MEDICAL ETHICS

ARMY MEDICAL COLLEGE, JESSORE

Asst.Prof.Dr.LAILA YESMIN
Dept of Forensic Medicine
 Geneva Declaration
The Declaration of Geneva
(Physician's Oath) was adopted by the 3rd
General Assembly of the
World Medical Association at Geneva in
September ,1948, amended in 1968, 1983,
1994 & 2017 and editorially revised in 2005
and 2006.[1] It is a declaration of a physician's
dedication to the humanitarian goals of
medicine, acknowledged in a modern way.[3]
 Conti..
a declaration that was especially important in
view of the medical crimes which had just
been committed in Nazi Germany. The
Declaration of Geneva was intended as a
revision[2] of the Hippocratic Oath to a
formulation of that oath's moral truths that
could be comprehended .
 Changes from original
The original oath read "My colleagues will be my
brothers," later changed to "sisters and
brothers."
Age, disability, gender, and sexual
orientation have been added as factors that must
not interfere with a doctor's duty to a patient;
some rephrasing of existing elements has
occurred. Secrets are to remain confidential
"even after the patient has died."
The violation of "human rights and civil
liberties" replaces "the laws of humanity" as a
forbidden use of medical knowledge. “
 The health" in general of a patient is now the doctor's first
consideration compared to the "health and life" as stated in
the original declaration. This was apparently changed to
free the medical profession from extending life at all cost.
The 68th WMA General Assembly in October 2017
approved revisions including: respecting the autonomy of
the patient; mutual respect for teachers, colleagues and
students; sharing medical knowledge for the benefit of
patients and the advancement of healthcare; a requirement
for physicians to attend to their own health as well as their
patients.
Furthermore, the revised text is meant to be used
by all active physicians ("as member of the medical
profession") while before the text was used by beginners
only ("At the time of being admitted as a member of the
medical profession").
 The newly revised text contains some
modifications in terms of words throughout but
also some entirely new points.

• I WILL RESPECT the autonomy and dignity of

my patient.
• I WILL SHARE my medical knowledge for the
benefit of the patient and the advancement
of healthcare.
• I WILL ATTEND TO my own health, well-
being, and abilities in order to provide care
of the highest standard.
 WMA meetings
• 1948: Adopted. 3rd General Assembly, Geneva
• 1968: First amendment. 22nd General Assembly,
Sydney
• 1983: Second amendment. 35th General Assembly,
Venice
• 1994: Third amendment. 46th General Assembly,
Stockholm
• 2005: Editorial Revision. 170th Council Session,
Divonne-les-Bains
• 2006: Editorial Revision. 173rd Council Session,
Divonne-les-Bains
• 2017: amended. 68th WMA General Assembly,
Chicago, United States
 Geneva Declaration
1. I solemnly pledge myself to consecrate
my life to the service of humanity.
2. I will give to my teachers the respect
and gratitude that is their due.
3. I will practice my profession with
conscience and dignity.
4. The health of my patient will be my first
consideration.
5. I will respect the secrets that are
confided in me, even after the patient
has died.
 Conti…
6. I will maintain by all the means in my
power, the honour and the noble
traditions of the medical profession.
7. My colleagues will be my sisters and
brothers.
8. 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.
 Cont..
9. I will maintain the utmost respect for
human life.
10. I will not use my medical knowledge to
violate human rights and civil liberties,
even under threat.
11. I make these promises solemnly, freely
and upon my honour.
 Duties of medical practitioner
A .Duties towards self patient :
1. Duty to exercise a Reasonable Degree of Skill
and knowledge
2. Duties with regard to Attendance and
examination.
3. Duty to furnish proper and suitable
medicines.
4. Duty to give instructions.
5. Duty to control and warn.
 Conti..
6. Duty to third parties.
7. Duty towards children and Adults incapable of
taking care of themselves.
8. Duty to inform patient of risks
9. Duty with Regard to poisons.
10. Duty to Notify certain diseases .
11. Duties with regards to operations
12. Duties under geneva conventions
13. Duties with regard to consultation
14. Duty in connection with X-ray examination
15. Professional secrecy
 Conti..
B) Duties of a doctor towards
Community:
1.Notification of infectious disease i.e.
plagues, cholera, small pox etc.
2.Information of birth & death.
3.Notification of any new dangerous
disease or epidemic outbreak I.e.
AIDS, Dengue.
 Conti..
C) Duties towards state:
1.Responding to emergency military medical
service.
2.Attending to the accident & mass disaster
cases.
3.Reporting to law enforcing agencies in cases
of homicidal or suspicious cases.
4.Reporting of unnatural deaths.
5.Reporting of certain cases falling under the
category of privileged communication,
especially as regards moral & social duties and
responsibility in criminal cases.
 Conti..
D) Duties towards doctor community
1. Free medical service.
2. Should not depreciate own professional
brethren.
3. Should not entice patient from other medical
profession.
4. Notification of fitness of servant & employees for
their employment if known.
5. Taking the responsibility of community health
education.
 MEDICAL ETHICS
Definition:
Medical ethics means the moral principles,
which should guide the members of medical
profession in course of their practice of
medicine and their dealings with patient and
other members of same profession.

This is not law. It is moral ethics.

 VIOLATION OF MEDICAL ETHICS
Violation of medical ethics may be of two types-
1. Professional Infamous Conduct or
Professional Misconduct .
2. Professional Negligence or Malpraxis.
 Professional death sentence
• It is the erasure of name from the professional
register due to infamous conduct in any.
• professional respect which deprives the
practitioner of all the privileges of a registered
practitioner.
 Conti..
When it occurs/Registration of a doctor can be
erased by BMDC in following
conditions:
1. After the death of the registered practitioner.
2. Entry which is made in error or as a result of
fraud.
3. Penal erasure: due to professional infamous
conduct.
 Professional infamous
conduct/serious misconduct
Any conduct of the doctor which might
reasonably be regarded disgraceful and
dishonorable to the profession judged by his
professional brethren of good repute and
competence.
 Warning notice for misconduct
• Warning notice:
A registered medical practitioner is required to
observe certain prescribed rules of conduct in
code of medical ethics. The council gives
examples of offences which constitute serious
professional misconduct but stresses the fact
that it is not a complete list.
 Conti..
• The council can also consider any form of
alleged professional misconduct which is not
contained in warning notice. If any one is
found guilty any of the following act of
omission & commission in warning notice
rendering him liable for disciplinary action.
PROFESSIONAL INFAMOUS CONDUCT
ARE
1. Adultery. Voluntary sexual intercourse between a
married person and a person married or not.
Other than his or her spouse.
2. Performing Criminal Abortion.
3. Association. With Bad people.
4. Advertising. no photo on sign board , No add on
paper Except on starting practice, changing ,on
closing temporary ,on changing practice, public
declaration of charges.
•
5. Addiction to any drug or Alcoholism
6. Association with unqualified persons .
7. Conviction by the Criminal Court of Law.
8. Issuing a false Certificate.
9. Contravention current Drug Act.
10. Covering. Assisted by non medical persons.
11. Running an open shop for selling Drugs.
12. Dichotomy or fee splitting, receiving or
giving commission.
13. Disclosing the secrets of a patient.
14. Refusal to give professional service on
religious, racism, political or social ground.
15. Selling Scheduled poison to the public ,
except to his patient.
16. Using of Touts.

***To remember list of professional infamous conduct:

•[Mnemonic: 6=3+3;6A, 3C, 3D & others
Difference between fee splitting & fee
sharing
Fee splitting Fee sharing
receiving or giving commission or other Sharing of received amount of a
benefits to or from a professional combined operation among doctor,
colleague or manufacturer or trader of assistant , nurse , OT boy & others
drugs or appliances or a chemist, dentist, relating with the operation.
etc
It is unethical It is ethical.

Question of punishment arises. No question of punishment.

 Unethical acts of a doctor
1. Advertising
2. Printing of self photograph on signboard
3. patent of surgical instrument or medicine
for benefits
4.Running an open shop for sale of
medicine & instruments.
5. Dichotomy: Fee splitting or Receiving or
giving commission.
 Cont..
6.Presciption of drug of unknown
composition
7. Human right
8. Adultery :Voluntary sexual intercourse
between a married person and a person
married or not. Other than his or her
spouse.
Criminal Abortion
Advertisment
 Professional secrecy
Definition:
It is an implied term of contract between the
medical practitioner and his patient where by
the medical man is obliged both morally &
ethically to keep secret all that comes to his
knowledge about his patient in course of his
professional work.
 Cont..
• The doctor should first persuade the
patient to obtain his consent before
notifying the proper authority
• If the doctor discloses professional secrets
for the purpose of protecting the interest
of the community, he will not be liable to
damages.
 A doctor should not disclose secrecy
• A doctor should not discuss the illness of his
patient with others without the consent of the
patient.
• A doctor should not answer any enquiry by third
parties even when enquired by near relatives of
the patient either with regard to the nature of the
illness or with regard to any subsequent effect of
such illness on the patient without the consent of'
the patient.
• If the patient is major, The doctor should not
disclose any facts about the illness without his
consent to parents or relatives even though they
may be paying the doctor's fees.
 Conti..
• In the case of a minor or an insane person,
guardians or parents should be informed of the
nature of the illness.
• A doctor should not disclose any information
about the illness of his patient without the
consent of the patient even when requested by a
public or statutory body, except in case of
noticeable diseases.
• If the patient is a minor or insane, consent of the
guardian should be taken.
• Even in the case of husband and wife, the facts
relating to the nature of illness of the one, must
not be disclosed to the other, without the consent
of the concerned person.
 Cont..
• In divorce and nullity cases, no information
should be given without getting the consent of
the person concerned.
• When a domestic servant is examined at the
request of the master, the doctor should not
disclose any facts about the illness to the master
without the consent of the servant, even though
the master is paying the fees.
• The medical officer of a firm or factory should not
disclose the result of his examination of an
employee to the employers without the consent
of the employee.
 Conti..
• When a doctor examines a Government servant
on behalf of the Government, he cannot disclose
the nature of illness to the Government without
the patient's consent.
• Medical officers in Government service are also
bound by the code of professional secrecy, even
when the patient is treated free.
• A person in police custody as an under trial
prisoner has the right not to permit the doctor
who has examined him to disclose the nature of
his illness to any person.
 Cont..
• If a person is convicted, he has no such right and
the doctor can disclose the result to the
authorities.
• The medical examination for taking out life
insurance policy is a voluntary act by the
examinee, and therefore consent to the
disclosure of the finding may be taken as implied.
• A doctor should not give any information to an
insurance company about a person who has
consulted him before, without the patient's
consent. Any information regarding a dead
person may be given only, after obtaining the
consent from the nearest relative.
 Conti..
• In reporting a case in any medical journal, care
should be taken that patient's identity is not
revealed from the case notes or photograph
 When A doctor can disclose the
secrecy of a patient?
1. To give evidence on the court.
2. About existing infectious disease.
3. Any injury which is connected with homicide.
4. Any person attempt to suicide or a case of
suicide inform top relatives or to police.
5. Death by abortion or taking dying declaration of
adding pt after abortion.
6. Any disease which is illegible for the person for a
govt. job or in a private institution: Tb, Night
blindness, convulsion, Epilepsy etc
 Privileged communication
Definition:
It is a bona fied information to a concerned
person or authority given by a doctor by
virtue of his duty to protect the interest of the
community or the society.
 Privileged communication
1. Infectious disease: TB, enteric fever—Cook,
teacher
2. Venereal disease : Pt of Syphilis-advice not to
marry.
3. Servants & employees: Driver-Epilepsy, high BP-
not to drive.
4. Notifiable diseases: to notify birth, death,
infectious diseases to public health authority
5. Suspected crime: Murder, assault ,rape.pt of gun
shot, stab inform to police/magistrate.
 Cont..
6.Patients own interest : for treatment of suicidal
tendencies ,melancholies—can be disclosed
7. Self- interest : Suit by pt. against doctor evidence
about pts condition
8.Negligence suit.
9. Courts of law .
Courts of law ( prev. communication )
• In a court of law , a doctor can not claim
privilege concerning the facts about the
illness of his patient, if it is relevant to the
inquiry before court.
The doctor should appeal to the court if he is
asked to reveal any professional secret.
• If court does not accept this plea , he may
request the court in writing.
 Cont..
• If this is denied by court, doctor must answer
otherwise risk of penalties for contempt of
court.
• A doctor can disclose the facts with other
doctor, nurse, radiologist, to provide better
service to the pt.
 Physician ‘s responsibility in criminal
matters
• The doctor knowing or having reason to
believe that an offence has been committed
by a patient whom the patient shall be
punished with imprisonment up to 6 months
(S.202, B . p c. ).
• But if he treats a person who has attempted
to commit suicide, he is not legally bound to
report, but if the person dies he has to inform
the police.
Special duty of a doctor in emergency
cases
• In emergency he has moral, ethical and
humanitarian duty to do his best to help the
patient in saving his life.
• In medico-legal injury cases , a doctor is obliged
to give necessary medical aid and to save the life
of the patient .
• He should render all help to see that the person
reaches the proper expert/institution as early as
possible.
 Rights & privilege of medical
practitioner
1.Right to practice medicine .
2.Right to choose a patient .
3.Right to dispense medicines.
4. Right to possess and supply dangerous drugs
to his patients
5. Right to add title, descriptions, etc., to the
name.
6. Right to recovery of fees.
 Cont..
7. Right for appointment to public and local
hospitals.
8. right to issue medical certificates.
9. right to give evidence as an expert.
10. exemption from serving as a juror at an inquest.
Physicians can suffix to their nasmes only
recognised medical degrees/ diplomas and
membership/honours which confer professional
knowledge or recognise any exemplary
qualifications/ achievements.
 Cont..
11. The use of the red cross and allied emblems by
medical practitioners is prohibited.
 Right of a doctor to refuse to give
treatment
1.If another doctor is present to treat the pt.
2.If the pt. use medicine out of his physicians
prescription.
3.If the pt. does not carry out the advice of his
physician.
4.If the pt. Takes narcotics by violating advice
of physician.
 Conti..
5.If the pt. or his guardian conceal to describe
the history of Disease.
6.If the pt . Deceive with his physician.
7.If the pt does not pay the proper fees to his
physician.
8.If the physician himself become ill.
 Right of a doctor to refer his pt .
• If He can not diagnose the disease.
• If the life of the pt. is in threatened condition for
operation.
• If operation needed for injuries produced by
criminal activities.
• If destructive operation of a fetus needed to
save the life of mother
• In case of homicidal poisoning complication
arises.
• If pt. desires to change his physician.
• If the pts attendance produce un wanted
circumstances.
 Duties of a patient
1. He should furnish the doctor with complete
information about past illness , family history
of diseases and the facts and circumstances
of his illness.
2. He should strictly follow the instructions of
the doctor as regards diet, medicine, mode of
life etc .
 Conti..
3. He should pay a reasonable fee to the
doctor.
4. He should respect the physician.
5. He should not insist the physician to
refer to higher centre.
 Privileges and rights of the patients
1. To choose his own doctor freely.
2. Access (a) to health facilities available regardless
of age, sex, religion economic and social status,
(b) to emergency services.
3. dignity : to be treated with care, compassion,
respect and dignity without any discrimination.
4. privacy: to be treated in privacy during
consultation and therapy.
5. Assurance of Confidentiality. All information
about his illness and any other be kept
confidential.
 Cont…
6. information : to receive full information about his
diagnosis, investigation and treatment plans and
alternative , complications, side- effects/
expected results as well as facilities available in
the institution .
7. Right to know day to day progress line of action,
diagnosis and prognosis.
8. Refusal right to consent or refuse and specific or
all measures.
9. Second opinion At any time.
 Cont..
10. Records access to his records and demand
summary or other details regarding to it .
11. Continuity to receive continuous care for his
illness from the physician /institution.
12. Comfort: to be treated in comfort during illness
and follow up .
13. Complaint : Right to complain and rectification
of grievances.
14. Compensation : To obtain compensation for
medical injuries/ negligence.
 Types of physician-patient
relationship
Types of physician-patient relationship

1.Therapeutic relationship

2. Formal relationship
 Professional negligence / Malpraxis
Professional Negligence may be defined as
“absence of reasonable care and skill or
willful negligence of a medical practitioner
in the treatment of a patient, which causes
damage or bodily injury or death of a
patient . ( Doing
something that one should not supposed
to do )
Professional Negligence two types-
1. Civil Negligence.
2. Criminal Negligence.
 Civil Negligence
The question of civil negligence arises:
1) When a pt. or in case of death, any relative bring
suit in a civil court for getting compensation from
his doctor, if he has suffered injury due to
negligence.
2) when a doctor brings a civil suit for getting his
fees from the patient or his relatives, who refuse
to pay the same alleging professional negligence.
• Liability for negligence arises if the following
conditions are satisfied.
Civil Negligence:
1. Duty : .Existance of a duty of care by the
doctor.
2. Dereliction.: The failure of applicable
standard of care & standard
3. Direct Causation:: The failure must lead to
damage. Pt must prove this is due to acts
of ommision or nagligent act & not due to
any inervening cause
4. Damage: The damage should be of a type
that would have been foreseen by a
resonable physician
The patient should prove all the 4
elements.
CIVIL NEGLIGENCE Examples are:
1. Breaking of needle during giving of
injection.
2. Drug overdose.
3. Failure to give tetanus toxoid in tetanus
prone injury.
4. Over load I.V. fluid infusion.
5. Failure to warn about side effect.
6. Wrong diagnosis
7. Cannot manage Pyrogenic reaction of
blood or infusion.
 Cont..

8.Failure to obtain informed consent.

9.Failure to examine patient himself.
10.Failure to attend the patient in time or failure to
attend altogether.
11.Making a wrong diagnosis, due to absence of skill or
care.
12.Negligent management of procedures.
 Criminal Negligence
Conditions to be satisfied:
1.Indifference to an obvious risk of injury to
health.
2.Actual foresight of the risk,but
continuation of the same treatment.
3.Appreciaton of the risk & intention to avoid
it,but showing high degree of negligence
in the attempted avoidance.
4.Inattention or failure to avoid a serious
risk.
 CRIMINAL NEGLIGENCE examples
are
1. Mismatched blood transfusion.
2. Gross mismanagement of delivery.
3. Amputation of wrong finger or limb.
4. Operation on wrong area or on wrong patient.
5. Leaving instrument in the abdomen.
6. Performing criminal abortion.
7. Grossly incompetent administration of
general anesthetics.
8. Causing loss of vision or hearing due to
administration of wrong drug.
Difference between civil & criminal negligence:
Trait Civil Negligence Criminal Negligence
1.Offence: No specific & clear violation Must have specifically violated a
of law need to be proved. particular criminal law in question.
2.Negligence: Simple absence of care & Gross negligence,inattention or
skill. lack of competency.
3.Conduct of Compared to a generally Not compared to a single test.
physician: accepted simple standard of
a professional conduct.
4.Consent for Good defence, can not Not a defence, can be prosecuted.
act: recover damages.
5.Litigation: Between two parties. Between state & doctor.

6.Trial by: Civil court. Criminal court.

7.Evidence: Strong evidence is sufficient. Guilt should be proved beyond

reasonable doubt.
8.Punishment: Liable to pay damages. Imprisonment with or without
fine.
 Difference between Professional Negligence &
Infamous conduct:
Trait Professional Infamous Conduct
Negligence
1.Offence: Absence of proper care or Violation of code of medical
skill or wilful negligence. ethics.
2.Duty of care: Should be present. Need not be present.
3.Damage to Should be present. Need not be present
person:
4.Trial by: Courts; civil or criminal. Medical Council(BMDC)
5.Punishment: Fine or Imprisonment. Warning or erasure of name.
6.Appeal: To higher court. To Government.
 RES IPSA LOQUITUR
RES IPSA Loquitur means “the thing or fact speaks
for itself”
Ordinarily , the professional negligence of a
physician must be proved in court by the expert
evidence of another physician.
Patient need not to prove negligence.
The rule is applied in 3 conditions—
1.In the absence of negligence the injury would not
have occurred ordinarily.
2. That the doctor had exclusive control over the
injury producing instrument or treatment.
3. That the patient was not guilty of contributory
negligence.
 RES IPSA LOQUITUR are

1. Failure to remove the swabs during

operation.
2. Leaving of instruments at the site of
operation.
3. Amputation of wrong limb.
4. Overdose of drug.
5. Mismatched blood transfusion.
6. Burn from X-ray or radiotherapy.
 Novus actus interveniens
Definition:
This principle state that a person is responsible not
only for his negligent acts but also for the logical
consequences of those actions.
Example:
-- complication arising due to consequence of
leaving a swab or surgical instrument after
completing operation.
-- Accidental substitution of poisonous drug for
therapeutic drug.
 Medical mal occurrence
Medical maloccurence is defined as a bad
outcome that is unrelated to the quality of care
delivered by the health care team.

This includes:
• medical and surgical complications that can be
anticipated and represent unavoidable risks of
appropriate medical care.
• complications that arise unpredictably and are
unavoidable .
 Cont..
• complications that arise as a result of decisions
made by patient and physicians with fully
informed consent but appear, in retrospect, to
have been a less appropriate choice
• Malpractice requires the demonstration of
negligence or substandard practice that causes
harm.
• In this case doctor is not responsible or negligent
of his act.
 Contributory negligence
It may be define as Concurrent negligence by the
patient and the doctor which causes delayed
recovery or harm to the patient.

That means , where a person suffers injury partly

due to the negligence on the part of another
person or persons and partly as a result of his
own negligence, then the negligence on the part
of the injured which contributed to the accident is
referred to as his contributory negligence.
Importance:
• Patient loses his rights.
• Good defense of a Doctor against negligence in
civil case but not in criminal case.
 Calculated risk
• A chance of exposure to loss or injury that might
be undertaken after its advantages and
disadvantages have been carefully weighted and
considered. Many business operators need to
take a calculate risk to expand their business
activities into a new competitive arena.
• That’s mean the injury complained is of a type
that may occur even though reasonable care has
been taken.
• It is a good defense to any doctor for professional
negligence.
 Doctrine of common
•
knowledge
The common knowledge doctrine allows plaintiffs in a
malpractice action to “present triable issues without resort
to the testimony of an expert. In such a case the jury itself
is allowed ‘to supply the applicable standard of care and
thus to obviate the necessity for expert testimony relative
thereto.
• “it is the unusual professional malpractice case in which
the common knowledge doctrine can be invoked,” as it was
intende Significantly to apply in “situations where the
carelessness of the defendant is readily apparent to anyone
of average intelligence and ordinary experience.” Ibid. The
doctrine has applied in such cases of a dentist pulling the
wrong tooth, or a physician failing to inform a patient of a
needle left in the patient’s body after a medical procedure,
 Composite negligency
Composite negligence refers to the negligence on
the part of the two or more persons.
Where a person is injured as a result of the
negligence on the part of two or more wrong
doers, it is said that the person was injured on
account of the composite negligence of those
wrong-doers.
In such a case, each wrong doer is jointly and
severally liable to the injured for payment of the
entire damages and the injured person has the
choice of proceeding against all or any of them.
The injured need not establish the extent of
responsibility of each wrong-doer separately.
 Assumption of risk –violent non –fit
injury
• Assumption of risk is a defense in the law of torts, which
bars or reduces a plaintiff's right to recovery against a
negligent tortfeasor if the defendant can demonstrate that
the plaintiff voluntarily and knowingly assumed the risks at
issue inherent to the dangerous activity in which he was
participating at the time of his injury.
• What is usually meant by assumption of risk is more
precisely termed primary or "express" assumption of risk. It
occurs when the plaintiff has either expressly or implicitly
relieved the defendant of the duty to mitigate or relieve the
risk causing the injury from which the cause of action arises
 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.
• Any small health-care business could theoretically
be sued under the doctrine of corporate
negligence for the actions of its employees.
Example:
• A doctor may be charged for negligence in his
part of duty.
• A nurse may be charged if she doesn’t take
proper care of the pt according to the advice of
the doctor.
• The hospital superintendent may be charged if
he does not take steps to make the drugs
necessary for the patient.
Malpractice litigation involving
various specialties:
• Anesthesiology
• Orthopedic &accident surgery
• General surgery
• Gynae & obs.
• General medical practice
 Therapeutic misadventure
• A therapeutic misadventure is an unexpected or
unexplained medical care-related injury or
adverse outcome, which is not an inherent
disability, side effect, or unpreventable natural
complication of the involved procedure or
medication, or a natural complication of the
patient's initial conditions.
• Therapeutic misadventures are adverse effects
caused by diagnostic or therapeutic procedures,
excessive or inappropriately administered
medication, allergy to medication, and failure of
equipment.
Vicarious liability/Liability for the
act of another/Responded superior
It may be define as the responsibility of a medical
practitioner for negligent acts of assistant or
nurses .
• During surgical operation if any gauge or
instrument is kept with in abdominal cavity,
Surgeon will be liable for the wrong act .because
all the decisions are under the control of surgeon
although the wrong acts are done by the
assistants.
• But in absence of doctor if any fault is done by
nurse or any assistant, doctor will not be liable.
Doctor will not also be liable for the wrong act
done by anesthesiologist during operation.
Appointing authority & institution will be liable for
the act of assistant. But if it is proved that they
have been appointed by an expert team, hospital
authority will not be liable.
Condition:
• There must be an employer- employee
relationship
• While on the job.
 Product liability
Product liability refers to the physical agent
which caused injury or death of the patient during
treatment by the doctor. This may result from the
unexpected by-product of faulty,defective,or negligently
designed medical or surgical instruments or inadequate
operating instructions.
In such cases, manufacturers, distributors, suppliers,
retailers, and others who make products are responsible
for injury or death.
Products Liability distinguishes between three major
types
• manufacturing defect,
• design defect,
• a failure to warn ( also known as marketing defects).
 DEFENSE OF A DOCTOR AGAINST
NEGLIGENCE

1. Contributory Negligence
2. Corporate Negligence
3. Calculated Risk
4. Medical Mal-occurrence.
5. Medical Misadventure.
6. Product Liability.
7. Novus Actus .
Precautionary steps to prevent or how
a doctor can prevent negligence :
1. By obtaining consent from the patient prior to
examination.
2. By keeping a female attendance during
examination of a female patient.
3. By advising X-ray or other investigations to
confirm diagnosis.
4. By taking proper history from the patient.
5. By showing average degree of skill & care during
treatment.
6. By reading X-ray film correctly.
7. By giving ATS to a injured patient where
required.
8. By giving proper post operative care.
9. By giving supportive treatment in emergency
cases.
10.By referring the patient to a specialist when
necessary.
11.By doing sensitivity test before injecting allergic
drugs.
12. By avoiding treatment over telephone.
13. By using proper & clean instruments.
14. By avoiding use of date expired drugs.
15. By giving proper and clear instructions in the
prescription.
16. By choosing efficient assistants for performing
operation.
 Euthanasia
Definition:
Euthanasia or mercy killing is the practice of
killing a person ( pain less death) for giving
relief who is suffering from hopelessly
incurable & painful diseases.
Like Malignancy, AIDS, severely Defective new
born baby.
It is practice at Uruguay & Netherland.
It is not practiced in our county as because:
• Legal obligation
• Ethical contraindication
• Religious disapproval
Types / Methods of practice :
• Active / Positive / act of commission
• Passive / Negative / act of omission
Active: Here death is executed by an act of
commission e.g. by giving over dose of any drug
(such as Morphine,short acting barbiturates) or
introduction of some poison which causes
painless death (such as CO).
Passive: Here death is executed by discontinuing or
withdrawing artificial life sustaining measures
that prolongs the life e.g. O2 inhalation, dialysis,
defibrillator etc.
Others Methods:
• Voluntary: with the desire & consent of the pt /
person concerned.
• Involuntary: when it is practiced without the
scope to make desire of the person ( as in case of
unconscious pt).
• Non-voluntary: against the will of the pt/ person.
 Human experimentation
Human experimentation:
In human experimentation, effects of drugs or
any biomedical agent are studied on human
subjects.
Types:
• Therapeutic: to improve the condition of the
patient who dose not respond to any
established conventional treatment.
• Research: to study the effect of different
biomedical agents, to find out its results, their
acceptability & usefulness.
• Innovative: discovery of therapeutic agents
that have not yet earned a place in medical
science.
 Rules of human experimentation
• The agent used for research must not be known
harmful agent.
• There must be scientific justification.
• Must be preceded investigation in laboratory on
animal.
• Should be immediately stopped if unwanted
desires occurred.
• Should have written consent from subjects or
from their guardians.
• Should be conducted under specialists.
• Should be against a single & diagnosed case.
• No monitory benefit should be offered.
• Should be conducted just find out a substitute of
same efficacy & safety.
 Workmen’s compensation act
It was establish at 1923. it is the act for
employee.
This act provides for payment of compensation
by the employer to the employees for
suffering any injury or disability or diseases
resulting from accident or as occupational
hazard.
• Amount of compensation is related with the
degree of disability , extent of injury or nature
of the disease.
• To be compensated , the harm or the
suffering should have been caused in course
of delivery of duty.
 Consent
Definition:
It is a free,voluntary, valid agreement,
approval or permission for compliance of
some act .
Classification:
• Implied
• Expressed
– Verbal
– Written
active-when written by owns hand.
passive-when written by other & signed later on.
• Informed consent
 Implied consent
When the conduct of a person is clearly indicative
that he is agreeable to some act or he desires the
act to be done, then it is implied that he has
given consent for the act, even though he has not
expressed his consent in words or in writing.
For example when a patient comes to a doctors
chamber for treatment and narrates his
complaints, it is implied that he has given
consent to the doctor for his physical
examination.
 Expressed consent

• Expressed consent may be in verbal, non-

verbal or written form and is clearly and
unmistakably stated.
– Verbal consent is expressed verbally / orally in
words.
– Nonverbal / Written consent is expressed in
writing.
 Tort
• Can be either expressed or implied. For example,
participation in a contact sport usually implies
consent to contact by other participants, when
contact is permitted by the rules of the sport.
Express consent exists when verbal or written
contractual agreement occurs.
• If a person signs a document stating that he or
she is aware of the hazards of an activity, and
that individual is then injured during that activity,
the express consent given in advance may
excuse another person who caused an injury to
that person.
 Information should be supplied by the
doctor to the pt.
● The nature of his condition
• The nature of proposed treatment & procedure
• The risk & benefit of the proposed procedure
• The alternative procedure
• The advantage & disadvantage of alternative
procedure
• The relative change of success & failure of both
procedure
• The possible consequences of refusal
 Consent in medical purposes
• Medical physical examination.
• Medico legal examination in case of rape,
pregnancy, abortion, age determination, delivery
etc.
• Before any surgical operation.
• For contraceptive sterilization( consent of both of
spouse).
• Examination of blood, urine or breath of a drunk.
• Before blood or plasma transfusion.
• Before radiotherapy
 Cont..
• Before giving of immunosuppressive drugs.
• For disclosure of professional secrecy except
those are privileged communication.
• Therapeutic abortion.
• Risky diagnostic procedure-endoscope,
myelogram, laparoscopy, radioisotope scan,
bronchoscopy, angiogram etc.
• Consent from the heirs of corpse in case of:
--Clinical or pathological autopsy
--Removal of eyes, viscera or any organ of the
dead body.
 Where consent is not necessary

• Examination of an accused on a charge of

committing an offence.
• Prisoner.
• Emergency diagnostic procedure, treatment
or operation.
• Examination or treatment of a mentally ill
patient.
• Compulsory vaccination or sterilization.
• Privileged communication.
• Medico legal autopsy.
• Patient with coma.
• Children under the age of 12 years here
consent given by guardian.
 Rules of consent:
• the consent should be
free→voluntary→clear→intelligent→informed→dirc
et→ personal.
• There should be no undue / consent is invalid
influence→fraud→misinterpretation of
Fact→compulsion→threat of physical injury or
death intoxication.
• Consent given for committing crime or an illegal
act is always invalid.
• A person above 18 years of age can give valid
consent to suffer any harm that may result from
an act not intended to cause death or grievous
hurt.(S.87 BPC).
 Cont..
• A person can give valid consent to suffer any
harm that result from an act not intended to
cause death or grievous hurt, done in good faith
& for his benefit (S.88 BPC).
• A child under 12 years of age & an insane
person can not give valid consent. The consent
of the parent or guardian should be taken.
(S.89BPC).
• Consent is given under fear of injury or due to
misunderstanding of a fact is not valid.(S.90
BPC).
 Conti..
• Consent given by an insane or intoxicated
person, who is unable to understand the nature
& consequences of that act to which he gives
the consent, is invalid. (S.91 BPC).
• Any harm caused to a person done in good faith
is not an offence, even with out that person ‘s
consent, if it is impossible for that person to
signify consent or has no guardian to obtain
consent in time for the thing to be done in
benefit.(S.92 BPC).
Importance of consent:
1)Any medical act without consent is an assault.
2) The medical man may be charged for negligence,
if he does not take consent.

Loco parentis:
In an emergency involving children, when there
parents or guardians are not available, consent
are taken from person-in-charge, such as provost
of the hall, superintend of asylum, principal of
any institute etc.
 Informed consent
When consent has been given after knowing
all the pros & cons of the act for which
consent has been given , e.g
• The nature and quality of the act,
• risk involved in it ,
• whether he has any other choice, called
informed consent.
Indication of informed consent:
• Administration of general anaesthesia.
• Before any Operation.
• Before Blood transfusion.
• Before Examination of rape victim.
• Examination of a victim in criminal case.
• Examination of medico legal case like
Pregnancy, Abortion, Delivery.
 Malingering
It is conscious, planned feigning or pretending a
disease for the shake of gain.
Disease may be feigned- Dyspepsia,Intestinal
colic,Ulcer,Blindness,Deafness,Vertigo,Epilepsy,In
sanity etc.
Patient can distort or exaggerate their
symptoms,but true stimulation is very rare.
Can be diagnosed by keeping the pt under close
observation & watching him without his
knowledge.
Commonly done by-
• Soldiers or policemen to avoid duties.
• Prisoners to avoid hard work.
• Businessman to avoid business.
• Workman toclaim compensation.
• Criminals to avoid legal responsibilities.
• Beggers to draw public sympathy.
Thank you all