--- module: 067-02 language: en chapter: 67 title: "Ethics, Consent, Confidentiality, Safeguarding, and Medical Law Principles" module_title: "Resolving ethical conflict, supported decisions, digital privacy, and safeguarding practice" source_sha256: 72955e84ad0da6acc6b6da6b2f22e39b24460d3d74c3d10ad884a0bc16bdbe96 --- # Ethical conflict, supported decisions, privacy, safeguarding ## Structuring ethical conflict ### Separate facts, values, and process ### Define state, options, urgency, reversibility ### Identify interests, authority, unequal power ### Fair process with a set review point ### Uncomfortable outcome is not necessarily unethical #### Some conflicts reflect unavoidable loss ## Supported decisions and capacity ### Autonomy is relational as well as individual ### Strengthen agency before substituting #### Treat pain or delirium, professional interpreter #### Short stages, extra time, best time of day #### Supporter must not replace the patient's voice ### Capacity assessment tracks the actual decision #### Patient explains options and consequences #### Unusual beliefs may still be capacitous #### Delirium can defeat a familiar-sounding answer #### Reassess after reversible impairment ## When capacity is absent ### Decision remains centred on the person ### Valid applicable advance refusal may control ### Substitute uses patient's values, not own ### Best interests if values unknown ### Relatives' disagreement is not a vote #### Clarify legal role, escalate unresolved conflict ### Emergency exception #### Prevent death or serious irreversible harm #### Not for convenience or planned procedures #### Return to ordinary consent once stable ## Consent, voluntariness, and objection ### Proportional but not perfunctory ### Connect probabilities to consequences ### Teach-back tests the explanation ### Form cannot repair coercion or incapacity ### Pressures undermining voluntariness #### Recommendation fine, manipulation not #### Competent refusal prompts harm reduction ### Treatment over objection #### Least restrictive measure, shortest period #### Chemical restraint still needs safeguards ## Confidentiality and digital privacy ### Structured threshold for disclosure #### Minimum necessary, limit onward disclosure ### Worried relative may give, not receive, information ### Digital hazards beyond the bedside #### Curiosity access, screen photos, online cases #### Metadata and rare facts re-identify patients ### Generative AI and external analytics #### Check approval, storage, training, deletion #### Removing a name is not enough #### Responsibility stays with the clinician ## Documentation that makes decisions reproducible ### Record values, risks, alternatives, decision ### Capacity: functional assessment, reversible factors ### Safeguarding: quotes, observation, inference ### Dated correction, never invisible alteration ## Safeguarding practice ### Signals rather than proof ### Privacy without increasing danger #### Qualified interpreter, not involved relative ### Prioritise danger, weapons, strangulation ### Respond to disclosure with belief #### No interrogation or confronting perpetrator #### Support not conditional on police ### Mandatory reporting varies locally ### Non-fatal strangulation #### Delayed airway oedema, cerebral hypoxia #### Risk of future fatal violence ### Safety planning checks device monitoring ## Children and professional boundaries ### Welfare protection plus participation ### Parental authority narrows with serious risk ### Explain privacy limits before sensitive questions ### Boundaries tested in small increments ### Boundary protection is not emotional coldness ## Adverse events, scarcity, and research ### Honest communication and evidence preservation ### Sincere apology without inventing facts ### Just culture still addresses reckless conduct ### Prognosis estimates can encode bias ### Fair tie-breaker for equally suitable patients ### Research consent separate from care consent #### Refusal will not diminish standard care ## Communication, persistent conflict, and distress ### State recommendation and what could change it ### Law cannot substitute for compassion ### Make power visible, least restrictive option ### Moral distress needs supervision and support #### Conscience does not justify abrupt abandonment #### Organisations convert problems into improvement ### Locate disagreement: facts, values, authority ### Independent opinion is fair reconsideration ### Make final decision-maker and review explicit