medicolegal aspects

1. Principles of ethics
Medicolegal issues
Importance of documentation
Dr Vijay kumar, Associate Professor

2. INTRODUCTION
● Criminal / Surgeon ? intentions difer

3. Principles of ethics
Learning objectives
● Define ethics
● Identify the issues in surgical ethics
● Explain the boundaries of autonomy, informed consent and confidentiality
● Describe the good surgical practice

4. ETHICS
● The word ETHICS is derived from Greek word ethos which means character.
● To put it formally, ethics is the branch of philosophy that defines what is good
for the individual and for society and establishes the nature of obligation or
duties that people owe themselves and one another

5. Surgical ethics
● Ethics is essential discipline in the practice of surgery.
● Represent your best understanding of moral responsibility
● Ethical studies investigate what should be our character and conduct

6. Issues
● Autonomy
● Informed consent and difficulties
● Confidentiality
● Excellent standards

7. Autonomy
● Respect autonomy of patient and their ability to make choice about their Tt
● It recognizes right of patient to self determination
● So, patient have right to make choice over their surgical care

8. Attention
● Information accurate and reasonably complete
● Avoid technical language
● Provision of translator
● Clarification of doubts

9. Practical difficulties
● Temporary unconscious patient
● Children <18 y are minors and are legally incompetent
● Incompetence - other kind

10. Confidentiality
● The principle of confidentiality is that information a patient reveals to
practitioner is private and has limits how and when it can be disclosed to a
third party
● Breaking confidentiality
● If the patient is a threat to self or others
● Other team members (improving treatment options)
● Public interest
● Court order

11. Good standard
● To optimize success in protecting life and health to an acceptable standard
● Practitioner must offer specialized treatment in which they have been properly
trained

13. Medico Legal Case (MLC)
● MLC  A case of injury or ailment etc., wherein investigation by the legal
enforcing agencies is essential to fix the responsibility with regard to cause.
● Integral part of medical practice that is frequently encountered by Medical
Officer.
● MLC vs Non MLC
● Doctor to decide

14. Examples - mainly injury and poisoning
1. Assault and battery, including domestic violence and child abuse
2. Road Traffic Accidents (RTA), industrial accidents etc.
3. Any cases of trauma with suspicion of foul play
4. Electrical injuries, Burns and Scalds
5. Poisoning, Alcohol and other Intoxication
6. Drug overdose and Drug abuse
7. Undiagnosed coma
8. Chemical injuries

51. Medical certificate
Should include 
● Patient Name
● Doctor Name
● Illness patient is suffering
● Dates when patient was ill
● Signature of patient
● Signature and seal of Doctor
● Place of Issue
● Date of Issue

52. Medical Fitness Certificate
● Mention the title of the document clearly (bold) letters
● Address the certificate to the correct party (employer, insurer, etc.)
● State the date of examination
● Name and address of the patient
● Also, the name, designation and address of the doctor (Clinic or Hospital)
● Conclude with a closing signature, registration number of doctor.
● Copy of the medical certificate shall be retained by the doctor x3 years

53. DEATH CERTIFICATE
● A death certificate is an official document issued by the government, which
declares
○ cause of death
○ location of death
○ time of death
○ other personal information about the deceased.
● There are several reasons why you may need to obtain a death certificate.
○ Most often it’s to serve as proof for legal purposes.

54. Medical Certificate of Cause of Death (MCCD)
● Issued by the attending Dr who had treated the Pt during admission in a Hosp
● In the last illness (prior to death) while taking Tt from a dr outside Hosp
● Recording and reporting death using standard Form 4 (institutional deaths)
and Form 4A (non-institutional deaths) as per the rules of the Registration of
Births and Death Act, 1969
● Contains
○ Part 1 to record the immediate and antecedent causes
○ Part 2 to record the significant conditions that contributed to the death but were not part of the
sequence of events leading to death.

57. AGE DETERMINATION

58. Introduction
 Why we need to learn how to estimate age ?
 Age can be determined by 4 main criteria:
Teeth examination.
Ossification centers.
General development in children
Bone examination

59. Stages of life and their main characteristics
Intrauterine life (during pregnancy)
By USG and LMP
From 0-15 days (neonatal period)
By umbilical stump examination
From 15 days - 2 years(Infancy period)
By primary dentition

60. From 2- 6 years
Closure of metopic suture
Appearance of ossific centers
From 6-12 years
Secondary dentition
Childhood period:
rapid dental and bony
growth and development
Stages of life and their main characteristics

61.  From 12- 18 (Adolescence period)
Closure of epiphysial plates
 Adulthood
Early stage: bone remodeling and maintenance
Late stage: bone wear and tear
Stages of life and their main characteristics

63. Appearance of ossific centers after birth

66. Appearance of ossific centers after birth
 1 year : head of humerus ,femur and tibia .
 2 years : lower radius and tibia.
 3 years ; Patella.
 4 years ; upper fibula ,greater trochanter of femur.
 5 years ; lower fibula
 6 years ;head of radius ,lower ulna, calcaneum

67. Below1 year as
ossific center of the
head of femur not
appeared.

69. Below 2 years
(no ossific
centre in the
wrist)

70. Ossific centre at lower
radius = 2 years

71. What is the age ?
Above 2 years.
Ossific center of
lower radius

72. Determination of age by bone
examination - Sternum

73. What is the age?
 < 15 y (non-
united
segments)

74. Determination of age by bone examination – Epiphyseal closure

75. Age from upper limb examination
1) At the wrist and shoulder joint (lower ends of radius and ulna and head of
the humerus)19-20 years.
2) At the elbow region: trochlea and capitulum (14 years)-trochlea and
capitulum + lower end of the humerus (15years)
3) Lat.epicondyle and head of ulna(17 years).
4) Med epicondyles and the head of the radius (18years)
5) Metacarpals and phalanges (16 y in females and 18 years in males).

76. Age from lower limb
examination
1)Lesser trochanter (16y)---Greater trochanter (17y) --- Head of femur (18y).
2) Lower end of the femur + shaft (21y).
3) Upper end of the tibia +shaft (21y).
4) Lower end of the tibia +shaft (18 y).

77. What is the age?
above18ys

78. What is the age?
<21 knee

79. Thank you