This document discusses several key legal issues in emergency medicine, including duty of care, consent, competence and capacity, privacy and confidentiality, refusal of treatment, and negligence. It emphasizes the importance of acting in the patient's best interests, obtaining valid consent, properly assessing decision-making capacity, and thorough documentation. Legal concepts are complex, so the focus should be on doing what a reasonable practitioner would do in any given situation.
detail knowledge of medico-legal cases, introduction,types, reports, consent,death certificate, patient right. it will help you to understand the concept of medico-legal cases
Triage is the term derived from the French verb trier meaning to sort or to choose
It’s the process by which patients classified according to the type and urgency of their conditions to get the Right patient to the Right place at the
Right time with the
Right care provider
I picked that presentation from the internet and edited it, all rights reserved to the original owner. Anyhow this presentation might be helpful for med students doing their emergency rotation/elective and especially those who don't have an instructor or any kind of mentor in their emergency elective, like me.
detail knowledge of medico-legal cases, introduction,types, reports, consent,death certificate, patient right. it will help you to understand the concept of medico-legal cases
Triage is the term derived from the French verb trier meaning to sort or to choose
It’s the process by which patients classified according to the type and urgency of their conditions to get the Right patient to the Right place at the
Right time with the
Right care provider
I picked that presentation from the internet and edited it, all rights reserved to the original owner. Anyhow this presentation might be helpful for med students doing their emergency rotation/elective and especially those who don't have an instructor or any kind of mentor in their emergency elective, like me.
Definition of Triagea
Triage is the term derived from the French verb trier meaning to sort or to choose
It’s the process by which patients classified according to the type and urgency of their conditions to get the . Right patient to the
Right place at the
Right time with the
Right care provider
Nursing management of critically ill patient in intensive care unitsANILKUMAR BR
Critical care nursing: it is the field of nursing with a focus on the utmost care of the critically ill (or) unstable patients.
Critically ill patients : critically ill patients are those who are at risk for actual (or) potential life threatening health problems.
Admission QGeneral appearance (consciousness)
Airway: Patency Position of artificial airway (if present)
Breathing: Quantity and quality of respirations (rate, depth, pattern, symmetry, effort, use of accessory muscles) Breath sounds Presence of spontaneous breathing.
Circulation and Cerebral Perfusion: ECG (rate, rhythm, and presence of ectopy) Blood pressure Peripheral pulses and capillary refill Skin, color, temperature, moisture Presence of bleeding Level of consciousness, responsiveness.
quick Check Assessment in CCU.
A crash cart or code cart (crash trolley in UK medical jargon) or "MAX cart" is a set of trays/drawers/shelves on wheels used in hospitals for transportation and dispensing of emergency medication/equipment at the site of medical/surgical emergency for life support protocols to potentially save someone's life.
The retarded development of nursing and nursing profession seems to be mainly due to the fact that no serious thought has been given to this discipline.
Polices for intensive care units / critical care units ANILKUMAR BR
What is a Policy?
A Policy is a statement, verbal, written or implied, of those principles and rules that are set by Board of Directors as guidelines on organizations actions.
There should be written polices for the intensive care units or critical care units which will guide the personnel working there.
The polices making body, there should be representation from administrative team, medical team and the nursing team.
ADMISSION POLICES: This should specify whether the patients can be admitted directly to CCU /ICU or through the casualty department.
There should be polices regarding the admission of medico-legal cases.
the ot nursing is an essential concept that every student nurse must have an adequate knowledge in order to counteract the issues related to OT nursing.
introduction to MLC
Laws related to MLC
General guidelines
Evidence
Legal Requirements of MLC
Preservation of MLC documents
Precautions
Examples of MLC
Definition of Triagea
Triage is the term derived from the French verb trier meaning to sort or to choose
It’s the process by which patients classified according to the type and urgency of their conditions to get the . Right patient to the
Right place at the
Right time with the
Right care provider
Nursing management of critically ill patient in intensive care unitsANILKUMAR BR
Critical care nursing: it is the field of nursing with a focus on the utmost care of the critically ill (or) unstable patients.
Critically ill patients : critically ill patients are those who are at risk for actual (or) potential life threatening health problems.
Admission QGeneral appearance (consciousness)
Airway: Patency Position of artificial airway (if present)
Breathing: Quantity and quality of respirations (rate, depth, pattern, symmetry, effort, use of accessory muscles) Breath sounds Presence of spontaneous breathing.
Circulation and Cerebral Perfusion: ECG (rate, rhythm, and presence of ectopy) Blood pressure Peripheral pulses and capillary refill Skin, color, temperature, moisture Presence of bleeding Level of consciousness, responsiveness.
quick Check Assessment in CCU.
A crash cart or code cart (crash trolley in UK medical jargon) or "MAX cart" is a set of trays/drawers/shelves on wheels used in hospitals for transportation and dispensing of emergency medication/equipment at the site of medical/surgical emergency for life support protocols to potentially save someone's life.
The retarded development of nursing and nursing profession seems to be mainly due to the fact that no serious thought has been given to this discipline.
Polices for intensive care units / critical care units ANILKUMAR BR
What is a Policy?
A Policy is a statement, verbal, written or implied, of those principles and rules that are set by Board of Directors as guidelines on organizations actions.
There should be written polices for the intensive care units or critical care units which will guide the personnel working there.
The polices making body, there should be representation from administrative team, medical team and the nursing team.
ADMISSION POLICES: This should specify whether the patients can be admitted directly to CCU /ICU or through the casualty department.
There should be polices regarding the admission of medico-legal cases.
the ot nursing is an essential concept that every student nurse must have an adequate knowledge in order to counteract the issues related to OT nursing.
introduction to MLC
Laws related to MLC
General guidelines
Evidence
Legal Requirements of MLC
Preservation of MLC documents
Precautions
Examples of MLC
In the presentation efforts have been made to guide the medical professionals how to deal with a MLC case in a step by step manner and certain issues relating to medical case records.
London iCAAD 2019 - Richard Collins - THE INTERACTION BETWEEN THE FAMILY LAW ...iCAADEvents
This interactive talk considers the role of the clinical expert in Family Law both for the legal professional and the client, the practicalities and procedure governing the selection of the clinical expert in private children proceedings and the role of the clinical expert in those proceedings.
Consent' is a patient's agreement for a health professional to provide care.
There are different forms of consent.
Implied - indicate consent nonverbally (for example by presenting their arm for their pulse to be taken
Oral
Written
Now-a-days public are expecting Skills, Knowledge as well as Ethical behaviour from Doctors. This PPT gives the 2 basic principles of Bio-ethics in brief & apt form
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
4. Why do we need to know this?
• To avoid getting sued
• To keep our employers happy
• To pass fellowship exams
• To provide the best possible care to our
patients and avoid adverse outcomes
5. When do we you get taught about
legal issues in medicine?
•
•
•
•
At medical school?
As a junior doctor?
As a trainee?
As a specialist?
6. Where do we get information on
this topic?
•
•
•
•
Textbooks/journals/online resources
Medical defence organisations
Hospital policies
Legal precedents
• Informal conversations with colleagues
• Trial and error
• Experience
7. Legal issues in emergency
medicine
•
•
•
•
•
•
•
•
•
Consent
Patient confidentiality
Competence
Documentation
Medical error
Open disclosure
Medicolegal reports
Mental health act
Coronial police
•
•
•
•
•
•
Duty of care
Giving advice
Transfer of responsibility
Leaving against advice
Leaving without being seen
Refusing treatment
8.
9. What will we discuss
•
•
•
•
•
•
Duty of care
Consent
Competence/capacity
Privacy/confidentiality
DAMA/Refusal of treatment
Negligence
10. Duty of care
• Not just relating to mental health issues
• Principle that doctors have a duty to
provide care to patients which is
– In the patients best interests
– Is to the best of his/her ability
– Is appropriate to the situation
• Focussed on what is reasonable
• Negligence requires a duty of care
11. Some examples in ED
•
•
•
•
•
Cardiac arrest
End of shift
Medication prescribing
Clinical knowledge
Consultant responsibility
12. Consent
• Medical treatment requires patient
consent
• Consent may given
– Implied
– Verbally
– Written
• Involving the patient in decision making
about their care
13. Valid Consent
1. Must be legally capable of giving consent
– Competent, not a minor, under guardianship,
mentally ill, disabled by drugs or alcohol
2.
3.
4.
5.
Consent must be informed
Consent must be specific
Consent must be freely given
Consent must cover that which is
actually done
14. What does informed consent imply?
•
•
•
•
Clear
Accurate
Relevent
Material
• Treatment options
• Consequences of treatment
• Consequences of no treatment
15. Rogers & Whittaker
• Australian High Court decision
• The case
• The decision
– All medical treatment is preceded by the
patients choice
– Duty to disclose all material risks to the patient
• A reasonable person would attach significance to it
• The outcome
16. Ability to consent in difficult situations
•
•
•
•
•
Children/adolescents
Intellectually impaired
Mentally ill
Drug and alcohol affected
Patient in the emergency department
• What would a reasonable doctor do?
– The “will I look like a dickhead” test
17. Capacity vs Competence
• Capacity
–
–
–
–
Decision making capacity
Personal values
Comprehension
Understanding
• Our role to determine
• Competence
– Whether a person is
legally able to manage
their affairs or not
– Presumed for adults
• Courts role to
detemine
18. Determining capacity
• Functional assessment
• Ability to understand the information
• Ability to appreciate the situation and
consequences
• Ability to rationally manipulate the information
• Ability to communicate a choice
• Understanding/Belief/Reasoning/Choice
19. How to determine capacity
What do you believe is wrong with you?
What treatment has been proposed?
What will happen if you don’t have it?
Why have I(has the doctor) recommended it?
Can you tell me what your decision is?
How did you reach your decision?
20. Consent/Competence in Children
• Not usually a problem if parental consent available
• In absence of parental consent
– Not strictly determined by age
– More about maturity
• Adult >18
• Mature minor > 16
• Minor ~14 or less
– Grey area in between
• Gillick competence (test)
– Understanding
– Maturity
“A minor is considered to be competent to consent to treatment when
the person ‘achieves a sufficient understanding and intelligence to
enable him or her to understand fully what is proposed’”
21. Consent/Competence in Children
• Advice for young players
– Depends on understanding of child
– Depends on complexity of treatment
– Try to persuade child to involve parents
– Involve colleague/second opinion
– Document all discussion/actions taken
– Exceptions include emergency/life-saving
treatments
22. Privacy/Confidentiality
• Information gained in doctor-patient relationship
shall remain confidential
• Grey areas exist
• Exceptions
• Conflicts
– Duty to community
– Notifiable diseases
• Medical risk
– Mandatory reporting
• Serious crime
– Impaired health practitioner
23. DAMA/Refusal of treatment
• Patient has right to refuse treatment
–
–
–
–
Competent
Informed
Meticulous documentation
Responsibility to ensure safe discharge
• Risks for DAMA
–
–
–
–
Young, male
Indigenous
Alcohol/drug user
Low socioeconomic status
24. Negligence
• Requires a duty of
care situation
• Negligence
– Medical duty of care
– Breach of duty of care
– Harm and causation
• Court decision
– Expert opinion
– Guidelines
– Bolam (UK law)
– Bolitho
• Reasonable care
25. Bolam and Bolitho
• UK high court
decision 1954
• The case
• UK House of Lords
1993
• The case
• Not negligent if
actions in keeping
with current practice
of peers
• Medical profession
decides
• Defence cannot be
based on standard
practice if that is not
reasonable practice
• Up to the court to
decide
26. Take Home Message
• Legal issues are complex
– Focus on what a reasonable person would do
• Always act in the best interests of the patient
– Bearing in mind what they would want
•
•
•
•
Know the features of valid consent
Know how to assess capacity
Documentation is important
Our work environment makes it more difficult
27. Sources of information
•
•
•
•
Cameron, Adult Textbook of Emergency Medicine, 3rd edition
Tintinalli, Emergency Medicine 7th Edition
Dunn, The Emergency Medicine Manual 5th Edition
Life in the Fast Lane website
– http://lifeinthefastlane.com/education/ccc/consent/
– http://lifeinthefastlane.com/education/ccc/consent-and-competence-inchildren/
– http://lifeinthefastlane.com/education/ccc/capacity-and-competence/
• Stewart C, et al. The Australian Medico-Legal Handbook (1st edition),
Elsevier,2007
•
Don’t forget the bubbles website
– http://dontforgetthebubbles.com/gillick-competence-crash-course/
Editor's Notes
Going to talk about a number of issues
Why – it’s important to have a clear idea
When we practice we don’t really think about it – most of the time we don’t have to
Now and then we get a case where these issues do come into play and we do have to, or at least we should stop and think about it.
Common/courts/legislation
Civil – one party takes another to court – business, financial, domestic land and environemt court
Criminal – someone is charged with doing something that is unlawful – against the law.
I just want to briefly discuss medical ethics bfore we go on
Hippocrates. Principles of medical ethics thomas percival
Really comes back to doing the best for our patients. Concepts like duty of care and medical ethics and even moral duty comes into it. The legal aspect becomes involved to do a couple of things 1. to determine whether care is appropriate or not 2. to provide guidance to the profession in cases where there has been uncertainty – why we should take an interest in this.
When in our careers do we get taught this topic
Good samaritan act, Cardiac arrest on ward, Medication prescribing, up to date with medical knowledge and treatments, consultant supervision
Lies at the heart of doctor patient interaction
Any examination or investigation is voluntary and we need consent to perform them.
Essentially everything requires consent.
Legally a very complex issue
These are the features of valid informed consent
Also that the patient understands
Appropriate for the doctor to give their opinion as to the best option.
Often expected and desired by patients
Would not be considered coercive unless given in a manipulative fashion
Facts: The respondent, Maree Whitaker, had been almost totally blind in her right eye for nearly 40 years since suffering a severe injury to the eye at the age of nine. Despite the injury she had lived a substantially normal life. She consulted the appellant, Christopher Rogers, an ophthalmic surgeon, who advised her that an operation on the injured eye would not only improve its appearance but would probably restore sight to it.
Following the surgery, which was conducted with the required skill and care, the respondent developed a condition known as 'sympathetic ophthalmia' in her left eye. In the end she lost all sight in her left eye, and as there had been no restoration of sight in her right eye, she was almost totally blind.
She sued the appellant alleging his failure to warn her of the risk of sympathetic ophthalmia was negligent. She had not specifically asked whether the operation to her right eye could affect her left eye but she had incessantly questioned the appellant as to possible complications. The appellant said in evidence, "sympathetic ophthalmia was not something that came to my mind to mention to her". Evidence given at the trial was that the risk of sympathetic ophthalmia was about one in 14,000 and even then not all cases lead to blindness in the affected eye.
The appellant relied on the principle used in UK cases, (the "Bolan" principle), that a medical practitioner is not negligent if he acts in accordance with a practice accepted at the time as proper by his peers, even though other medical practitioners adopt a different practice. In other words, the standard of care owed to a patient in all things is determined by medical judgment.
High Court Decision: The six High Court judges agreed that except in cases of emergency or necessity, all medical treatment is preceded by the patient's choice to undergo it. The choice is meaningless unless it is made on the basis of relevant information and advise. "The Law should recognise that a medical practitioner has a duty to warn a patient of a material risk inherent in the proposed treatment; a risk is material if, in the circumstances of the particular case, a reasonable person in the patient's position, if warned of the risk, would be likely to attach significance to it or if the
medical practitioner is or should reasonably be aware that the particular patient, if warned of the risk, would be likely to attach significance to it."
Child – to come
Intellect – mild may be ok, more severe guardianship – predetermined
Mental – does not automatically preclude – need to determine competence – if difficult get psychiatrist help
Drugs and alcohol – not clear. Legal and medical opinion of the capacity of patient who is affected by alcohol or drugs often will not agree. Act in the best interests of the patient – you will be on solid ground
Restraing patient – may be justified if leaving is judged to have adverse medical consequences and you determine the patient lacks the capacity intheir intoxicated state. – better to be sued for assault than for damage if allowed to leave
Emergency- time and urgency may justify proceding in absence of consent if deemed to be in the best ibterests of the patient. Explain treatment as early as possible
Competence can vary over time
A mental illness does not necessarily imply a lack of capacity to consent, if the above elements can still be satisfied
Competence is specific and/or can vary with specific tasks — a patient may be competent to consent for a simple procedure but not a complex procedure
The patient’s decision need not be one that others would regard as reasonable, but it must involve a process of reasoning
improvements in the patient’s level of comfort may improve competence – giving them time to think, allowing the support of friends and relatives, treating any reversible symptoms, such as pain, that may be compromising their capacity, or putting them in a quiet room or somewhere with a non-threatening atmosphere
comprehensive testing (e.g. neuropsychiatric testing) and extensive corroborative testing is advised if there is disagreement between health professionals, or between them and patients or guardians
the more serious the decision that has to be made, the greater the care needed to ensure that competence can be presumed
The health department advised that contraception was at the doctors discretion and it could be provided without parental consent. Gillick set up litigation saying a doctor prescibing contracetion to her daughter would be unlawful and would be encouraging underage sex.
Went through a few levels of court. The house of lords had to decide whethrer the minor could consent in principle. Consent to battery and assault in the absence of patient consent to treatment even is the doctor felt it was in the best interests of the patient
The House of Lords focused on the issue of consent rather than a notion of 'parental rights' or parental powers.
In fact, the court held that 'parental rights' did not exist, other than to safeguard the best interests of a minor.
The majority held that in some circumstances a minor could consent to treatment, and that in these circumstances a parent had no power to veto treatment. Provided the minor could consent if he or she fully understood the medical treatment that is proposed:
"As a matter of Law the parental right to determine whether or not their minor child below the age of sixteen will have medical treatment terminates if and when the child achieves sufficient understanding and intelligence to understand fully what is proposed." Lord Scarman
The ruling holds particularly significant implications for the legal rights of minor children in England in that it is broader in scope than merely medical consent. The authority of parents to make decisions for their minor children is not absolute, but diminishes with the child's evolving maturity; except in situations that are regulated otherwise by statute, the right to make a decision on any particular matter concerning the child shifts from the parent to the child when the child reaches sufficient maturity to be capable of making up his or her own mind on the matter requiring decision.
NOT BEEN DEFINED RIGIDLY BY THE COURTS – IT IS UP TO THE INDIVIDUAL DOCTOR TO DETERMINE COMPETENCE
Fraser guidelines – deal specifically with contraception in a minor
..a doctor could proceed to give advice and treatment provided he is satisfied in the following criteria: 1) that the girl (although under the age of 16 years of age) will understand his advice; 2) that he cannot persuade her to inform her parents or to allow him to inform the parents that she is seeking contraceptive advice; 3) that she is very likely to continue having sexual intercourse with or without contraceptive treatment; 4) that unless she receives contraceptive advice or treatment her physical or mental health or both are likely to suffer; 5) that her best interests require him to give her contraceptive advice, treatment or both without the parental consent."
Hysterctomy vs appendicectomy
Dependant patients/ethical duty to prevent harm to others/ legal exceptions