Medical Ethics Principles

Medical Ethics Principles - Guiding Lights

Core tenets guiding medical practice. 📌 Mnemonic: Be A Nice Jellyfish (Beneficence, Autonomy, Non-maleficence, Justice).

Medical Ethics Principles - Patient's Power Play

• Autonomy: Patient's right to self-determination.
• Valid Consent Elements (📌 CIViC):
  • Capacity: Understand, retain, weigh info, communicate choice. Age: 18 years (India - Indian Majority Act, 1875). However, 'mature minor' concept increasingly recognized for medical decisions with sufficient understanding.
  • Information: Diagnosis, procedure, risks, benefits, alternatives (PDRBA).
  • Voluntariness: Free from coercion, undue influence.
• Types:
  • Implied: By action (e.g., extending arm for injection).
  • Expressed: Oral or written (essential for major procedures).
  • Surrogate/Proxy: If patient lacks capacity (e.g., minor).
• Exceptions:
  • Emergency: Life-saving; consent implied.
  • Therapeutic Privilege: Very narrow exception - only if reasonable justification exists or patient waives information right.
  • Waiver: Patient knowingly refuses information.
  • Legal Mandate: Court order, notifiable disease.

⭐ Minors (<18 yrs): parental/guardian consent with detailed protocols for surrogate consent. Unconscious adults (emergency): treat to save life/limb following modern consent guidelines and 'best interest' principles.

Medical Ethics Principles - Secrets & Candor

• Professional Secrecy (Confidentiality): Obligation to not disclose patient information shared in trust. Foundation of doctor-patient relationship.
• Privileged Communication: Legal protection against compelled disclosure of patient information in court.
  • Absolute Privilege: Complete protection (e.g., communication between spouses, lawyer-client). Not typically granted to doctors in India.
  • Qualified Privilege: Protection if communication made in good faith, without malice, and to protect an interest (e.g., doctor to another doctor for patient care).
• Exceptions to Confidentiality (Disclosure Permitted/Required):
  • Patient consent (express or implied).
  • Court order (subpoena).
  • Notifiable diseases (e.g., TB, cholera, plague, dengue, chikungunya, COVID-19, viral hepatitis as per current official guidelines).
  • Danger to self (suicidal intent) or others (homicidal intent, child/elder abuse).
  • Public interest (e.g., infectious disease threats, impaired drivers, individuals posing direct public safety risks).
  • Medical research (anonymized data).
  • Medical audit.

⭐ Section 131 of the Bharatiya Sakshya Adhiniyam, 2023, deals with privileged communications between a legal advisor and client, which has implications for how medical records might be treated if part of legal counsel, though direct doctor-patient privilege is limited under this act specifically for doctors themselves without a court order or other legal mandate for disclosure or protection based on context (e.g. mental health acts).

Medical Ethics Principles - Duty & Damage

• Medical Negligence (4 D's) 📌 Mnemonic: "Doctors Definitely Deserve Defense"
  • Duty: Doctor's obligation to care.
  • Dereliction/Breach: Failure in standard of care.
  • Direct Causation: Breach directly caused harm.
  • Damages: Patient suffered actual harm.
• Types of Negligence:
  • Civil: Compensation sought (tort).
  • Criminal: Gross negligence, reckless disregard (Sec 304A IPC).
• Res Ipsa Loquitur: "The thing speaks for itself." Negligence is obvious (e.g., wrong-site surgery, retained foreign object).
• Contributory Negligence: Patient's own actions contributed to harm; may reduce doctor's liability.

⭐ The Bolam Test (UK: peer-accepted practice) was refined in India by Jacob Mathew vs. State of Punjab (2005): for criminal liability, negligence must be "gross" or "reckless."

High‑Yield Points - ⚡ Biggest Takeaways

• Autonomy: Uphold patient's right to choose; informed consent is key.
• Beneficence: Always act in the patient's best medical interest.
• Non-maleficence: "Primum non nocere" - do no harm to the patient.
• Justice: Ensure fair and equitable distribution of care and resources.
• Confidentiality: Protect patient information; exceptions exist (e.g., notifiable diseases, court order).
• Veracity: Be truthful and honest in all patient communications.
• Professionalism: Maintain ethical conduct and accountability in practice.