[Forensics] laws related to medical practice

INTRODUCTIONINTRODUCTION
MEDICAL PRACTICE AND STATUTE LAW.MEDICAL PRACTICE AND STATUTE LAW.
ROLE OF COMMON LAW.ROLE OF COMMON LAW.
ROLE OF CONSENT AND ACCOUNTABILITYROLE OF CONSENT AND ACCOUNTABILITY
OF NEGLIGENCE.OF NEGLIGENCE.

VARIOUS SYSTEMS OF HEALINGVARIOUS SYSTEMS OF HEALING
Allopathic SystemAllopathic System
Ayuverdic SystemAyuverdic System
Homeopathic SystemHomeopathic System
Unani TibUnani Tib

Allopathic SystemAllopathic System
Modern , Scientific, Recognized.Modern , Scientific, Recognized.
Achievements:-Achievements:-
Increase in age span, Extinction of manyIncrease in age span, Extinction of many
infectious diseases, Understanding ofinfectious diseases, Understanding of
Psychological illnesses etc.Psychological illnesses etc.

LAWS RELATED TOLAWS RELATED TO
ALLOPATHIC SYSTEM OFALLOPATHIC SYSTEM OF
MEDICAL PRACTICEMEDICAL PRACTICE
Medical and dental degree OrdinanceMedical and dental degree Ordinance
1980.1980.
Allopathic System (Prevention of misuse)Allopathic System (Prevention of misuse)
act 1962.act 1962.
Pakistan Medical and Dental CouncilPakistan Medical and Dental Council
Ordinance 1962.Ordinance 1962.
Drug Act 1976.Drug Act 1976.
Dangerous Drug Act 1930.Dangerous Drug Act 1930.

MEDICAL AND DENTAL DEGREEMEDICAL AND DENTAL DEGREE
ORDINANCE 1980ORDINANCE 1980
Defines scientific medical and dentalDefines scientific medical and dental
system.system.
Identifies authorities having right ofIdentifies authorities having right of
granting medical degree and diploma.granting medical degree and diploma.
Prohibits unauthorized conformant ofProhibits unauthorized conformant of
medical degree and diploma and falselymedical degree and diploma and falsely
assuming or using medical or dental title.assuming or using medical or dental title.

IMPORTANT POINTSIMPORTANT POINTS
1. Scientific medical and dental system in1. Scientific medical and dental system in
law means allopathic system of medicinelaw means allopathic system of medicine
including obstetrics, surgery andincluding obstetrics, surgery and
dentistry.dentistry.
2. Only Universities established by an act of2. Only Universities established by an act of
Federal or Provincial Legislature andFederal or Provincial Legislature and
College of Physicians and Surgeons,College of Physicians and Surgeons,
Pakistan have the right of grantingPakistan have the right of granting
degrees and diplomas.degrees and diplomas.

3. The proceedings for contravention of this3. The proceedings for contravention of this
law are initiated in the Court oflaw are initiated in the Court of
Magistrate. The offence is punishableMagistrate. The offence is punishable
with maximum of five years rigorouswith maximum of five years rigorous
imprisonment or fine of fifty thousands orimprisonment or fine of fifty thousands or
both.both.

ALLOPATHIC SYSTEMALLOPATHIC SYSTEM
(PREVENTION OF MISUSE) ACT(PREVENTION OF MISUSE) ACT
19621962
Defines Registered Medical Practitioner.Defines Registered Medical Practitioner.
Prevents misuse of Allopathic System.Prevents misuse of Allopathic System.

Registered Medical Practitioner means aRegistered Medical Practitioner means a
medical practitioner registered withmedical practitioner registered with
Pakistan Medical and Dental Council.Pakistan Medical and Dental Council.
No one other than Registered MedicalNo one other than Registered Medical
Practitioner shall:Practitioner shall:
Use with his name or address the wordUse with his name or address the word
““doctor”doctor” or any of its grammaticalor any of its grammatical
variations or abbreviations so as to givevariations or abbreviations so as to give
an impression that he is entitled toan impression that he is entitled to
practice allopathic medicine.practice allopathic medicine.

Use medical degree or diploma to giveUse medical degree or diploma to give
impression that he is a qualified medicalimpression that he is a qualified medical
practitioner or for any purpose connectedpractitioner or for any purpose connected
with allopathic medical practice.with allopathic medical practice.
Perform any surgical operation other thanPerform any surgical operation other than
circumcision, incision of boils andcircumcision, incision of boils and
administration of injections.administration of injections.
Prescribe any antibiotic or dangerous drugPrescribe any antibiotic or dangerous drug
specified in the rules made under thisspecified in the rules made under this
Ordinance.Ordinance.

Proceedings for contravention of this ActProceedings for contravention of this Act
are initiated by Drug Inspectors in theare initiated by Drug Inspectors in the
Court of a Magistrate and the offence isCourt of a Magistrate and the offence is
punishable with maximum of one yearpunishable with maximum of one year
imprisonment or fine of Rs. 2000/- or both.imprisonment or fine of Rs. 2000/- or both.

PAKISTAN MEDICAL ANDPAKISTAN MEDICAL AND
DENTAL COUNCIL ORDINANCEDENTAL COUNCIL ORDINANCE
19621962
Have specific objectives of establishingHave specific objectives of establishing
the statutory body of medical practitionersthe statutory body of medical practitioners
called Pakistan Medical & Dental Council.called Pakistan Medical & Dental Council.

CONSTITUTION OF PAKISTANCONSTITUTION OF PAKISTAN
MEDICAL AND DENTALMEDICAL AND DENTAL
COUNCILCOUNCIL
Elected Members:Elected Members:
→→ 1 from National Assembly.1 from National Assembly.
→→ 1 from Each Medical Institution.1 from Each Medical Institution.
→→ 4 Registered Medical Practitioners.4 Registered Medical Practitioners.
→→ 2 Registered Dental Practitioners.2 Registered Dental Practitioners.
→→ 1 from Each University Granting Medical1 from Each University Granting Medical
Degrees.Degrees.

Nominated Members:Nominated Members:
a) Legal Membera) Legal Member
→→ One Legal Member.One Legal Member.
b)b) Medical Members:Medical Members:
→→ Director General Health, Pakistan.Director General Health, Pakistan.
→→ 1 from Each Province.1 from Each Province.
→→ 4 from Federal Government Including 24 from Federal Government Including 2
from Armed forces.from Armed forces.

FUNCTIONS OF P.M.D.C.
To maintain proficiency of the medicalTo maintain proficiency of the medical
profession.profession.
To maintain Medical register.To maintain Medical register.
To Over see professional conduct ofTo Over see professional conduct of
registered medical practitioner (ethicalregistered medical practitioner (ethical
standard).standard).

POWERS FOR MAINTAININGPOWERS FOR MAINTAINING
PROFICIENCY OF THE MEDICALPROFICIENCY OF THE MEDICAL
PROFESSIONPROFESSION
P.M.D.C. canP.M.D.C. can
Evaluate courses of studies of medicalEvaluate courses of studies of medical
qualifications.qualifications.
Prescribe minimum qualifications ofPrescribe minimum qualifications of
medical teachers.medical teachers.
Inspect medical institutions andInspect medical institutions and
examinations.examinations.

The council is fully empowered toThe council is fully empowered to grantgrant
recognitionrecognition to a medical institution or onto a medical institution or on
the basis of any derogatory informationthe basis of any derogatory information
regarding courses of studies, facilities forregarding courses of studies, facilities for
medical education or examinationmedical education or examination refuserefuse
recognitionrecognition or with the approval of theor with the approval of the
Federal Government alsoFederal Government also withdrawwithdraw
recognition that is already approvedrecognition that is already approved..

MEDICAL REGISTERMEDICAL REGISTER
Medical Register is the register that containsMedical Register is the register that contains
names of all the available medical practitionersnames of all the available medical practitioners
in the country. Every medical practitioner, hasin the country. Every medical practitioner, has
to register himself with the Council.to register himself with the Council.

The Medical Register has twoThe Medical Register has two
portions:portions:
The first having the names of ordinaryThe first having the names of ordinary
medical practitioners who possess onlymedical practitioners who possess only
the basic medical qualification i.e.,the basic medical qualification i.e.,
M.B.B.S.M.B.B.S.
The second having the names ofThe second having the names of
specialists who have also acquiredspecialists who have also acquired
additional medical qualification afteradditional medical qualification after
attaining the basic medical qualification.attaining the basic medical qualification.

The medical registration can be obtainedThe medical registration can be obtained
by submitting an application supportedby submitting an application supported
with requisite fee and certificates ofwith requisite fee and certificates of
medical proficiency, good moral charactermedical proficiency, good moral character
and citizenship.and citizenship.
Medical Practitioner’s name may beMedical Practitioner’s name may be
removed from the register due to non-removed from the register due to non-
payment of maintenance fee or ifpayment of maintenance fee or if
practitioner is found guilty of moralpractitioner is found guilty of moral
turpitude.turpitude.

PREVILEGES ANDPREVILEGES AND
OBLIGATIONS OF R.M.P.OBLIGATIONS OF R.M.P.
Three Privileges:Three Privileges:
1. Employment:1. Employment:
Can seek employment against job orCan seek employment against job or
permission for independent practice.permission for independent practice.
2. Certification:2. Certification:
Can Issue medical certificate forCan Issue medical certificate for
administrative and judicial purposes.administrative and judicial purposes.
3. Fees:3. Fees:
Can charge fees for medical servicesCan charge fees for medical services
rendered.rendered.

Two Obligations:Two Obligations:
1.1. To notify to the council change ofTo notify to the council change of
address on transfer within a period of 30address on transfer within a period of 30
days of the change.days of the change.
2.2. Not using any name, title, description orNot using any name, title, description or
abbreviation indicating that heabbreviation indicating that he
possesses an additional qualification,possesses an additional qualification,
which is not conferred to him.which is not conferred to him.

MAINTENANCE OF ETHICALMAINTENANCE OF ETHICAL
STANDARDSTANDARD
Ethical standard is maintained byEthical standard is maintained by
overseeing professional conduct ofoverseeing professional conduct of
registered medical practitioner by theregistered medical practitioner by the
council critically.council critically. His name can beHis name can be
suspended or removed altogethersuspended or removed altogether if theif the
disciplinary committee of the council findsdisciplinary committee of the council finds
him guilty of professional misconduct.him guilty of professional misconduct.

DISCIPLINARYDISCIPLINARY
PROCEEDINGS AGAINST APROCEEDINGS AGAINST A
MEDICAL PRACTITIONERMEDICAL PRACTITIONER
Court ConvictionCourt Conviction PatientPatient Hospital Admin.Hospital Admin.
PRESIDENT OF P.M.D.C.PRESIDENT OF P.M.D.C.
Frivolous complaints rejected.Frivolous complaints rejected.
Doctor asked to explain.Doctor asked to explain.
Complaint dismissed. Warning issued.Complaint dismissed. Warning issued.
DISCIPLINARY COMMITTEEDISCIPLINARY COMMITTEE
Name suspended Complaint Name erasedName suspended Complaint Name erased

DISTINGUISHED STATUS OFDISTINGUISHED STATUS OF
MEDICAL PROFESSIONMEDICAL PROFESSION
Medical Profession is different from allMedical Profession is different from all
other professions due to specialother professions due to special
relationship existing between a medicalrelationship existing between a medical
practitioner and his patient. Medicalpractitioner and his patient. Medical
practitioner has privileged position havingpractitioner has privileged position having
both skill and authority. While patient is atboth skill and authority. While patient is at
his mercy, dependent and in a state ofhis mercy, dependent and in a state of
complete surrender.complete surrender.

CONTROLLING INFLUENCECONTROLLING INFLUENCE
UPON MEDICAL PRACTITIONERUPON MEDICAL PRACTITIONER
Laws related to medical practice.Laws related to medical practice.
Medical ethics.Medical ethics.

MEDICAL ETHICSMEDICAL ETHICS
Ethics… derived from the Greek termEthics… derived from the Greek term
“Ethicos”“Ethicos” which stands for rules of conductwhich stands for rules of conduct
that govern natural disposition in humanthat govern natural disposition in human
beings.beings. Ethics means “Philosophy ofEthics means “Philosophy of
Morals”.Morals”. Study of ethic is essentially anStudy of ethic is essentially an
examination of:examination of:
What is wrong & what is right?What is wrong & what is right?
What is virtuous & what is evil?What is virtuous & what is evil?
in the human conduct.in the human conduct.

Medical ethicsMedical ethics means morality in medicalmeans morality in medical
profession. It is code of conduct imposed byprofession. It is code of conduct imposed by
the profession itself depending upon thenthe profession itself depending upon then
moral values.moral values.
Moral values differ in accordance with theMoral values differ in accordance with the
attitude of the society:attitude of the society:
e.g.,e.g.,
→→ Satti in Hindus.Satti in Hindus.
→→ Punishment of Hudood in Muslims.Punishment of Hudood in Muslims.
→→ Abortion in Western countries.Abortion in Western countries.
→→ Bhuddish – suicide by fire.Bhuddish – suicide by fire.

Can we enforce ethicsCan we enforce ethics
legally?legally?
No.No.
you cannot make people moralyou cannot make people moral
by Act of Parliamentby Act of Parliament
ButBut
that is precisely what can bethat is precisely what can be
donedone

VARIOUS CODES OF MEDICALVARIOUS CODES OF MEDICAL
ETHICSETHICS
The Hippocratic Code.The Hippocratic Code.
International Code of Medical Ethics.International Code of Medical Ethics.
P.M.D.C. Code of Medical Ethics.P.M.D.C. Code of Medical Ethics.

THE HIPPOCRATIC CODETHE HIPPOCRATIC CODE
The oldest known …… 25 centuries old ……The oldest known …… 25 centuries old ……
Laid by Hippocrates (Father of WesternLaid by Hippocrates (Father of Western
Medicine in Greece in 5Medicine in Greece in 5thth
century) …… Usedcentury) …… Used
to be sworn by Greek physicians.to be sworn by Greek physicians.

INTERNATIONAL CODE OFINTERNATIONAL CODE OF
MEDICAL ETHICSMEDICAL ETHICS
Recommended by World Medical AssociationRecommended by World Medical Association
after 2after 2ndnd
World War at its 3World War at its 3rdrd
generalgeneral
assembly in Geneva (Declaration of Genevaassembly in Geneva (Declaration of Geneva
1948). It is basically simple and modern1948). It is basically simple and modern
version of Hippocratic Oath.version of Hippocratic Oath.

P.M.D.C. CODE OF MEDICALP.M.D.C. CODE OF MEDICAL
ETHICSETHICS
Almost same as InternationalAlmost same as International
Code of Medical Ethics with fewCode of Medical Ethics with few
modifications.modifications.

IMPORTANT COMMON POINTSIMPORTANT COMMON POINTS
IN VARIOUS MEDICAL CODESIN VARIOUS MEDICAL CODES
Indiscriminate service of humanity.Indiscriminate service of humanity.
Respect of teachers.Respect of teachers.
Respect of colleagues.Respect of colleagues.
Respect and care of patient.Respect and care of patient.
Respect of the secrets of the patient.Respect of the secrets of the patient.
Maintenance of the noble traditions andMaintenance of the noble traditions and
honor of medical profession.honor of medical profession.
Respect for human life from the time ofRespect for human life from the time of
conception.conception.

OATH FOR MEDICALOATH FOR MEDICAL
GRADUATESGRADUATES
An oath is administrated to the medicalAn oath is administrated to the medical
graduates at the time of their passing out.graduates at the time of their passing out.
------------------------------------------------------------------------------------------------------------------------------
In the name of Allah, Most Gracious andIn the name of Allah, Most Gracious and
Merciful.Merciful.
I solemnly pledge thatI solemnly pledge that
I shall abide by the principles laid down in theI shall abide by the principles laid down in the
Code of Medical Ethics of the Pakistan MedicalCode of Medical Ethics of the Pakistan Medical
and Dental Council.and Dental Council.

I further make solemn declaration that:I further make solemn declaration that:
I consecrate my life to the service of humanity.I consecrate my life to the service of humanity.
I will give to my teachers the respect and theI will give to my teachers the respect and the
gratitude which is their due.gratitude which is their due.
I will practice my profession with conscience dignityI will practice my profession with conscience dignity
and fear of God.and fear of God.
The health of any patient will be my firstThe health of any patient will be my first
consideration.consideration.
I will respect the secrets, which are confined to me.I will respect the secrets, which are confined to me.
I will maintain by all the means in my power, theI will maintain by all the means in my power, the
honor and the noble traditions of the medicalhonor and the noble traditions of the medical
profession.profession.

My colleagues will be my brothers andMy colleagues will be my brothers and
sisters.sisters.
I will not permit consideration of religion,I will not permit consideration of religion,
nationality, race, party politics, socialnationality, race, party politics, social
standings to intervene between my duty andstandings to intervene between my duty and
my patient.my patient.
I will maintain the utmost respect, for humanI will maintain the utmost respect, for human
life, from the time of conception; even underlife, from the time of conception; even under
threat, and will not use my medicalthreat, and will not use my medical
knowledge contrary to the laws of humanity.knowledge contrary to the laws of humanity.
I make these promises solemnly, free andI make these promises solemnly, free and
upon my honor.upon my honor.

FACTORS RESPONSIBLE FORFACTORS RESPONSIBLE FOR
DETERIORIATION OF ETHICALDETERIORIATION OF ETHICAL
VALUES IN MEDICAL PRACTICEVALUES IN MEDICAL PRACTICE
Materialism:Materialism:
Tendency to be more concernedTendency to be more concerned
with material than spiritual value or anwith material than spiritual value or an
abnormal desire for wealth. “Get richabnormal desire for wealth. “Get rich
quick” Syndrome.quick” Syndrome.
Decline in Religious Influence:Decline in Religious Influence:
Decline in Religious influence onDecline in Religious influence on
the character resulted in Lack of Fear ofthe character resulted in Lack of Fear of
Allah.Allah.

Commercialism:Commercialism:
To exploit mainly for profit. MedicalTo exploit mainly for profit. Medical
practice is often called and industry or business.practice is often called and industry or business.
Objective is maximum profit with minimum input. ItObjective is maximum profit with minimum input. It
lead to a change fromlead to a change from
Mission ------------- to ------------- Commission.Mission ------------- to ------------- Commission.
e.g., “percentage” from the Labs, Pharmaceuticale.g., “percentage” from the Labs, Pharmaceutical
concerns and Hospitals etc.concerns and Hospitals etc.
Science & Technology:Science & Technology:
Newly developed intricateNewly developed intricate
procedures whose ethical value is doubtful e.g.,procedures whose ethical value is doubtful e.g.,
Artificial insemination, Surrogate motherhood,Artificial insemination, Surrogate motherhood,
Organ transplantation, Cloning.Organ transplantation, Cloning.

PROFESSIONALPROFESSIONAL
MISCONDUCTMISCONDUCT
Lord Justice Lopes LJ defined it in 1894.Lord Justice Lopes LJ defined it in 1894.
““If a medical man in pursuit of his professionIf a medical man in pursuit of his profession
has done something which would behas done something which would be
reasonablyreasonably regarded as disgraceful orregarded as disgraceful or
dishonorable by his professional brethren ofdishonorable by his professional brethren of
good repute and competency,good repute and competency, then he isthen he is
guilty of infamous conduct in professionalguilty of infamous conduct in professional
respect.”respect.”

EXAMPLESEXAMPLES
Abuse of Medical Practitioner’sAbuse of Medical Practitioner’s
Privileges:Privileges:
1.1. Issuing false medical certificate.Issuing false medical certificate.
2.2. Prescribing drugs of addiction for abuse.Prescribing drugs of addiction for abuse.
3.3. Disclosing of patient’s secret.Disclosing of patient’s secret.
Abuse of Doctor-PatientAbuse of Doctor-Patient
Relationship:Relationship:
1.1. Indecent assault on patient.Indecent assault on patient.
2.2. Adultery with patient.Adultery with patient.

Abuse of Professional Knowledge:Abuse of Professional Knowledge:
1.1. Criminal abortion.Criminal abortion.
Abuse of Financial Opportunities:Abuse of Financial Opportunities:
1.1. Dichotomy or fee splitting.Dichotomy or fee splitting.
2.2. Commission in labs, medicine, bogus bills.Commission in labs, medicine, bogus bills.
Association with UnqualifiedAssociation with Unqualified
Persons in Professional WorkPersons in Professional Work
(Covering):(Covering):
e.g., Administration of anesthetic to enablee.g., Administration of anesthetic to enable
such a person to perform operation.such a person to perform operation.

Advertising and Canvassing with aAdvertising and Canvassing with a
View to have Unreasonable Gains:View to have Unreasonable Gains:
e.g., Advertisements and interviews in printe.g., Advertisements and interviews in print
and electronic media.and electronic media.
Disregard of the Responsibilities toDisregard of the Responsibilities to
the Patient:the Patient:
e.g., Persistent failure to attend the patiente.g., Persistent failure to attend the patient
through idleness or carelessness.through idleness or carelessness.
Conduct Discredible to the MedicalConduct Discredible to the Medical
Profession:Profession:
e.g., Notification of the conviction being guiltye.g., Notification of the conviction being guilty
of fraud, forgery or theft.of fraud, forgery or theft.

Personal Tendencies Dangerous toPersonal Tendencies Dangerous to
the Patients:the Patients:
e.g., Alcoholism and drug addiction.e.g., Alcoholism and drug addiction.
Profiting at the Expense of hisProfiting at the Expense of his
Colleagues:Colleagues:
e.g., Deprecation of other doctors.e.g., Deprecation of other doctors.

PROFESSIONAL SECRETPROFESSIONAL SECRET
Is oneIs one which a doctor come to know in hiswhich a doctor come to know in his
professional capacityprofessional capacity e.g., during history taking,e.g., during history taking,
on examination or privacy of domestic life.on examination or privacy of domestic life.
Any information received by a medicalAny information received by a medical
practitioner during the doctor patientpractitioner during the doctor patient
relationship is a sacred trust with the doctor.relationship is a sacred trust with the doctor.
Maintenance of secrecy is notMaintenance of secrecy is not only a moralonly a moral
obligation but also a legal oneobligation but also a legal one and a practitionerand a practitioner
is liable to damage for its neglect.is liable to damage for its neglect.

PRIVILEGED COMMUNICATIONPRIVILEGED COMMUNICATION
A communication made by a doctor to aA communication made by a doctor to a
proper authority who has corresponding legal,proper authority who has corresponding legal,
social and moral duties to protect the public.social and moral duties to protect the public.

TYPES OF PREVILEGEDTYPES OF PREVILEGED
COMMUNICATIONCOMMUNICATION
Absolute Privilege:Absolute Privilege:
Any statement made in theAny statement made in the
court of law. All matters voiced in the courtcourt of law. All matters voiced in the court
of law are absolute privilege professionalof law are absolute privilege professional
dictates are completely ignored.dictates are completely ignored.
Qualified Privilege:Qualified Privilege:
Statement made to protectStatement made to protect
an interest, which may be one’s own or ofan interest, which may be one’s own or of
another’s. All statement, made outside theanother’s. All statement, made outside the
court by the doctor may be protected.court by the doctor may be protected.

CONDITIONSCONDITIONS
Statement must not be malicious.Statement must not be malicious.
Must have been in good faith.Must have been in good faith.
Must have been in the interest ofMust have been in the interest of
community.community.
Statement is made only to those who haveStatement is made only to those who have
an interest or duty to receive it.an interest or duty to receive it.

EXAMPLESEXAMPLES
Information of homicidal poisoning toInformation of homicidal poisoning to
police.police.
Notification of infectious disease to PublicNotification of infectious disease to Public
Health Authority.Health Authority.
Certification of birth and death.Certification of birth and death.
Cooks ….. Open T.B., Typhoid infection.Cooks ….. Open T.B., Typhoid infection.
Venereal disease – stop to enterVenereal disease – stop to enter
swimming pool.swimming pool.
Hotel waiter having T.B. or infectiousHotel waiter having T.B. or infectious
disease.disease.
Bus or engine driver – Hypertension,Bus or engine driver – Hypertension,
Epilepsy, Color blindness.Epilepsy, Color blindness.

MEDICAL NEGLIGENCEMEDICAL NEGLIGENCE
Negligence is aNegligence is a “tort”“tort” meaningmeaning
conduct which creates risk ofconduct which creates risk of
causing damage”. It also meanscausing damage”. It also means
“carelessness”.“carelessness”.

ELEMENTS OF NEGLIGENCEELEMENTS OF NEGLIGENCE
(3Ds)(3Ds)
Duty:Duty:
Doctor owed a duty to treat theDoctor owed a duty to treat the
patient.patient.
Dereliction:Dereliction:
There was breech of theThere was breech of the
duty due to his negligent conduct.duty due to his negligent conduct.
Damage:Damage:
Patient has suffered damage asPatient has suffered damage as
a result of breach of the duty.a result of breach of the duty.

DUTIES OF A DOCTORDUTIES OF A DOCTOR
Care of patient (private / govt. Service).Care of patient (private / govt. Service).
Duty to respond to emergency or nightDuty to respond to emergency or night
call.call.
Standard of skill or knowledge required.Standard of skill or knowledge required.
Duty to show reasonable care and skill.Duty to show reasonable care and skill.
Duty to have informed consent.Duty to have informed consent.
Duty to maintain professional secrecy.Duty to maintain professional secrecy.
Knowledge of recent Advances.Knowledge of recent Advances.

NEGLIGENCE ---- LEGALNEGLIGENCE ---- LEGAL
CONSIDERATIONCONSIDERATION
Neither a doctor can be forced to startNeither a doctor can be forced to start
treatment nor can a patient be forcedtreatment nor can a patient be forced
to submit to treatment. When bothto submit to treatment. When both
agree, they enter into anagree, they enter into an
“Implied contract”“Implied contract” having their ownhaving their own
share of responsibilities.share of responsibilities.

Patient’s Share Of Responsibility:Patient’s Share Of Responsibility:
(a). To pay the mutually agreed fee.(a). To pay the mutually agreed fee.
(b). To submit himself to the command of(b). To submit himself to the command of
doctor.doctor.
Doctor’s Share Of Responsibility:Doctor’s Share Of Responsibility:
(a). To apply skill with competence(a). To apply skill with competence
proportionate to his own claim.proportionate to his own claim.
(b). During application of skill should exercise(b). During application of skill should exercise
reasonable care.reasonable care.

The treatment must proceed withoutThe treatment must proceed without
interruption till:interruption till:
Mutual agreement between doctor andMutual agreement between doctor and
patient.patient.
Discharge of Doctor by the patient.Discharge of Doctor by the patient.
Death of either party.Death of either party.
Transfer in govt. Service.Transfer in govt. Service.

The termination of contract is unilateral.The termination of contract is unilateral.
Unless there is a claim by the sufferer, theUnless there is a claim by the sufferer, the
Law does not come in automatically.Law does not come in automatically.
When a case of negligence is broughtWhen a case of negligence is brought
forward, the burden of proof normally liesforward, the burden of proof normally lies
with the patient. However, in caseswith the patient. However, in cases
covered by doctrine ofcovered by doctrine of “RES IPSA“RES IPSA
LOQUITOR”LOQUITOR” (Thing speaks for itself),(Thing speaks for itself), thethe
burden of proof is shifted from patient toburden of proof is shifted from patient to
doctor.doctor.

EXAMPLESEXAMPLES
Leaving electric cautery unattended.Leaving electric cautery unattended.
Transfusion of wrong bottle of blood.Transfusion of wrong bottle of blood.
Amputation of the wrong limb.Amputation of the wrong limb.
Leaving swab or instrument in the body.Leaving swab or instrument in the body.
Operation on the wrong patient.Operation on the wrong patient.

PUNISHMENTPUNISHMENT
Section 337-H (PPC):Section 337-H (PPC):
Deals with punishment for hurtDeals with punishment for hurt
caused by Negligence. It may becaused by Negligence. It may be Arsh, DamanArsh, Daman
or imprisonment upto three years.or imprisonment upto three years.
Section 319 (PPC):Section 319 (PPC):
Deals with the punishment of theDeals with the punishment of the
death due to Negligent act. It may bedeath due to Negligent act. It may be Diyat andDiyat and
imprisonment upto five years.imprisonment upto five years.

TYPES OF NEGLIGENCETYPES OF NEGLIGENCE
Civil Negligence.Civil Negligence.
Contributory Negligence.Contributory Negligence.
Third Party Negligence.Third Party Negligence.
Criminal Negligence.Criminal Negligence.

CIVIL NEGLIGENCECIVIL NEGLIGENCE
Failure to exercise reasonable degree of careFailure to exercise reasonable degree of care
and skill on part of doctor in the treatment ofand skill on part of doctor in the treatment of
patient and as a result, health of patientpatient and as a result, health of patient
suffers. The negligent act must be proved bysuffers. The negligent act must be proved by
claimant.claimant.
For example:For example:
Extraction of healthy teeth.Extraction of healthy teeth.
Failure to give ATT.Failure to give ATT.
Failure to take X-Ray in case of injury.Failure to take X-Ray in case of injury.
Civil mal-praxis results in damages but doesCivil mal-praxis results in damages but does
not effect life so cases are dealt in civilnot effect life so cases are dealt in civil

CONTRIBUTORY NEGLIGENCECONTRIBUTORY NEGLIGENCE
In this, patient also contributes to the damageIn this, patient also contributes to the damage
caused by negligent act of doctor. The award ofcaused by negligent act of doctor. The award of
damages will be reduced accordingly. Burdendamages will be reduced accordingly. Burden
of proof lies on the doctor.of proof lies on the doctor.
Patient tampers with his dressing and inducesPatient tampers with his dressing and induces
infection or removes a plaster cast or ignoresinfection or removes a plaster cast or ignores
instructions to return for further treatment /instructions to return for further treatment /
follow up.follow up.

THIRD PARTY NEGLIGENCETHIRD PARTY NEGLIGENCE
Negligence of paramedical staff, nurses andNegligence of paramedical staff, nurses and
students working under supervision of astudents working under supervision of a
doctor. The doctor is held equally responsibledoctor. The doctor is held equally responsible
by virtue ofby virtue of doctrine of “respondent superior”doctrine of “respondent superior”
(let the master answer) or(let the master answer) or doctrine ofdoctrine of
“caption of the ship”“caption of the ship” now a days beingnow a days being
replaced byreplaced by doctrine of “borrowed servant”.doctrine of “borrowed servant”.
Failure to check swabs, paralysis duringFailure to check swabs, paralysis during
spinal anesthesia or failure to check drug andspinal anesthesia or failure to check drug and
its expiry.its expiry.

CRIMINAL NEGLIGENCECRIMINAL NEGLIGENCE
It is described asIt is described as gross ignorance, grossgross ignorance, gross
carelessness ort gross neglect for the lifecarelessness ort gross neglect for the life
which may amount to criminal offence.which may amount to criminal offence. ItIt
reflects disregard for life and safety of others.reflects disregard for life and safety of others.
Mere monitory compensation is not sufficient,Mere monitory compensation is not sufficient,
wrong doer should also be punished. Caseswrong doer should also be punished. Cases
are dealt in criminal courts.are dealt in criminal courts.
Injecting anesthetic, in fatal dose.Injecting anesthetic, in fatal dose.
Amputation of wrong finger, wrong limb,Amputation of wrong finger, wrong limb,
wrong organ.wrong organ.
Operation on wrong patient.Operation on wrong patient.

CONSENTCONSENT
MeansMeans “to agree”“to agree” or active will in the mind of aor active will in the mind of a
person to permit doing of act.person to permit doing of act.

REQUIREMENTSREQUIREMENTS
It must be free from fear, force or fraud.It must be free from fear, force or fraud.
Must not be obtained by any sharpMust not be obtained by any sharp
practice or blackmail.practice or blackmail.
The facts of consent must clearly beThe facts of consent must clearly be
stated.stated.
Possible results and complications mustPossible results and complications must
be explained.be explained.
Person must understand what he isPerson must understand what he is
consenting to.consenting to.
Reasonable time interval between consentReasonable time interval between consent
and treatment.and treatment.

INVALID CONSENTINVALID CONSENT
Child.Child.
Insane.Insane.
Unconscious or under the influence ofUnconscious or under the influence of
drug.drug.
Consent obtained by force, fear, fraud orConsent obtained by force, fear, fraud or
threat.threat.
Consent given for illegal purposes e.g.,Consent given for illegal purposes e.g.,
Euthanasia.Euthanasia.

TYPES OF CONSENTTYPES OF CONSENT
Implied.Implied.
Informed or ExpressedInformed or Expressed (oral/written).(oral/written).

IMPLIED CONSENTIMPLIED CONSENT
Mere action of patient, while he comesMere action of patient, while he comes
to doctor and sits on examination stoolto doctor and sits on examination stool
with some problem indicate that he iswith some problem indicate that he is
giving permission for treatment withoutgiving permission for treatment without
expressing his consent.expressing his consent.

EXPRESSED CONSENTEXPRESSED CONSENT
Verbal or written both are acceptable underVerbal or written both are acceptable under
Law but written is best because if it is keptLaw but written is best because if it is kept
in record for further reference.in record for further reference.
Oral consent is obtained in the presence ofOral consent is obtained in the presence of
third party who is disinterested. May be athird party who is disinterested. May be a
nurse or other paramedical staff member.nurse or other paramedical staff member.

REQUIREMENTS FORREQUIREMENTS FOR
INFORMED CONSENTINFORMED CONSENT
Understandable communication betweenUnderstandable communication between
doctor taking consent and the persondoctor taking consent and the person
entitled by law to grant consent.entitled by law to grant consent.
Doctor should inform the patient about:Doctor should inform the patient about:
1.1. Diagnosis.Diagnosis.
2.2. Choice of treatment.Choice of treatment.
3.3. Doctors experience.Doctors experience.
4.4. Method to be used.Method to be used.
5.5. Major or collateral risks.Major or collateral risks.
6.6. Type of anesthesia.Type of anesthesia.

7.7. Any alternative available.Any alternative available.
8.8. Prognosis.Prognosis.
9.9. Stay in hospitalStay in hospital
Note:Note:
““Blanket consent”Blanket consent” is not acceptableis not acceptable
in courts.in courts.

SITUATION WHERE CONSENT ISSITUATION WHERE CONSENT IS
NOT REQUIREDNOT REQUIRED
Examination of immigrant by port or airportExamination of immigrant by port or airport
authorities.authorities.
A person suffering from notifiable disease.A person suffering from notifiable disease.
Handlers of food and dairy man.Handlers of food and dairy man.
Members of Armed forces.Members of Armed forces.
New prisoners to rule out infectiousNew prisoners to rule out infectious
diseases.diseases.

COMPONENTS OF INFORMEDCOMPONENTS OF INFORMED
CONSENTCONSENT
Disclosure of information.Disclosure of information.
Voluntariness.Voluntariness.
Competence.Competence.

CONSENT IN SPECIAL CASESCONSENT IN SPECIAL CASES
Consent by Spouse:Consent by Spouse:
In operation interfering with marital rightsIn operation interfering with marital rights
such as abortion or sterilization where……such as abortion or sterilization where……
consent of the patient as well as spouse isconsent of the patient as well as spouse is
necessary.necessary.
If the patient is unconscious, consent ofIf the patient is unconscious, consent of
spouse is valid.spouse is valid.
Consent of Insane:Consent of Insane:
By guardian appointed by court of protection.By guardian appointed by court of protection.

Consent in Minors:Consent in Minors:
Under 16 years of age ---- Parents orUnder 16 years of age ---- Parents or
guardian. However in emergency, if both areguardian. However in emergency, if both are
not available, then person innot available, then person in “Loco parentis”“Loco parentis”
(e.g., headmaster of the school) may(e.g., headmaster of the school) may
consent. For some life saving treatment ifconsent. For some life saving treatment if
parents withhold consent (e.g., refusal toparents withhold consent (e.g., refusal to
blood transfusion in Jehovah’s witness) thenblood transfusion in Jehovah’s witness) then
consent may be obtained through court.consent may be obtained through court.
Consent in Emergency:Consent in Emergency:
In unconscious patient with no one availableIn unconscious patient with no one available
for consent, doctor can give the necessaryfor consent, doctor can give the necessary
treatment to save life, but no more.treatment to save life, but no more.

Note:Note: In emergency situation aIn emergency situation a
doctor may override a patient’sdoctor may override a patient’s
objection to treatment in good faithobjection to treatment in good faith
in his interest.in his interest.

CONSENT FORMCONSENT FORM
I,____________NIC number ____________I,____________NIC number ____________
do hereby consent to ____________do hereby consent to ____________
Operation of ________________Operation of ________________
under anesthesia ________________under anesthesia ________________
I have been explained fully the nature, purposeI have been explained fully the nature, purpose
and inherent risks involved in this surgery andand inherent risks involved in this surgery and
the type of anesthesia by Dr. __________. Nothe type of anesthesia by Dr. __________. No
assurance has been given to me that anyassurance has been given to me that any
particular surgeon will perform the operation.particular surgeon will perform the operation.
Signature of the consenterSignature of the consenter
________________________
Date ____________Date ____________

I confirm that all-relevant detail in respect ofI confirm that all-relevant detail in respect of
the above-referred operation andthe above-referred operation and
anesthesia has been fully explained to theanesthesia has been fully explained to the
consenter who has signed this form.consenter who has signed this form.
Signature of the doctor _____________Signature of the doctor _____________
taking consent.taking consent.
Date _____________Date _____________

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