Chapter3

MEDICAL LAW AND ETHICS 1. INDIAN MEDICAL COUNCIL 2. STATE MEDICAL COUNCILS 3. SERIOUS PROFESSIONAL MISCONDUCT 4. DUTIES OF MEDICAL PRACTITIONERS 5. Physician’s Responsibility in Criminal Matters: 6. 7. 8. 9. 10.

PROFESSIONAL NEGLIGENCE (MALPRAXIS) THERAPEUTIC MISADVENTURE EUTHANASIA RULES OF CONSENT MALINGERING

• MEDICAL LAW AND ETHICS • INDIAN MEDICAL COUNCIL • Functions: • (1) Medical Register: The Council maintains a register of medical practitioners, known as the Indian Medical Register.

• (2) Medical Education: • (3) Recognition Qualifications:

of

Foreign

Medical

• (4) Appeal Against Disciplinary Action: • (5) Warning Notice:

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• STATE MEDICAL COUNCILS Functions: 1.Medical Register: The Declaration of Geneva: (1) I solemnly pledge myself to consecrate my life to the service of humanity. (2) I will maintain the utmost respect for human life from the time of conception. Even under threat, I will not use my medical knowledge contrary to the laws of humanity.

• (3) I will not permit consideration of religion, nationality, race, party politics, or social standing to intervene between my duty and my patient. • (4) I will practice my profession with conscience and dignity. • (5) The health of my patient will be my first consideration.

• (6) I will respect the secrets which are confided in me. • (7) I will give to my teachers the respect and gratitude which is their due. • (8) I will maintain by all the means in my power, the honour and noble traditions of the medical profession.

• (9) I will treat my colleagues with all respect and dignity. • (10) I shall abide by the Code of Medical Ethics as enumerated in the Indian Medical Council (professional conduct, etiquette and ethics) Regulations, 2002, I make these promises solemnly, freely and upon my honour.

• 2. Disciplinary Control: • 3. They can issue warning notice similar to that of the Indian Medical Council. • SERIOUS PROFESSIONAL MISCONDUCT:

• If any one is found guilty of any of the following offences mentioned in the Warning Notice issued by the Medical Council of India, his name can be erased from the Medical Register.

• (1) Adultery • (2) Improper conduct or association with a patient or member of the patient’s family. • (3) Conviction by a Court of Law for offences involving moral turpitude and criminal acts.

• (4) Issuing a false, misleading or improper certificate in connection with sick benefit, insurance, passport, attendance in Court, public services, etc. •

(5) Withholding from health authorities information of notifiable diseases.

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(6) Performing or enabling an unqualified person to perform an abortion or any illegal operation for which there is no indication.

• (7) Contravening provisions of the Drugs and Cosmetics Act and regulations. (a) Prescribing steroids/psychotropic drugs when there is no absolute medical indication. (b) Selling schedule H and L drugs to the public except to his patients.

• (8) Not displaying the registration number given to him by State Medical Council in his clinic, prescription and certificates, etc. issued by him.

• (9) Dichotomy or fee-splitting, i.e., receiving or giving commission or other benefits to a professional colleague or manufacturer or trader in drugs or appliances or a chemist, dentist, etc. A physician shall not give, solicit or receive nor shall he offer to give solicit or receive any gift, gratuity, commission or bonus in consideration of or return for the referring, recommending or procuring of any patient for medical, surgical or other treatment.

• (10) Using of touts or agents for procuring patients. • (11) disclosing the secrets of a patient that have been learnt during his professional experience, except in a Court of law and notifiable diseases, and privileged communications.

• (12) Covering, i.e., assisting someone who has no medical qualification to attend, treat, or perform an operation on some person in cases requiring professional discretion or skill.

• (13) Association with manufacturing firms: (a) A physician may patent surgical instruments, appliances and medicines or copyright application methods and procedures. However, it shall be unethical if the benefits of such patents of copyright are not available in situations where the interest of large population is involved. (b) He should not solicit or receive rebates or commission from prescribing of any agent used therapeutically. (c) A physician must not write prescriptions in private formulae of which only he or a particular pharmacy has the key. He can keep certain lotions or mixtures, as long as the formulae of the same are available.

• (14) Advertising: (a) A physician should not publish on his own in the lay press, reports of cases treated or operated on by him. He should not sanction the publication of any certificates for drugs, or appliances issued by him. (b) A physician can write to the lay press under his own name on matters of public health, hygienic living or can deliver public lectures, give talks on the radio, TV/internet, chats, for the same purpose. (c) A physician can announce in lay or professional press, his starting of practice, interruption or restarting it after a long interval, a change of his address temporary absence from duty, change of type of practice, resumption of another practice, or succeeding to another practice.

• (d) An institution, such as a maternity home, a sanatorium, a house for the crippled or blind, nursing home, private hospital, rehabilitation centre or any type of training institution, etc, may be advertised in the lay press but is should not contain anything more than the name of institution, type of patients admitted, type of training and other facilities offered and the fees. (e) It is improper for a physician, to use an unusually large signboard and to write on it anything other than his name, qualification, titles, and name of his speciality. The same should be the contents of his prescription paper, which may in addition contain his address, registration number, and telephone number. It is improper to affix a signboard on a chemist’s shop, or in places where he does not reside or work.

• (f) A physician must not exhibit publicly the scale of fees except in his consulting or waiting room. (g) He should not advertise himself through manufacturing firms directly or indirectly. (h) Printing of self photograph, or any such material of publicity in the letter head or on sign board or the consulting room or any such clinical establishment shall be regarded as acts of self advertisement.

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(15) Professional association with bodies or societies of unqualified persons formed for the purpose of turning unqualified practitioners. • (16) Running an open shop for sale of medicines, for dispensing prescriptions of other doctors, or for sale of medical or surgical appliances. • (17) A physician shall not refuse on religious grounds alone to give assistance in or conduct of sterility, birth control, circumcision, MTP, unless the physician feels himself incompetent to do so.

• (18) Drunk and disorderly so as to interfere with proper skilled practice of medicine. • (19) The physician shall not aid or abet torture nor shall he be a party to either inflict mental o r physical trauma or concealment of torture inflicted by some other person or agency in clear violation of human rights.

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(20) A physician shall not publish photographs or case reports of his patients without their permission by which their identity could be made out. If the identity is not to be disclosed, consent I s not needed. • (21) Sex determination test shall not be undertaken with the intent to terminate the life of a female foetus. •

• (22) Failure to obtain consent of both husband and life in an operation which may result in sterility. • (23) No act of in vitro fertilisation or artificial insemination shall be undertaken without the informed consent of the female patient, her husband and the donor.

• (24) Violation of existing ICMR guidelines in clinical drug trials or other research involving patients or volunteers constitutes misconduct. • The important offences may be described as “the 6 A’s”. (1) Adultery arising out of professional relationship. (2) Advertising. (3) Abortion (unlawful). (4) Association with unqualified persons in professional matters. (5) Addiction. (6) Alcohol.

• Indian Medical Council (Professions Conduct, Etiquette and Ethics) Regulations (2002): • Rights and Privileges of Registered Medical Practitioners: • RED CROSS EMBLEM:

• DUTIES OF MEDICAL PRACTITIONERS • The following are the various types of duties: • (I) Duty to Exercise a Reasonable Degree of Skill and Knowledge:

• (II) Duties with Regard to Attendance and Examination: • He cannot withdraw without the consent of the patient except for valid reasons, such as: (1) That he himself becomes sick. (2) That he is convinced that the patient is malingering. (3) Remedies other than those prescribed by him are being used. (4) That his instructions are being ignored. (5) That previous financial obligations are not being fulfilled by the patient. (6) That another practitioner is also attending the patient. (7) That the patient persists in the use of intoxicants or poisons.

• (III) Duty to Furnish Proper and Suitable Medicines: • (IV) Duty to Give Instructions: • (V) Duty to Control and Warn: • (VI) Duty to Third Parties:

• (VII) Duty Towards Children and Adults incapable of taking care of themselves: • (VIII) Duty to Inform Patient of Risks: • (IX) Duty with Regard to Poisons: • (X) Duty to Notify Certain Diseases:

• (XI) Duties with Regards to Operations: • (XII) Duties Under Geneva Conventions: • (XIII) Duties with Regard to Consultation: • (XIV) Duty in Connection with X-ray Examination:

• (XV) PROFESSIONAL SECRECY • The following points may be noted: • PRIVILEGED COMMUNICATION:

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(1) Infectious Diseases: (2) Servants and Employees: (3) Venereal Diseases: (4) Notifiable Diseases: (5) Suspected Crime: (6) Self-interest: (7) Patient’s own Interest: (8) Negligence Suits: (9) Courts of Law:

• Physician’s Responsibility in Criminal Matters: • Duties of a Patient: • Privileges and Rights of the Patients: • Types of Physician-Patient Relationship. • (I)Therapeutic Relationship:

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Special duty of a doctor in Emergency Cases: In emergency he has moral, ethical and humanitarian duty to do his best to help the patient in saving his life.

• (II) Formal Relationship:

• PROFESSIONAL NEGLIGENCE (MALPRAXIS) • Due Care:

• CIVIL NEGLIGENCE:

• Liability for negligence arises if the following conditions are satisfied: • (1) Duty: • (2) Dereliction: • (3) Direct causation: • (4) Damage:

• Instances of Medical Negligence: • A doctor is not liable: • The Doctrine of Res Ipsa Loquitur: • “Calculated Risk” Cases:

• Doctrine of Common Knowledge: • Medical Maloccurrence: • Novus Actus Interveniens: • CRIMINAL NEGLIGENCE:

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Causes of action by the patients: (I) Physician related: (II) Patient related: (III) Media related: (IV) Attorney related: (V) Economic: (VI) Social:

• Defensive medicine: • Prevention: • Case: • CORPORATE NEGLIGENCE:

• Precautions against Negligence: • Table (3-1). Difference between Civil and Criminal Negligence • Table (3-2). Difference between Professional Negligence and Infamous Conduct

• Defences against Negligence: • CONTRIBUTORY NEGLIGENCE: • Limitations to Contributory Negligence: • CASE:

• THERAPEUTIC MISADVENTURE: • Neoplasia induced by Medical Treatment: • VICARIOUS LIABILITY (liability for act of another):

• MEDICAL 　 RECORDS Format for Medical Record (Regulation 3.1 of M. C. I.) Name of the patient Age Sex Address Occupation Date of first visit Clinical note (smmary) of the case Provisional diagnosis Diagnosis after investigation Advice Observations Follow up Date Signature in full Name of treating physician

• PRODUCTS LIABILITY • MEDICAL INDEMNITY INSURANCE

• EUTHANASIA (mercy killing): • Types: (1) active or positive. (2) Passive or negative. Active euthanasia is positive merciful act, to end useless suffering or a meaningless existence. • Iatrogenic Diseases: • Deaths due to Medical Care:

• CONSENT IN MEDICAL PRACTICE • Reasons for obtaining Consent: • Kinds of Consent: • Full Disclosure:

• Therapeutic privilege: • Prudent patient rule, • Informed Consent: • Informed Refusal: • Paternalism

• RULES OF CONSENT • Penal Provisions Applicable to Medical Practice: •

S. 118, I. P. C.: Concealing design to commit offence punishable with death or imprisonment for life. • S. 175, I. P. C.: Omission to produce document to public servant by person legally bound to produce it (imprisonment one to six months).

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S. 176, I. P. C.: Omission to give notice or information to public servant by person legally bound to give it (imprisonment up to one month). • S. 177, I. P. C.: Furnishing false information (imprisonment up to six months). • S. 178, I. P. C.: Refusing oath or affirmation when duly required by public servant to make it (imprisonment up to six months).

• S. 179, I. P. C.: Refusing to answer public servant authorized to question (imprisonment up to six months). • S. 182, I. P. C.: False information with intent to cause public servant to use his lawful power to the injury of another person (imprisonment up to six months). •

S. 191, I. P. C.: Giving false evidence.

• S. 192, I. P. C.: Fabrication false evidence. • S. 193, I. P. C.: Punishment for false evidence (imprisonment up to seven months). • S. 194, I. P. C.: Giving or fabricating false evidence with intent to procure conviction of capital offence (imprisonment up to ten months).

• S. 195, I. P. C.: Giving or fabrication false evidence with intent to procure conviction of offence punishable with imprisonment for life or imprisonment. • S. 197, I. P. C.: Issuing or signing false certificate (imprisonment up to seven months). • S. 201, I. P. C.: Causing disappearance of evidence of offence, or giving false information to screen offenders (imprisonment up to ten years).

• S. 202, I. P. C.: Intentional omission to give information of offence by person bound to inform (imprisonment up to six months). • S. 203, I. P. C.: Giving false information respecting an offence committed (imprisonment up to two years). • S. 204, I. P. C.: Destruction of document to prevent its production as evidence (imprisonment up to two years). • S. 269, I. P. C.: Negligent act likely to spread infection of disease dangerous to life (imprisonment up to six months).

• S. 270, I. P. C.: Malignant act likely to spread infection of disease dangerous to life (imprisonment up to two years). • S. 39, Cr. P. C.: Every person, aware of the commission of, or of the intention of any other person to commit any offence punishable under I. P. C. shall forthwith give information to the nearest Magistrate or police officer of such commission or intention. • S. 160, Cr. P. C.: Police officer has the power to summon any witness (doctor) to police station for recording a statement.

• S. 161, Cr. P. C.: The police has the power to examine witnesses. • S. 162, Cr. P. C.: Oral statements made to the police and recorded by the police should not be signed. • Legal protection to medical doctors is provided by S. 88 to 93, I. P. C.

• MALINGERING • HUMAN EXPERIMENTATION • (1) Basic Principles: • (2) Clinical Research Combined with Professional Care: • (3)Non-therapeutic Clinical Research:

• Human experimentation may be: • THE WORKMEN’S COMPENSATIONACT, 1923:

• CONSUMER PROTECTION ACT, (CPA/COPRA) 1986 (Amended in 2002) • Consumer Disputes Redressal Agencies: •

• THE TRANSPLANTATIO OF HUMAN ORGANS ACT, 1994 (amended in 2002) • The Protection of Human Rights Act, 1993