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Ethics in Forensic Medicine
- 3. Ethics – understanding Moral Value Code of Ethics – Rules Framed
- 4. Ethics in relation to the practice of medicine had continuity from the time of Hippocrates 460-377 BC HIPPOCRATIC OATH
- 5. I swear by Apollo the physician, by Aesculapius, Hygiea and panacea and I take to witness all the Gods, all the Goddesses to keep according to my ability and judgment the following oath: “To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; to look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone, the precepts and the instruction. I will prescribe regimen for the good of my patients according to my ability and my judgment and never do harm to anyone. To please no one will I prescribe a deadly drug, nor give advice which may cause his death. Nor, will I give a woman a pessary to procure abortion. But I will preserve the purity of my life and my art. I will not cut for stone, even for patients in whom the disease is manifested I will leave this operation to be performed by practitioners (specialists in this art). In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction, and especially from the pleasures of love with women or with men, be they free or slaves. All that may come to my knowledge in the exercise or my profession or outside or any profession or in daily commerce with men, which ought not to be spread abroad. I will keep secret and will never reveal. If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.” HIPPOCRATIC OATH
- 6. The Declaration of Geneva 1948 : The Declaration of Geneva of the world Medical Association binds the doctor with the words, “The health of my patient will be my first consideration” More or less Mordern Version of HIPPOCRATES OATH Amended by World Medical Association in 1968, 1984, 1994,2006
- 7. The Declaration of Geneva, 2006, reads: • I solemnly pledge to consecrate my life to the service of humanity; • I will give to my teachers the respect and gratitude that is their due; • I will practice my profession with conscience and dignity; • The health of my patient will be my first consideration; • I will respect the secrets that are confided in me, even after the patient has died; • I will maintain by all the means in my power, the honour and the noble traditions of the medical profession; • My colleagues will be my sisters and brothers; • I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient; • I will maintain the utmost respect for human life; • I will not use my medical knowledge to violate human rights and civil liberties, even under threat. •I make these promises solemnly, freely and upon my honour
- 8. International Code of Medical ethics 1949: It declares, “Any act or advice which could weaken physical or mental resistance of a human being may be used only in his interest”
- 9. MCI The Medical Council of India was established by the Indian Medical Council Act of 1956 FUNCTIONS Maintenance of a Medical Register Medical Education Recognition of foreign medical qualifications Appeal against disciplinary action Warning notice
- 10. Constitution of the Indian Medical Council One member from each State other than a Union Territory One member from each University One member from each State where a State Medical Register is maintained Seven members are to be elected from amongst persons enrolled in any of the State Medical Register. Eight members are to be nominated by the Central Government The President and Vice President of the Council are to be elected from amongst the members of the Council.
- 11. THE INDIAN MEDICAL COUNCIL REGULATIONS, 2002 The doctors are free to choose their patients but should not arbitrarily refuse treatment and must not refuse to help in an emergency. Doctor should not refer their patients for consultation to other doctors or clinical investigations unless absolutely necessary. Once a case is taken, the doctor must not abandon or neglect the patient without proper reason and appropriate notice to the patient and his family. Doctors must display their fees and other charges clearly and should write clear prescriptions for dispensing medications.
- 12. Doctors must not provide any endorsement for medications and equipment with or without any financial gains. Drugs should be prescribed with their generic name as far as possible. No sex determination tests should be done with the intention to destroy the female fetus if present. The patients must not be subjected for trials except under ICMR guidelines. Doctors should keep records for a minimum period of 3 years for in patients and must produce the documents if asked for within 72 hours. The doctors should undergo 30 hours of CME training in every five years for renewal of registration.
- 13. Composition of the State Medical Council – in State Capital • Medical teachers from different universities of the State elected by the teachers of the different medical institutions. • Registered medical practitioners elected by the registered medical practitioners of the State. • Some members nominated by the State Government. •The members of the State Medical Council elect a President and a Vice President from amongst themselves. STATE MEDICAL COUNCIL
- 14. •Maintenance of Medical Register •Exercise of Disciplinary Control – Penal Erasure or Professional Death Sentence. FUNCTIONS OF THE STATE MEDICAL COUNCIL
- 15. RIGHTS AND PRIVILEGES OF MP Right to choose his patients Use title and description of qualification Appointment in public and private hospital Prescribe and dispense medicine Realize fee and other expenses Issue medial certificate Give evidence in court of law. Removal of organ for transplantation MTP Not to use red cross emblem
- 16. CODE OF MEDICAL ETHICS IN GENERAL To Patient Duty to exercise necessary care and skill To examine the patient properly To prescribe proper medicines Duty to give proper instructions Duty to inform the risks
- 17. Toward Colleagues Never criticize Never take fees Always help Consultation Towards State • Notifiable diseases. • Geneva Conventions- armed forces (I Convention), ship wrecked persons (II Convention); prisoner of war (III convention) and civilians of enemy nationalist (IV Convention)
- 18. Professional Misconduct Infamous conduct or disgraceful act Doctor may be issued warning notice or the name may be erased from the register
- 19. Few examples for which action can be taken are Adultery, Advertisement, Association, Abortion, Alcohol, Addiction, Dichotomy or fee splitting,
- 20. Using touts and agents for fetching patients, Not informing about the notifiable diseases to Health Authority, Disclosing the patient’s secrets, Refusal to treat a patient on religious grounds, To run a chemist shop for the sale of medicine or for dispensing prescriptions of other doctors. Issuing false certificates. He should not assist a person who has no qualification to attain or treat a patient.
- 21. CONSENT It is defined as voluntary agreement, compliance, and permission. Types of Consent 1. Implied 2. Express • Oral • Written—informed
- 22. The exceptions to the informed consent are: Emergency Incompetence Therapeutic privilege waiver
- 23. Professional Secrecy The doctor should not discuss any point with others except with the consent of the patient If the patient is a major a doctor should not disclose anything about his illness even to his parents without getting the consent. In case of husband and wife the facts relating to the nature of illness of one should not be disclosed to the other without the consent. If the doctor examines a domestic servant at the request of the master who is paying the fees still he should not disclose even to the master without the consent of the servant.
- 24. Doctors in government service are bound by code of professional secrecy even if they are treating the patients free of cost. The criminals in police custody has right not to allow the treating doctor to disclose about the nature of illness to any person. However once the person is convicted he has lost this right and the doctor can disclose to the proper authorities. While reporting about any case in a medical journal care should be taken not to disclose the identity of the person.
- 25. When somebody submits for medical examination while taking the life insurance the doctor can disclose the result to the proper authorities because of implied consent. A doctor should not disclose any information about the illness of his patient without consent whenever requested by a statutory body except notifiable diseases. The examination of the dead body at times may reveal certain facts that affect the reputation of the deceased as well as the family members so the doctor should not disclose the fact to others.
- 26. EXCEPTIONS TO PROFESSIONAL SECRECY / PRIVILEGED COMMUNICATION Infectious diseases Notifiable diseases Suspected crimes Servants and Employees Sexually transmitted diseases In patient’s interest Court of Law Negligent suits Self Intrest
- 27. MEDICAL NEGLIGENCE (MALPRAXIS) It could be defined as a failure to perform the duty to exercise a reasonable degree of skill and care in the treatment of patient CRIMMINAL CIVIL ETHICAL
- 29. Features Civil negligence Criminal negligence Offence No specific and clear violation There is specific violation of a particular Of law criminal law in question Negligence Simple absence of care and skill Gross negligence, inattention or ]ack of competency Conduct of physician Compared to a generally accepted standard of profesisonal conduct Not compared to a any single test Consent for act Good defence in court of recover damages Not a defence; can be prosecuted TRIAL CIVIL COURT CRIMMINAL COURT Evidence PUNISHMENT Strong evidence is sufficient DAMAGES TO BE PAID Guilt should be proved beyond reasonable doubt IMPRISONMENT
- 31. Contributory Negligence Contributory Negligence is the absence of reasonable care on the part of the patient or his attendant that combines with the negligent action of the doctor resulting in the damage completed off directly and without which damage should not have occurred. 1. The doctor can’t plead contributory negligence, if he fails to give proper instruction. 2 This is only a partial defence. and court has right to fix liabilities between parties. 3. The onus of proof lies entirely on the doctors.
- 32. CORPORATE NEGLIGENCE Corporate negligence is the legal doctrine that holds health-care facilities, such as hospitals, nursing homes and medical clinics, responsible for the well-being of patients. If a health-care facility fails to maintain a clean and safe environment, hire competent and properly trained employees, oversee care and implement safety policies, it can be held liable for any harm to patients.
- 33. Respondent Superior (Vicarious Liability) The employer is responsible not only for the wrongful deeds committed by him, but also the wrongful deeds of his employees.
- 34. Doctrine of Res Ipsa Loquitur “ the facts speaks for itself” the patient need not prove the negligence. 1. That in the absence of negligence the injury would not have occur. 2. The doctor had exclusive control over the injury producing instrument or treatment 3. There is no contributory negligence by the patient
- 35. Precautions against Medical Negligence 1. Never guarantee a cure. 2. Obtain informed consent from the patient. 3. The diagnosis to be confirmed by proper investigation depending upon the nature of cases. 4. Reasonable skill and care to be taken 5. Proper, accurate and legible records to be maintained. 6. Immunization to be done specially tetanus in cases of injuries.
- 36. 7. Sensitivity test to be performed before injecting the drugs known to cause hypersensitivity reactions specially in cases of penicillin, streptomycin and antivenins. 8. The patient or his attendant should be advised that the medicine should be given in the proper dosage and in time and no telephonic consultation should be done. 9. Consultation to be undertaken with appropriate specialist in case of need. 10. Never criticise your colleagues regarding his professional ability.
- 37. MISADVENTURE The term Misadventure is mischance or accident or disaster. Misadventure is of three type- Therapeutic-when treatment is given Diagnostic Experimental
- 38. Therapeutic Misadventure A misadventure is a accident or unexpected damage to the patient which the doctor is attending during the treatment is called Therapeutic misadventure. It can be during diagnosis or during experiment.
- 39. Product liability It is the area of law in which manufacturers, distributors, suppliers, retailers, and others who make products available to the public are held responsible for the injuries those products cause.
- 40. Medical Indemnity Insurance It is a contact under which the insurance company agrees, in exchange for payment of premiums, to compensate the insured doctor as a result of his claimed professional negligence.
- 41. Euthanasia (Mercy Killing) It means producing painless death of a person suffering from hopelessly incurable and painful; disease. Types 1.Active Euthanasia –it is an act of commission, e.g. by giving large doses of drug to hasten death. 2.Passive Euthanasia-it means discontinuing or not using extraordinary life sustaining measures to prolong life.
- 42. THANK YOU