Medical Ethics

MEDICAL LAW AND ETHICS IN INDIA

APURVA AGARWAL

ETHICS IN CORPORATE COMMUNICATION: ETHICS IN CORPORATE COMMUNICATION: CONCEPTS AND PRACTICES CONCEPTS AND PRACTICES

February 23, 2007February 23, 2007

WHO IS A MEDICAL PRACTITIONER?

The Indian Medical Council Act defines a Medical Practitioner

A Medical Practitioner is supposed to be registered with the Indian Medical Council (“IMC”) and have the requisite qualifications

A Medical Practitioner is entitled to practice in the Country but he has to observe the code of ethics

A patient is anyone who consults a medical practitioner

The moment a person consults a medical practitioner he becomes that medical practitioners patient

WHO IS A PATIENT?

RIGHTS OF MP … Contd

The right to refuse treatment

Clause 10 of the Code of Medical Ethics

"Though a physician is not bound to treat each and everyone for his services except in emergencies, for the sake of humanity and the noble traditions of the profession, he should not only be ever ready to respond to calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he incurs in the discharge of his professional duties. In his ministrations, he should never forget that the health and the lives of those entrusted to his care depend upon his skill and attention."


The right to be reimbursed

The Code does not prescribe any standard of charges nor does it say that charges must be reasonable.

Whether the physician should specify charges before he undertakes to treat a patient ?

Does the rule of caveat emptor (let the buyer beware) apply in the relationship between a patient and a physician since it the patient who seeks out a physician for obtaining relief ?


The right to withhold information

A physician-patient relationship is fiduciary and requires confidentiality

The physician is not expected to divulge information about his patient

This right to withhold information is not absolute


The right to retain medical documents

There is one view which holds that since information contained in a document is privileged the physician/ hospital has the right to retain such document

A contrary view holds that since the information, though privileged, may be needed by the patient for future reference it should be given when specifically sought.


The right to reputation

There is no other right as dear to a physician as the right to a good name

Defamation (the opposite of name or reputation) is broadly defined as "the publication of a statement which tends to lower a person in the estimation of right thinking members of society generally"

The usual form of publication is writing or printing

DUTIES AND OBLIGATIONS OF MP

Duties and obligations of MP are enlisted under various laws of the land and Codes of Medical Ethics and Declarations - Indian and International, which are

Code of Medical Ethics of Medical Council of India;

Hippocratic Oath;

Declaration of Geneva;

Declaration of Helsinki;

International Code of Medical Ethics;

Government of India Guidelines for Sterilization

The duties can be summarized as under -

Duties to Patient

Duties to Public

Duties towards Law Enforcers

Duties not to violate Professional Ethics

Duties not to do anything illegal or hide illegal acts

Duties to each other.

DUTIES AND OBLIGATIONS OF MP …

CONTD

Standard Care,

Providing Information to the Patient /Attendant

Consent for Treatment

Emergency Care

DUTIES TO PATIENT

Patient autonomy is an accepted principle

Informed consent flows from the doctrine of autonomy

In India, informed consent = Consumer Protection Act

DUTIES TO PATIENT

- Consent for treatment

Fully informed consent is probably never attainable

A sick person has lost some measure of autonomy

Complexities of medical and their many possible side effects can never be explained to the nonmedical person: many are not even known to the medical profession

DUTIES TO PATIENT


There are no precise words to communicate the extent and quantum of pain

Pain remains beyond communication

Communication forms the soul of the concept on informed consent

DUTIES TO PATIENT


DUTIES TO PUBLIC

Health Education

Medical help when natural calamities like drought, flood, earthquakes, fire etc.

Medical help during train accidents, house collapse, road accidents

Compulsory notification of births, deaths, infectious diseases, food poisoning etc.

DUTIES TOWARDS LAW ENFORCERS

To inform the police all cases of poisoning, burns, injury, illegal abortion, suicide, homicide, manslaughter, grievous hurt and its natural complications like tetanus, gas-gangrene , etc.

This includes vehicular accidents, fractures, etc.

To call a Magistrate for recording dying declaration

To inform about bride burning and battered child cases

Not to associate with unregistered medical practitioner

Not to indulge in self-advertisement Not to write secret formulations.

Not to refuse professional service on grounds of religion, nationality, race, party politics or social status.

DUTY NOT TO VIOLATE ETHICS

DUTY NOT TO DO OR HIDE ANYTHING ILLEGAL

Not calling Magistrate for recording dying declaration

Unauthorized, unnecessary, uninformed treatment and surgery or procedure

Sex determination

When a patient ( consumer ) hires or avails of services of a Medical Practitioner for treatment, he has the following duties :-

He must disclose all information

He must co-operate with the doctor for any relevant investigations required to diagnose and treat him.

DUTIES OF A PATIENT / ATTENDANT

A Medical Practitioner cannot be forced to treat any person

He has certain possibilities for those whom he accepts as patients.

It is an implied contract.

MEDICAL PRACTITIONER

PATIENT CONTRACT

Responsibility towards a patient begins the moment a Medical Practitioner agrees to examine the case.

He must not, therefore, abandon his patient except under the following circumstances –

The patient has recovered from the illness, for which treatment was initiated.

The patient / attendant does not pay the Medical Practitioner ’s fees (in case of a private practitioner).

CONTINUE TO TREAT

The patient / attendant consults another Medical Practitioner without the knowledge of the first attending Medical Practitioner .

The patient / attendants do not co-operate and follow the Medical

Practitioner ’s instructions.

The patient is under some other responsible care, e.g., the patient, after admission in a hospital, comes under care of senior Medical

Practitioner s / unit head.

The Medical Practitioner has given due notice (orally or written ) for discontinuing treatment.

The Medical Practitioner is convinced that the illness is a fictious

one.

CONTINUE TO TREAT … CONTD

Use clean and proper instruments

Provide proper and suitable medicines if he dispenses them himself

If not, he should write the prescriptions legibly, using standard abbreviations and mention instructions for the pharmacist in full

He should give full directions to his patients as regards administration of drugs and other measures

REASONABLE CARE

The degree of skill a Medical Practitioner undertakes is the average degree of skill possessed by his professional brethren of the same standing as himself.

The best form of treatment may differ when different choices are available.

There is an implied contract between the Medical Practitioner and the patient when the patient is told in effect : "Medicine is not an exact science. I shall use my experience and best judgment and you take the risk that I may be wrong. I guarantee nothing."

REASONABLE SKILL

PROFESSIONAL SECRETS

A professional secret is one which a Medical Practitioner comes to learn in confidence from his patients

A Medical Practitioner is under a moral and legal obligation not to divulge any such secret

This is known as privileged communication which is defined as a communication made by a Medical Practitioner to a proper authority who has corresponding legal, social and moral duties to protect the public.

PROFESSIONAL SECRETS… CONTD

EXCEPTIONS: It must be bonafide and without malice, e.g.,

as a witness in a court of law;

warning spouses of AIDS patients and those found infected with HIV;

informing public health authorities of food poisoning from a hotel etc;

assisting apprehension of a person who has committed a serious crime;

informing law enforcers about medico-legal cases, etc.

THANK YOU

QUESTIONS

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Medical Ethics