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Section E: Professional guidelines

British Medical Association (BMA)

The following guidelines have been published by the British Medical Association. All the guidelines are available on their web site, www.bma.org.uk, free of charge.

The Law and Ethics of Abortion, BMA Views

www.bma.org.uk/ap.nsf/Content/abortion
March 1997
Revised December 1999

Legal considerations
Conscientious objections clause
Ethical considerations
Consent
Confidentiality

Access to Health Records by Patients

www.bma.org.uk/ap.nsf/Content/accesshealthrecords
Revised December 2002

Legal rights of access to health records and information
Rights under the Data Protection Act 1998
Applications for access
Information which cannot be disclosed
Access to records of deceased patients
BMA advice on record keeping

Access to Medical Report Act (1988)

www.bma.org.uk/ap.nsf/Content/accessmedreps
December 1988
Revised September 1995

Consent
Individual’s rights
Seeing the report
Amendments
Delayed access
Withholding of information

Medical treatment for adults with Incapacity – guidance on ethical and medico-legal issues in Scotland

www.bma.org.uk/ap.nsf/Content/adults+with+incapacity+-+scotland
June 2002
2nd Edition October 2002

Adults with Incapacity (Scotland) Act
Assessment of capacity
Adults with capacity
Certificate of incapacity
Proxy decision making
General authority to treat
Mental Health (Scotland) Act
Special safeguards

Advance Statements – BMA Views

www.bma.org.uk/ap.nsf/Content/advancestatements
November 1992
Revised May 1995

What is an advance statement?
Legal scope of an advance statement
Assistance with drafting
Healthcare advocates and proxy decision makers
Doctors’ responsibilities

Advance Statements about Medical Treatment – Code of Practice

www.bma.org.uk/ap.nsf/Content/codeofpractice
April 1995

Making treatment choices
Drafting
Implementation

Decisions Relating to Cardiopulmonary Resuscitation

www.bma.org.uk/ap.nsf/Content/cardioresus

Presumption in favour of attempting resuscitation
Essential aspects of decision making
Information to patients
Competent adults
Incapacitated adults
Children and young people
Involving people close to the patient
Refusal of treatment
When is it appropriate to consider making a DNAR order?
Responsibility for decision making
Effects on others

Confidentiality and Disclosure of Health Information

www.bma.org.uk/ap.nsf/Content/Confidentiality+and+disclosure+of+health+information
October 1999

Disclosure with consent
Disclosure without consent in the subject's vital interests
Obligatory disclosure
Other disclosures and their safeguards
Disclosure in the public interest
Examples of disclosure in the public interest
Safeguards

Confidentiality and People Under 16

www.bma.org.uk/ap.nsf/Content/Confidentiality+and+people+under+16
January 1994

Teenage sexual activity
Reasons for concern
The legal position
Consulting another doctor
Confidentiality
Immature patients
Exceptional circumstances
Breach of confidentiality

End of Life Decisions – Views of the BMA

www.bma.org.uk/ap.nsf/Content/End+of+life+decisions+-+June+2000
June 2000

Refusal of treatment
Euthanasia
Physician-assisted suicide
Withholding and withdrawing life prolonging medical treatment
Advance statements

Parental Responsibility – Guidance form the Ethics Department

www.bma.org.uk/ap.nsf/Content/Parental
February 2004

What is parental responsibility?
Who possesses parental responsibility?
Consent from people with parental responsibility
What are the limits to parental responsibility?
What happens when people with parental responsibility disagree?
Some common questions relating to parental responsibility
Parental responsibility and Human Rights
Competent children and the limits to parental responsibility

Treatment Decisions for People in Persistent Vegetative State

www.bma.org.uk/ap.nsf/Content/Treatment+decisions+for+patients+in+persistent+vegetative+state
Revised June 1996

Defining PVS
Misdiagnosis
Initial assessment and treatment
Diagnosis
Review of treatment options
Views of the patient
Views of people close to the patient
Views of healthcare professionals
Conscientious objection
The legal position
Use of tissue
Research on PVS
Pregnant PVS patients

General Medical Council (GMC)

The following guidelines have been published by the General Medical Council. All the guidelines are available on their web site, www.gmc-uk.org, free of charge.

Seeking Patients’ Consent: the Ethical Considerations

www.gmc-uk.org/standards/consent.htm
November 1998

Consent to investigation and treatment
Providing sufficient information
Presenting information to patients
Ensuring voluntary decision making
Establishing capacity to make consent
‘Best Interests’ principle
Applying to the court
Forms of consent

Confidentiality: Protecting and Providing Information

www.gmc-uk.org/standards/confidentiality.htm
April 2004

Patients' right to confidentiality
Sharing information with patients
Disclosure of information
Frequently asked questions

Withholding and Withdrawing Life Pro-longing Treatments: Good Practice in Decision-making

www.gmc-uk.org/standards/whwd.htm
August 2002

Guiding principles
Good practice framework
Areas for special consideration

Antenatal Testing for HIV

http://www.gmc-uk.org/standards/antenatal.htm
November 2002

Priorities and Choices

http://www.gmc-uk.org/standards/priorities_and_choices.htm
July 2000

The duties of care
The provision of services
The role and responsibility of doctors
Quantity or Quality?

Management in Healthcare – the Role of Doctors

http://www.gmc-uk.org/standards/manage.htm
May 1999

Managers' responsibilities - what takes priority when they conflict?
When are doctors held accountable for management decisions
Protecting patients from serious harm
Dealing with colleagues - the role of managers
Public health
Occupational health
Standards of practice
Management practice
Honesty in financial matters
A short selection of publications for doctors in management

Department of Health (DH)

The following guidelines have been published by the Department of Health. All the guidelines are available as pdf documents on their web site, www.dh.gov.uk, free of charge.

Seeking Consent Working with Children

http://www.dh.gov.uk/assetRoot/04/06/72/04/04067204.pdf
November 2001

Who can give consent?
Seeking consent
Consent to treatment for mental disorder

Seeking Consent Working with Older People

http://www.dh.gov.uk/assetRoot/04/06/70/20/04067020.pdf
November 2001

Seeking consent: people with capacity
When adults lack capacity
Withdrawing and withholding life-prolonging treatment

Seeking Consent Working with People with Learning Disabilities

http://www.dh.gov.uk/assetRoot/04/06/70/19/04067019.pdf
November 2001

Seeking consent: people with capacity
When adults lack capacity
Withdrawing and withholding life-prolonging treatment

The Use of Human Organs and Tissue. An Interim Statement.

http://www.dh.gov.uk/assetRoot/04/05/47/79/04054779.pdf
April 2003

Organs and tissues taken in the future
Existing stored organs and tissues
Genetics research
Disposal of tissue

The Import and Export of Human Body Parts and Tissue for Non-therapeutic Uses. A Code of Practice.

http://www.dh.gov.uk/assetRoot/04/07/71/12/04077112.pdf

Royal Colleges and Societies

The following guidelines are available on the Royal Colleges and Societies web sites free of charge.

Royal College of General Practitioners

Confidentiality – Examining the principle of medical confidentiality

www.rcgp.org.uk/rcgp/corporate/position/confidentiality/confidentiality.doc
November 2000

Confidentiality
Implied consent
Explicit consent

Royal College of Midwives

Royal College of Nurses

Confidentiality – RCN guidance for occupational health nurses

http://www.rcn.org.uk/publications/pdf/confidentiality.pdf

Royal College of Obstetrics and Gynaecology

A consideration of the law and ethics in relation to court-authorised obstetric intervention

www.rcog.org.uk/guidelines.asp?PageID=109&GuidelineID=33
April 1994

Good practice
United Kingdom law
Consent
Refusal of consent
Possible exception to right to refuse consent
Court-authorised caesarean section – United Kingdom
The Infant Life Preservation Act (1929)
Professional ethics

Confidentiality and disclosure of health information: RCOG Ethics Committee comments on a BMA document

http://www.rcog.org.uk/guidelines.asp?PageID=109&GuidelineID=36
October 2000

Royal College of Ophthalmologists

Guidance on the retrieval of human eyes used in transplantation and research

http://www.rcophth.ac.uk/scientific/docs/OcularTissueAndTransplantation_.pdf
1998

Consent
Donor medical assessment
Acknowledgement of eye donation

Royal College of Paediatrics and Child Health

The British Paediatric Surveillance Unit (BPSU) and patient confidentiality

www.rcpch.ac.uk/publications/BPSU/Ethics_Advice_summary_May_2001.pdf
2001

The BPSU mechanism
Maintaining confidentiality in BPSU investigations
Ethical consent for BPSU studies

Responsibilities of doctors in child protection cases with regard to confidentiality

http://www.rcpch.ac.uk/publications/recent_publications/Confidentiality.pdf

Royal College of Physicians

Guidelines on the practice of ethics committees in medical research involving human subjects

www.rcplondon.ac.uk/pubs/brochures/pub%5Fprint%5Fgpecmr.htm
Third Edition 1996

Royal College of Psychiatrists

Good psychiatric practice

www.rcpsych.ac.uk/publications/cr/council/cr83.pdf
2002

The trusting relationship
Consent to treatment
Confidentiality

Good practice guide on confidentiality

www.rcpsych.ac.uk/publications/cr/council/cr85.pdf
2001

Keeping patients informed
Consultant responsibility with respect to other professionals in multi-disciplinary teams
Disclosure
Situations with dual obligations
Provision of reports
Requests for case notes
Child and adolescent issues
Issues arising in relation to people with learning disabilities and people with dementia
Security and secondary use of patient information

Royal College of Surgeons of England

Code of practice for the surgical management of Jehovah's Witnesses

www.rcseng.ac.uk/services/publications/publications/pdf/witness.pdf
2002

Ethical considerations
Legal and consent issues
Preoperative considerations
Surgical techniques

Good surgical practice

www.rcseng.ac.uk/services/publications/publications/pdf/gsp2002.pdf
2002

Good clinical care
Maintaining good surgical practice
Teaching, training and supervising
Relationship with patients

Nursing and Midwifery Council

Code of professional conduct

http://www.nmc-uk.org/nmc/main/publications/codeOfProfessionalConduct.pdf

Guidelines for mental health and learning disabilities nursing

http://www.nmc-uk.org/nmc/main/publications/guidelinesForMh.pdf

UKCC position statement on the covert administration of medicines

http://www.nmc-uk.org/nmc/main/publications/covertAdministrationOfMedicines.pdf

UK Clinical Ethics Network