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  <head>
    <title>067-02 Resolving ethical conflict, supported decisions, digital privacy, and safeguarding practice</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Ethical conflict, supported decisions, privacy, safeguarding">
      <outline text="Structuring ethical conflict">
        <outline text="Separate facts, values, and process"/>
        <outline text="Define state, options, urgency, reversibility"/>
        <outline text="Identify interests, authority, unequal power"/>
        <outline text="Fair process with a set review point"/>
        <outline text="Uncomfortable outcome is not necessarily unethical">
          <outline text="Some conflicts reflect unavoidable loss"/>
        </outline>
      </outline>
      <outline text="Supported decisions and capacity">
        <outline text="Autonomy is relational as well as individual"/>
        <outline text="Strengthen agency before substituting">
          <outline text="Treat pain or delirium, professional interpreter"/>
          <outline text="Short stages, extra time, best time of day"/>
          <outline text="Supporter must not replace the patient&#x27;s voice"/>
        </outline>
        <outline text="Capacity assessment tracks the actual decision">
          <outline text="Patient explains options and consequences"/>
          <outline text="Unusual beliefs may still be capacitous"/>
          <outline text="Delirium can defeat a familiar-sounding answer"/>
          <outline text="Reassess after reversible impairment"/>
        </outline>
      </outline>
      <outline text="When capacity is absent">
        <outline text="Decision remains centred on the person"/>
        <outline text="Valid applicable advance refusal may control"/>
        <outline text="Substitute uses patient&#x27;s values, not own"/>
        <outline text="Best interests if values unknown"/>
        <outline text="Relatives&#x27; disagreement is not a vote">
          <outline text="Clarify legal role, escalate unresolved conflict"/>
        </outline>
        <outline text="Emergency exception">
          <outline text="Prevent death or serious irreversible harm"/>
          <outline text="Not for convenience or planned procedures"/>
          <outline text="Return to ordinary consent once stable"/>
        </outline>
      </outline>
      <outline text="Consent, voluntariness, and objection">
        <outline text="Proportional but not perfunctory"/>
        <outline text="Connect probabilities to consequences"/>
        <outline text="Teach-back tests the explanation"/>
        <outline text="Form cannot repair coercion or incapacity"/>
        <outline text="Pressures undermining voluntariness">
          <outline text="Recommendation fine, manipulation not"/>
          <outline text="Competent refusal prompts harm reduction"/>
        </outline>
        <outline text="Treatment over objection">
          <outline text="Least restrictive measure, shortest period"/>
          <outline text="Chemical restraint still needs safeguards"/>
        </outline>
      </outline>
      <outline text="Confidentiality and digital privacy">
        <outline text="Structured threshold for disclosure">
          <outline text="Minimum necessary, limit onward disclosure"/>
        </outline>
        <outline text="Worried relative may give, not receive, information"/>
        <outline text="Digital hazards beyond the bedside">
          <outline text="Curiosity access, screen photos, online cases"/>
          <outline text="Metadata and rare facts re-identify patients"/>
        </outline>
        <outline text="Generative AI and external analytics">
          <outline text="Check approval, storage, training, deletion"/>
          <outline text="Removing a name is not enough"/>
          <outline text="Responsibility stays with the clinician"/>
        </outline>
      </outline>
      <outline text="Documentation that makes decisions reproducible">
        <outline text="Record values, risks, alternatives, decision"/>
        <outline text="Capacity: functional assessment, reversible factors"/>
        <outline text="Safeguarding: quotes, observation, inference"/>
        <outline text="Dated correction, never invisible alteration"/>
      </outline>
      <outline text="Safeguarding practice">
        <outline text="Signals rather than proof"/>
        <outline text="Privacy without increasing danger">
          <outline text="Qualified interpreter, not involved relative"/>
        </outline>
        <outline text="Prioritise danger, weapons, strangulation"/>
        <outline text="Respond to disclosure with belief">
          <outline text="No interrogation or confronting perpetrator"/>
          <outline text="Support not conditional on police"/>
        </outline>
        <outline text="Mandatory reporting varies locally"/>
        <outline text="Non-fatal strangulation">
          <outline text="Delayed airway oedema, cerebral hypoxia"/>
          <outline text="Risk of future fatal violence"/>
        </outline>
        <outline text="Safety planning checks device monitoring"/>
      </outline>
      <outline text="Children and professional boundaries">
        <outline text="Welfare protection plus participation"/>
        <outline text="Parental authority narrows with serious risk"/>
        <outline text="Explain privacy limits before sensitive questions"/>
        <outline text="Boundaries tested in small increments"/>
        <outline text="Boundary protection is not emotional coldness"/>
      </outline>
      <outline text="Adverse events, scarcity, and research">
        <outline text="Honest communication and evidence preservation"/>
        <outline text="Sincere apology without inventing facts"/>
        <outline text="Just culture still addresses reckless conduct"/>
        <outline text="Prognosis estimates can encode bias"/>
        <outline text="Fair tie-breaker for equally suitable patients"/>
        <outline text="Research consent separate from care consent">
          <outline text="Refusal will not diminish standard care"/>
        </outline>
      </outline>
      <outline text="Communication, persistent conflict, and distress">
        <outline text="State recommendation and what could change it"/>
        <outline text="Law cannot substitute for compassion"/>
        <outline text="Make power visible, least restrictive option"/>
        <outline text="Moral distress needs supervision and support">
          <outline text="Conscience does not justify abrupt abandonment"/>
          <outline text="Organisations convert problems into improvement"/>
        </outline>
        <outline text="Locate disagreement: facts, values, authority"/>
        <outline text="Independent opinion is fair reconsideration"/>
        <outline text="Make final decision-maker and review explicit"/>
      </outline>
    </outline>
  </body>
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