--- module: 067-01 language: en chapter: 67 title: "Ethics, Consent, Confidentiality, Safeguarding, and Medical Law Principles" module_title: "Foundations" source_sha256: c769a66327b4cb532fa005c1deaacfcb5b8a40ed97b96bc7f3eb19914d029d07 --- # Ethics, consent, confidentiality, and medical law ## Orientation and ethical reasoning ### Law sets minimum standards, ethics often asks more ### Four principles #### Autonomy supports informed self-determination #### Beneficence promotes welfare #### Non-maleficence avoids disproportionate harm #### Justice: fair distribution, equal respect ### Principles conflict and give no mechanical answer ### Clarify facts, options, values, capacity, law ### Least restrictive effective option, documented ### Ethics consultation supports, never replaces ## Informed consent ### Voluntary, informed, capacitous, specific ### A process, not a signature ### Explain purpose, risks, alternatives, no treatment ### Material risk #### What a reasonable person would find significant #### What this patient is likely to value ### Plain language, interpreters, teach-back ### Consent can be withdrawn at any time ### Emergency necessity #### Lacks capacity, no valid refusal, delay harms #### Not for convenient non-urgent care ### Therapeutic privilege is extremely narrow ## Decision-making capacity ### Decision-specific and time-specific ### Understand, retain, use or weigh, communicate ### Diagnosis or unwise choice does not remove it ### Support capacity first #### Treat pain, delirium, hypoxia, withdrawal, fear #### Interpreters, supporters, optimal timing ### When absent #### Advance directives and appointed decision-makers #### Substituted judgement: what patient would choose #### Best interests integrate welfare and wishes #### Family not automatically legal decision-makers ## Children and adolescents ### Parental authority limited by child's welfare ### Seek assent according to development ### Some adolescents can consent independently ### Confidential care encourages disclosure #### Explain limits for serious risk and safeguarding ### Harmful parental refusal: escalate, do not abandon ## Confidentiality and privacy ### Enables trust and candid disclosure ### Collect and access only what care needs ### De-identification fails with rare details ### Disclosure without consent #### Serious harm, protection, statutory duties #### Minimum necessary, tell patient, document ### Continues after death ### Genetic information has familial implications #### Patient-led sharing and specialist counselling ## Documentation and boundaries ### Record is a care tool and legal document ### Separate observation, allegation, inference ### Dated, traceable amendments #### Copying inaccurate text propagates harm ### Boundaries prevent exploitation #### Power persists after care ends ### Chaperones support but do not replace consent ## Safeguarding and violence ### Abuse, neglect, exploitation, coercive control ### Warning signs never prove abuse alone ### Speak privately with a trained interpreter ### No confrontation, no promise of secrecy ### Document patient's words and injuries ### Intimate-partner violence #### Escalates during separation or pregnancy #### Strangulation: delayed injury, few marks #### Abrupt intervention can increase danger ## Error, candour, and negligence ### Stabilise, preserve evidence, disclose facts ### Apology is compatible with analysis ### Just culture: error, shortcuts, recklessness ### Negligence: duty, breach, causation, harm #### Poor outcome alone is not negligence ### Abandonment when care ends without transition ### Conscientious objection limits ## Resource allocation and public health ### Transparent, consistent clinical criteria #### Not social worth, wealth, or stereotypes ### Disability is not lower life value ### Restrictive measures need necessity, proportionality #### Coercion without support damages trust ## Research ethics ### Validity, risk-benefit, fair selection, review ### Equipoise: genuine expert uncertainty ### Consent distinguishes research from therapy ### Placebo must not cause serious avoidable harm ### Genomics, AI, biobanks add governance concerns