Medicine and law

Kong-lung, Consultant Forensic Pathologist (Kowloon) Forensic Pathology Service, Department of Health Introduction Obviously, this was to protect the public from quackery. Fees for the doctors were paid by the State. If unsatisfactory results followed a course of treatment that had departed from the orthodox, the doctor responsible would be liable to punishment, which could be very harsh. Similar legal restrictions on medical practice were also found in other early civilizations such as Babylon and India.It is now a firmly established belief that legal and ethical considerations are integral to medical practice in the planning for the care of the patient. With the advances in medical sciences and growing sophistication of the legal framework in modern society as well as increasing awareness of human rights and changing moral principles of the community at large, doctors and other healthcare workers alike are now frequently caught in difficult dilemmas in many aspects arising from dai ly practice.Examples are plenty such as the duty to respect informed onset, truth-telling, breach of confidentiality, disclosure of medical errors, rationing of scarce health resources, biomedical research, organ donation, etc. Besides, there is also growing anxiety both within the medical profession and in the community regarding increasing trends of complaints and lawsuits against doctors. From the bitter experience of many doctors who were engaged in complaint or lawsuits in the past, many of them had resulted from failing of their doctor-patient communication skill or inadequate ability to comprehend and resolve dilemmas in clinical settings.Throughout the history of mankind, medical legislation has continuously evolved to regulate the practice of medicine. The fundamental objective is to safeguard the standards of the medical profession and to protect the public against unskilled vendors of medicine who would be as injurious to the community as other criminals. The Justinian Co de of the Byzantine Empire in 529 AD is probably the earliest law code found to contain clauses to require educational standard and proof of competence of doctors by examinations.It also restricted the number of doctors in each town and penalties were imposed for alphabetic. By 12th century, there were well established medical legislations in Italy, namely the edict of Roger II of Sicily in 1140 and Frederick II in 1224, to prescribe organized medical teaching, set courses, examinations and qualifications. 3 Medical ethics has developed into a well based discipline which acts as a â€Å"bridge† between theoretical bioethics and the bedside. L The goal is â€Å"to improve the quality of patient care by identifying, analyzing, and attempting to resolve the ethical problems that arise in practice†. In addition to our moral obligations, doctors are also bound y laws and official regulations which form the legal framework regulating medical practice. It is now a universal c onsensus that legal and ethical considerations are inherent and inseparable parts of good medical practice across the whole spectrum. The disciplines of law and ethics in medical practice overlap in many areas and yet each has its unique parameters and distinct focus. In Hong Kong, laws on public health and medical practice, essentially an adoption of the English Acts, had been introduced from the early days.The monumental principles that apply generally to medicine or health care at large are: (a) respect of patient's autonomy; (b) the principle of malefaction, I. E. , the duty to avoid harm or injury to patients; (c) the principle of beneficence, I. E. , the duty to do good to your patients, relieve their pain and suffering and to save life if you can; and (d) the principle of justice and act fairly. Meaning of Law and Medical Ethics in a Nutshell The values that encompass the four fundamental principles in medical ethics are self-evident.They are considered to be doctor's prima f acie duties to the patients and society. It is necessary for a doctor to take all of them into account when they are applicable to the clinical case under consideration. Not infrequently, when two or more principles apply, they may be in conflict. For instance, the decision to operate on a case of acute appendicitis involves at least two competing prima facie duties on the part of the doctor. At one end, the doctor is obliged to provide the greatest benefit to the patient by performing an immediate appendectomy.At the other end, surgery and general anesthesia carry risks and the doctor is under the obligation to avoid causing harm to the patient. The solution adopted must base on a balance between the demands of the competing principles by determining which carries more weight in the particular case. In the case of appendicitis, a generally accepted rational calculus holds that the patient is in far greater risk of harm from a ruptured appendix if the doctor do not act, than from th e operation and anesthesia if the doctor proceed to surgery.In its simplest context, law can be defined as enforced rules devised by the State to govern the behavior of its members for the mutual benefits of all. Observance of the rules must be guaranteed by some kinds of sanction erected against the rule breakers. In addition to laws for the general public, doctors are bounded by certain specific rules stipulated in statutes as well as code of professional conduct laid down by the official regulating authority, namely the Medical Council, and administrative codes set by the institutions.Together, they form the legal framework regarding the practice of medicine, violation of which may lead to criminal or civil liability, or disciplinary actions. In addition to legal obligations, there are also expectations of society for the doctors and the goal of the profession eased on long established moral principles of self-evident value, which define the moral framework of medical practice. M edical ethics can be defined as a self-imposed code of conduct accepted voluntarily within the medical profession, the observance of which depends on one's conscience and moral values.Law and Medicine Law and medical ethics are both dynamic and are in a constant state of change with time due to changing circumstances and societal values. Thus, new legislation and court decisions give rise to changes of the law and new ethical issues emerge in response to challenges rated by new technology, law or other influence. There is also wide difference in law from country to country because of factors regarding religion, culture, traditions, political systems and social standards.Broadly speaking, medical matters come into interaction with law in four aspects: (a) legislation and administrative regulations affecting medical practice; (b) court Judgments on problematic or controversial ethical issues in medicine; (c) medical matters or personnel may become subjects of lawsuits when issues of m edical malpractice or alleged medical negligence arise; and (d) use of medical matters s evidence in courts for other criminal or civil proceedings such as cases of homicide, rape, wounding, workman's compensation, insurance claims and the like.Fundamental Principles in Medical Ethics Medical ethics is an applied ethics which involves examining specific controversial issues such as abortion, breach of confidentiality, end-of-life care, rationing of scarce medical resources. The objective is to try to identify the issue concerned, analyze it with reasoned ideas and arguments and arrive at a viable and morally acceptable resolution for it.In the realm of medical practice, it is official to hold rules or principles that are absolute in view of the many variables that exist in the context of clinical cases as well as new issues that arise as a result The Interaction of Law and Ethics in Medical Practice Despite their distinctive roles, law and medical ethics overlap in many areas. It is indeed difficult to dissociate the legal and ethical basis of the professional duties of doctors. For instance, both law and medical ethics address to issues of confidentiality, euthanasia, abortion, use of dangerous drugs, medical malpractice and the like. 4 Volvo. 8 NO. 6