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  <head>
    <title>067-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Ethics, consent, confidentiality, and medical law">
      <outline text="Orientation and ethical reasoning">
        <outline text="Law sets minimum standards, ethics often asks more"/>
        <outline text="Four principles">
          <outline text="Autonomy supports informed self-determination"/>
          <outline text="Beneficence promotes welfare"/>
          <outline text="Non-maleficence avoids disproportionate harm"/>
          <outline text="Justice: fair distribution, equal respect"/>
        </outline>
        <outline text="Principles conflict and give no mechanical answer"/>
        <outline text="Clarify facts, options, values, capacity, law"/>
        <outline text="Least restrictive effective option, documented"/>
        <outline text="Ethics consultation supports, never replaces"/>
      </outline>
      <outline text="Informed consent">
        <outline text="Voluntary, informed, capacitous, specific"/>
        <outline text="A process, not a signature"/>
        <outline text="Explain purpose, risks, alternatives, no treatment"/>
        <outline text="Material risk">
          <outline text="What a reasonable person would find significant"/>
          <outline text="What this patient is likely to value"/>
        </outline>
        <outline text="Plain language, interpreters, teach-back"/>
        <outline text="Consent can be withdrawn at any time"/>
        <outline text="Emergency necessity">
          <outline text="Lacks capacity, no valid refusal, delay harms"/>
          <outline text="Not for convenient non-urgent care"/>
        </outline>
        <outline text="Therapeutic privilege is extremely narrow"/>
      </outline>
      <outline text="Decision-making capacity">
        <outline text="Decision-specific and time-specific"/>
        <outline text="Understand, retain, use or weigh, communicate"/>
        <outline text="Diagnosis or unwise choice does not remove it"/>
        <outline text="Support capacity first">
          <outline text="Treat pain, delirium, hypoxia, withdrawal, fear"/>
          <outline text="Interpreters, supporters, optimal timing"/>
        </outline>
        <outline text="When absent">
          <outline text="Advance directives and appointed decision-makers"/>
          <outline text="Substituted judgement: what patient would choose"/>
          <outline text="Best interests integrate welfare and wishes"/>
          <outline text="Family not automatically legal decision-makers"/>
        </outline>
      </outline>
      <outline text="Children and adolescents">
        <outline text="Parental authority limited by child&#x27;s welfare"/>
        <outline text="Seek assent according to development"/>
        <outline text="Some adolescents can consent independently"/>
        <outline text="Confidential care encourages disclosure">
          <outline text="Explain limits for serious risk and safeguarding"/>
        </outline>
        <outline text="Harmful parental refusal: escalate, do not abandon"/>
      </outline>
      <outline text="Confidentiality and privacy">
        <outline text="Enables trust and candid disclosure"/>
        <outline text="Collect and access only what care needs"/>
        <outline text="De-identification fails with rare details"/>
        <outline text="Disclosure without consent">
          <outline text="Serious harm, protection, statutory duties"/>
          <outline text="Minimum necessary, tell patient, document"/>
        </outline>
        <outline text="Continues after death"/>
        <outline text="Genetic information has familial implications">
          <outline text="Patient-led sharing and specialist counselling"/>
        </outline>
      </outline>
      <outline text="Documentation and boundaries">
        <outline text="Record is a care tool and legal document"/>
        <outline text="Separate observation, allegation, inference"/>
        <outline text="Dated, traceable amendments">
          <outline text="Copying inaccurate text propagates harm"/>
        </outline>
        <outline text="Boundaries prevent exploitation">
          <outline text="Power persists after care ends"/>
        </outline>
        <outline text="Chaperones support but do not replace consent"/>
      </outline>
      <outline text="Safeguarding and violence">
        <outline text="Abuse, neglect, exploitation, coercive control"/>
        <outline text="Warning signs never prove abuse alone"/>
        <outline text="Speak privately with a trained interpreter"/>
        <outline text="No confrontation, no promise of secrecy"/>
        <outline text="Document patient&#x27;s words and injuries"/>
        <outline text="Intimate-partner violence">
          <outline text="Escalates during separation or pregnancy"/>
          <outline text="Strangulation: delayed injury, few marks"/>
          <outline text="Abrupt intervention can increase danger"/>
        </outline>
      </outline>
      <outline text="Error, candour, and negligence">
        <outline text="Stabilise, preserve evidence, disclose facts"/>
        <outline text="Apology is compatible with analysis"/>
        <outline text="Just culture: error, shortcuts, recklessness"/>
        <outline text="Negligence: duty, breach, causation, harm">
          <outline text="Poor outcome alone is not negligence"/>
        </outline>
        <outline text="Abandonment when care ends without transition"/>
        <outline text="Conscientious objection limits"/>
      </outline>
      <outline text="Resource allocation and public health">
        <outline text="Transparent, consistent clinical criteria">
          <outline text="Not social worth, wealth, or stereotypes"/>
        </outline>
        <outline text="Disability is not lower life value"/>
        <outline text="Restrictive measures need necessity, proportionality">
          <outline text="Coercion without support damages trust"/>
        </outline>
      </outline>
      <outline text="Research ethics">
        <outline text="Validity, risk-benefit, fair selection, review"/>
        <outline text="Equipoise: genuine expert uncertainty"/>
        <outline text="Consent distinguishes research from therapy"/>
        <outline text="Placebo must not cause serious avoidable harm"/>
        <outline text="Genomics, AI, biobanks add governance concerns"/>
      </outline>
    </outline>
  </body>
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