Bio Ethics in Medical Profession

1. • Dr. Sudhir Ninave
• MBBS,MD, LLB Mphil ,PhD, PGDGM Scholar
• EX Prof & HOD ,Senior Prof
• Department Of Forensic Medicine
• J.N.Medical College, Sawangi (M) Wardha.
(M.S.)

2. Professional Negligence
(Medical Malpractice/Malpraxis)
Professional negligence
Lack or want of reasonable degree of
care and skill or willful negligence
on the part of medical practitioner
during the practice of his profession,
which causes bodily harm, ill health
or death of his patient. (S 304 A IPC)

3. Professional Negligence
Every medical practitioner is required :
a) To possess ‘reasonable’ medical
knowledge and
b) To exercise ‘reasonable’ care and skill.
The quantum of ‘knowledge’ and ‘skill’
has not been prescribed. A doctor is
expected to have such knowledge and skill
as possessed by other doctors of his
standing in similar circumstances.

4. Types of Professional Negligence
The two main types of professional
negligence are:
 Civil Negligence
 Criminal Negligence
Other types are:
 Ethical negligence
 Corporate negligence
 Contributory negligence

5. Medical Malpractice/ Negligence
1. Civil
Can be compensated by money
Do not demand legal punishment
2. Criminal
Manipulation of medical records
Performing criminal abortion etc
3. Ethical
Breach of ethics
May lead to debar the physician.

6. Elements of Malpraxis suits :
Liability for negligence arises if following
conditions are satisfied :
1. Duty of care :-
There must be duty on the part of doctor to
take care of the patient.
2. Dereliction of duty :-
Failure of doctor to exercise that duty.
3. Direct causation :-
Failure to exercise duty of care must directly
result into the harm to the patient.
4. Damage :-
The harm must be caused and must be
reasonably foreseeable.

7. Civil Negligence :
• Simple absence of care and skill
• Nature and extent of harm is such that it can be
compensated in terms of money (damages).
• Amount of harm/damage is a measure of extent of
Liability.
• If proved, the doctor is liable to pay damages.
• Tried by Civil Courts
• No special violation of Law
• Consent of the patient amounts to good defence
• Contributory negligence may also constitute a
defence.

8. Criminal Negligence :
• More serious than civil negligence
• There is Carelessness
Negligence
Disregard for life and safety of the patient.
• Extreme departure from ordinary standard of
care.
• The nature and extent of Loss/harm is such that it
can not be compensated in terms of money.
• Practically limited to cases in which the patient has
died.
• Examples – operating on wrong person or wrong
organ.

9. Important Doctrines :
Res Ipsa Loquitur :-
 Ordinarily negligence of a doctor must be proved
in court by the patient or relatives through expert
evidence.
 Res Ipsa loquitur is the exception – it means “the
thing or fact speaks for itself.”
 It enables the patients lawyer to prove his case
without medical evidence.
 E.g. wrong prescription, swab in abdomen etc.

10. Vicarious Liability :
 “A liability that exists, in absence of
blameworthy conduct on the part of
master”.
 Based on the principle,
“Respondent superior” (let the master answer)
 Here, the employer is responsible for the
negligent acts of his employee, provided :
i) There is employee-employer relationship.
ii) The employees conduct occurs during the course of
employment and
iii) While on job.

11. CONTRIBUTORY NEGLIGENCE
Any unreasonable conduct or absence of
ordinary care on the part of the patient, which,
along with doctor’s negligence, has contributed
to the harm complained of.
Some contribution by the patient.
Doctor partly held responsible.
“last clear chance”

12. CONTRIBUTORY NEGLIGENCE
Examples :
- Failure to give correct history.
- Failure to carry out doctor’s instructions.
- Refusal to take suggested treatment.
- Leaving the hospital DAMA.
- Failure to seek timely assistance/advice.
Failure to attend for follow-up.

13. CONTRIBUTORY NEGLIGENCE
Legal aspects :
- Contributory negligence is a good
defence for the doctor, but
- Only a partial defence and, if proved,
doctors liability can be
proportionately reduced.
- Burden of proof lies entirely on the
doctor.
- Doctor can not plead it, if fails to give
proper instructions.

14. THERAPEUTIC MISADVANTURE
Almost every therapeutic drug and
every therapeutic procedure carry
inherent risks or complications.
Ignorance of the doctor about
possibility of reaction or continuation
in prescribing the drug with adverse
reaction amounts to negligence.

15. THERAPEUTIC MISADVANTURE
The doctor is not considered as negligent if
he can prove that :
- Steps he took were quite justified.
- The hazard was quite unexpected & was not
known to occur.
- Reasonable precautions were taken.
- No better treatment or procedure was
available.

16. HOW TO AVOID NEGLIGENCE?

17. PRECAUTIONS AGAINST NEGLIGENCE
• Establish good rapport with the patient.
• Maintain proper and complete record.
• Employ laboratory tests, whenever
indicated.
• Obtain informed consent.
• Seek consultation whenever necessary.
• Never guarantee a cure.
• Do not employ experimental methods
without valid reason/informed consent.

18. HOW TO DEFEND?

19. DEFENCES AGAINST NEGLIGENCE
1. No duty of care owed to the plaintiff.
2. Duty discharged according to prevailing
standards.
3. It was a case of therapeutic misadventure.
4. Novus actus intervenins.
5. It was an error of judgment.
6. Contributory negligence (partial defence)
7. Res judicata (Sec 300Crpc)
8. Time limit (within 2 years)

20. Civil Negligence Criminal Negligence
1. Simple absence of care
and skill.
2. Can be compensated in
terms of money.
3. Tried in Civil court.
4. No specific and clear
violation of Law.
5. A dispute between the
two parties in their
individual capacities.
6. Strong evidence is
sufficient to prove.
7. Repairable damage
1. gross carelessness and
regard to life & safety of
patient.
2. Not so. Doctor is
punishable with fine and/or
imprisonment.
3. Tried in Criminal courts.
4. Specific violation of a
criminal Law.
5. A case between the state
and the accused doctor.
6. Guilt should be established
beyond reasonable doubt.
7. Irreparable damage

21. Professional Negligence Infamous Conduct
1. Absence of care and
skill or willful
negligence.
2. Damage to the patient
should be present.
3. Duty of care should be
present.
4. Tried by courts – Civil
or Criminal.
5. Punishable with fine or
imprisonment or both.
6. Appeal – to higher
Court.
1. Violation of code of
Medical Ethics.
2. Need not be present
3. Need not be present.
4. Tried by State Medical
Council.
5. Punishable with penal
erasure – temporary or
permanent.
6. Appeal – to State or
Central Government.

22.  Voluntary agreement, compliance
or permission.
 S. 13 of Indian Contract Act :
When two or more persons agree
upon the same thing in the same
sense, they are said to consent.
 Two types : a) Implied
Oral
b) Express
Written
CONSENT IN MEDICAL PRACTICE

23. Valid Consent
 Free, fair and voluntary
 No Force, Fraud or Coercion (Sec90IPC)
 Fully IMFORMED
 Adult patient of sound mind
 Obtained before the procedure
 Specific for the procedure
 Properly witnessed
 Proper age ( <12 89 IPC, <18 87 IPC)
CONSENT IN MEDICAL PRACTICE

24.  Informed consent
Obtained after giving full understanding of
Nature of proposed procedure.
Alternative procedure available.
Risks and benefits involved in both.
Potential risks of not performing the procedure.
Relative chances of success / failure.
CONSENT IN MEDICAL PRACTICE

25.  No consent required
 From an accused of offence brought by
police. (Sec 54 CrPC)
 Life saving emergency treatment done in
good faith.
 Procedures made compulsory by Law.
 Medico-legal autopsy.
CONSENT IN MEDICAL PRACTICE

26. Special circumstances
Consent of spouse for the treatment of other is
generally not required.
Consent of spouse required if
 Procedure involves danger to life.
 May limit sexual or reproductive functions.
 May result in death of unborn child.
 Contraceptive sterilization.
 Artificial insemination
CONSENT IN MEDICAL PRACTICE

27. At the end of the class, the student shall be able to –
Define & understand, Enumerate the types
of Consent. Importance of ‘Informed
consent’. Objectives of ‘Consumer
protection act’ and about Ethical & Legal
aspects of Bio medical Research.

28. Consumer Protection Act, 1986
(C.P.A.)
“Consumer Protection Act is not the
weapon of offence, it is the remedy
made available to the aggrieved
consumer to deal with defect or
deficiency in Service”
In April 1992 – Kerala State ,
Commission. Amendment (50) 1993
Amended in 2002

29. The objectives of C.P. Act :
1. To protect the interests of the consumers of
different commodities, for which they pay,
but do not get standard quality of service.
2. To provide mechanism for inexpensive and
speedy redressal of consumer grievances.
3. To promote and protect the rights of the
consumers by establishing Central and State
Consumer Protection Councils.
4. To provide for organization of activities
aimed at consumer education and
awareness.

30. The Grievance Redressal Mechanism:
(Consumer Courts)
1. District Level
District Consumer Disputes Redressal Forum
Three member forum chaired by a person who
is/was/ qualified to be a District Judge.
Two other members having ability, integrity,
knowledge and experience.
One of the members is a woman.
Can entertain claims for compensation upto
Rs. 20 lacs.

31. 2. State Level
State Consumer Disputes Redressal
Commission
Also a three member commission chaired
by a person who is/has been a High Court
Judge.
Two other members as in District Forum.
Can entertain claims between Rs. 20 lacs to
Rs. one crore & appeal from district forum.

32. 3. National Level
National Consumer Disputes Redressal
Commission
Five member commission Chaired by a
person who is/has been a Supreme Court
Judge.
Four other members including a lady.
Can entertain claims more than Rs. one
crore and appeals from State Commission.

33. Consumer Courts :
Powers :
 The consumer forum/commission has got the
same powers as those of Civil Courts under
C.P.C. 1908.
 Every proceeding is deemed to be a ‘judicial
proceeding’.
Penalties :
1. For the noncompliance of the order made by
the forum/commission, the person can be
punished with imprisonment ranging from
the one month to 3 years and fine from Rs.
2,000 to Rs. 10,000/-
2. For false and frivolous complaints, the
complainant can be fined up to Rs. 10,000/-

34. • Step 1
• Send a notice to the construction company/ developer,
before filing a formal complaint. It is important for the
consumer to give notice to the opposite party regarding the
deficiency in service or unfair practice. This is to see if the
other party is willing to offer the compensation to make the
good the loss suffered by the consumer. If the developer
refuses or neglects the notice, the you can approach the
consumer court.

35. • Step 2
• Submit a formal complaint under the Consumer Protection Act,
1986. You need not hire a lawyer for filing the suit. Fill
this complaint form and submit it to the commission.
• On a plain paper, mention the details of the complainant and the
opposite party. Otherwise, you can consult consumer grievance
redressal forums which also help consumers in filing and forming
petition at nominal charges. One such non-governmental
organisation is International Consumer Rights Protection Council.
• The consumer should file the complaint in the district forum which
has under its jurisdiction the other party's residence or office of
profit or the area where the project is located.

36. • Step 3
• You have to submit the fee through a demand draft. The consumer
forum follows difference jurisdiction to entertain complaint:
• If the claim is for less than Rs 20 lakh, the District Consumer
Disputes Redressal Forum will hear the plea.
• If the claim is for more than Rs 20 lakh but less than Rs 1 crore, the
State Consumer Dispute Redressal Commission will entertain the
complaint.
• If the claim is more than Rs 1 crore, the National Consumer
Disputes Redressal Commission will attend to the plea.

37. Fee details
For district forums
• Up to Rs 1 lakh: Rs 100
• Between Rs 1-5 lakh: Rs 200
• Between Rs 5-10 lakh: Rs 400
• Above Rs 10 lakh and up to Rs 20 lakh: Rs 500
For state forums
• Above Rs 20 lakh but less than Rs 50 lakh: Rs 2,000
• Above Rs 50 lakh and up to Rs 1 crore: Rs 4,000
For the National Commission
• A standard amount of Rs 5,000

38. (Consent & C. P. A. etc.)
At the end of the class, the student shall be able to –
1) Define and understand what is ‘Consent’.
2) Enumerate and understand types of consent.
3) Describe ‘Informed Consent’ and elements of valid
consent.
4) Describe the objectives of ‘Consumer Protection
Act’ and mechanism available for redressal of
consumer grievances.

39. • Abortion/Miscarriage –
It is premature expulsion of foetus from
mother’s womb at any time of pregnancy
before full term.
• 7-10 days – after Implantation of
developing ovum k/a Embryo.
• >2 Months -K/a fetus
• After birth K/a Neonate up to 1 month
• Infant – up to 1 year.

40. Classification

41. Classification
1. Natural (Spontaneous) Abortion
In 10-15% of pregnancies- in 1st trimester.
Causes – Defect in ova/ fetus.
- Local diseases/ defects
- General diseases
- Accidental trauma
- HT/DM
- Hormonal deficiency
2. Artificial (Induced) Abortion
a) Legal /Justifiable- with provisions under MTP act.
( Declaration of Oslo 1970 )
b) Criminal Abortion- Unlawfully induced expulsion.

42. The Medical Termination Of
Pregnancy Act, 1971
An Act to provide for the termination of certain pregnancies by registered
medical practitioners and for matters connected therewith or incidental
thereto.
Medical Termination of Pregnancy (MTP) is a maternal health care measure, which
helps to avoid the maternal mortality and morbidity resulting from illegal
abortions.

43. Legal/Justifiable Abortion
Legal provisions/grounds for M.T.P.
1. Therapeutic – When continuation of pregnancy endangers
life of mother.
2. Eugenic- Risk of child being born with physical/ mental
abnormality.
(Disease, Drugs, X-rays & Insane)
3. Humanitarian – When Pregnancy caused due to Rape.
4. Socio-economic- When Pregnancy caused due to failure of
contraceptive.

44. Under this act, there are certain indications
for the legal termination of pregnancy.
1. Therapeutic
The continuance of the pregnancy would
involve a risk to the life of the pregnant
woman or of grave injury to her physical or
mental health.

45. 2. Eugenic
There is a substantial risk that if the child were born, it would suffer from such
physical or mental abnormalities as to be seriously handicapped.
Infection
• If the pregnant woman in the first three
months suffers from German measles,
smallpox, chicken pox, toxoplasmosis, viral
hepatitis or any severe viral infection
Drugs •Thalidomide, cortisone, antimitotic drugs,
hallucinogens or antidepressants.
Radiation
• If the pregnant woman is treated with X-rays
or radioisotopes.
Others • Insanity of the parents

46. 3. Humanitarian
Pregnancy caused by rape may effect the mental health of the mother. It is
assumed that the victim mother does not want the child and does not want
to bear the continuing result of a crime for which she was not culpable.

47. 4. Social and Economic
When the pregnancy has resulted from a failure of contraceptive methods in
case of a married woman, which is likely to cause to cause serious injury to her
mental health.
When social or economic environment, actual or reasonably expected, can
injure the pregnant woman’s health.

48. MTP & Duration
Rules :
 Only qualified M.O
 Up to 12 wk – one M.O
 12 wk-20 wk – opinion of 2 M.O
 In emergency termination by 1 doctor in good faith by
trained M.O.
Place:- In Govt. hospitals Or place approved by Govt.
Consent :- By pregnant woman, if >18yrs. In minor
Guardian. Spouses consent not required.

49. Methods for inducing criminal abortion
1) Abortifacient drugs :
a) Ecbolics- act on uterus. E.g. Quinine, Lead
b) Emenogogues- Increase menstrual flow.
e.g. Savin, Borax , Estrogens etc.
c) GIT irritants- Castor/ croton oil.
d) Uterine Stimulants- Oil of tansy, oil of
turpentine.
e) Drugs irritants to other systems-
e.g. Lead, Arsenic,
Abrus precatorious,
calatropis, Plumbago etc.

50. 2) Mechanical Violence :-
a) General Violence
b) Local violence
a) General Violence- e.g. cycling, Riding, Jumping,
use of alternate hot & cold baths, uterine massage,
cupping etc.
b) Local Violence- local irritation or Dilatation of
cervix with/ without rupture of membranes.
Syringing
Rupture of Membranes
Syringing aspiration
Electricity

51. Methods for inducing criminal abortion

52. ABORTIFACIENT
DRUGS
GENERAL VIOLENCE
LOCAL VIOLENCE DILATATION OF
CERVIX
ABORTION STICKS
CURETTAGE
AIR INSUFFLATION
ELECTRICITY PASTES

53. Instruments used for inducing
criminal abortion

54. ABORTION & MTP
Sr.No. Natural Criminal
1) Cause Predisposing Pregnancy in
diseases Widow / unmarried
woman
2) Infection Rare Frequent
3) Marks of violence Not seen present on Abdomen.
4) Genital No injuries Present.
5) Toxic effect Absent Erosions &
inflammation due to
drugs present in
vagina , Cx.
6) Foreign Not present May be seen.
bodies in Genital tract
7) Fetus Wounds absent Rarely may
be +nt

55. Complications leading to death -
• Immediate - Vagal inhibition.
- Hemorrhage & Shock.
- Air embolism/ Fat embolism.
• Delayed - Septicemia / Pyaemia.
- Peritonitis / Toxemia.
• Remote - Jaundice & Renal failure.
- Bacterial endocarditis
- Pulmonary embolism
- Poisonous effects of drugs.
- Tetanus.

56. Complications leading to death -

57.  Hemorrhage, softening of external os, vaginal walls,
Enlarged uterus.
 Breast changes.
 Injuries to vaginal canal, cervix.
 Signs of injuries to abdomen.
 Material & liquid from vagina, uterine cavity and blood
sent for chemical & bacteriological examination.
 Urine & Vomitus- for C.A.
Evidence of abortion in living -

58. Post Mortem Evidence of criminal abortion -
 Abortion by the drugs- GIT- E/O irritant poisoning, Vagina &
Cervix for erosions. Sent to RFSL.
 Instrumental abortion- Injury to vagina, cervix, uterus.
 Peritoneum, pelvic organ & floor for injury,
 hemorrhage or inflammation, E/O air embolism, E/O
infection.
 Abortion by syringing- May be fluid in vagina & soiling the
clothes, Segmentation of the coronary vessels.
Right side of heart, superior & inferior vena cava may contain foamy
blood.

59. SUMMARY-
• What is MTP? What are the rules?
• Define abortion or infanticide.
• Give the classification of abortion.
• Describe the Methods used in criminal abortion
• What are the complications of criminal abortion
.
• Define live birth, stillbirth & dead birth.
• Enlists the Signs & tests for live birth.
• Enumerate the Acts of commission & acts of
omission.

60. References/Bibliography :
Textbooks –
 Parikh’s textbook of Medical Jurisprudence and
Toxicology, 5th edition, 1990.
 Modi’s Medical Jurisprudence and Toxicology, 21st
edition 1992.
 The essentials of Forensic Medicine and Toxicology by
Dr. K.S.N.Reddy, 25th edition, 2006.
Reference books –
 Principles of Forensic Medicine by Apurba Nandy, 2nd
edition, 2004.

61. At the end of the class, the students shall be
able to–
1) Define & classify abortion & infanticide.
2) Describe the rules of the MTP Act.
3) Describe the methods used in criminal abortion and their
complications.
4) Conduct examination of a woman who has allegedly
aborted.
5) Describe the concept of live birth & stillbirth.
6) Describe the signs & tests for live birth.
7) Enumerate the acts of commission & acts of omission.
8) Describe the development of fetus & medico legal
aspects.

62. SUMMARY-
• Definitions & classification of abortion &
infanticide.
• Rules of the MTP Act.
• Methods used in criminal abortion and their
complications.
• Examination of a woman who has allegedly
aborted.
• Concept of live birth, stillbirth & dead birth.
• Signs & tests for live birth.
• Acts of commission & acts of omission.

63. ARTIFICIAL INSEMINATION
Artificial introduction of semen into the vagina,
cervix or uterus to produce pregnancy.
Types:- 1) AIH-husband
2) AID-donor
3) AIHD-donor semen to
which semen from husband added.
Indications:-
 When husband is Impotent, Sterile.
 Rh incompatibility between husband & wife.
 Mental disease or hereditary disease in husband.

64. 1. A.I.H : If the semen of the
woman’s husband is used, it is
known as artificial insemination
homologous or artificial
insemination husband
Types
2. A.I.D. : If semen of some other
person other than the husband is
used it is known as aritificial
insemination donor

65. Types
3. A.I.H.D. : Pooled donor semen
is composed of donor semen to
which semen from the husband
has been added

66. Biological Aspects
Semen is obtained by masturbation and one ml. is deposited by means
of a syringe in or near the cervix
usual time taken for sperm to travel from vagina to tubes is 6-24 hrs
Fertilisation can occur in 48 hrs
Success rate is 70-75%
Frozen semen: done by
adding glycerol. And
storage below -79 C

67. Biological Aspects
Timing:
Timing of insemination is important as the life span of
spermatozoa in the female genital tract is short
The time of maximum fertility coincides with the time of
ovulation
Ovum survives in the fertilizing form 8-12 hrs after it leaves
the ovary

68. ARTIFICIAL INSEMINATION
Indications:-
 When husband is Impotent, Sterile.
 Hypospadiasis, epispadiasis, etc
 Rh incompatibility between husband & wife.
 Mental disease or hereditary disease in husband.

69. Techniques used
1. Intrauterine insemination: 'Washed sperm', that is, spermatozoa
which have been removed from most other components of the
seminal fluids, can be injected directly into a woman's uterus in a
process called intrauterine insemination (IUI)
2. Intracervical insemination: Intracervical insemination, or 'ICI' is the
easiest way to inseminate. This involves the deposit of raw fresh or
frozen semen which has been provided by the woman's partner or by a
sperm donor into the cervix usually by injecting it with a needle-less
syringe

70. Techniques used
3. Intrauterine tuboperitoneal insemination: Intrauterine
tuboperitoneal insemination (IUTPI) is insemination where both the
uterus and fallopian tubes are filled with insemination fluid

71. Techniques used
4. Intratubal insemination : IUI can furthermore be combined with intratubal
insemination (ITI), into the Fallopian tube although this procedure is no
longer generally regarded as having any beneficial effect compared with IUI

72. Surrogate Motherhood
• Definition:
A women who by contract agrees to
bear a child for someone else
It is intended to help a couple, of
whom the woman is infertile but the
male has no reproductive deficiency.
The legal problems of surrogate
motherhood are those of artificial
insemination donor.

73. Surrogate Motherhood
• Types:
1. Gestational Surrogacy (GS): When the intended mother is not be able to
carry a baby to term , her egg and the intended father's sperm are used to
create an embryo that is implanted into and carried by the surrogate
mother.
2. Traditional Surrogacy (TS): This involves artificially inseminating a
surrogate mother with the intended father's sperm via IUI, IVF or home
insemination
3. Traditional Surrogacy & Donor Sperm (TS/DS): This involves
artificially inseminating a surrogate mother with donor sperm via IUI, IVF
or home insemination

74. Surrogate Motherhood
4. Gestational Surrogacy & Egg Donation (GS/ED): If there is no intended
mother or the intended mother is unable to produce eggs, the surrogate
mother carries the embryo developed from a donor egg that has been
fertilized by sperm from the intended father
5. Gestational Surrogacy & Donor Sperm (GS/DS): If there is no intended
father or the intended father is unable to produce sperm, the surrogate mother
carries an embryo developed from the intended mother's egg (who is unable
to carry a pregnancy herself) and donor sperm
6. Gestational Surrogacy & Donor Embryo (GS/DE): When the intended
parents are unable to produce either sperm, egg, or embryo, the surrogate
mother can carry a donated embryo

75. Surrogate Motherhood
• Methods:
1. Womb Leasing: Artificial insemination with the semen of
barren woman’s husband is carried out in a hired woman.
after surrogate birth, the baby is returned to his biological father
and his wife.
2.Another method: A healthy mature ovum is removed from the
wife and fertilized in vitro with the husbands semen. The
embryo is implanted in the womb of the hired woman.

76. Legal Aspects
• In cases where the difficultyarises from the impotence of a husband
who is neverthelessfertile,it would seem that artificialinsemination
with the semen of the husband(AIH)can be regarded as a justifiable
and unobjectionable procedure. However, the birth of a child in wedlock
as a consequence of such inseminationdoes not constituteevidence of
proper consummation of marriage.
• When for any reason, AIH is not possible and AI is done withthe
semen of an unknown donor(AID),theposition is radicallydifferent
from the above. The legal issues arisingthere from are as follows:

77. Legal Issues
1. Adultery: The donor
and recipient cant be
held responsible for
adultery

78. 2. Legitimacy: The child will be illegitimate and cannot
inherit property
3. Nullity of marriage and divorce: Mere A.I. is not a
ground for divorce, but A.I. due to impotence is ground for
divorce
4. Natural Birth: If a child is born naturally sometime after
A.I., the status of the natural born child remain legitimate
and the status of the child born by A.I. remains illegitimate
(unless adopted)

79. Legal Issues
5. Unmarried women or widow: If uses A.I. the child
remains illegitimate
6. Incest: between the child born by A.I. and the child of
the donor. It is not an offence in India

80. Complications
For the father: He may feel humiliated or may develop
psychiatric symptoms. He may develop bitter
feelings if the child is deformed or mentally retarded
For the mother: May develop neurosis feeling the
child is her alone. Or may develop an obsession to
know the donor or to have another child from the
same donor

81. Complications
For the child: She/he may develop mental trauma if he learns his
past history

82. P
R
E
C
A
U
T
I
O
N
S
1. Consent of donor and wife
2. Identity of donor must remain a secret
3. Donor must be mentally and physically healthy
4. Donor must not be relative or spouse
5. Blood group matching
6. Rh incompatibility must be ruled out
7. Couple and should be psychologically fit and mentally stable
8. Witness must be present
9. Pooled semen should be used
10. Physician carrying out the insemination should avoid
delivering the child

83. Test Tube Baby
The ovum is removed from the ovary and fertilised by the sperm of
her husband.
 Own ova fertilised by donor sperm.
 Another woman’s ovum.
 Donor ovum fertilised by donor
sperm.

84. Cloning
CLONING
It is the technique of producing a genetically
identical
duplicate of an organism artificially.
DNA is taken from oocyte and put in a petridish
together with a
donor cell and electric current is passed through it
to fuse as a
zygote. This is implanted in surrogate mother

85. Cloning and Test tube babies
Cloning: It is the technique of producing
a genetically identical duplicate of an
organism artificially
Test tube babies: The ovum is removed
from the ovary and fertilized by the
sperm of her husband invitro

86. • EUTHANASIA (mercy killing): It means producing
painless death of a person suffering from hopelessly
incurable and painful disease.
• Types: (1) Active or positive. (2) Passive or negative.
Active euthanasia is a positive merciful act, to end useless
suffering or a meaningless existence. It is an act of
commission, e.g. by giving large doses of drugs to hasten
death. Passive euthanasia means discontinuing or not
using extraordinary life-sustaining measures to prolong
life. This includes acts of omission, such as failure to
resuscitate a terminally ill or hopelessly

87. • incapacitated patient or a severely defective newborn infant. It is not
using measures that would probably delay death and permits natural
death to occur. Voluntary euthanasia means at the will of the person,
and involuntary means against the will of the person, i.e., compulsory.
Non-voluntary refers to cases of persons incapable of making their
wishes known, e.g., in persons with irreversible coma or severely
defective infants. Euthanasia advocates the administration of lethal
doses of opium or other narcotic drugs. It has no legal sanction.
• Netherlands is the first country to legalise euthanasia from April, 2002
in persons above 12 years. Strict rules govern assisted suicide. Patients
must face a future of unbearable, interminable suffering and must
make a voluntary, well-considered request to die. Another physician
must be consulted first and life must be ended in a medically
appropriate way.

88. • Bioethics is the study of the ethical issue emerging from
advances in biology and Medicine.
• It is also moral discernment as it relates to medical policy
and practice.
• Bioethicists are concerned with the ethical questions that
arise in the relationships among lifescinces ,biotechnology
medicine, politics and laws and philosophy . It includes the
study of values relating to primary care and other branches
of medicine.

89. • Medical ethics is the study of moral
values and judgments as they apply
to medicine.

90. • Principles[edit]
• One of the first areas addressed by modern bioethicists was that of human
experimentation. The National Commission for the Protection of Human
Subjects of Biomedical and Behavioral Research was initially established in
1974 to identify the basic ethical principles that should underlie the conduct of
biomedical and behavioral research involving human subjects. However, the
fundamental principles announced in the Belmont Report (1979)—
namely, respect for persons, beneficence and justice—have influenced the
thinking of bioethicists across a wide range of issues. Others have added non-
maleficence, human dignity and the sanctity of life to this list of cardinal
values. Overall, the Belmont Report(1979) has guided research in a direction
focused on protecting vulnerable subjects as well as pushing for transparency
between the researcher and the subject. Research has flourished within the past
40 years and due to the advance in technology, it is thought that human
subjects have outgrown the Belmont Report (1979) and the need for revision is
desired.[8]
• Another important principle of bioethics is its placement of value on