Upload
nadia-rahman
View
227
Download
0
Embed Size (px)
Citation preview
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
1/47
INTRODUCTION TO
MEDICOLEGAL AND ETHICAL ISSUESIN CURRENT CLINICAL PRACTICE
A LOOK FROM CLASSICAL AND
ISLAMIC PERSPECTIVE
DATO DR. MAHMUD MOHD NOR
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
2/47
So you want to be a doctor!
Do you know what you want to be?
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
3/47
So you want to be a doctor
Do you know what you want to be?
What is your profession?
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
4/47
So you want to be a medical doctor!
Do you know what you want to be?
What is your profession? What is a professional?
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
5/47
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
6/47
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
7/47
ETHICS - THE BASIS OF GOOD
MEDICAL PRACTICE
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
8/47
BUT WITHIN THE CONFINES OF
THE LAW
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
9/47
MEDICAL ETHICS
CIVIL CODE OF BEHAVIOUR
CONSIDERED CORRECT BYMEMBERS OF THE PROFESSION
FOR THE GOOD OF BOTH THE
PROFESSION AND PATIENT.
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
10/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
11/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
12/47
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)
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
13/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
14/47
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
15/47
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;
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
16/47
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;
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
17/47
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;
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
18/47
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;
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
19/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
20/47
FUNDAMENTAL PRINCIPLES
- RESPECT FOR LIFE
- LIFE WITH DIGNITY
- ? DEATH WITH DIGNITY
- CONFIDENTIALITY
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
21/47
1960s and
1970s
ADVANCES IN SCIENCE ,TECHNOLOGY
RESEARCH INVOLVING PATIENTS
PATIENT RIGHTS MOVEMENT
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
22/47
PATIENT RIGHTS MOVEMENT
- PROTECTION OF PATIENT WELFARE
- INFORMED CONSENT
- RESPECT FOR PATIENTS AUTONOMY
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
23/47
Bioethical Principles
Beneficence
Non Malificence Autonomy
Justice
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
24/47
ETHICAL CONCERNS IN HEALTH
- GLOBALISATION - DIVERSITY
- RISING INDIVIDUALISM, SOCIAL
PRESSURES
- TECHNOLOGY
- ECONOMICS OF HEALTH- CULTURAL DOMINATION BY
SMALLER POWERFUL GROUPS
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
25/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
26/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
27/47
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
28/47
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
29/47
LAW AND MEDICINE
ETHICS - DEFINES THE MAXIMUM LIMIT
LAW - DEFINES THE MINIMUM LIMIT
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
30/47
MEDICOLEGAL AND ETHICAL ISSUES
1. CONFIDENTIALITY
2. INFORMED CONSENT
3. NEGLIGENCE
4. TRANSPLANT
5. GENOME, GENETIC ENGINEERING
6. CONCEPTION
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
31/47
MEDICOLEGAL AND ETHICAL ISSUES
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.
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
32/47
MEDICOLEGAL AND ETHICAL ISSUES
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
33/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
34/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
35/47
EXCEPTIONS TO THE RULE OF
CONSENT
UNCONSCIOUS
GENUINE EMERGENCY
CONFINE ONLY TO NECESSARY
TREATMENT
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
36/47
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
37/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
38/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
39/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
40/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
41/47
MEDICOLEGAL AND ETHICAL ISSUES
4. TRANSPLANT
- Live living related/non related
- Foetal tissue
- Brain death
- Consent
- Commercialisation
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
42/47
MEDICOLEGAL AND ETHICAL ISSUES
5. GENOME, GENETIC
ENGINEERING/MANIPULATION
Complex and evolving
Will need to address
Ethics and Law
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
43/47
MEDICOLEGAL AND ETHICAL ISSUES
6. CONCEPTION/TERMINATION OF LIFE
Ethically more complex than legally
- In vitro fertilisation
- Selection of sex
- Surrogacy
- Paternity issues
- Termination for congenital anomalies
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
44/47
Future Challenges in Ethics andLaw
The beginning of life
Thejourney for healthy life
The end of life
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
45/47
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
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
46/47
8/8/2019 INTRO to MEDICOLEGAL.with ISlamic Perspective
47/47
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