Sunday, March 15, 2009

Ethics in Resuscitation

Other Important Points Not Covered in the Lecture:

The Concept of Patient Autonomy

“Every human being of adult years and sound mind has the right to determine what shall be done with his own body, and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable”

- Justice Cardozo in Schloendorff v Society of New York Hospital, 105 NE 92 (NY1914)

Bolam Test and Bolitho Test

Under the Bolam test, a doctor is not negligent if he is acting in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art, merely because there is a body of such opinion that takes a contrary view.

In this case, a patient, Mr Bolam, sued the hospital and its doctors for damages, claiming negligence on the part of the doctors in performing electroconvulsive therapy on him which resulted in fractures. The patient also claimed that he did not give informed consent to the hospital doctors.

“. . . (a doctor) is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art . . . a man is not negligent, if he is acting in accordance with such practice merely because there is a body of opinion who would take a contrary view. At the same time that does not mean that a medical man can obstinately and pigheadedly carry on with some old technique if it has been proved to be contrary to what is really substantially the whole of informed medical opinion . . .”

- Judge McNair

Bolitho case - the court must be satisfied that the exponents of a body of professional opinion have a logical basis and had directed their minds to the comparative risks and benefits in reaching a defensible conclusion. The opinion of the expert witnesses must be founded on logic and good sense. It is now a matter for court & not medical opinion to decide standard of professional care

The ability and willingness of the courts in Bolitho case to consider the correctness of a professional view has been extended beyond information disclosure and into treatment. This case arose out of a failure of a hospital doctor to examine and intubate a child experiencing respiratory distress, leading to brain damage through asphyxia. The plaintiff patient had expert evidence that a reasonably competent doctor would have intubated in those circumstances. The defendant doctor had her own expert witnesses saying that non-intubation was a clinically justifiable response.

1. A set of power point slides by Assoc Prof Catherine Tay can be downloaded here.

2. Medico-legal articles by Assoc Prof Catherine Tay:

- Informed Consent To Medical Treatment: What Needs To Be Disclosed? Click here
- Recent developments in informed consent: the basis of modern medical ethics. Click here
- Informed Consent in Obstetrics and Gynecology. Click here
- Recent Developments of Informed Consent in Eye Research. Click here

3. Elements of Informed Consent — A Survey of Medical Professionals
Click here

4. sBMJ series
- Biomedical ethics: The basic principles. Click here
- Biomedical ethics: Patients' right. Click here
- Biomedical ethics: Organ transplantation. Click here
- Biomedical ethics: Genetics. Click here


Anonymous said...

nice blog Dr chew! =)

Anonymous said...

Dear Dr.Chew,
Any update on MCEM exam? Came across MCEM training in India. Is it advisable for Malaysian doctors to do MCEM thr?Thx

Anonymous said...

Used some of the posts for class preparation. Very helpful and nicely-presented.Thx. Hope more will come :-)


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