legal (consent) issues in clinical practice

8/11/2019 Legal (Consent) Issues in Clinical Practice

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Some Legal Issues in

Clinical Practice (Consent)


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Aitkenhead AR, The Pattern of Litigation Against Anaesthetists.

BJA 1994, 1993; 73:10-21


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2

7

3

15

1

5

25

2475

1 68

76

371

121

87

61

59

28

12

9 7


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Files Opened 2003-2012

World Anaesthesia (MPS Data)


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Questionnaire prior to pre-op visit

Information received & patient satisfactionAnaesthesia: 64% spoke to nobody

beforehand

62% received no information59% would have liked more

Nurses (40%) most frequent providers

Williams OA, Patient knowledge of operative care.

Journal of the RSM. 1993. 86(6): 328-31.


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What makes a good consent form


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HIPPOCRATES

Perform your duties calmly and adroitly,

concealing most things from the patient while

you are attending to him turning his attention

away from what is being done to him revealing nothing of the patients future or

present condition

Hippocrates, Decorum. Havard UP, MA 1967: 267.


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CONSENT IS ADVICE

In Past Drs = No duty to provide information HippocratesPhysicians take active steps to

conceal information from patients

Providing information may cause distress,confusion and jeopardise recovery

Limited information

Silence and ? Deception

Hatcher v Black (Times, 2July 1954)

Denning His Peers did not condemn him and

neither should we


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Paternalistic approachDr-centric


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AutonomyPatient Centric

Schloendorff v Soc. Of New York Hospital (1914)

Hucks v Cole (1993) Rogers v Whittaker (1992), Chappel v Hart (1998)

Hong Chuan Lay v Dr Eddie Soo Fook Mun (1998)

.. It was for the court, and not medical men,to judge the adequacy of information

disclosed


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Patients Expectation

Akkad (2006)

88% = legal requirement

68% = give authority to Drs

46% = to protect hospital

41% = made their wishes be known

10% = did not know what they agreed to sign

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KS Hoe, BM Karis MedJ Malaysia, 57 June 2002


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22 KS Hoe, BM Karis MedJ Malaysia, 57 June 2002


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23 KS Hoe, BM Karis MedJ Malaysia, 57 June 2002


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Patients Expectation (Beresford 2001)

Royal Brompton & Univ College Hosp. London

Pts undergoing cardiac surgery (CABG)

42% = dont want information of risks

50% = dont want to know risk of death

54% = dont want to know risk of stroke

Statistical figures just confuse

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Asian Patients Expectation

I leave it to GOD

I have faith in you

Dr do what you think is best

If you are the patient what would you decide

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Consent For Transfusion

Culture of just, openness & transparency Allows patient to make consent decision

Allows doctors to document reason for

transfusion Management of unexpected outcome

seroconversion

Medico-legal aspect : Duty to inform In accordance with current international best

practice.

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Seroconversion Cases:2011/12 IJN

2011 2012

Total number 7 7

Donors seroconverted

with Hepatitis C

2 2

Donors seroconvertedwith HIV 2 4

Donors seroconverted

with Syphilis

3 1

No of cases closed5 3

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2011 : No of cases clo sed = 5 ( 1 deceased, 3 tested non reactive, 1

disc arded )

2012 : No of cases c losed = 3 ( 1 HCV tested negative, 1 HIV not

transfused, 1 syphi l is)


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(National Bld. Trans. Services)

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MMC Consent Guide 2011 & 2013


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Consent Validity


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MMC Consent Guideline 2013


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MMC Consent Guideline 2013


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Abdul Razak Datuk Abu Samahv

Raja Badrul Hisham Raja Zezeman Shah and others

Facts of the case: Colorectal surgeon and insertion of Ryles tube

Assigned consent to Trainee Officer

Patient refused Decision to do it under anaesthesia

Patient had aspiration and subsequently died


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NO ABBREVIATIONS

TO BE USED


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Example Aneasthesia Consent


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Severe Left Main Stem with

Possible Difficult Intubation:

Limited Mouth Opening

Poor dentition

Dr: : Your operation will


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IS OUR EXPLANAITION CLEAR?

Dr: : Your operation will

be done with local

anaesthetic


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There is yet no legal duty to

ensure patients understand

information that is communicated

to them.

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Most Frequently Lost Documentation:

Anaesthetic Records & Charts

D t i d Cl i 2008 2012


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Determined Claims 2008-2012

World Anaesthesia

1 Augus t 2011


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DOCUMENTATION

IS ONE OF THE

MOST

PROBLEMATIC

AREAS INMEDICAL

LITIGATION


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Informed Consent

Western Idea of Autonomy

Influenced by

Social, Cultural, Family, education standard

Disease type, severity, specialty

Clinical, research, nursing

Law Use Professional Guidelines

? Reformulate IC for Asian Culture

Asian Judges use Western philosophy/case law

Asian Patients use Asian values 49


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Lancet 1994


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However the landscape is changing with awareness of medical indemnity

legal (consent) issues in clinical practice

Documents