of involuntary admission are both to act in patients’ best interests, providing treatment for them when they have lost *insight into their illness, and to manage the risk that may arise from a mental disorder to the patients themselves or to others. One of the principal amendments in the 2007 Act is the introduction of Community Treatment Orders, which provide for the involuntary treatment of patients who have left hospital. Another, more controversial, change was the introduction of *sexual deviancy as a mental disorder to which the Act applies. In Scotland the current legislation is the Mental Health (Care and Treatment) (Scotland) Act 2003, which came into effect in April 2005. See section.... mental health act
a medical specialty established by the Royal Society of Medicine in 1931. Initially the members pioneered clinics devoted to the diagnosis and management of rheumatic diseases, but later extended their interests to the *rehabilitation of patients with physical disabilities ranging from asthma and hand injuries to back trouble and poliomyelitis. The term has caused confusion in recent years, with many doctors preferring the description rheumatology and rehabilitation for this specialist activity. Since 1972, however, when the Royal College of Physicians approved it, physical medicine has become the generally accepted term. See also rheumatology.... physical medicine
a section of the National Assistance Act 1948 that enables a local authority to arrange for the compulsory removal to a place of care of a person who is unwilling to go voluntarily from his or her own home. Individuals who are suffering from a grave chronic disease, or are physically incapacitated, or are living in insanitary conditions because of old age or infirmity can be removed if they are unable to care for themselves and do not receive care and attention from others. A public health consultant and another registered medical practitioner (usually the patient’s general practitioner) must certify that removal is in the interests of the patient or that it would prevent injury to the health of, or serious nuisance to, other people.... section 47 removal
a hypothetical state, advanced by the US political philosopher John Rawls, in which decisions about social justice and the allocation of resources would be made fairly, as if by a person who must decide on society’s rules and economic structures without knowing what position he or she will occupy in that society. By removing knowledge of status, abilities, and interests, Rawls argued, one could eliminate the usual effects of egotism and personal circumstances on such decisions. Rawls maintained that any society designed on this basis would adhere to two principles: the principle of equal liberty, which gives each person the right to as much freedom as is compatible with the freedom of others, and the maximin principle, which allocates resources so that the benefit of the least advantaged people is maximized as far as possible. Rawls’s exposition, and the maximin principle in particular, have proved widely influential in discussions of welfare provision and, especially, the allocation of medical resources.... veil of ignorance
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