MEDICO-LEGAL ISSUES

Lecture 2 & 3

Date:16.01.15 & 23.01.15

T ime:9.30 TO 10.30 am & 8.30 TO 9 .30 am

AVANIANBAN CHAKKARAPANI

Learning ObjectiveTo promote an understanding and increase the awareness of the student regarding the

A. Human Rights to Health and Health Care

B. Confidentiality

C. Consent To Medical Treatment

D. Legal Institutions and Legal Process

E. Handling Complaints

Learning OutcomeA. Able to explain Human Rights to Health and Health Care

B. Able to describe Confidentiality

C. Able to explain Consent To Medical Treatment

D. Able to describe Legal Institutions and Legal Process

E. Able to explain Handling Complaints

A. What is the Human Right to Health and Health Care?The human right to health means that everyone hasthe right to the highest attainable standard ofphysical and mental health, which includes access toall medical services, sanitation, adequate food,decent housing, healthy working conditions, and aclean environment.

3 Vital Components1. The human right to health guarantees a system of health

protection for all.

2. Everyone has the right to the health care they need, and to living conditions that enable us to be healthy, such as adequate food, housing, and a healthy environment.

3. Health care must be provided as a public good for all, financed publicly and equitably.

Human Right To Health Care The human right to health care means that hospitals, clinics,medicines, and doctors’ services must be accessible,available, acceptable, and of good quality for everyone, onan equitable basis, where and when needed.

Key Human Rights Standards:The design of a health care system must be guided by the following key human rights standards:

1. Universal Access

2. Availability

3. Acceptability and Dignity

4. Quality

Universal AccessAccess to health care must be universal, guaranteed for allon an equitable basis. Health care must be affordable andcomprehensive for everyone, and physically accessiblewhere and when needed.

AvailabilityAdequate health care infrastructure (e.g. hospitals,community health facilities, trained health careprofessionals), goods (e.g. drugs, equipment), and services(e.g. primary care, mental health) must be available in allgeographical areas and to all communities.

Acceptability and DignityHealth care institutions and providers must respect dignity, provide culturally appropriate care, be responsive to needs based on gender, age, culture, language, and different ways of life and abilities. They must respect medical ethics and protect confidentiality.

QualityAll health care must be medically appropriate and of goodquality, guided by quality standards and controlmechanisms, and provided in a timely, safe, and patient-centered manner.

Procedural PrinciplesThe human right to health also entails the following procedural principles, which apply to all human rights:

1. Non-Discrimination

2. Transparency

3. Participation

4. Accountability

Non-DiscriminationHealth care must be accessible and provided withoutdiscrimination (in intent or effect) based on health status,race, ethnicity, age, sex, sexuality, disability, language,religion, national origin, income, or social status.

TransparencyHealth information must be easily accessible for everyone,enabling people to protect their health and claim qualityhealth services. Institutions that organize, finance or deliverhealth care must operate in a transparent way.

ParticipationIndividuals and communities must be able to take an activerole in decisions that affect their health, including in theorganization and implementation of health care services.

AccountabilityPrivate companies and public agencies must be heldaccountable for protecting the right to health care throughenforceable standards, regulations, and independentcompliance monitoring.

B. Confidentiality And PrivacyPractitioners have ethical and legal obligations to protectthe privacy of people requiring and receiving care. Patientsor clients have a right to expect that practitioners and theirstaff will hold information about them in confidence, unlessrelease of information is required by law or public interestconsiderations.

Good Practice

a. treating information about patients or clients as confidential.

b. seeking consent from patients or clients before disclosing information where

practicable.

c. being aware of the requirements of the privacy and/or health records legislation that

operates in relevant countries and applying these requirements to information held in

all formats, including electronic information.

d. sharing information appropriately about patients or clients for their health care

while remaining consistent with privacy legislation and professional guidelines about

confidentiality.

e. where relevant, being aware that there are complex issues relating

to genetic information and seeking appropriate advice about

disclosure of such information.

f. providing appropriate surroundings to enable private and

confidential consultations and discussions to take place.

g. ensuring that all staff are aware of the need to respect the

confidentiality and privacy of patients or clients and refrain from

discussing patients or clients in a non-professional context.

h. using appropriate consent forms for release of information which

limits disclosure to relevant health and medical information.

C. Informed consentInformed consent is a person’s voluntary decision abouthealth care that is made with knowledge and understandingof the benefits and risks involved. A useful guide to theinformation that practitioners should provide about theirproposed management or approach, including the need toprovide more information where the risk of harm is greaterand likely to be more serious and advice about how topresent information.

Good Practice Involves

a. providing information to patients or clients in a way they can

understand before asking for their consent.

b. obtaining informed consent or other valid authority before

undertaking any examination or investigation, providing

treatment (this may not be possible in an emergency) or

involving patients or clients in teaching or research, including

providing information on material risks.

c. when referring a patient or client for investigation or treatment, advising

the patient or client that there may be additional costs, which he or she

may wish to clarify before proceeding.

d. when working with a patient or client whose capacity to give consent is or

may be impaired or limited, obtaining the consent of people with legal

authority to act on behalf of the patient or client and attempting to obtain

the consent of the patient or client as far as practically possible.

e. documenting consent appropriately, including considering the need for

written consent for procedures which may result in serious injury or death.

Fees and Financial consenta. Patients or clients should be made aware of all the fees and

charges involved in a course of treatment, prior to the health

service being provided as much as practical.

b. Discussion about fees should be in a manner appropriate to the

professional relationship and should include discussion about the

cost of all required services and general agreement as to the level

of treatment to be provided.

References:1. Heng Leng Chee. (2009).Health Care in Malaysia: The Dynamics of

Provision, Financing and Access. New York: Routledge.

2. Bridgit C. Dimond. (2009) Legal Aspects of Physiotherapy. (2ndEd.). Chichester, West Sussex: John Wiley & Sons.