Medical interventions can be withdrawn in selective patients with Do Not Resuscitation form signed or in patients with terminal illness based on patients best interest

1. Refusal of care and conflicts
of interest
DR. KEERTHANA,
DNB GENERAL MEDICINE

2. Refusal of care
65 year female with severe anemia (Hb – 4g/dl) has presented with signs of cardiac
failure. You have started treatment with diuretics and have advised blood transfusion.
Patient and her relatives are not willing for blood transfusion as it is against their
religious principles.
Without transfusion, there is a chance that patient may die of cardiac failure. What
will you do???

3. Continued..
After 3 days patient died despite diuretic therapy and other supportive measures.
Now the relatives are arguing that you have not explained it clearly and that’s the
reason they have refused transfusion.
How will you argue?

4.  Should act in the best interest of the patient.
 Patient has the right to decide.
 Informed consent before performing any procedure
 Documentation in case of refusal of care.
Documentation should include,
1. Negative consent by the family member in their native language.
2. Name and relationship of the person who is giving negative consent.
3. Date and time

6. Do Not Resuscitate

7.  Successful outcomes of resuscitation mean restoration of patient’s health to their pre-
arrest state.
 Resuscitation must be instituted in only when there is a reasonable chance of restoring
cardiopulmonary functions, optimal mental capacity and length and quality of life that
would be in the best interests of patients to sustain.

12. Medical Negligence
 Common errors by medical professionals:
1. Failure to communicate
2. Failure to diagnose
3. Failure to identify a complication
4. Inadequate follow up
5. Prescribing errors

13. Legal aspects
 Victim can seek any of the following actions against a negligent medical
professional.
1. Compensatory action - monetary compensation
2. Punitive action – can lodge criminal complaint.
3. Disciplinary action – through Medical council
4. Recomendatory action – through Human Rights Commission

14. Prevention of medical negligence
 Always do the best for the patient
 Informed consent
 Adherence to clinical guidelines and hospital policies
 Documentation
 Keeping updated
 Contributory negligence
 Consider every patient as a Potential litigant.

15. Conflict of interest
 Acting in patients’ best interests may sometimes conflict with a physician’s self-
interest or the interests of third parties such as insurers or hospitals.

16.  Financial incentives:
1. Will result in ordering more interventions or ordering investigations which are not
indicated.
2. Health care providers may avoid sick patients with terminal illness in order to get
good outcomes and financial incentives

17.  Pharmaceutical companies:
1. Providing gifts and meals for doctors.
2. Will create a burden on the doctors to prescribe the brand name of the drugs
instead of generic one.
 Occupational risks :
1. Fear about risk of having occupational infections
2. Institutions should provide adequate training, protective equipment and
supervision

18. Conflicts of interest
 Financial incentives
 Relationships with pharmaceutical companies
 Occupational risks
 Learning clinical skills
 Response to Medical errors
 Physician impairment