intro to medicolegal.with islamic perspective

8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective

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INTRODUCTION TO

MEDICOLEGAL AND ETHICAL ISSUESIN CURRENT CLINICAL PRACTICE

A LOOK FROM CLASSICAL AND

ISLAMIC PERSPECTIVE

DATO DR. MAHMUD MOHD NOR


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So you want to be a doctor!

Do you know what you want to be?


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So you want to be a doctor


What is your profession?


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So you want to be a medical doctor!


What is your profession? What is a professional?


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ETHICS - THE BASIS OF GOOD

MEDICAL PRACTICE


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BUT WITHIN THE CONFINES OF

THE LAW


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MEDICAL ETHICS

CIVIL CODE OF BEHAVIOUR

CONSIDERED CORRECT BYMEMBERS OF THE PROFESSION

FOR THE GOOD OF BOTH THE

PROFESSION AND PATIENT.


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MEDICAL ETHICS

Members of the Medical Profession areexpected to abide by a code of ethicsestablished by the profession itself. The

purpose of the code is to safeguard thepublic, ensure propriety in professionalpractice and to prevent abuse ofprofessional privileges

Code of ProfessionalConduct of theMalaysian MedicalCouncil was adopted byMMCon 9thDecember 1986


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Hippocratic Oath

Original Code of Medical Ethics

Formulated by Hippocrates 460 B.C

Founder of Medical Teaching in Kos

Oath taken by all graduating practitioners

Purpose is to protect patients and practitioners

No longer used in the original version

Modified not to name the Gods of old Religions


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TRADITIONAL EMPHASIS UP TO

1960s

- Related to doctors duties to their patients

(Hippocratic tradition)

i.e. 1. NON-MALAFICENCE

( DO NO HARM)

2. BENEFICENCE

(DO GOOD)


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THE INTERNATIONAL CODE OF

MEDICAL ETHICS

Adopted by the 2nd General Assembly of

the World Medical Association, Geneva,

Switzerland, September 1948, amended

by the 22nd World Assembly, Sydney,

Australia, August 1968, and the 35thWorld Medical Assembly, Venice, Italy,

October 1983


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THE DECLERATION OF GENEVA

a) I SOLEMNLY PLEDGE myself to

consecrate my life to the service ofhumanity;

b) I WILL GIVE to my teachers therespect and gratitude which is theirdue;

c) I WILL PRACTICE my professionwith conscience and dignity;


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THE DECLERATION OF GENEVA

d) THE HEALTH OF MY

PATIENT willbe my first consideration;

e) I WILL RESPECT the secrets which areconfided in me, even after the patient has

died;


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THEDECLARATI

ON OF GENEVA

f ) I WILL MAINTAIN by all the means in

my power, the honour and the noble

traditions of the medical profession;

g ) MY COLLEAGUES will be my

brothers;


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DECLARATI

ON OF GE

NEVA

h ) I WILL NOT PERMIT consideration of

religion, nationality, race. Party politics

or social standing to intervene between

my duty and my patient;


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DECLARATI

ON OF GE

NEVA

i ) I WILL MAINTAIN the utmost respect

for human life from its beginning even

under threat and I will not use my

medical knowledge contrary to the laws

of humanity

j ) I MAKE THESE PROMISES solemnly,freely and upon my honour


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FUNDAMENTAL PRINCIPLES

- RESPECT FOR LIFE

- LIFE WITH DIGNITY

- ? DEATH WITH DIGNITY

- CONFIDENTIALITY


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1960s and

1970s

ADVANCES IN SCIENCE ,TECHNOLOGY

RESEARCH INVOLVING PATIENTS

PATIENT RIGHTS MOVEMENT


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PATIENT RIGHTS MOVEMENT

- PROTECTION OF PATIENT WELFARE

- INFORMED CONSENT

- RESPECT FOR PATIENTS AUTONOMY


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Bioethical Principles

Beneficence

Non Malificence Autonomy

Justice


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ETHICAL CONCERNS IN HEALTH

- GLOBALISATION - DIVERSITY

- RISING INDIVIDUALISM, SOCIAL

PRESSURES

- TECHNOLOGY

- ECONOMICS OF HEALTH- CULTURAL DOMINATION BY

SMALLER POWERFUL GROUPS


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C

ode of MedicalE

thics inI

slam Not written or codified in History of Islamic

Medicine or literature

The Oath of a Muslim Physician adopted byIslamic Medical Association of North America1977

Character of The Islamic Physician of The KuwaitDocument of Islamic Code of Medical Ethics,

International Organisation of Islamic Medicine1981

Islamic Code of Medical Ethics by IslamicOrganisation for Medical Sciences


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I

slamicC

ode of MedicalE

thics I swear by God.The Great

To regard God in carrying out myprofession

To protect human life in all stages andunder all circumstances doing my utmost to

rescue it from death, malady pain andanxiety

To keep peoples dignity, cover theirprivacies and lock up their secrets


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LAW AND MEDICINE

ETHICS - DEFINES THE MAXIMUM LIMIT

LAW - DEFINES THE MINIMUM LIMIT


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MEDICOLEGAL AND ETHICAL ISSUES

1. CONFIDENTIALITY

2. INFORMED CONSENT

3. NEGLIGENCE

4. TRANSPLANT

5. GENOME, GENETIC ENGINEERING

6. CONCEPTION


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1. CONFIDENTIALITY - Who should know

- How much

When is a doctor justified to break

confidentiality

e.g. AIDS, STD, Mental Illness, CrimePublic interest to break confidence.


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2a. CONSENT

Law of Trespass

Trespass - Wrongful direct and intentional

interference with the person

Any medical intervention no matter how

benevolent in motivation may constitutebattery if done without consent


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MEDICOLEGAL ISSUES

2b. Consent of Minors and mentally disabled.

Every person is competent to contract

who is of the age of majority according to

the law to which he is subject and who is

of sound mind and not disqualified from

contracting by any law to which he is

subject.

Section II of the Contracts Act1950


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MEDICOLEGAL ISSUES

Age of majority 18 - Age of Majority Act 1971A child 18 years - The Child Protection Act 1991

Appointment Committee/s

by the court - Mental Disorder Ordinance 1952


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EXCEPTIONS TO THE RULE OF

CONSENT

UNCONSCIOUS

GENUINE EMERGENCY

CONFINE ONLY TO NECESSARY

TREATMENT


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Principle ofReasonable skill andCare

Legal point of view

A

duty of acting as would a reasonableand prudent person possessing the same or

similar skills or knowledge under similar

circumstances


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NegligentTreatment in Law

Failing to or delay in diagnosing a condition

Failing to or delay in providing the appropriate

treatment or referral Failing to perform surgery with reasonable careand skill

Failing to report correctly of test results

Failing to provide post-operative care withreasonable care and skill

Failing to properly advise the patient on risks ofsurgery so informed consent could be given


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Forms ofInfamous Conduct or

Unacceptable Professional

Misdemenour

Neglect or disregard of Professionalresponsibilities

Abuse of Professional privileges and skills

Conduct derogatory to the reputation of themedical profession

Advertising, canvassing and related

professional offences


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Negligent from Ethics point of view

(a) Gross neglect of professional

responsibility

(b) Persisting in independent practice of a

branch of medicine in which he does not

have the appropriate knowledge and skill

and has not acquired the experiencenecessary


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4. TRANSPLANT

- Live living related/non related

- Foetal tissue

- Brain death

- Consent

- Commercialisation


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5. GENOME, GENETIC

ENGINEERING/MANIPULATION

Complex and evolving

Will need to address

Ethics and Law


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6. CONCEPTION/TERMINATION OF LIFE

Ethically more complex than legally

- In vitro fertilisation

- Selection of sex

- Surrogacy

- Paternity issues

- Termination for congenital anomalies


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Future Challenges in Ethics andLaw

The beginning of life

Thejourney for healthy life

The end of life


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Questions to Ponder

If medical ethics are the guiding principles

of the medical profession, to what extent do

we allow medical decisions be the object of

legal scrutiny and control ?

How do we reconcile Medical Ethics and

Law in multiethnic, multicultural and multi

religious Malaysia?

How do we reconcile the International

Code of medical Ethics with the Islamic

Code of Ethics


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CONCLUSION

1. Good medical practice requires proper

etiquette and is guided by ethical

principles within the confines of the law.

2. Public conscience as embodied in the law

provided a useful foundation for medical

ethics.3. Ethics and law are dynamic processes.

4. A need to address Medical Ethics and Law

from Islamic perspectives

intro to medicolegal.with islamic perspective

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