Medico-Legal Aspects of Clinical Practice

Medico-Legal Aspects of Clinical Practice

Introduction

·       Clinical practice is not only governed by medical ethics and scientific knowledge but also by legal principles.

·       Doctors must adhere to laws that protect patient rights, ensure accountability, and maintain trust in the health care system.

Duties and Responsibilities of Doctors towards Patients

a) General Duties

• Duty of Care – Doctors must provide a reasonable standard of care as expected from a competent professional in similar circumstances.
• Duty of Competence – Keep updated with medical knowledge, practices, and skills.
• Duty of Non-Negligence – Avoid acts of omission or commission that may harm patients.
• Duty of Emergency Care – Provide medical assistance in emergencies, irrespective of the patient’s background or ability to pay (as per Supreme Court directives).
• Duty to Refer – If unable to treat, refer the patient to a specialist without delay.
• Duty to Inform – Explain diagnosis, treatment, prognosis, and alternatives in understandable language.

b) Ethical Responsibilities

• Beneficence – Always act in the best interest of patients.
• Non-maleficence – Do no harm intentionally.
• Autonomy – Respect patients’ right to make informed choices.
• Justice – Provide fair treatment without discrimination.

c) Legal Duties

• Maintain accurate medical records.
• Issue medical certificates and reports truthfully.
• Report notifiable diseases, deaths, births, and medico-legal cases (MLC).
• Respect patient confidentiality and privacy.

Consent of Patients

a) Types of Consent

1. Implied Consent
• Inferred from patient’s behavior (e.g., extending an arm for injection).
• Valid for minor, non-invasive procedures.
2. Express Consent
• Oral or written.
• Required for invasive, surgical, and risky procedures.
3. Informed Consent
• Patient must be informed of:
• Nature and purpose of the procedure.
• Risks, complications, and side effects.
• Alternatives and prognosis.
• Must be voluntary, without coercion.
• Must be obtained from a competent adult (18+ years in India).
• For minors/incompetent persons → consent from parent/guardian.
4. Special Consent
• Consent for sterilization, MTP, organ donation, HIV testing has specific legal rules.

b) Exceptions to Consent

• Emergency situations (when patient is unconscious and delay may risk life).
• Therapeutic privilege (when full disclosure may harm the patient).
• Court orders (for medical examination in legal cases).

Doctor–Patient Relationship

a) Nature

• Fiduciary relationship – Doctor must act in patient’s best interests.
• Contractual – By seeking care, an implicit contract is formed.
• Confidential – Requires privacy of patient information.

b) Types

1. Express – Clear agreement between patient and doctor.
2. Implied – Arises when a patient seeks consultation in OPD/clinic.
3. Third-party relationship – When employer, insurer, or court directs examination.

c) Legal Implications

• Breach of duty → negligence or malpractice claim.
• Failure to maintain confidentiality → legal liability.
• Exploitation or abandonment of patient → misconduct.

Professional Secrets and Privileged Communication

a) Professional Secrets

• Doctors must not disclose patient information obtained during professional duty.
• Covers diagnosis, treatment, history, laboratory findings, etc.
• Even after patient’s death, confidentiality must be respected.

b) Privileged Communication

• Certain situations require disclosure of confidential information by law for public interest or justice.

Examples of mandatory disclosure in India:

1. Births & Deaths
• Compulsory reporting under the Registration of Births and Deaths Act, 1969.
2. Abortion / MTP (Medical Termination of Pregnancy)
• Permissible only under the MTP Act, 1971 (amended 2021) with consent of woman.
• Confidentiality of patient’s identity is mandatory (Sec. 5 of MTP Act).
• Illegal abortions must be reported if they constitute a criminal offense.
3. Communicable/Notifiable Diseases
• Diseases like TB, HIV, COVID-19, cholera, plague, etc., must be reported to public health authorities.
• Legal duty overrides confidentiality to protect community health.
4. Criminal Cases
• Gunshot wounds, stab injuries, poisoning, sexual assault, burns, accidents → must be reported to police.
• Failure to report may lead to criminal liability for the doctor.

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