Medical Jurisprudence

Prof. Dr. S. SOUNDARARAJAN, MD(s) PRINCIPAL,

Government Siddha Medical College, Palayamkottai.

Medical Jurisprudence

Juris = Law

Prudentia = Knowledge

• in relation to practice of Medicine• in relation with legal consequences

Knowledge of Law

Important Examples

Doctor - Patient Relationship

Doctor - Doctor Relationship

Doctor - state Relationship

•AFFIDAVIT•CRIME•COMPLAINT•COURT•DEPOSITION•DOCUMENT•EVEDENCE•EXHIBIT•FACT•HURT•INJURY •TESTIMONY

Legal Procedure-Important terms

•INQUIRY•INVESTIGATION•JUDICIAL PROCEED•JURY•OATH•OFFENCE•OPEN VERDICT•PERJURY•PLAINTIFF•REFRES. MEMORY•SUMMONS•WARRANT

ETHICAL ASPECTS OF MEDICAL PRACTICE

Ethics - Manner and habit of man relates to understanding of moral Principles

Medical Etiquette – Sense of Courtesy and mutual relationship b/w Members of Medical Profession

Qualified & Registered Med Practitioner(RMP) – Realise his responsibility to the society.

A RMP – allowed to use knife on the body (or) - Toxic medicine on his patient.

ETHICAL ASPECTS OF MEDICAL PRACTICE

Not to criticize colleagueNever take feesAlways helpDuties with regard to consultation

Duties of RMP Towards Professional Colleague

Duties of RMP Towards State

Notify certain diseasesUniform vital eventsUnder Geneva conventionsRegarding medico-legal cases

Provide all information related with healthShould follow doctor’s instruction/advice should pay feeIf patient wish to take 2nd opinion, they must informed to the 1st DoctorShould have faith in the doctor chosen for treatmentShould not contribute to medical negligenceShould co-operate

InvestigationsTreatment schedules

Duties of Patients

to issue certificate Right for appointment to public(government) hospitals To Give evidence as an expert witness in the court of law To claim payments of fees for professional service given

Rights & Privileges of RMP(Registered Medical Practitioner)

Right to Practice Medicine Right to Choose Patient to Prescribe / Dispense Medicine (inclu. Drug listed in Dangerous Drug Act) to add Professional titles to his name to Perform Surgical Operation

Right to have privacy during consultation or treatmentRight to receive full information about diagnosisRight to know the procedure/results of surgery/ risks involved/available alternatives/ the type of procedure/results & PrognosisRight to demand for the medical recordRight to complain & rectification of grievances

Rights & Privileges of Patients

Right to choose doctor Right to access healthcare facility available (regardless of age,sex,caste,religion & economic or social status) Right to be treated with diginity,with care, respect & without any discrimination right to have Confidentiality of all his information furnished to doctorRight to seek 2nd opinionRight to obtain compensation (for medical injuries/negligence)

PROFESSIONAL SECRETS & CONFIDENTIALITY

Should know his professional capacity Prof. secrets should not be disclosed to anyone except under following circumstances

In a court of law under orders of the presiding judge

Privileged communicationIn case of notifiable diseases

LEGAL ASPECTS OF MEDICAL PRACTICE

• Bio-Medical waste rules 1998• Consumer Protection act 1986

• Children Act 1960• Code of Criminal Procedure 1973• Drugs & cosmetic Act 1940

• Dentist Act 1948• Dock workers Act 1954

• Drug Act 1950• Epidemic disease Act 1897

Medical Practitioner- Under legal obligation to follow the law of land- various Acts, rules & regulation

• Employ state Insurance Act 1948• Environmental Protection Act 1986

• Factories Act 1948• Fatal Accidents Act 1855• Indian evidence Act 1872• Insecticides Act 1868

• Indian Majority Act 1875• Indian Penal code 1860• Leprosy Act 1898

•Indian Medical Degrees Act 1916•Ind. Med. Council Act 1956•Maternity Benefit Act 1961•Mental Health Act 1987•Minimum wages ACT 1948

•Med.Termi. Pregnancy Act 1971• Mines Act 1952

•Motor Vehicles Act 1988

• Personal Injury Act 1962 (emergency Provisions)

• Personal Injury Act 1963 (Compensation/Insurence)• Pharmacy Act 1948• Poisons Act 1919

• Pre-natal diagnostic technic Act 1994• The Vaccination Act 1880

LAW AND DOCTOR

•Sec 179 IPC – Omission to give notice or Information to Public servant by person legally bound to give it•Sec 177 IPC – furnishing false information•Sec 191 IPC – give false evidence•Sec 192 IPC – fabricating false evidence•Sec 193 IPC – punishment for false evidence•Sec 194 IPC – giving false evidence/intent to procure conviction of capital offense•Sec 194 IPC – giving false evidence/intent to procure conviction of offence punishable with imprisonment for life.•Sec 197 IPC – issuing/signing false certificate

LAW AND DOCTOR

•Sec 201 IPC – disappearance of evidence of offence•Sec 203 IPC – giving false information respecting an offence committed •Sec 204 IPC – destruction of documents to prevent its production as evidence•Sec 269 IPC – negligent act likely to spread infection of disease dangerous to life •Sec 270 IPC – malignant act likely to spread infection of disease dangerous to life•Sec 271 PC – disobedience to quarantine rules•Sec 272 IPC – adulteration of foods•Sec 273 IPC – sales of noxious food or drink

LAW AND DOCTOR•Sec 275 IPC – sales of adulterated drugs•Sec 274 IPC – adulteration of drugs•Sec 276 IPC – sales of drugs as a different drug or Preparation•Sec 277 IPC – fouling water of public spring/reservoir •Sec 278 IPC – making atmosphere noxious to health•Sec 284 PC – negligent conduct with respect to poisonous substances•Sec 304 A IPC – causing death by negligence •Sec 312 IPC – causing miscarriage•Sec 39 Cr PC – public to give information of certain offences•Sec 53 Cr PC – examination of accused by practitioner at the request of Police officer

LEGAL PROTECTION TO RMP•Sec 88 IPC Act not intended to cause death done by consent in good faith for the persons benefit•Sec 89 IPC

Act done in faith for benefit of child or insane person by consent of guardian

In the above two Sec 88 IPC , Sec 89 IPC the law does not provide sanction of mercy killing or euthanasia.

1. The intension is not to kill the patient but to cure his disease2. Consent of the particular patient or guardian has been

obtained for the procedure

LEGAL PROTECTION TO RMP•Sec 92 IPC

Act done in god faith for benefit of a person without consent

•Sec 93 IPC• Communication made in good faith• No communication made in good faith is an offence

by reason of any harm to the person to whom it is made, if it is made for the benefit for that person

This section highlights important principles that1. The act is done in good faith for the benefit of patient2. The intention of doctor is to save the life and not to kill

the person

Responsibility of RMP in Criminal Matters

Communication to Police• Under Sec 39 Cr PC, RMP should communicate to the policy any information about criminal act that has come to his knowledge•Offence to attempt to commit sucide (Sec 309 IPC) is not included in sec 39 of Cr PC. •Under sec 175 Cr PC, the doctor has to provide all the information asked by police/ magistrate

•Not Providing such information or concealing is punishable (Sec 202 IPC for destruction of evidence)•Giving false information is also punishable•Preservation of trace evidences & samples in an injured or poisoning pt or Sexually offenses cases should done by doctor and handover to police.•Preservation of Record.

DOCTORS AND MEDICAL RECORDS

1. Medical Negligence cases2. Life insurance policy3. 3rd party claims – health/accident insurance 4. Proof of disability5. Workman’s compensation cases6. Traffic accidents cases7. Follow-up cases or taking treatment from another doctor8. Medico-legal cases

Medical Record required for Patients for

DOCTORS AND MEDICAL RECORDS

1. For Medical research2. For cost accounting3. Hospital audit4. Evaluation of drug therapy5. Planning6. Legal purpose7. Administration8. Follow-up cases9. Insurance claims

Medical Record required for Doctors/Hospitals for

DOCTORS AND MEDICAL RECORDS

1. OPD cards2. IPD Cards3. Details of provisional and final diagnosis4. Treatment record5. X-ray films/USG report/MRI6. Laboratory reports

What constitute Medical records?

CONSENT

Sec 90 IPC, defines consent in negative terms. Consent given under five circumstances will not be true.

1. Person under fear of injury2. Person who is under misconception3. Intoxicated person4. Person who is of unsound mind5. Person, below 12years of age

Defined as- Free and voluntary agreement, compliance or permission or permission given for a specified act or purpose

CONSENT

As per Sec 14 Indian contract Act, consent is said to be free and voluntary.

1. Not obtained by coercion/force2. Not obtained by fraud3. Not obtained by influence4. Not obtained under influence of intoxication5. Not obtained by misrepresentation6. Not obtained from mistaken subjects7. Not obtained from mentally unsound persons

IMPORTANCE OF CONSENT

Consent obtained by a doctor to examine, treat or operate a patient.

Treating/examining patient without consent is an assault on patient

Adult who is conscious and have sound mind is at liberty to decline the consent for treatment/examination.

Consent and submission are not same. Consent involves submission, but it is not said that mere submission amounts to consent.

If a doctor fails to ask consent, may be charged for negligence

For operation which are negligible or unlawful, there cannot be any valid consent, for ex. Procuring criminal abortion.

TYPES OF CONSENTImplied

1

Expressed

1. Oral/verbal2. Written 2

Common type

Criteria for consent

Valid consent – Sec 90 IPC1. Mentally free2. Above 12 year of age3. Not under any fear of injury/threat4. Not under misconception or false conception of facts5. Not be intoxicated

Other Types of consent

• Blanket consent• Surrogate consent• Proxy consent

Consent- not required

• Emergency• Notifiable diseases• Public interest• Public health• The court order• Prisoner• Immigrants• Medico-legal postmortem

examinations• Armed force – statutory

requirement

Consent of spouse• Termination of pregnancy• Sterilization• Artificial insemination• Donation of sperm• Any operation that harms sexual right of spouse

Consent and Medico-legal cases• For medico-legal autopsy-consent not required• For clinical or pathological autopsy, consent is must• Examination of Victim- Consent required• Examination of accused for medico-legal purpose –

consent required.

Right to refuse ConsentA competent person has a right to refuse treatment and refuse to consent for medical treatment or Procedure

Advance directives

• Also know as living will• Issuing or execution of advance directives entitles the

patient to refuse treatment at any time in future• Advance directive is rather new concept and not

prevailing in India

Medical Negligence/ Malpractice- want of reasonable degree of care and skill or willful

negligence on the part of RMP while treating a patient resulting in bodily injury, ill health or death.

Two Components

Patient has died due to non application of reasonable degree of care and skill

Willful negligence on part of doctor while treating a patient

1 2

Classification1. Civil Negligence2. Criminal negligence

1. Civil Negligence• In Civil negligence, patient has to approach

Consumer court1. Recognised legal right of patient –infringed2. Existence of a duty of care3. Dereliction of duty4. Breach of duty was the cause of injury or harm5. Patient had suffered damage

2. Criminal negligence

• In Civil negligence, patient brings allegation of criminaling against a doctor

1. Operation on wrong limb2. Removal of wrong organ3. Wrong blood transfusion4. Leaving instruments in abdomen5. Performing criminal abortion

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