medical law and ethics presentation .ppt

medical law and ethics presentation .ppt

1. Medical Jurisprudence
and Ethics

2. Objectives
Introduction
Functions of medical council
Declaration of Geneva
Conditions for the erasure of name of the doctor from
the medical register
Duties of medical practitioners and of patients
Rights and privileges of registered medical
practitioners and of patients
Types of physician-patient relationship
Professional Negligence
Prevention and defence against negligence
Various doctorines
Euthanacia
consents

3. Introduction
Forensic medicine: It is the application of medical knowledge
to aid in the administration of justice in a court of law.
Medical jurisprudence: It is the application of knowledge of
law in relation to practice of medicine.
It includes:
Doctor-patient relationship
Doctor-doctor relationship
Doctor-State relationship

4. Medical ethics: It is concerned with moral principles
for the members of the medical profession in their
dealing with eachother, their patients and the state.
The medical profession is governed by legislation and
by a code of Ethics and enforcement of the code is
done by the medical council.

5. Functions of medical council
Maintainance of a register of medical practitioners.
Regulation of standard of undergraduate and
postgraduate medical education.
Permission for establishment of new medical college
and new course of study
Recognition of foreign medical qualifications
Appeal against disciplinary action
Warning notice for serious professional misconduct

6. Declaration of Geneva
I solemnly pledge myself to dedicate my life to the service of
humanity.
Even under threat, I will not use my knowledge contrary to the
laws of humanity.
I will maintain the utmost respect for human life form time of
conception.
I will not permit considerations of religion, nationality, race,
party-politics or social standing to intervene between my duty
and my patient.

7. I will practice my profession with conscience and dignity.
The health of my patient will be my first consideration.
I will respect the secrets which are confided in me.
I will give to my teachers the respect and gratitude which is their due.
I will maintain by all means in my power, the honor and noble
traditions of the medical profession.
I will treat my professional colleagues with respect and dignity.
I shall abide by Code of ethics enumerated by NMC
I make these promises solemnly, freely and upon my honor.

8. Conditions for the erasure of name of
the doctor from the medical register
After the death of registered medical practitioner
When entries of the medical practitioner are erranous
or fraudulent
In a professional misconduct which is known as penal
erasure which is if permanent it is called professional
death sentence
When the registered medical practioner is not
traceable at the address recorded with the council

9. Power of the Council to give order to delete
name from the Registration book.
(a) If convicted and sentenced by the Court in a criminal
offence involving moral turpitude.
(b) If decided by two third majority vote of members of the
Council accusing of any misconduct relating to the
profession.
TheNMCcanordertheerasureofnameofphysicianfrom
themedicalregisterfortwoyearsonrecommendationof
theProfessionalConductandHealthCommittee.The
erasureremainseffectiveunlessthephysician'sapplication
isacceptedforrestorationofname.

10. Serious professional misconduct
Thatactofamedicalmandoneinthepursuit
ofhisprofession,withregardtowhichitwould
bereasonablyregardedasdisgracefulor
dishonorableasjudgedbyprofessionalmenof
goodreputeandcompetence.

11. WARNING NOTICE
1.Adultery arising out of professional relationship.
2.Advertising.
3.Abortion (unlawful).
4.Association with unqualified persons in professional matters
(Covering).
5.Addiction.
6.Alcohol.

12. WARNING NOTICE
7.Conviction by a court of law for offences involving moral
turpitude and criminal acts.
8.Issuing a false certificate.
9.Using of touts or agents for procuring patients.
10.Dichotomyor fee splitting.
11.Sex determination.
12.Prescribing narcotic drugs to addicts.

13. ADVERTISING
[ADVERTISING SHOULD BE DONE IN ETHICAL
MANNER]
A medical practitioner is permitted a formal announcement in the
press regarding the following:
i.On starting practice;
ii.On change of type of practice;
iii.On changing address;
iv.On temporary absence from duty;
v.On resumption of another practice;
vi.On succeeding to another practice;

15. Duties of Medical practitioners
1.Dutytoexercisereasonabledegreeofskilland
knowledge.
•Thedutyofcarearisessimplybyexaminingsomeonefor
signsofillnessortrauma.
•Heoweshisdutytothechildevenwhenengagedbyhis
father.
•Evenwhenthepatientistreatedfreeofcharge.
•Doctorisliableforimproperinvestigations,wrong
treatmentmethodsetc.

16. 2. Duties with regard to attendance and
examination
Physician can’t withdraw without the consent of the patient except
for valid reasons as:
1.He himself becomes sick.
2.He is convinced that the patient is malingering.
3.Remedies other than those prescribed by him are being used.
4.His instructions are being ignored.
5.Previous financial obligations are not being fulfilled.
6.Patient persists in the use of intoxicants or poisons.
7.Patient goes under treatment of another physician without
informing the previous physician.

17. 3.Duty to furnish proper and suitable medicines.
4.Duty to give instructions.
5.Duty to control and warn.
6.Duty to third parties.
7.Duty towards children and adults incapable of taking
care of themselves.

18. 8.Duty to inform patient of risks.
9.Duty to notify certain diseases.
10.Duty with regards to poisons.
11.Duty in connection with X-ray
examination.

19. 12. Duties with regards to operations
1.Explain nature of operation and take consent.
2.Proper care to avoid mistakes.
3.Must not delegate the duty to another.
4.Must not experiment.
5.Well informed of current standard practice.
6.Sterilized instruments.
7.All the swabs and instruments removed.
8.Proper post operative care.

20. 13. Duties under Geneva Conventions
Following are to be treated without any adverse
distinction based on sex, race, nationality, political
opinions or any other similar criteria:
1.Wounded or sick of the armed forces.
2.Ship-wrecked persons.
3.Prisoners of war.
4.Civilians of army nationality.

21. 14. Duties with regard to consultation
Consultation with specialist in following cases:
•Patient’s request.
•Emergency.
•Case has taken serious turn.
•Quality of care can be considerably enhanced.
•Surgery or special treatment involving danger to life.
•Homicidal poisoning and criminal assault.
•Therapeutic abortion to be procured.

22. 15. Medicolegal examination and certificates
16. Postmortem examination
Only after proper authorisation
17. Sending pathological material by post
Precautions to be taken to prevent the spread of
infection
18. Attending to accidents
Though a doctor has right to choose his patients, in case
of emergency, he is expected to offer that much help
under the circumstances

23. Professional secrecy (confidentiality)
Thedoctorisobligedtokeepsecret,allthathe
comestoknowconcerningthepatientinthecourse
ofhisprofessionalwork.
•consenttobetaken.
•minorchild,insaneorintoxicated.
•domesticservantandgovernmentservant.
•employee.
•husbandandwife.
•prisonerundertrialorinpolicecustody.
•convictedperson.
•Insurancepolicy.
•deadperson.
•reportingcaseinmedicaljournal.

24. Privileged communication
Itisabonafideinformationtoaconcernedperson
orauthority,givenbyadoctorbyvirtueofhisduty
toprotecttheinterestofthecommunityorthe
society.
•Infectiousdiseases
•Sexuallytransmitteddiseases
•Servantsandemployees
•Disclosureinpatient’sinterest
•Notifiablediseases
•Doctor’sselfinterest
•Incourtsoflaw
•Suspectedcrime

25. Rights and Privileges of Registered Medical Practitioners
1.Right to practice medicine.
2.Right to choose a patient.
3.Right to dispense medicines.
4.Right to possess and supply dangerous drugs to his
patients.
5.Right to add title, descriptions, etc to the name.

26. Rights and Privileges..
6.Right to recovery of fees.
7.Right for appointment to public and local
hospitals.
8.Right to issue medical certificates.
9.Right to give evidence.
10.Exemption from serving as a juror at an inquest.

27. Duties of a patient
He should furnish the doctor with the complete
informations about the facts and circumstances of his
illness.
He should strictly follow the instructionsof the doctor
as regard dite, medicine and lifestyle.
He should pay the reasonable fee to the doctor

28. Rights privileges of patients
Access to health care facilities and emergencies services
regardless of age, sex, religion, social or economic status.
To receive continuous care for his illness from
doctor/institute.
To be treated in comfort during illness and follow up.
Right to complain and redressal of grievances.
All the informationsabout his illness should be confidential.
To be treated with care, compassion, respect without any
discrimination.
Right for information about his diagnosis, investigations,
complications and side-effects
Can refuse any specific or all measures
Can have access to his records and demand summary or other
details

29. Types of physician-patient relationship
Therapeutic relationship
Formal relationship: It pertains to the situation where
the third party has referred the patient/ person for
impartial medical checkup.
Pre-employment
Insurance policy
Yearly medical checkup
Cases of rape or victims of crimes
Intimate body searches and other medico-legal cases
In certain psychiatric illness referred by court or police

30. Professional Negligence
It is absence of reasonable care and skills or willful
negligence of a medical practitioner in the treatment
of patient which causes bodily injury or the death of
the patient.
It consists of two acts:
Act of commission
Act of omission

31. According to Black’s Law Dictionary, medical
negligence requires that the plaintiff (i.e. patient)
establish the following(4 D’s):
Existence of the physician’s dutyto the plaintiff, based
on the existence of the patient-physician relationship.
Applicable standard of care and its violation (dereliction
of duty)
Causal connection between the violation of care and the
harm complained of (direct causation).
Damage(a compensable injury)

32. Civil negligence
For getting compensation
For getting fees
Criminal negligence
A doctor shows gross absence of skill or care
Performs an illegal act
Amputation of wrong finger or wrong hand
Leaving instrument or swab
Incompetent GA administration
Gross mismanagement of delivery of a woman
Criminal abortion
Wrong substance into eye causing loss of vision

33. S.N.TRAIT CIVIL NEGLIGENCE CRIMINAL NEGLIGENCE
1 Offence No specific and clear
violation of law
Specifically violated a
particular criminal law
2 NegligenceSimple absence of care and
skill
Gross negligence, lack of
competency
3 Consent for
act
Good defence Not a defence
4 Trail by Civil court Criminal court
5 Evidence Strongevidence is sufficientGuilt should be proved
beyond reasonable doubt
6 Punishment Liable to pay damages imprisonment

34. Corporate negligence
Failureofthosepersonswhoareresponsiblefor
providingaccommodation,facilitiesandtreatmentto
followtheestablishedstandardofconduct.
Hospitalprovidesdefectiveequipmentordrugs
Selectsorretainsuncompetitiveemployees
Ethical negligence

35. Contributory negligence
Anyunreasonableconduct/absenceofordinarycareon
thepartofthepatientorhispersonalattendant;which
combinedwithdoctor’snegligence,contributedtothe
injurycomplainedof.
Failure to give accurate medical history
Failure to co-operate with the doctor
Refusal to take suggestive treatment
Leaving hospital against doctor’s advice
Failure to seek further medical assistance if symptoms
persists

36. Last-clear-chance doctrine
Apersonwhohasnegligentlyplacedhimselfinposition
ofdangermayrecoverdamages,ifthedoctordiscovered
thedangerwhiletherewasstilltimetoavoidtheinjury
orfailedtodoso.
Avoidable consequences rule
Whenthenegligenceoftheperson(injured)occurs
afterthatofthedoctorbeingsuedandincreasesthe
severityofinjury.

37. Res Ipsa Loquitur
Essentials
In the Absence of negligence, injury would not have
occured
Exclusive control
Contributory negligence
Examples
Anti-tetanus serum
Burns-hot water bottle/x-ray therapy
Medicine overdose
Failure to remove swab
Prolonged splinting

38. Inevitable accident
Not avoidable by any precautions as a reasonable man can
be expected to take.
Novus Actus Interveniens
For plea, an element of negligence is essential
Applies in the case of assault and accidental injury

39. Misadventure
A case in which an individual has been injured/died due
to some unintentional act by a doctor/agent of
doctor/hospital.
Types-
I.Therapeutic
II.Diagnostic
III.Experimental

40. Prevetions of medical litigations
Awareness of potential areas of litigations and medicolegal
problems.
Good doctor-patient relationship
Appropriate training and maintenance of authorized protocol
Maintaining standard medical services
Proper counseling and informed consent
Proper investigations
Adequate supervision and timely referral
Surgical intervention
Meticulous record keeping

41. Defenses against negligence
1.No duty to the plaintiff
2.Discharged his duties in accordance with the prevailing
standard of medical practice
3.Not due to his negligence but could be due to the act of any
other person who also was concerned with his treatment
4.Result of a third party who interfered in the treatment without
his knowledge or consent
5.Contributory negligence
6.Reasonable error of judgment
7.Misadventure
8.Medical maloccurence
9.Res judicata-it has already been tried once by a court of law
10.Time limit allowed by the law for lodging such a complaint is
over and the complaint may not entertained now

42. Consent
The consent means voluntary agreement, compliance, or
permission.
Implied consent: It is a consent which is not written, its
existence is not expressly asserted, it is legally effective.
It implies consent to medical examination in a general sense
but not to procedures more complex than inspection,
palpation, percussion and auscultation.

43. Express consent: It is on the terms of which are stated in
distinct and explicit language.
It may be oral or written.
To be legally valid consent that is given must be
informed and intelligent.
Informed consent: When the general nature of the
procedure has been explained to the patient who can
assess the risks and decline or accept the procedure if
he so wishes.

44. Euthanasia
It is a mercy killing or putting a person to painless death especially
in case of incurable suffering or when life becomes purposeless
as a result of mental or physical handicap.
Types:
Active & pasive
Voluntary, involuntary and non-voluntary

45. "Apersonmaybeapoorwriter,abadpainter,orabadactorbuta
mancannotandmustnotbeabaddoctor.“
-Prof.M.P.Konchalovsky