Law And Medicine

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1. Any two varieties of medical profession

Ans:- Medical careers are available across a multitude of educational and skill levels, but also in
diverse fields such as homeopathy or allopathy.

Here's a list of the various healthcare/ medical career options in India:

• Audiology.
• Ayurveda.
• Dentist.
• Electropathy.
• Homeopathy.
• Medical Lab Technologist.
• Microbiology.
• Naturopathy.

2. Informed consent
Ans:- The process is known as informed consent. People have the right to information about risks,
benefits, and alternative treatments when making decisions about medical care and the freedom to
choose. (See also Overview of Legal and Ethical Issues in Health Care. Valid informed consent for
research must include three major elements: (1) disclosure of information, (2) competency of the patient
(or surrogate) to make a decision, and (3) voluntary nature of the decision. Basic Elements of Informed
Consent

• Description of Clinical Investigation. ...

• Risks and Discomforts. ...
• Benefits. ...
• Alternative Procedures or Treatments. ...
• Confidentiality. ...
• Compensation and Medical Treatment in Event of Injury. ...
• Contacts. ...
• Voluntary Participation.
There are 4 components of informed consent including decision capacity, documentation of consent,
disclosure, and competency.

What are the Different Types of Consent?

• Informed consent.
• Implied consent.
• Explicit consent.
• Active consent.
• Passive consent.
• Opt-Out consent.
• Key takeaway.
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3. Privileged Communication
Ans:- Under this section, any conversation between a husband and wife is privileged whether such
communication was sensitive or confidential or not. [2] The Court further held that such communication
would refer only to verbal or written words said by the spouse and not their actions. Privileged
communication, in law, communication between persons who have a special duty of fidelity and secrecy
toward each other. Communications between attorney and client are privileged and do not have to be
disclosed to the court. Conversation that takes places within the context of a protected relationship,
such as that between an attorney and client, a husband and wife, a priest and penitent, and a
doctor and patient. The law often protects against forced disclosure of such conversations.

4. Res ipsa loquitor

Ans:- Res Ipsa Loquitur is a Latin phrase that means the thing speaks for itself. In the law of
torts, it is a very popular doctrine. In cases, where the evidence is itself sufficient to prove the
guilt of the defendant, the maxim is used there. A doctrine or rule of evidence in tort law that
permits an inference or presumption that a defendant was negligent in an accident injuring the
plaintiff on the basis of circumstantial evidence if the accident was of a kind that does not
ordinarily occur in the absence of negligence a plaintiff who establishes the Various examples
of res ipsa loquitur include the following: a piano falling from a window and landing on an
individual, a barrel falling from a skyscraper and harming someone below, a sponge is left inside
a patient following surgery or the carcass of an animal is discovered inside a food can.

5. Right to health under Constitution of India

Ans:- Right to Health is a part and parcel of Right to Life and therefore right to health is a
fundamental right guaranteed to every citizen of India under Article 21 of the Constitution of
India. The 1948 Universal Declaration of Human Rights mentioned health as part of the right to
an adequate standard of living (article 25). It was again recognised as a human right in 1966 in
the International Covenant on Economic, Social and Cultural Rights, Article 12: Article 42 in The
Constitution Of India 1949. 42. Provision for just and humane conditions of work and maternity
relief The State shall make provision for securing just and humane conditions of work and for
maternity relief. That all the citizens irrespective of their sex whether men or women shall equally
have the right to adequate means of livelihood. [Article 39(a) of the Indian Constitution] That the
resources and the ownership of those resources and materials shall be distributed in such a way
that it fulfils the common goal. Refer the presentation.

6. Right to self determination

Ans:- The right to self-determination refers to the right of an individual to determine his own
destiny. The right allows people to choose their own political status and to determine their own
form of economic, cultural and social development. Self-determination denotes the legal right of
people to decide their own destiny in the international order. Self-determination is a core principle
of international law, arising from customary international law, but also recognized as a general
principle of law, and enshrined in a number of international treaties. During World War I, U.S.
President Woodrow Wilson promoted the concept of "self-determination," meaning that a
nation—a group of people with similar political ambitions—can seek to create its own
independent government or state. What is an example of self-determination?
The ability or right to make one's own decisions without interference from others. Self
determination is defined as the personal decision to do something or think a certain way. An
example of self determination is making the decision to run a marathon without asking anyone's
opinion.
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7. Duties of medical practitioner

Ans:- While treating the patient of suspected poisoning, the role of doctor is not only to treat the patient
but also to handle the legal formalities. In such cases, it is must to keep documentation record accurate
and clear. As a medical practitioner, you might:

• examine the patient to make a diagnosis.

• record the patient's medical information.
• prescribe medication or administer treatments.
• order laboratory tests, X-rays and other diagnostic images and procedures.
• examine the results of tests and diagnostic images.

8. Kinds of disaster
Ans:- These types of disasters include:

• Tornadoes and Severe Storms.

• Hurricanes and Tropical Storms.
• Floods.
• Wildfires.
• Earthquakes.
• Drought.
What are the 10 types of disaster?
• Hurricanes and tropical storms.
• Landslides & debris flow.
• Thunderstorms and lighting.
• Tornadoes.
• Tsunamis.
• Wildfire.
• Winter and ice storms.
• Sinkholes.
What are 5 man-made disasters?
Such man-made disasters are crime, arson, civil disorder, terrorism, war, biological/chemical
threat, cyber-attacks, etc.

9. Medical negligence
Ans:- We can define 'Medical negligence' as the improper or unskilled treatment of a patient by
a medical practitioner. This includes negligence in taking care from a nurse, physician, surgeon,
pharmacist, or any other medical practitioner. Commission of mistakes or Negligence within
the health profession could result in minor injuries or even lead to some serious injuries
and these mistakes could even lead to death. Since no one is perfect in this world, a
person who is skilled and has knowledge of a particular subject can also commit
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mistakes. To err is human but to replicate the same mistake due to one’s carelessness
is negligence.

The fundamental reason behind medical negligence is that the carelessness of the
doctors or medical professionals are often ascertained in various cases where reasonable
care is not taken during the diagnosis, during operations, while injecting anesthesia, etc.

We can define ‘Medical negligence’ as the improper or unskilled treatment of a patient

by a medical practitioner. This includes negligence in taking care from a nurse, physician,
surgeon, pharmacist, or any other medical practitioner. Medical negligence leads to
‘Medical malpractices’ where the victims suffer some sort of injury from the treatment
given by a doctor or any other medical practitioner or health care professional.

Examples of medical negligence

Some examples of medical negligence are as follows:

• improper administration of medicines.

• performing the wrong or inappropriate type of surgery.
• not giving proper medical advice.
• leaving any foreign object in the body of the patient such as a sponge or bandage, etc. after
the surgery.

What does not come under medical negligence

A doctor is not liable in all cases where a patient has suffered an injury. He might have a valid defense
that he has not breached the duty of care.

The error of judgment can be of two types:

• An error of judgment – In such cases, it has been recognized that it doesn’t amount to a breach
of duty. Merely because a doctor’s decision turned out to be wrong, we cannot make him liable
for medical negligence.
• The error of judgment due to negligence – If all the factors were considered before coming to
a decision then it would be called an error of judgment due to negligence. This amounts to a
breach of duty.

Types of medical negligence

Medical negligence can occur in different ways. Generally, it occurs when a medical professional deviates
from the standard of care that is required.
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So, we can say that any kind of deviation from the accepted standards of medication and care is
considered to be medical negligence and if it causes injury to a patient then the doctor who operated on
him, other staff and/or hospital may be held liable for this.

Some of the common categories of medical negligence are as follows:

• Wrong diagnosis – When someone goes to a hospital, clinic or medical room, etc. the first
step after admittance is the diagnosis. Diagnosing symptoms correctly is critical and important
to provide medical care to any patient. However, if a patient is not treated properly due to any
mistake in diagnosis, the doctor can be made liable for any further injury or damages caused
as a result of the wrong diagnosis.
• Delay in diagnosis – A delayed diagnosis is treated as medical negligence if another doctor
would have reasonably diagnosed the same condition in a timely fashion. A delay in diagnosis
can cause undue injury to the patient if the illness or injury is left to worsen with time rather than
being treated. Obviously, any delay in the identification and treatment of an injury can reduce
the chance of recovery for the patient.
• Error in surgery – Surgical operations require an enormous level of skill and it should be done
with due care and caution because even the slightest mistakes can have profound effects on
the patient. The wrong-site surgery, lacerations of any internal organ, severe blood loss, or a
foreign object being left in the body of the patients, all this comes under Surgical error.
• Unnecessary surgery – Unnecessary surgery is usually associated with the misdiagnosis of
patient symptoms or a medical decision without proper consideration of other options or risks.
Alternatively, sometimes surgery is chosen over conventional treatments for their expediency
and ease compared to other alternatives.
• Errors in the administration of anesthesia – Anesthesia is a risky part of any major medical
operation and requires a specialist (anesthesiologist) to administer and monitor its effect on the
patient. Prior to any medical procedure requiring anesthesia, the anesthesiologist has to review
the patient’s condition, history, medications, etc. to determine the most suitable of all the
medicine to use. Anesthesia malpractice can happen even during the pre-operation medical
review or during the procedure itself.
• Childbirth and labor malpractice – Childbirth is a difficult event for a woman and it becomes
worse if not handled properly by the doctors and nurses. There are many instances of medical
negligence during childbirth including the mishandling of a difficult birth, complications with
induced labor, misdiagnosis of a newborn medical condition, etc.
• Long-Term negligent treatment – Medical negligence can also occur in subtle ways over the
course of a long treatment period. Usually, the negligence can take the shape of a failure to
follow up with treatment, or a doctor’s failure to monitor the effects of the treatment properly.

Essentials of medical negligence

The term ‘Medical negligence’ consists of two words – medical and negligence. Negligence is solely the
failure to exercise reasonable care. Medical negligence is no different. It is only that, in case of medical
negligence, the doctor is the defendant.

In an action for negligence, the following essentials are required:

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• The defendant owed a duty of care to the plaintiff.

• The defendant made a breach of that duty.
• The plaintiff suffered damage as a consequence of that breach.
A doctor owes certain duties of care to his patients, they are as follows:

• It is his duty to decide whether he wants to undertake the case or not,

• It is his duty to decide what treatment to give and;
• It is his duty to decide the administration of treatment.
If a doctor fails to perform the aforesaid duties it results in breach of duty and gives a right of action to the
patient. A breach of duty is committed by a doctor when he does not perform the degree of care like a
reasonable doctor.

In Kusum Sharma v. Batra Hospital[1], it was held by the Supreme Court that a doctor often adopts a
procedure which involves a higher element of risk, but in doing so he honestly believes that it will provide
greater chances of success for the patient. If a doctor has taken a higher risk to redeem the patient out of
his/her suffering and it did not yield the desired result, this may not amount to medical negligence.

In Jasbir Kaur v. State of Punjab[2], a newly born child was found missing from the bed in a hospital. The
child was found bleeding and near the wash-basin of the bathroom. The hospital authorities argued that
the child had been taken away by a cat which caused the damage to him. The court held that the hospital
authorities were negligent and had not taken due care and precaution. Thus, awarded the compensation
amounting to Rs. 1 lakh.

Standard of care
A standard of care specifies the appropriate treatment and medication procedure as per the requirements
that should be taken into account by a doctor while providing the treatment to his patients. The care should
not be of the highest degree nor the lowest.

Here, the degree means the level of care an ordinary health care professional, with the same training and
experience, would render in similar circumstances in the same community. This is the critical question in
medical malpractice cases and if the answer is “no,” and you suffered injury as a result of the poor
treatment, you may file a suit for medical malpractice.

In the case of Dr. Laxman Balkrishna Joshi Vs. Dr. Trimbak Bapu Godbole and Anr.[3], the Supreme Court
held that a doctor has certain aforesaid duties and a breach of any of those duties can make him liable for
medical negligence. A doctor is required to exercise a reasonable degree of care that is set for this
profession.

Duty of care
A duty of care in cases of medical negligence is an obligation on one party (doctor) to take care to prevent
harm being suffered by another (patient). Generally, doctors owe an obligation to take care of their
patients.
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There are certain requirements to establish a duty of care. They are as follows:

• A physician is not asked to deal with everyone but when he is taking a case then he should
deal with it with proper care and in accordance with the set standard of care. A doctor or clinical
practitioner prescribing a patient to seek a provider of an extra health practitioner is acceptable.
However, when there is an emergency, a medical professional ought to deal with the patient.
No health care professional shall immediately resist dealing with the case unless it is out of the
area of his expertise.
• The physician should never stretch nor reduce the gravity of a patient’s condition. He will have
to make sure that he gives proper treatment to the patient considering the type of ailment the
person is suffering from.
• A doctor must have patience as he cannot do without it. The confidentiality of the details of the
patient should be kept secret. However, in a few cases, he can reveal the details if he feels that
it is his duty to do so. For instance, if there is a disease that is spreading and is dangerous for
people then he can make it public and let others know about it.
• A physician or a doctor is free to choose whom he wants to treat but in case of emergency he
cannot deny dealing with the patient. But after undertaking a case, the health care professional
cannot withdraw from the case without informing the family members of the sufferer. A
temporarily or fully registered medical practitioner should not voluntarily commit any act of
negligence that deprives his patients of the standard of care.
• When a physician who deals with a particular problem and has expertise in that field is
unavailable and another physician is sent for the treatment, the acting doctor is entitled to get
his charges but should ensure the patient’s approval or permission to resign on the coming of
the physician engaged.

Burden of proof
The burden of proof of negligence generally lies with the complainant. The law requires a higher standard
of evidence to support an allegation of negligence against any doctor. In cases of medical negligence, the
patient must establish a claim against the doctor in order to succeed.

In Calcutta Medical Research Institute vs Bimalesh Chatterjee[4], it was held that the onus of proving
proofs against negligence and deficiency in service was clearly on the complainant.

Proof of negligence
It has been held in different judgments to charge a doctor for medical negligence the burden of proof lies
upon the person who alleges negligence against him (patient). It is a known fact that things can go wrong
even with the specialists. And the guilt or negligence can only be established if his acts fall below the
standard of care that he ought to take.

Steps to proving a medical malpractice claim

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• The first thing you need to prove is that there exists a doctor-patient relationship. This is the
easiest step that one can take in order to prove medical negligence.
• The next thing you should do is prove that your doctor did not meet the set standards required
as an obligation for this profession.
• Then prove that you have suffered an injury as a result of that medical negligence.
• The proof of damages must be presented and this includes all the harm you have suffered due
to the negligent behavior of the doctor.
• All the above-mentioned elements should be proved in order to succeed in a claim against
medical negligence.

When does the liability arise

Generally, the liability of a doctor arises when the patient suffers injury due to the substandard conduct of
the doctor, which was far below the reasonable standard of care. Hence, the patient should establish that
there exists a duty which the doctor needs to follow and then the next step is to prove breach of duty.

Normally the liability arises only when the complainant is ready to discharge the burden on him of proving
negligence. However, in some cases the principle of “res ipsa loquitor” which implies that the thing speaks
for itself, can come into action. Mostly the doctor is liable only for his own acts but there are some cases
in which a doctor can also be made vicariously liable for the acts of another. For example, when a junior
doctor is working for the senior doctor commits an error then it becomes the responsibility of the senior
making him vicariously liable.

Res ipsa loquitur

The Latin maxim “res ipsa loquitur” means that “the thing speaks for itself.”

In terms of medical malpractice, it refers to the cases where the doctor’s treatment was far below the set
standards of care under that negligence is assumed.

The doctrine assumes the following:

• Nature of injury gives the clue that without negligence it could not have happened.
• There was no involvement of the patient himself in the injury in any way.
• The injury happened under the circumstances which were under the supervision and control of
the doctor.
It means that by applying the principle the judge has accepted that the negligence has occurred. After
this, the doctor will have to rebut this thing and if he fails to do so then the patient would be considered as
successful in the case of medical negligence.

How to prove a res ipsa loquitur case?

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The injured party must prove that the physician breached the duty of care by failing to adhere to the set
standards of care a doctor must follow. The breach must be demonstrated by an expert’s attestation. In
res ipsa negligence cases expert declaration about the standard of care is not really required.

In order to prove a res ipsa case, the following must be done:

• It is well known to everyone that if a case seems like it could never happen without negligence
on the part of the doctor then this directly proves that it falls under the category of res ipsa
cases.
• The equipment or manner of treatment that caused the damage was under the doctor’s control
at all times.
• The injury was the one which the injured person couldn’t assume voluntarily.

Some Examples of Res Ipsa Medical Cases

Some common scenarios of res ipsa cases are given below:

• Leaving some object inside the body of the patient after surgery.
• If a wrong patient gets operated.
• If the wrong part of the patient gets operated.

10. Medical negligence and consumer protection act any two case
Ans:- Medical Negligence is the tort which takes cognizance of the following:

1. A legal duty either express or implied to treat patient must exist.

2. Breach of such legal duty, if any, in comparison to the expected conduct and
performance of the people from the same profession.
3. Presence of damage caused by such breach which must result in injury which
needs to be compensated.
The remarkable statement of law propounded in the famous Bolam’s case has been
extensively accepted as decisive for the standard of care necessary for both, professional
men generally and medical practitioners specifically. The two things which are vital
before hearing any case relating to medical negligence have been noted below:

1. When evaluating the standard of care as adopted in the practice by the medical
practitioner, the standard of care is assessed bearing in mind the knowledge
obtainable at the time contemporary to the occurrence of the incident, and not
at the date of trial.
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2. At the time of emergence of medical negligence caused due to failure to use

some particular medical equipment, the charge will not be successful if the
medical equipment was not present or accessible at that moment of time on
which it is recommended as must have been employed.

What is not Medical Negligence?

• It is imperative to quote Lord Denning’s judgment in Roe vs. Minister of Health,
where he has tried to explain an act that would not amount to medical
negligence: “But we should be doing a disservice to the community at large if
we were to impose liability on hospitals and doctors for everything that happens
to go wrong. Doctors would be led to think more of their own safety than of the
good of their patients. The initiative would be stifled and confidence shaken. A
proper sense of proportion requires us to have regard to the conditions in which
hospitals and doctors have to work. We must insist on due care for the patient
at every point, but we must not condemn as negligence that which is only a
misadventure.”
• Without a second thought, the doctor has complete autonomy in choosing and
administering the appropriate therapy or treatment which he considers fit for
the particular patient and puts forward to give to his patient and such autonomy
is relatively higher in instances of emergency.
• Hence, any default to cure, complication, an occurrence of an infection, or even
death, cannot be considered in segregation and labelled as being an act of
medical negligence. Failure of operation and side effects cannot always be said
to be due to medical negligence.

Medical Services Within the Purview of Consumer

Protection Act
It was only after the judgment of Supreme Court in Indian Medical Association vs. VP
Shantha, that medical profession has been brought under the purview of Consumer
Protection Act,1986 vide Section 2(1)(o), 1986 of the act.

What Can Be Considered As ‘services’

1. Contract of Service – It connotes a relationship between a master and servant
which involves complete obedience of a just and reasonable order provided by
the master to the servant with respect to the mode and manner of performance
of the order. This does not come within the purview of COPRA.
2. Contract for Service – It refers to a contract in which one party accepts to
render services, for example, professional or technical services to or for some
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other person in the discharge or conduct of which, he is not bound by any

control or direction but employs his professional skills and exercises his own
knowledge and comprehension.
In order to bring the ‘service’ within the purview of the definition of services provided in
Section 2(1)(o) of COPRA following basis needs to be adhered to:

1. Service(s) should not be free of charge

2. Service(s) under a contract of personal service is not covered under the
Consumer Protection Act.
Therefore, medical services under the contract of personal services or rendered free of
cost will not be within the scope of the definition of the services itself provided under
Section 2(1)(o) of COPRA.

“Free” Medical Services Covered Under Consumer Protection Act

In the judgment rendered in Indian Medical Association vs. VP Shantha, the court chose
to assume a narrow approach for cases pertinent to ‘free medical care’. It differentiated
between the following circumstances-

1.Services which are rendered free of cost to everyone availing them;

2.Services which must be availed by payment by everyone availing of them;

3.Services which are availed usually by payment, however, are made available free of
cost to the persons who cannot afford to pay for them.

The Apex court in this landmark judgment found that services rendered by doctors and
hospitals which fall in the second and third category will be covered within the ambit and
definition of a “service” as defined in Section 2(1)(o) of COPRA. Therefore, persons who
avail free service are “beneficiaries” and as such are covered within the ambit of
definition of “consumer” under Section 2(1)(d) of the Act.

Additionally, any forum trying a case involving an issue of medical negligence in any
jurisdiction must take into consideration at least the following three considerations
before coming down to a decision. These are that:

1. legitimate and disciplinary method must be strictly initiated on firm, virtuous

and scientific grounds.
2. patients will be better treated if the actual causes of harm are correctly
recognized and befittingly acted upon.
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3. numerous incidents include a contribution from more than one person, and it is
more likely to hold accountable the last discernible element in the chain of
causation and mainly accuse this person of holding the ‘smoking gun’.

Burden of Proof
The patient or relatives have the burden of proof to prove the negligence, except in cases
where relatives have no access, for example in a nursery, intensive care unit, operation
theatre, etc. Res ipsa loquitur is a state of gross negligence where things speak for
themselves and hence there is no need to prove.

In Fardon v.Harcourt Rivington, the court set out the ‘reasonable man test’ for
foreseeable ability. “If the possibility of danger emerging is reasonably apparent, then
to take no precautions is negligence; but if the possibility of danger emerging is only a
mere possibility which would never occur to the mind of reasonable man, then there is
no negligence in not having to take extraordinary precautions.”

A study demonstrated that the majority of cases are from:

• Gynaecology
• Obstetrics
• Surgery branches
In a writ petition, Mr. R Raheja vs. The Maharashtra Medical Council the High Court of
Bombay has given a landmark judgment that the patient or his legal heir have the
privilege to acquire copies of the entire medical record on payment of reasonable costs.

Defenses for Medical Negligence

There are several defenses which are available to a medical professional accused of
medical malpractice which has been enumerated below-

1. Known complications
2. Difference of opinion
3. Unexpected or unforeseen results
4. Contributory negligence
5. Emergency care
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Where to seek Redressal

Consumer disputes redressal agencies which are popularly called as Consumer Forums
or Consumer Courts have been created under the act at national, state and district level.
In India, the COPRA, 1986 envisages three-tier grievance redressal mechanisms:

1. National Consumers Dispute Redressal Commission

2. State Consumers Dispute Redressal Commission
3. District Consumer Disputes Redressal Commission
There is a particular time limit provided for the disposal of cases under the Act. A notice
is sent to the respondent after the complaint is registered. The respondent compulsorily
has to reply within a time period of 45 days, failing which ex parte hearing can be held.
An appeal can be filed in the higher commission, within 30 days from the date of the
decision.

An appeal can be filed before the State Commission against the decision of the district
forum. An appellate jurisdiction has been provided with the National Commission for a
further appeal against the decision of the State Commission. Any verdict rendered by
the National Commission can be challenged in the Apex Court of India as well.

It is worthwhile to note that a total of 44,47,487 out of 48,85,877 cases have been
disposed of since the inception of the Consumer Protection Forums all over the nation,
striking a disposal percentage of 91.03%.

Sl. Cases filed since Cases disposed of Cases % of total

Name of Agency
No. inception since inception Pending Disposal

National
1 124418 105070 19348 84.45%
Commission

State
2 812044 696466 115578 85.77%
Commissions

3 District Forums 3949415 3645951 303464 92.32%

TOTAL 4885877 4447487 438390 91.03%

Total number of consumer complaints filed /disposed

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since inception under COPRA

Procedure for Filing a Case

1. Consumer Complaint as is provided under Section 21(a)(i) of COPRA, 1986, is
to be filed with the Registry of this Commission within a time span of two years
from the date on which the cause of action has arisen,where the value of the
goods or services and compensation, claimed, is more than Rs.10,00,000.

1. First Appeal as is provided under Section 19 of COPRA, 1986 – Any person

distressed by an order rendered by the State Commission in application of its
powers granted by Section 17(a)(i) may consider an appeal against such order
before this Commission within a time frame of 30 days, beginning from the date
the order was received.
2. Revision Petition as is provided under Section 21(b) of the COPRA, 1986 can be
filed to ask for the records and advance suitable orders in any consumer dispute
which is lying unresolved or has been determined by any State
Commission,within a time frame of 90 days beginning from the date the order
was received, be filed with the Registry of this Commission.
3. Transfer Application as is provided under Section 22(b) of COPRA, 1986 – The
National Commission may, on the application of the aggrieved party or of its
own will, at any juncture of the proceeding, in the best interest of equity,
transfer any complaint lying unresolved before the District Forum of one State
to a District Forum of another State or before one State Commission to another
State Commission.

How to File a Consumer Complaint

1. The grievance can simply be filed on a plain paper.
2. There is no requirement of stamp paper for any declaration.
3. The complaint should have all the details of the aggrieved party and the party
against whom the complaint is being filed.
4. The complainant can register the complaint, in person or through his/her
authorized agent or by post to be sent to the Redressal Agency.
5. Engaging a lawyer is not mandatory to file a case under COPRA.
6. The fees charged will depend upon the value of the claim and is generally low.
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Where to File a Complaint

According to the Consumer Protection Act, 1986 a complaint can be filed in:

1. If the value of the claim is more than one crore – National Consumer Disputes
Redressal Commission
2. If the value of the claim is more than 20 lakhs but is within one crore – State
Consumer Disputes Redressal Commission
3. If the value of the claim is up to 20 lakh – District Consumer Disputes Redressal
Forum

Fee for Filing Complaint

Every grievance filed shall be accompanied by a fee in the form of crossed Demand Draft
drawn on a national bank or via a crossed Indian Postal Order drawn in favour of the
Registrar of the State Commission and payable at the respective place where the State
Commission or the National Commission is based.(Table)

Guidelines Issued by Supreme Court – Case to Be Referred to an

Expert Body
Whenever a Consumer Forum whether it is a National, State, District forums or a criminal
court receives a complaint against a doctor or then it must refer the issue to a competent
doctor or a committee of doctors and get the allegations confirmed.

After the confirmation by the aforementioned parties, if it is prima facie found that
medical negligence has taken place, then only a notice can be sent to the doctor or the
hospital.
According to the criterion laid down in Jacob Mathew case, the police officials were
warned not to arrest or harass doctors, otherwise, they will have to face legal action.

Frivolous Litigation
Section 26 has been provided to keep a check on the tendency of filing false and trivial
or vexatious complaints. Where the Consumer Disputes Redressal Forum is satisfied that
the complainant had approached the Forum without adequate justification, and
frivolously, it provides for the following actions to be taken:

• Dismissal of the frivolous and vexatious complaints.

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• Orders while dismissing the complaint that the complainant shall compensate
the opposite party such costs, not surpassing ten thousand rupees, as may be
specified in the order.
Frivolous lawsuits have been the major reason for increasing healthcare cost.

Impact of Consumer Protection Protection Act on Healthcare Services

Hereunder are the negative impact on the medical sector:

• Administration and prescription of defensive medicines by doctors

• Increase in the cost of healthcare services
• Filing of frivolous lawsuits leading to unnecessary litigation
Hereunder are the positive impact on the medical sector:

• Quick grievance redressal

• Quality of healthcare services has become better
• Training of medical practice
• Improvement in introspection by the medical practitioners about their
profession

Conclusion
• Under the Consumer Protection Act, the goods bought and used for commercial
purposes or activities dedicated to the extraction of profit are not covered under
the purview of COPRA. This particular provision needs to be amended since it
keeps out all medical equipment used in hospitals from the scrutiny of the act.
Usage of defective equipment and medical tools in health care can be pernicious and
lead to injury to the consumer resulting in a complaint against the doctors. Yet, as per
this provision, the manufacturers of such unfit equipment will go scot-free.

Another concern is that the services which are rendered free of charge are excluded from
the scope of COPRA. This at one stroke denies recourse for those aggrieved persons who
have availed such free medicare.

It is necessary for the medical profession to undertake some serious introspection. The
Medical Sector needs to accept the fact that it has failed miserably in self-governance.
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• Miraj Medical Centre Miraj ... vs Shri. Sunil Tukaram Danane And Anr on 15 October, 2019

• Dr. (Mrs.) Indu Sharma vs Indraprastha Apollo Hospital on 22 April, 2015

11. Define Magic Remedy under DMR (OA) Act, 1954

Ans:- The act defines "magic remedy" as any talisman, mantra, amulet or any other object which
is claimed to have miraculous powers to cure, diagnose, prevent or mitigate a disease in humans
or animal.

12. Give two Examples of Medico Legal Case

Ans:- WHAT IS MEDICO LEGAL CASE?

• A Medico-Legal Case can be defined as a case of injury or ailment, etc., in which investigations by
the law-enforcing agencies are essential to fix the responsibility regarding the causation of the injury
or ailment.
• It is a medical case with legal implications for the attending doctor where the attending doctor, after
eliciting history and examining the patient, thinks that some investigation by law enforcement
agencies is essential.
• It may be a legal case requiring medical expertise when brought by the police for examination.

DOCTOR’S DUTY

• Every doctor under law bound by a contract to serve its patient and can not refuse treatment.
• Every doctor has to fulfill certain legal requirements in service by compulsion or voluntarily as
defined under law.
• Medico legal case (MLC) examination and reporting is one of the legal responsibility of all doctors
working in a hospital.

In the judgment of case Parmananda Katara Vs Union of India, the apex court said:

“ Every doctor is bound to provide medical aid to the victims irrespective of the cause of injury; he
cannot take any excuse of allowing law to take its course”.

LIST OF MEDICO-LEGAL CASE

• All cases of injuries and burns -the circumstances of which suggest commission of an offense by
somebody. (irrespective of suspicion of foul play)
• All vehicular, factory or other unnatural accident cases specially when there is a likelihood of
patient’s death or grievous hurt.
• Cases of suspected or evident sexual assault.
• Cases of suspected or evident criminal abortion.
• Cases of unconsciousness where its cause is not natural or not clear.
• All cases of suspected or evident poisoning or intoxication.
• Cases referred from a court or otherwise for age estimation.
• Cases brought dead with improper history creating suspicion of an offense.
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• Cases of suspected self-infliction of injuries or attempted suicide.

• Any other case not falling under the above categories but has legal implications.

PROCEDURE FOR REGISTERING A MEDICO LEGAL CASE

• TREATMENT (All legal formalities to be suspended till the patient is resuscitated)

• IDENTIFICATION (Whether the said case falls under Medico Legal Case or not)
• INTIMATION TO POLICE (if it does fall in this category, then he must register the case as an MLC
and/ or intimate the same to the nearest police station, either by telephone or in writing.)
• ACKNOWLEDGEMENT RECEIPT (From the police should be received for future reference.)

REPORTING OF MEDICO LEGAL CASE

• Reports must be prepared in duplicate on proper pro-forma giving all necessary details
• Avoid abbreviations, over writings. Correction if any, should be initialed with date and time.
• Reports must be submitted to the authorities promptly.
• Medico-legal documents should be stored under safe custody for 10 years
• Age, sex, father’s name, complete address, date and time of reporting, time of incident, brought by
whom.
• Identification marks and finger impressions
• All MLC to be informed to the police for taking legal evidence
• If the patient is dying, inform the magistrate to record ‘dying declaration’.

CONCLUSION

• In any of the medico-legal cases, it is the legal duty of the treating doctor to report it to the nearest
police station immediately after completing primary lifesaving medical care.
• This is in accordance with Section 39 of Criminal Procedure Code of India.
• The idea is to initiate the legal proceeding at the earliest is so that maximum evidence can be
collected by the police officer.
• Quick action by the police also helps to avoid the destruction of evidence by the treating physician.

13. Write Short Note – Female Foeticide

Ans:- Female foeticide is the process of finding out the sex of the foetus and undergoing abortion if
it is a girl. Although it is illegal, many people continue to practice it. Besides this, there are some
communities which practice female infanticide - the practice of killing the girl child once she is born.

14. Define Donor under TOHO Act 1994

Ans:- Transplantation of Human Organs Act (THOA) 1994 was enacted to provide a system of
removal, storage and transplantation of human organs for therapeutic purposes and for the
prevention of commercial dealings in human organs. THOA is now adopted by all States except
Andhra and J&K, who have their own similar laws. What are the six types of donors?
• The procrastinator. The procrastinator really would like to donate but never quite gets around to
it
• The charity nerd. ...
• The peer pressured donor. ...
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• The rationalizer. ...

• The time-effective donor. ...
• The first time donor.

15. What is meant by “Privileged communication‟

Ans:- Under this section, any conversation between a husband and wife is privileged whether
such communication was sensitive or confidential or not. [2] The Court further held that such
communication would refer only to verbal or written words said by the spouse and not their
actions. Privileged communication, in law, communication between persons who have a special
duty of fidelity and secrecy toward each other. Communications between attorney and client are
privileged and do not have to be disclosed to the court.

16. What is meant by a patient's rights to self-determination?

Ans:- The protection of patient self-determination entails the following elements: (a) recognition
of, and respect for, the patient's right to decide what treatment to have or not to have; (b)
provision of an enabling climate for the patient to make self-determined choices (ensuring
effective communication and building trust . For example, a legal definition is as follows; patient
rights is general statement adopted by most healthcare professionals, covering such matters
as access to care, patient dignity, confidentiality, and consent to treatment.

17. Define “Genetic Counselling Centre‟ according to PCPNDT Act, 1994

Ans:- No Genetic Counselling Centre, Genetic Laboratory or Genetic Clinic shall be registered
under this Act unless the Appropriate Authority is satisfied that such Centre, Laboratory or Clinic
is in a position to provide such facilities, maintain such equipment and standards as may be pre-
scribed. The PC-PNDT Act was enacted on 20 September 1994 with the intent to prohibit
prenatal diagnostic techniques for determination of the sex of the fetus leading to female feticide.
That is to say the preliminary object was to put a check on female feticide. Introduction:-Pre-
Conception and Pre-Natal Diagnostic Techniques (PCPNDT) Act, 1994 is an Act of the
Parliament of India enacted to stop female foeticides and arrest the declining sex ratio in India.
The act banned prenatal sex determination.

18. State any three important provisions of Helsinki Declaration with respect to human experimentation of
drugs /
Ans:- Like the Nuremberg Code, the goal of the Declaration of Helsinki was to prevent human
subjects from being mistreated. The Declaration of Helsinki provided guidance for physicians who
were conducting clinical research and focused on researchers' roles and responsibilities when it
comes to protecting human subjects. According to the Declaration of Helsinki, “This goal can
never take precedence over the rights and interests of individual research subjects.” Physicians
involved in medical research must protect: Life. Health. Dignity. In practice, these ethical
principles mean that as a researcher, you need to: (a) obtain informed consent from potential
research participants; (b) minimise the risk of harm to participants; (c) protect their anonymity and
confidentiality; (d) avoid using deceptive practices; and (e) give participants the right to The four
prima facie principles are respect for autonomy, beneficence, non-maleficence, and justice.
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19. What is the difference between ECH and EEG?

Ans:- ECG (electrocardiogram) is a record of the minute electrical pulses generated by the heart
during a cardiac cycle, whereas the EEG is a recording of electrical activity of the brain on a
moving paper strip through the electrodes placed on the scalp.

20. Write Short Note – Brain Stem Death

Ans:- Brain death (also known as brain stem death) is when a person on an artificial life support
machine no longer has any brain functions. This means they will not regain consciousness or be
able to breathe without support. A person who's brain dead is legally confirmed as dead. The
third step was to elicit clinical signs of brain stem death: (1) Absence of pupillary reflexes
(constriction of pupils when light is shorn in them). (2) Fixedly-dilated pupils. (3) Absence of the
corneal reflex (blinking when cornea is stimulated). (4) Absence of eye movements. About brain
stem death
Brain stem death is when a person no longer has any brain stem functions, and has permanently
lost the potential for consciousness and the capacity to breathe.
When this happens, a ventilator keeps the person's heart beating and oxygen circulating through
their bloodstream.
A person is confirmed as being dead when their brain stem function is permanently lost.
Confirming death
Confirming death used to be straightforward. Death was said to occur when the heart stopped
beating and a person was unresponsive and no longer breathing. The lack of oxygen, which
occurred as a result of no blood flow, quickly led to the permanent loss of brain stem function.
Confirming death is now more complex, because it's possible to keep the heart beating after the
brain stem has permanently stopped functioning. This can be done by keeping a person on a
ventilator, which allows the body and heart to be artificially oxygenated. However, that person
won't ever regain consciousness or start breathing again.
Once the brain stem has permanently stopped functioning, there's no way of reversing it and the
heart will eventually stop beating, even if a ventilator continues to be used.
To save a person's family and friends from unnecessary suffering, once there's clear evidence
that brain death has occurred, the person will be disconnected from the ventilator.
The brain stem
The brain stem is the lower part of the brain that's connected to the spinal cord (part of the central
nervous system in the spinal column).
The brain stem is responsible for regulating most of the body's automatic functions that are
essential for life. These include:
breathing
heartbeat
blood pressure
swallowing
The brain stem also relays information to and from the brain to the rest of the body, so it plays
an important role in the brain’s core functions, such as consciousness, awareness and
movement.
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After brain death, it's not possible for someone to remain conscious.
How brain death occurs
Brain death can occur when the blood and/or oxygen supply to the brain is stopped. This can be
caused by:
cardiac arrest – when the heart stops beating and the brain is starved of oxygen
heart attack – a serious medical emergency that occurs when the blood supply to the heart is
suddenly blocked
stroke – a serious medical emergency that occurs when the blood supply to the brain is blocked
or interrupted
blood clot – a blockage in a blood vessel that disturbs or blocks the flow of blood around your
body
Brain death can also occur as a result of:
a severe head injury
a brain haemorrhage
infections, such as encephalitis
a brain tumour

21. Quote the purpose of Pre-Natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act,
1994.
Ans:- The Act prohibits determination and disclosure of the sex of foetus . It also prohibits any
advertisements relating to pre-natal determination of sex and prescribes punishment for its
contravention.

22 An octogenarian couple have made a petition to Government for granting them

permission for active euthanasia. Quote landmark Indian case dealing with euthanasia and legal status of
euthanasia in India.
Ans:- Euthanasia is the practice of intentionally ending life to relieve pain and suffering. Different
countries have different euthanasia laws. Euthanasia and physician-assisted suicide refer to
deliberate action taken with the intention of ending a life, in order to relieve persistent suffering.
Self-administered euthanasia: the patient administers the means of death. Other-administered
euthanasia: a person other than the patient administers the means of death. Assisted: the patient
administers the means of death but with the assistance of another person, such as a physician.

On 9 March 2018 the Supreme Court of India legalised passive euthanasia by means of the
withdrawal of life support to patients in a permanent vegetative state. The decision was made
as part of the verdict in a case involving Aruna Shanbaug, who had been in a Persistent
Vegetative State (PVS) until her death in 2015.

23 What are the tests conducted by Doctors to prove sexual offences?

Ans:- Section 164A(7) bars the court and police to do the medical examination of the victim
without the consent of the victim. The consent can be given by the victim or the person
competent on her behalf to give the consent. P.C., the Accused has to medically examined by
the medical practitioner made compulsory. For the medical examination consent of the accused
is required to obtained, and he has to be informed that such an examination may go against
him, and then only medical examination should be done.
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Sexual assault is rape or any other sexual contact that results from coercion, including seduction of a
child through offers of affection or bribes; it also includes being touched, grabbed, kissed, or shown
genitals.

Rape and sexual assault, including childhood sexual assault, are common; the lifetime prevalence
estimates for both ranges from 2 to 30% but tends to be about 15 to 20%. However, actual prevalence
may be higher because rape and sexual assault tend to be underreported.

Females are raped and sexually assaulted more often than males. Male rape is often committed by
another man, often in prison. Males who are raped are more likely than females to be physically
injured, to be unwilling to report the crime, and to have multiple assailants.

Symptoms and Signs of Rape

Rape may result in the following:

• Extragenital injury

• Genital injury

• Psychologic symptoms

• Sexually transmitted infections (STDs—eg, syphilis, gonorrhea, chlamydial infection,

trichomoniasis)
• Hepatitis

• HIV infection
• Bacterial vaginosis

• Pregnancy (1)
Most physical injuries are relatively minor, but some lacerations of the upper vagina are severe.
Additional injuries may result from being struck, pushed, stabbed, or shot. Recent evidence indicates
that a lifetime experience of rape is also related to long-term physical health problems; for example,
risk of developing asthma, irritable bowel syndrome, frequent headaches, or chronic pain is higher for
rape victims than for people who are not victims of rape [2]).
Psychologic symptoms of rape are potentially the most prominent. In the short term, most patients
experience fear, nightmares, sleep problems, anger, embarrassment, shame, guilt, or a combination.
They may be unable to remember important parts of the event (dissociative amnesia, which is a
symptom of acute stress disorder or posttraumatic stress disorder [PTSD]).
Immediately after an assault, patient behavior can range from talkativeness, tenseness, crying, and
trembling to shock and disbelief with dispassion, quiescence, and smiling. The latter responses rarely
indicate lack of concern; rather, they reflect avoidance reactions, physical exhaustion, or coping
mechanisms that require control of emotion. Anger may be displaced onto hospital staff or family
members.

For acute stress disorder to be diagnosed, symptoms must be present for 3 days to 1 month after the
rape.

Friends, family members, and officials may react judgmentally, derisively, or in another negative way.
Such reactions can impede recovery after an assault.

Eventually, most patients recover; however, long-range effects of rape may include PTSD, particularly
among women. PTSD is a trauma-related disorder; symptoms of PTSD include
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• Re-experiencing the trauma (eg, flashbacks, intrusive upsetting thoughts or images)

• Avoidance (eg, of trauma-related situations, thoughts, and feelings)

• Negative effects on cognition and mood (eg, persistent distorted blame of self or others, inability
to experience positive emotions)

• Altered arousal and reactivity (eg, sleep difficulties, irritability, concentration problems)

For PTSD to be diagnosed, symptoms must last for > 1 month, must not be attributable to the
physiologic effects of a substance or a medical disorder, and must significantly impair social and
occupational functioning. Patients with PTSD often also have depression and/or other psychologic
disorders (eg, substance use disorder).
Symptoms and signs references
• 1. Holmes MM, Resnick HS, Kilpatrick DG, et al: Rape-related pregnancy: estimates and descriptive
characteristics from a national sample of women. Am J Obstet Gynecol 175 (2):320–324; discussion
324–325, 1996.
• 2. Basile KC, Smith SG, Chen J, Zwald M: Chronic diseases, health conditions, and other impacts
associated with rape victimization of U.S. women. J Interpers Violence 23:886260519900335, 2020.
doi: 10.1177/0886260519900335. [Epub ahead of print].
Evaluation of the Rape Victim

Goals of rape evaluation are

• Medical assessment and treatment of injuries and assessment, treatment, and prevention of
pregnancy and STIs

• Collection of forensic evidence

• Psychologic evaluation

• Recommendation of crisis intervention and psychologic support

If patients seek advice before medical evaluation, they are told not to throw out or change clothing,
wash, shower, douche, brush their teeth, clip their fingernails, or use mouthwash; doing so may
destroy evidence.

Whenever possible, all people who are raped are referred to a local rape center, often a hospital
emergency department; such centers are staffed by specially trained practitioners (eg, sexual assault
nurse examiners [SANE] ). Some areas in the US have a sexual assault response team (SART),
which includes members from health care, forensics, the local rape crisis center, law enforcement, and
the prosecutor's office. Benefits of a rape evaluation are explained, but patients are free to consent to
or decline the evaluation. The police are notified if patients consent. Most patients are greatly
traumatized, and their care requires sensitivity, empathy, and compassion. Patients may feel more
comfortable with a physician of the same sex; all patients should be asked about their preference
before the examination. A female staff member should accompany all males evaluating a female.
Patients are provided privacy and quiet whenever possible.

A form (sometimes part of a rape kit) is used to record legal evidence and medical findings (for typical
elements in the form, see table Typical Examination for Alleged Rape); it should be adapted to local
requirements. Because the medical record may be used in court, results should be written legibly and
in nontechnical language that can be understood by a jury.
TABLE
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History and examination / Typical Examination for Alleged Rape

Before beginning, the examiner asks the patient’s permission. Because recounting the events often
frightens or embarrasses the patient, the examiner must be reassuring, empathetic, and
nonjudgmental and should not rush the patient. Privacy should be ensured. The examiner elicits
specific details, including

• Type of injuries sustained (particularly to the mouth, breasts, vagina, and rectum)

• Any bleeding from or abrasions on the patient or assailant (to help assess the risk of
transmission of HIV and hepatitis)

• Description of the attack (eg, which orifices were penetrated, whether ejaculation occurred or a
condom was used)

• Assailant’s use of aggression, threats, weapons, and violent behavior

• Description of the assailant

Many rape forms include most or all of these questions (see table Typical Examination for Alleged
Rape). The patient should be told why questions are being asked (eg, information about contraceptive
use helps determine risk of pregnancy after rape; information about previous coitus helps determine
validity of sperm testing).
The examination should be explained step by step as it proceeds. Results should be reviewed with the
patient. When feasible, photographs of possible injuries are taken. The mouth, breasts, genitals, and
rectum are examined closely. Common sites of injury include the labia minora and posterior vagina.
Examination using a Wood’s lamp may detect semen or foreign debris on the skin. Colposcopy is
particularly sensitive for subtle genital injuries. Some colposcopes have cameras attached, making it
possible to detect and photograph injuries simultaneously. Whether use of toluidine blue to highlight
areas of injury is accepted as evidence varies by jurisdiction.

Testing and evidence collection

Routine testing includes a pregnancy test and serologic tests for syphilis, hepatitis B, and HIV; if done
within a few hours of rape, these tests provide information about pregnancy or infections present
before the rape but not those that develop after the rape. Vaginal discharge is examined to check for
trichomonal vaginitis and bacterial vaginosis; samples from every penetrated orifice (vaginal, oral, or
rectal) are obtained for gonorrheal and chlamydial testing. If the patient has amnesia for events
around the time of rape, drug screening for flunitrazepam (the date rape drug) and gamma
hydroxybutyrate should be considered. Testing for drugs of abuse and alcohol is controversial
because evidence of intoxication may be used to discredit the patient.

Follow-up tests for the following are done:

• At 6 weeks: Gonorrhea, chlamydial infection, human papillomavirus infection (initially using a

cervical sample from a Papanicolaou test), syphilis, and hepatitis

• At 90 days: HIV infection

• At 6 months: Syphilis, hepatitis, and HIV infection

However, testing for STIs is controversial because evidence of preexisting STIs may be used to
discredit the patient in court.
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If the vagina was penetrated and the pregnancy test was negative at the first visit, the test is repeated
within the next 2 weeks.

Patients with lacerations of the upper vagina, especially children, may require laparoscopy to
determine depth of the injury.

Evidence that can provide proof of rape is collected (see table Typical Examination for Alleged Rape);
it typically includes
• Clothing

• Smears of the buccal, vaginal, and rectal mucosa

• Combed samples of scalp and pubic hair as well as control samples (pulled from the patient)

• Fingernail clippings and scrapings

• Blood and saliva samples

• If available, semen

Many types of evidence collection kits are available commercially, and some states recommend
specific kits. Evidence is often absent or inconclusive after showering, changing clothes, or activities
that involve sites of penetration, such as douching. Evidence becomes weaker or disappears as time
passes, particularly after > 36 hours; however, depending on the jurisdiction, evidence may be
collected up to 7 days after rape.
A chain of custody, in which evidence is in the possession of an identified person at all times, must be
maintained. Thus, specimens are placed in individual packages, labeled, dated, sealed, and held until
delivery to another person (typically, law enforcement or laboratory personnel), who signs a receipt. In
some jurisdictions, samples for DNA testing to identify the assailant are collected.

Clinicians should encourage patients to seek help with managing the effects of their trauma and with
restoring their ability to function (crisis intervention) and to seek psychologic support.

Treatment of the Rape Victim

• Psychologic support and/or crisis intervention

• Prophylaxis for STDs

• Tests for hepatitis B, hepatitis C, and HIV infection

• When indicated, prophylaxis for hepatitis B and HIV infection

• Possibly emergency contraception

After the evaluation, the patient is provided with facilities to wash, change clothing, use mouthwash,
and urinate or defecate if needed. A local rape crisis team can provide referrals for medical,
psychologic, and legal support services.

Most physical injuries are minor and are treated conservatively. Vaginal lacerations may require
surgical repair.
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Psychologic support
Sometimes examiners can use commonsense measures (eg, reassurance, general support,
nonjudgmental attitude) to relieve strong emotions of guilt or anxiety. Possible psychologic and social
effects of rape are explained, and the patient is introduced to a specialist trained in rape crisis
intervention. Because the full psychologic effects cannot always be ascertained at the first
examination, follow-up visits are scheduled at 2-week intervals. Severe psychologic effects (eg,
persistent flashbacks, significant sleep disruption, fear leading to significant avoidance) or psychologic
effects still present at follow-up visits warrant psychiatric or psychologic referral.

Family members and friends can provide vital support (eg, gentle encouragement, reminders that the
rape was not their fault), but they may need help from rape crisis specialists in handling their own
negative reactions.

PTSD can be effectively treated psychosocially and pharmacologically.

Prevention of infections
Routine empiric prophylaxis for STDs consists of
• Ceftriaxone 125 mg IM in a single dose (for gonorrhea)
• Metronidazole 2 g orally in a single dose (for trichomoniasis and bacterial vaginosis)
• Either doxycycline 100 mg orally 2 times a day for 7 days or azithromycin 1 g orally once (for
chlamydial infection)
• Alternatively, azithromycin 2 g orally (which covers gonorrhea and chlamydial infection)
with metronidazole 2 g orally, both as a single dose
For hepatitis B, the Centers for Disease Control and Prevention (CDC) recommends hepatitis B
vaccination unless the patient has been previously vaccinated and has documented immunity. The
vaccine is repeated 1 and 6 months after the first dose. Hepatitis B immune globulin (HBIG) is not
given.
Empiric postexposure prophylaxis for HIV infection is controversial. Most authorities recommend
offering prophylaxis; however, the patient should be told that on average, the risk of HIV infection after
rape from an unknown assailant is only about 0.2%. Risk may be higher with any of the following:
• Anal penetration

• Bleeding (assailant or victim)

• Male-male rape

• Rape by multiple assailants (eg, male victims in prisons)

• Rape in areas with a high prevalence of HIV infection

Prophylaxis for HIV infection is best begun < 4 hours after penetration and should not be given
after > 72 hours. Usually, a fixed-dose combination of zidovudine (ZDV) 300 mg and lamivudine (3TC)
150 mg is given orally 2 times a day for 4 weeks if exposure appears low risk. If risk is higher, a
protease inhibitor is added.
Prevention of pregnancy
Emergency contraception should be offered to all women with a negative pregnancy test. Usually, oral
contraceptives are used; if used > 72 hours after rape, they are much less likely to be effective. An
antiemetic may help if nausea develops. An intrauterine device may be effective if used up to 10 days
after rape.
If pregnancy results from rape, the patient’s attitude toward the pregnancy and abortion should be
determined, and if appropriate, the option of elective termination should be discussed.

24 Give any three functions / activities of Red Cross.

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Ans:- The main functions of the Red Cross are:

• To extend relief and help to the victims of any calamity – fire, flood, famine, earthquakes, etc.
• To procure and supply blood for the victims of war and other calamities.
• To extend all possible first-aid in an accident.
• To educate people in accident prevention.

25 What do you mean by “Golden Hour”?

Ans:- The golden hour is the period of time immediately after a traumatic injury during which
there is the highest likelihood that prompt medical and surgical. the first hour after a serious
accident, when it is crucial that the victim receives medical treatment in order to have a chance
of surviving

26 A Doctor was negligent while operating his patient for transplantation of kidney. As an Advocate of your
client, how you will prove Doctor‟s negligence when you have approached Consumer Commission under
Consumer Protection Act, 1986?
Ans:- The injured party must prove that the physician breached the duty of care by failing to adhere to the
set standards of care a doctor must follow. The breach must be demonstrated by an expert's attestation.
In Res Ipsa negligence cases expert declaration about the standard of care is not really required. The first
necessary step if you are a victim of medical negligence is to file a Complaint against the doctor with
the State Medical Council. The victim can file a complaint in the state consumer court also and there
can be a criminal suit filed by the patient against the hospital or the doctor himself. Different types of
medical negligence
• different types of medical negligence.
• Misdiagnosis.
• Delayed Diagnosis.
• Surgical Error.
• Wrong Site Surgery.
• Unintentional Laceration or Perforation.
• Unnecessary Surgery.
• Negligent Anesthesia Preparation.

27 What do you mean by “informed consent”?

Ans:- The process is known as informed consent. People have the right to information about risks,
benefits, and alternative treatments when making decisions about medical care and the freedom to
choose. (See also Overview of Legal and Ethical Issues in Health Care. What are the 3 key features of
informed consent?
Valid informed consent for research must include three major elements: (1) disclosure of information, (2)
competency of the patient (or surrogate) to make a decision, and (3) voluntary nature of the decision.

Basic Elements of Informed Consent

• Description of Clinical Investigation. ...
• Risks and Discomforts. ...
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• Benefits. ...
• Alternative Procedures or Treatments. ...
• Confidentiality. ...
• Compensation and Medical Treatment in Event of Injury. ...
• Contacts. ...
• Voluntary Participation.
What is the purpose of informed consent? Informed consent has become the primary paradigm
for protecting the legal rights of patients and guiding the ethical practice of medicine. It may be
used for different purposes in different contexts: legal, ethical or administrative (Figure 1)

28 Quote any three principles to be followed by Health Workers.

Ans:- These principles include (1) autonomy, (2) beneficence, (3) nonmaleficence, and (4)
justice.The Principle of Nonmaleficence
• First of all, assess your patient.
• Not being malicious.
• Doing no harm.
• Avoiding malpractice.

29 Discuss in short any two varieties of Medical Profession in India.

Ans:- Here's a list of the various healthcare/ medical career options in India:

• Audiology.
• Ayurveda.
• Dentist.
• Electropathy.
• Homeopathy.
• Medical Lab Technologist.
• Microbiology.
• Naturopathy.

30 What is the ratio decidendi in Indian Medical Council V/s V.P. Shanta AIR 1996 SC 550.
Ans:- (1) Service rendered to a patient by a medical practitioner (except where the doctor renders
service free of charge to every patient or under a contract of personal service), by way of
consultation, diagnosis and treatment, both medicinal and surgical, would fall within the ambit of
'service' as defined in Section 2(1) (o) of the Act.

(2) The fact that medical practitioners belong to the medical profession and are subject to the
disciplinary control of the Medical Council of India and/or State Medical Councils constituted
under the provisions of the Indian Medical Council Act would not exclude the services rendered
by them from the ambit of the Act.
 Law And Medicine
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(3) A 'contract of personal service' has to be distinguished from a 'contract for personal services'.
In the absence of a relationship of master and servant between the patient and medical
practitioner, the service rendered by a medical practitioner to the patient cannot be regarded as
service rendered under a 'contract of personal service'. Such service is service rendered under
a `contract for personal services' and is not covered by exclusionary clause of the definition of
'service' contained in Section 2(1) (o) of the Act. (4) The expression 'contract of personal service'
in Section 2(1) (o) of the Act cannot be confined to contracts for employment of domestic
servants only and the said expression would include the employment of a medical officer for the
purpose of rendering medical service to the employer. The service rendered by a medical officer
to his employer under the contract of employment would be outside the purview of 'service' as
defined in Section 2(1) (o) of the Act.

(5) Service rendered free of charge by a medical practitioner attached to a hospital/Nursing home
or a medical officer employed in a hospital/Nursing home where such services are rendered free
of charge to everybody, would not be "service" as defined in Section 2(1) (o) of the Act. The
payment of a token amount for registration purpose only at the hospital/nursing home would not
alter the position.

(6) Service rendered at a non-Government hospital/Nursing home where no charge whatsoever

is made from any person availing the service and all patients (rich and poor) are given free
service - is outside the purview of the expression 'service' as defined in Section 2(1) (o) of the
Act. The payment of a token amount for registration purpose only at the hospital/Nursing home
would not alter the position.

(7) Service rendered at a non-Government hospital/Nursing home where charges are required
to be paid by the persons availing such services falls within the purview of the expression
'service' as defined in Section 2(1) (o) of the Act.

(8) Service rendered at a non-Government hospital/Nursing home where charges are required
to be paid by persons who are in a position to pay and persons who cannot afford to pay are
rendered service free of charge would fall within the ambit of the expression 'service' as defined
in Section 2(1) (o) of the Act irrespective of the fact that the service is rendered free of charge
to persons who are not in a position to pay for such services. Free service, would also be
"service" and the recipient a "consumer" under the Act.

(9) Service rendered at a Government hospital/health centre/dispensary where no charge

whatsoever is made from any person availing the services and all patients (rich and poor) are
given free service - is outside the purview of the expression 'service' as defined in Section 2(1)
(o) of the Act. The payment of a token amount for registration purpose only at the
hospital/nursing home would not alter the position.

(10) Service rendered at a Government hospital/health centre/dispensary where services are

rendered on payment of charges and also rendered free of charge to other persons availing such
services would fall within the ambit of the expression 'service' as defined in Section 2(1) (o) of
the Act irrespective of the fact that the service is rendered free of charge to persons who do not
pay for such service. Free service would also be "service" and the recipient a "consumer" under
the Act.
 Law And Medicine
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(11) Service rendered by a medical practitioner or hospital/nursing home cannot be regarded as

service rendered free of charge, if the person availing the service has taken an insurance policy
for medical care whereunder the charges for consultation, diagnosis and medical treatment are
borne by the insurance company and such service would fall within the ambit of 'service' as
defined in Section 2(1) (o) of the Act.

(12) Similarly, where, as a part of the conditions of service, the employer bears the expenses of
medical treatment of an employee and his family members dependent on him, the service
rendered to such an employee and his family members by a medical practitioner or a
hospital/nursing home would not be free of charge and would constitute 'service' under Section
2(1) (o) of the Act.

In view of the conclusions aforementioned the judgment of the National Commission dated April
21, 1992 in First Appeal No. 48 of 1991 [M/s Cosmopolitan Hospitals & Anr. v. Smt. Vasantha
P. Nair] and the judgment dated November 16, 1992 in First Appeal No. 97 of 1991 [Dr. Sr. Louie
& Anr. v. Smt. Kannolil Pathumma & Anr.] holding that the activity of providing medical
assistance for payment carried on by hospitals and members of the medical profession falls
within the scope of the expression 'service' as defined in Section 2(1) (o) of the Act and that in
the event of any deficiency in the performance of such service the aggrieved party can invoke
the remedies provided under the Act by filing a complaint before the Consumer Forum having
jurisdiction, must be upheld and Civil Appeal Nos. 688/93 and 689/93 and S.L.P. (Civil) Nos.
6885/92, 6950/92 and 351/93 filed against the said judgment have to be dismissed. The National
Commission in its judgment dated May 3, 1993 in O.P. No. 93/92 has held that since the
treatment that was given to the deceased husband of the complainant in the nursing home
belonging to the opposite party was totally free of any charge it does not contitute 'service' as
defined in Section 2(1) (o) of the Act. The Tribunal has not considered the question whether
services are rendered free of charge to all the patients availing services in the said nursing home
or such services are rendered free of charge only to some of the patients and are rendered on
payment of charges to the rest of the patients. Unless it is found that the services are rendered
free of charge to all the patients availing services at the nursing home, it cannot be held that the
said services do not constitute 'service' as defined in Section 2(1) (o) of the Act. Civil Appeal No.
254/94 has, therefore, to be allowed and the matter has to be remitted to the National
Commission for consideration in the light of this judgment. The judgment of the Madras High
Court in Dr. C.S. Subramaniam v. Kumaraswamy & Anr. (supra), holding that the services
rendered to a patient by a medical practitioner or a hospital by way of diagnosis and treatment,
both medicinal and surgical, would not come within the definition of 'service' in Section 2(1) (o)
and a patient who undergoes treatment under a medical practitioner or a hospital by way of
diagnosis and treatment, both medicinal and surgical, cannot be considered to be a 'consumer'
within the meaning of Section 2(1) (d) of the Act cannot be sustained and Civil Appeals Nos.
4664-65/94 as well as Civil Appeals arising out of S.L.P.(Civil) Nos. 21775/94 and 18445-73/94
have to be allowed and the said judgment of the Madras High Court has to be set aside and the
writ petitions disposed of by the said judgment have to be dismissed. The judgment of the
National Commission dated December 15, 1989 in First Appeal No. 2 of 1989 holding that
services rendered in Government hospitals are not covered by the expression 'service' as
defined in Section 2(1) (o) of the Act cannot be upheld in its entirety but can be upheld only to
the extent as indicated in conclusion No. 9. Civil Appeal arising out of S.L.P. (Civil) No. 18497/93
 Law And Medicine
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has to be allowed and the complaint has to be remitted to the State Commission for consideration
in the light of this judgment. S.L.P.(Civil) Nos. 21348-21349/93 have been filed against the
judgment of the Kerala High Court dated October 6,1993 in Writ Petitions filed on behalf of the
hospitals claiming that the services rendered by the hospitals do not fall within the ambit of
Section 2(1) (o) of the Act. The said Writ Petitions were dismissed by the High Court having
regard to the decision of the National Commission in Cosmopolitan Hospital (supra) and the
pendency of appeal against the said decision before this Court. Since the decision of the National
Commission in Cosmopolitan Hospital (supra) is being upheld by us, S.L.P. (Civil) Nos. 21348-
21349/93 have to be dismissed.

Writ Petition (Civil) No. 16/94 has been filed by the Cosmopolitan Hospital (P) Ltd. and Dr. K.
Venugopalan Nair who have also filed S.L.P. (Civil) Nos. 6885/92 and 6950/92 against the
judgment of the National Commission dated April 21, 1992. In the Writ Petition, the said writ
petitioners have sought a declaration that the provisions of the Act are not applicable to alleged
deficiency in medical service and that if the said provisions are held to be applicable to the
medical profession and hospitals the same may be declared as unconstitutional as being
violative of Articles 14 and 19(1)(g) of the Constitution. As regards the first part of the prayer
regarding the applicabilty of the provisions of the Act to the alleged deficiency in medical service,
we have already considered the matter and found that the provisions of the Act are applicable
to deficiency in service rendered by medical practitioners and hospitals and for the same reason
the said prayer cannot be allowed. the other prayer sought for in the Writ Petition regarding the
validity of the provisions of the Act is also without any substance. The ground on which the writ
petitioners are seeking to assail the validity of the provisions of the Act is that the composition
of the Consumer Disputes Redressal Agencies and the procedure to be followed by the said
Agencies is such that it is not suitable for adjudication of the complex issues arising for
consideration. We have already considered this grievance urged on behalf of the medical
profession and have found that the composition of the Consumer Disputes Redressal Agencies
as well as the procedure to be followed by them does not preclude a proper adjudication of the
consumer disputes arsing out of complaints relating to deficiency in service rendered by medical
practitioners and hospitals. In our opinion, on case is made out that the Act suffers from the vice
of arbitrariness or unreasonableness so as to be violative of Articles 14 and 19(1)(g) of the
Constitution. There is, therefore, no merit in the Writ Petition and it has to be dismissed.

In the result Civil Appeals Nos. 688/93 and 689/93, and S.L.P. (Civil) Nos. 6885/92 and 6950/92
are dismissed. The State Commission will deal with the complaints in the light of this judgment.
S.L.P.[Civil] Nos. 351/93 and 21348- 21349/93 and Writ Petition (Civil) Nos. 16/94 are also
dismissed. Civil Appeal No. 254/94 is allowed and the judgment of the National Commission
dated May 3, 199 is set aside and O.P.No. 93/92 is remitted to the National Commission for
consideration in the light of this judgment. Civil Appeals Nos. 4664-65/94 and Civil Appeals
arising out of S.L.P. (Civil) Nos. 21755/94 and 18445-73/94 are allowed and the judgment of the
Madras High Court dated February 17, 1994 is set aside and the writ petitions disposed of by
the said judgment of the High Court are dismissed and as a result the Consumer Disputes
Redressal Agencies would deal with the complaint petitions covered by those writ petitions in
the light of this judgment. Civil Appeal arising out of S.L.P. (Civil) No. 18497/93 is alos allowed
and Complaint Case No. 1 of 1988 is remitted to the State Commission for consideration in the
light of this judgment. No order as to costs.
 Law And Medicine
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31 Role and functions of the proposed national medical commission

Ans:- The main function was to determine uniform standards of higher qualifications in medicine and
recognition of medical qualifications in India and abroad. In 1956, the old act was repealed and a new
act was enacted in its place. Further, the new act was modified in 1964, 1993 and 2001. The Council
may prescribe standards of post-graduate medical education for the guidance of Universities, and may
advise Universities in the matter of securing uniform standards for post-graduate medical education
throughout India, and for this purpose the Central Government may constitute from among the members
of. The Medical Council of India (MCI) was a statutory body for establishing uniform and high standards
of medical education in India until its dissolution on 25 September 2020 when it was replaced by National
Medical Commission.

32. Privileged communication in medical cases

Ans:- Confidential information furnished (to facilitate diagnosis and treatment) by the patient to a
professional authorized by law to provide care and treatment. In some states, the person who has
received this communication cannot be made to divulge it. Privileged Communication refers to the
confidential conversations or interactions between two parties who are in a legally recognized protected
relationship. The information cannot be leaked to any third party, not even in the Court. Privileged legal
communications are confidential conversations that a witness cannot be compelled to disclose, even
though the communication is related to relevant facts. The court cannot force a witness to disclose such
interactions. Commonly cited relationships where privileged communication exists are those
between attorney and client, doctor–or therapist–and patient, and priest and parishioner.

33. Civil and criminal negligence in medico-legal cases

Ans:- Criminal negligence is when a person does an act which is in regard to the obvious risk to the
safety of human life whereas Civil negligence is negligence where a person omits to take ordinary care
which is also known as due diligence. What is criminal medical negligence?
It is not merely a lack of necessary care, attention and skill. The Supreme Court held that “Thus a doctor
can't be held criminally responsible for patient's death unless his negligence or incompetence showed
such disregard for life and safety of his patient as to amount to a crime against the State”.
Is medical negligence a civil Offence?
Under Civil law, a case for Medical Negligence may be initiated under Consumer Protection Act or by
means of filing a suit in a civil court against a private medical institution or a practitioner who are not
providing medical care free of charges

34. Determination of brain stem death under the transplantation of human organs act, 1994.
Ans:- Notwithstanding anything contained in sub-section (3), where brain-stem death of any
person, less than eighteen years of age, occurs and is certified under sub- section (6), any of
the parents of the deceased person may give authority, in such form and in such manner as
may be prescribed, for the removal of any human As per the Transplantation of Human Organ
Act of 1994, to make a diagnosis of brainstem death requires a panel of four doctors consisting
of the doctor in charge of the patient, the doctor in charge of the hospital where the patient was
treated, an independent specialist of unspecified specialty and a neurologist or a

35. Disaster management preparedness in case of industrial disasters

Ans:- Precautions to be taken during and after the Chemical (Industrial) Accidents
 Law And Medicine
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1. Do not panic, evacuate calmly and quickly perpendicular to wind direction through the
designated escape route.
2. Keep a wet handkerchief or piece of cloth/ sari on face during evacuation.
Prepare
1. Assemble a disaster supply kit.
2. Locate safe places in your home for each type of disaster.
3. Determine the best evacuation routes from your home.
4. Become trained in first aid and CPR.
5. Show each family member how and where to shut off utilities (water, gas, electricity).
To tackle the consequences of a major emergency inside the plant or immediate vicinity of the plant,
a Disaster Management Plan has to be formulated and this planned emergency document is called
"Disaster Management Plan".

36. Medical malpractices

Ans:- Medical malpractice involves the physician's failure to conform to the standard of care for
treatment of the patient's condition, or a lack of skill, or negligence in providing care to the patient,
which is the direct cause of an injury to the patient.
Following are types of the most common medical malpractice claims:
• Misdiagnosis or delayed diagnosis.
• Failure to treat.
• Prescription drug errors.
• Surgical or procedural errors.
• Childbirth injuries.
Misreading or ignoring laboratory results. Unnecessary surgery. Surgical errors or wrong site
surgery. Improper medication or dosage.

37. Medico-legal aspects of sexual assault cases

Ans:- Section 53A seeks to provide for a detailed medical examination of a person accused of an offence
of rape or an attempt to commit rape by the registered medical practitioner employed in a hospital run by
the Government or a local authority and in the absence of such a practitioner by any other registered
medical. Whenever a man penetrates or does sexual intercourse with a woman without her consent or will
it amounts to rape. [1] Section 354 of IPC criminalises any act by a person that assaults or uses criminal
force against a woman with an intention or knowledge that it will outrage her modesty. Introduction.
Medico-legal case (MLC) refers to a case of injury or illness that indicates investigation by law enforcement
agencies to establish and fix the criminal responsibility for the case according to the law of the country.
What are all examples of sexual assault?
Types of sexual assault include any unwanted sexual activity:

• attempted rape.
• fondling.
• unwanted sexual contact or touching.
• forcing victim to perform sexual acts (i.e. oral penetration or other forms of sex)
• rape: unlawful sexual intercourse or penetration of the victim's body by a body part or object.
 Law And Medicine
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38. Doctor-patient contractual relationship

Ans:- Aside from those sentinel events, there are generally two key elements required for a physician-
patient relationship to be initiated: 1. Contract — There must be a written or non-written contract between
the physician and patient. What is the contractual model of relations between a doctor and a patient?
In the Contractual Model of collaboration, physician and patient forge a mutually agreeable contract, more
like biblical covenant than legal construct. There is true sharing of decision making in such a way that both
physician and patient can be confident of retaining their moral integrity. Once the physician consensually
enters into a relationship with a patient in any of these ways, a legal contract is formed in which the
physician owes a duty to that patient to continue to treat or properly terminate the relationship.

39. Clinical trials on prisoners

Ans:- Also, involving prisoners in clinical trials would help them getting a medical intervention if needed,
which is usually not present in prison hospitals. Philosophically speaking, the convicts were imprisoned to
reform them so that they could become a useful part of society. Application of a risk-benefit analysis may
determine that, because the risks are very low and important knowledge or benefits may accrue for
prisoners as a class, the research may be considered ethically acceptable. Can you do experiments on
prisoners?
U.S. regulations limit studies involving prisoners to those that examine conditions causing incarceration
or that specifically affect prisoners as a group. There is a general prohibition on studies that are meant to
solely benefit the general U.S. population.

40. Civil and criminal liability of doctors

Ans:- Medical Negligence constitutes Civil as well as Criminal wrong. The person guilty is liable either for
compensation for damages or for imprisonment. Civil Liability, i.e., monetary compensation can be
imposed under the general law by pursuing a remedy before appropriate Civil court or consumer forums.
Is doctor liable for medical negligence?
Any aggrieved person can claim damages for medical negligence against a doctor or a hospital. Section
69(1) of the Consumer Protection Act, 2019 lays down the time limit within which a complaint for medical
negligence must be filed as 2 years from the date of injury.
What is civil medical negligence? Civil Law Frameworks

In other words an act or omission which causes a breach of duty to take care by a medical professional
and thereby causes injury to a patient is termed as tort of medical negligence.
It is not merely a lack of necessary care, attention and skill. The Supreme Court held that “Thus a doctor
can't be held criminally responsible for patient's death unless his negligence or incompetence showed
such disregard for life and safety of his patient as to amount to a crime against the State”.

41. Medico-legal aspects of road accident cases.

Ans:- Many general practitioners are rather reluctant to attend to cases of accident for fear of being
involved in unnecessary litigation later on. It has been seen that even if a serious accident has occurred
just in front of a doctor's clinic and he knows he can save the life of the patient by giving emergency
treatment, yet generally he advises the relatives to take the patient to a hospital. More often than not, the
patient dies on the way. This happens because most doctors have a "fear of the unknown." They are
 Law And Medicine
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generally not very well versed with the medicolegal issues involved and fear that if they treat the patient,
they would be "legally involved." Nothing of this is true as we shall see here.

The first question that arises in such cases is whether any medical man can be forced to accept an
accident victim. The answer to this till some time back was very clear. The doctor could choose patients
according to his own will. But now according to a recent Supreme Court verdict, no doctor can refuse
treatment in case of emergency. [1] Hence, if now a doctor refuses treatment, in case of emergency,
he/she could be sued under the law. Once the doctor accepts the case and starts treatment, then the
doctor-patient relationship is established. Now at this stage, suppose the doctor shows some gross
carelessness (say, he fails to administer injection Tetanus Toxoid (TT) despite multiple abrasions and
lacerations) and the patient dies as a result of this carelessness, the doctor may be sued for negligence.
Even a doctor working in a charity hospital or a private practitioner working on a charitable basis can be
sued for negligence. The doctor cannot take the defense that he/she was treating the patient free of
charge. [2] Many general practitioners are rather reluctant to attend to cases of accident for fear of being
involved in unnecessary litigation later on. It has been seen that even if a serious accident has occurred
just in front of a doctor's clinic and he knows he can save the life of the patient by giving emergency
treatment, yet generally he advises the relatives to take the patient to a hospital. More often than not, the
patient dies on the way. This happens because most doctors have a "fear of the unknown." They are
generally not very well versed with the medicolegal issues involved and fear that if they treat the patient,
they would be "legally involved." Nothing of this is true as we shall see here.

The first question that arises in such cases is whether any medical man can be forced to accept an
accident victim. The answer to this till some time back was very clear. The doctor could choose patients
according to his own will. But now according to a recent Supreme Court verdict, no doctor can refuse
treatment in case of emergency. [1] Hence, if now a doctor refuses treatment, in case of emergency,
he/she could be sued under the law. Once the doctor accepts the case and starts treatment, then the
doctor-patient relationship is established. Now at this stage, suppose the doctor shows some gross
carelessness (say, he fails to administer injection Tetanus Toxoid (TT) despite multiple abrasions and
lacerations) and the patient dies as a result of this carelessness, the doctor may be sued for negligence.
Even a doctor working in a charity hospital or a private practitioner working on a charitable basis can be
sued for negligence. The doctor cannot take the defense that he/she was treating the patient free of
charge. [2] of skill possessed by a practicing doctor. As we can see, this is a very vague definition. There
are however certain things which all doctors would do in an accident case. Failure to do these things will
make the doctor liable to be used for negligence. Some of these things are:

Inject TT immediately - many times the doctor may forget to inject TT in view of patient's other more
serious injuries. If the patient develops tetanus subsequently, the doctor will be sued for negligence.
Take X-rays - when the dilemma is "to do or not to do" the answer is "to do." Take X-ray of all possible
parts to exclude fractures. Even if you have the slightest doubt of fracture, take X-ray.
Bleeding points - bleeding points, internal or external, are surprisingly prone to be missed. Do not feel
ashamed to uncover the patient completely. Maintain a vitals chart. Any unexplained fall in B.P. could be
due to an internal bleeding.
Ophthalmoscopic examination - many doctors would not routinely do this examination and would thus
miss early signs of intracranial
 damage. With the increasing use of ophthalmoscopes in general practice, the courts now include this
examination within an average degree of skill and care. One must remember that about 60% of roadside
vehicular accident deaths are due to a head injury. In view of this fact, ophthalmoscopic examination is a
must in every accident case.
 Beware the patient who says there is nothing wrong with him-many patients, after a serious roadside
vehicular accident assert that there is nothing wrong with them. The doctor charges fees for his
examination, writes some prescription, and allows him to go. Later on, the patient may be readmitted for
 Law And Medicine
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a serious extradural hematoma or multiple fractures of ribs, or ruptured spleen or some other similar things
like that. If death occurs in such cases, the doctor may be sued for negligence. Hence, in all such cases
keep the patient under observation for at least 24 h.

42. Legal issues faced by victims of Bhopal Gas leak tragedy

Ans:- The Legal Battle: - In the February of 1985, the Indian Government filed a case in the U.S Court
for a claim of $3.3 billons against the Union Carbide Corporation. But by 1986 all of these litigations in
the U.S District were transferred to India on the grounds of forum non conveniens. Some half a million
survivors suffered respiratory problems, eye irritation or blindness, and other maladies resulting from
exposure to the toxic gas; many were awarded compensation of a few hundred dollars. The Supreme
Court which approved on February 14/ 15, 1989 the settlement by which Union Carbide
Corporation (UCC) was to pay 470 million US dollars as full and final settlement of all civil and
criminal claims by the victims, justified it saying: “this court, considered it a compelling duty, both
judicial and humane, ...

43. Role and functions of Indian medical council

Ans:- The main functions of the MCI were listed as: Establish and maintain uniform standards
for undergraduate medical education. Regulate postgraduate medical education in medical
colleges accredited by it. (The National Board of Examinations is another statutory body for
postgraduate medical education in India). The Council may prescribe standards of post-
graduate medical education for the guidance of Universities, and may advise Universities in the
matter of securing uniform standards for post-graduate medical education throughout India, and
for this purpose the Central Government may constitute from among the members of. Medical
Council is the name of the regulatory body that grants medical licenses in many countries.

44. Euthanasia
Ans:-DONE

45. Right to health under the constitution of India

Ans:-DONE

46. Doctor patient confidentiality

Ans:- He or she cannot divulge any medical information about the patient to third persons without
the patient's consent, though there are some exceptions (e.g. issues relating to health insurance,
if confidential information is at issue in a lawsuit, or if a patient or client plans to cause immediate
harm to others) here are privacy regulations, and specific legislations targeted toward protecting
information such as HIV status and the like. So what protection you may be given might depend
heavily on where you live. And the right can be broken, through a court order that breaks doctor-
patient confidentiality Physicians may be obligated by some legislation, policies, or by-laws to
report confidential patient information to a third party, such as a government body. This
mandatory obligation is generally referred to as a “duty to report.”

47. Role and functions of ethics committee in clinical trials

Ans:- The basic responsibility of the Ethics Committee is to ensure an independent, competent
and timely review of all ethical aspects of the project proposals received in order to safeguard
the dignity, rights, safety and well-being of all actual or potential research participants. The
 Law And Medicine
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main role of an ethics committee is to set and oversee the rules for a company's conduct. They
provide accountability for the company's behavior.

48. Female foeticide

Ans:- Female foeticide is the process of finding out the sex of the foetus and undergoing abortion
if it is a girl. Although it is illegal, many people continue to practice it. Besides this, there are
some communities which practice female infanticide - the practice of killing the girl child once
she is born. Some of the reasons for female foeticide are son preference, low status of women,
social and financial security associated with sons, socio-cultural practices including dowry &
violence against women, small family norm and consequent misuse of diagnostic techniques
with the intention of female foeticide.

49. Object of transplantation of human organs act, 1994

Ans:- Passed in 1994, it is aimed at the regulation of storage, removal, and transplantation of
different types of human organs that can be used for therapeutic purposes. The Act also focuses
on the prevention of illegal commercial dealings in various human organs. The Act main aim of
THOA, 1994 is to provide for the guidelines and regulation of storage, removal, and
transplantation of human organs strictly for therapeutic purpose. And for the prevention of
commercial dealings in human organs and for matters connected therewith or incidental thereto.

50. Brain stem death

Ans:-DONE

51. Right of self determination

Ans:- DONE

52. Disaster management plan

Ans:- DONE

53. Medical record

• Ans:- Medical Record contains the patient's identification information, the patient's health history and
medical examination findings. Medical Record also contains a summary of the patient's current and
previous medications a well as any medical allergies. PIL. A PIL is a patient information leaflet you can
find in any medicine bought at a pharmacy. ...
• Medical history record. ...
• Discharge Summary. ...
• Medical test. ...
• Mental Status Examination. ...
• Operative Report.
A medical record includes a variety of types of "notes" entered over time by healthcare
professionals, recording observations and administration of drugs and therapies, orders
for the administration of drugs and therapies, test results, x-rays, reports, etc.

What are the purposes of the medical record?

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The primary purpose of a medical record is to provide a complete and accurate description of the
patient's medical history. This includes medical conditions, diagnoses, the care and treatment you
provide, and results of such treatments.

54. Medical certificate

Ans:- A medical certificate or doctor's certificate is a written statement from a physician or
another medically qualified health care provider which attests to the result of a medical
examination of a patient. It can serve as a sick note (documentation that an employee is unfit for
work) or evidence of a health condition.

55. Who can give consent for the donation of a human organ?
Ans:- Anyone 18 years of age and above can be a donor. Parents or Guardians consent will be
required for any individual below 18 years wishing to donate an organ. Live on, after death.
There is no age limit for organ donation. It can be started at as young as six weeks. The only
essential thing is the health and condition of your organs. You can donate all your organs and
tissues – heart, kidneys, lungs, corneas, pancreas etc. Certain conditions, such as having HIV,
actively spreading cancer, or severe infection would exclude organ donation. Having a serious
condition like cancer, HIV, diabetes, kidney disease, or heart disease can prevent you from
donating as a living donor.

56. Indian medical association V/s. V. P. Shantha

Ans:-DONE-30

57. Ayurveda
Ans:- Ayurveda is an alternative medicine system with historical roots in the Indian subcontinent. The
theory and practice of Ayurveda is pseudoscientific. The Indian Medical Association describes Ayurvedic
practitioners who claim to practice medicine as quacks. It's based on the belief that health and wellness
depend on a delicate balance between the mind, body, and spirit. Its main goal is to promote good health,
not fight disease. But treatments may be geared toward specific health problems. What is Ayurveda and
how does it work? The basic principle of Ayurveda is to prevent and treat illness by maintaining balance
in the body, mind, and consciousness through proper drinking, diet, and lifestyle, as well as herbal
remedies. There are two main types of Ayurveda: traditional and Maharishi.

58. Right of registered medical practitioners

Ans:- A registered practitioner shall be eligible to hold any appointment as a physician or other
medical officer in any dispensary, hospital infirmary or lying-in-hospital supported by or receiving
a grant from the Government or any local authority and treating patients according to the
Homoeopathic system of medicine They must be professional, honest, and not only avoid fraud,
deception and breaking the law, but report physicians who engage in those activities. Physicians
have a duty to keep patient confidences and maintain privacy. They are expected to engage in
life-long learning and to educate their patients.

59. Authority under the transplantation of human organs act

Ans:- The person competent under this Act to give authority for the removal of any 1[human
organ or tissue or both] from such dead body may, if he has reason to believe that such
1[human organ or tissue or both] will not be required for the purpose for which such body has
 Law And Medicine
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been sent for post-mortem examination, authorise the . Authority for removal of human organs or
tissues or both.
1
[3. Authority for removal of 1[human organs or tissues or both].-- (1) Any donor may, in such manner and
subject to such conditions as may be prescribed, authorise the removal, before his death, of any 2[human
organ or tissue or both] of his body for therapeutic purposes.
3
[(1A) For the purpose of removal, storage or transplantation of such human organs or tissues or both,
as may be prescribed, it shall be the duty of the registered medical practitioner working in a hospital, in
consultation with transplant co-ordinator, if such transplant co-ordinator is available,--
(i) to ascertain from the person admitted to the Intensive Care Unit or from his near relative that such
person had authorised at any time before his death the removal of any human organ or tissue or both of
his body under sub-section (2), then the hospital shall proceed to obtain the documentation for such
authorisation;
(ii) where no such authority as referred to in sub-section (2) was made by such person, to make aware
to that person or near relative for option to authorise or decline for donation of human organs or tissues
or both;
(iii) to require the hospital to inform in writing to the Human Organ Removal Centre for removal, storage
or transplantation of human organs or tissues or both of the donor identified in clauses (i) and (ii) in such
manner as may be prescribed.
(1B) The duties mentioned under clauses (i) to (iii) of sub-section (1A) from such date, as may be
prescribed, shall also apply in the case of a registered medical practitioner working in an Intensive Care
Unit in a hospital which is not registered under this Act for the purpose of removal, storage or
transplantation of human organs or tissues or both.]
(2) If any donor had, in writing and in the presence of two or more witnesses (at least one of whom is a
near relative of such person), unequivocally authorised at any time before his death, the removal of any
human organ of his body, after his death, for therapeutic purposes, the person lawfully in possession of
the dead body of the donor shall, unless he has any reason to believe that the donor had subsequently
revoked the authority aforesaid, grant to a registered medical practitioner all reasonable facilities for the
removal, for therapeutic purposes, of that 2[human organ or tissue or both] from the dead body of the
donor.
(3) Where no such authority as is referred to in sub-section (2), was made by any person before his
death but no objection was also expressed by such person to any of his 1[human organs or tissues or
both] being used after his death for therapeutic purposes, the person lawfully in possession of the dead
body of such person may, unless he has reason to believe that any near relative of the deceased person
has objection to any of the deceased persons 1[human organs or tissues or both] being used for
therapeutic purposes, authorise the removal of any 2[human organ or tissue or both] of the deceased
person for its use for therapeutic purposes.
(4) The authority given under sub-section (1) or sub-section (2) or, as the case may be, sub-
section (3) shall be sufficient warrant for the removal, for therapeutic purposes, of the 2[human organ or
tissue or both]; but no such removal shall be made by any person other than the registered medical
practitioner:
3
[Provided that a technician possessing such qualifications and experience, as may be prescribed, may
enucleate a cornea.]
(5) Where any 2[human organ or tissue or both] is to be removed from the body of a deceased person,
the registered medical practitioner shall satisfy himself, before such removal, by a personal examination
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of the body from which any 2[human organ or tissue or both] is to be removed, that life is extinct in such
body or, where it appears to be a case of brain-stem death, that such death has been certified under
sub-section (6).
(6) Where any 2[human organ or tissue or both] is to be removed from the body of a person in the event
of his brain-stem death, no such removal shall be undertaken unless such death is certified, in such form
and in such manner and on satisfaction of such conditions and requirements as may be prescribed, by a
Board of medical experts consisting of the following, namely:--
(i) the registered medical practitioner in charge of the hospital in which brain-stem death has occurred;
(ii) an independent registered medical practitioner, being a specialist, to be nominated by the registered
medical practitioner specified in clause (i), from the panel of names approved by the Appropriate
Authority;
(iii) a neurologist or a neurosurgeon to be nominated by the registered medical practitioner specified in
clause (i), from the panel of names approved by the Appropriate Authority:4***
5
[Provided that where a neurologist or a neurosurgeon is not available, the registered medical
practitioner may nominate an independent registered medical practitioner, being a surgeon or a
physician and an anaesthetist or intensivist subject to the condition that they are not members of the
transplantation team for the concerned recipient and to such conditions as may be prescribed;]
(iv) the registered medical practitioner treating the person whose brain-stem death has occurred.
(7) Notwithstanding anything contained in sub-section (3), where brain-stem death of any person, less
than eighteen years of age, occurs and is certified under sub-section (6), any of the parents of the
deceased person may give authority, in such form and in such manner as may be prescribed, for the
removal of any 6[human organ or tissue or both] from the body of the deceased person.]

60. Mens rea in medical negligence

Ans:- It means that no one can be penalized unless he knew he was doing something improper or if a
reasonable person in his position could have prevented the detrimental consequence by exercising
reasonable caution. The mens rea part of negligence, for example, is a failure to fulfill an objective norm
of attentiveness rather than being subjective or a state of mind. Exception to Mens rea is the “Strict
Liability offences” in which punishments are provided even when the act is done without a guilty intent.
Motive is the reason for the crime, but the law is more concerned with the intention of the accused.
Objective mens rea expresses the conduct of the defendant as being lower than the standards of
expected behaviour from a reasonable person in that situation as well as the possibility of certainty for a
particular result to occur following the defendant's act.

61 What is therapeutic privilege and it is exception to which doctrine?

Ans:- Therapeutic privilege is an exception to the general rule of informed consent, and only applies
when disclosure of the information itself could pose serious and immediate harm to the patient, such as
prompting suicidal behavior. The current AMA Code of Medical Ethics rejects therapeutic privilege as a
defence. “Therapeutic privilege,” also known as “therapeutic nondisclosure,” is defined as the withholding
of relevant health information from the patient if nondisclosure is believed to be in the best interests of
the patient (President’s Commission, 1982; Berger, 2005). The two most common justifications for such
nondisclosure are that the disclosure would create incapacitating emotional distress and that disclosure
would violate a patient’s personal, cultural, or other social requirements (Crawley et al., 2001; Berger,
2005).
Although the balance of opinion has moved significantly over the last several decades in favor of
disclosure of information to patients (Goldberg, 1984), studies continue to demonstrate that physicians
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often take a relative approach to disclosure. A survey of European intensive care unit physicians, for
example, revealed that only one-fourth of European doctors would, without exception, give complete
information about a patient’s condition. More than half of the surveyed physicians said that the details
they would give would “depend on a combination of the type and severity of the disease and the perceived
personality of the patient” (Vincent, 1998). In another study, 20% of neurologists favored withholding
anxiety-provoking information from adult patients with seizure disorders and their families (Faden et al.,
1981).
Much has been written about whether it is ever ethically appropriate to invoke therapeutic privilege. The
focus has been the tension between respecting a patient’s autonomy and protecting a patient from harm
when the physician perceives that the patient might have difficulty processing particular information about
his or her medical situation (Goldberg, 1984; Berger, 2005; Sirotin and Lo, 2006; Richard et al., 2010).
Nondisclosure directly impairs patients’ autonomy by limiting their ability to make decisions about their
own medical care. It also has the potential to undermine the patient’s trust in the physician and to preclude
the patient from creating meaning out of illness and making plans and decisions with a realistic
understanding of the future. Given these significant potential harms and the moral duty to tell the truth,
the justification for nondisclosure must be extremely compelling.
The American Medical Association takes a strict stand on this issue, stating that therapeutic privilege
“creates a conflict between the physician’s obligations to promote patients’ welfare and respect for their
autonomy by communicating truthfully” and that “[w]ithholding medical information from patients without
their knowledge or consent is ethically unacceptable” (American Medical Association Council on Ethical
and Judicial Affairs, 2010, Opinion 8.082).
A physician’s own discomfort with delivering difficult news can never justify withholding such news from
a patient (Berger, 2005). Furthermore, the desire to avoid emotional suffering for the patient is not alone
sufficient justification for withholding critical medical information. In certain limited circumstances,
however, disclosure arguably stands to cause emotional distress to a patient so severe that it is
incapacitating and impairs the patient’s ability to make decisions (when, for example, a patient is suffering
from severe depression or other mental incapacity). Some have suggested that nondisclosure in such
circumstances, which is intended to avoid decisional incapacity, is ethically acceptable (Berger, 2005;
Richard et al., 2010). Prior to invoking this principle, however, physicians should critically examine the
moral justification for the nondisclosure, consulting with colleagues to ensure that the driving rationale is
to avoid decisional incapacity and is not to reduce moral distress for the physician or the patient’s loved
ones.
When a family invokes cultural practices as a basis for nondisclosure, the physician should attempt to
ensure that the patient subscribes to those cultural practices and elicit the patient’s preferences for
disclosure of information. If a patient explicitly requests that health-related information be conveyed to
family members or other loved ones instead of directly to the patient, it is appropriate to honor that
request. If a family member requests that certain information (for example, prognostic information in the
case of a stroke, other neurologic insult, or malignancy) be withheld from a patient, the physician should
ask the patient if he or she would prefer to be told everything or would prefer his or her family to filter
information (American Medical Association Council on Ethical and Judicial Affairs, 2010, Opinion 8.082).
Although disclosure is ethically required in all but the most extreme situations, it is not mandatory that
physicians disclose all information immediately or at a single encounter. Disclosure of the truth can be
an iterative process. The timing and style of disclosure of difficult information can be calibrated to
minimize the emotional harms to the patient. It is appropriate, for example, to engage a physician who
has a trusted relationship with the patient, to wait until family members or other loved ones are present
and able to support the patient emotionally, and otherwise to optimize the setting for disclosure by
ensuring that adequate supports are in place to assist the patient in coping with the disclosure (Goldberg,
1984; Sirotin and Lo, 2006; Richard et al., 2010).

62 What are the principles of Disaster Management Plan?

Ans:- Prevention of danger or threat of any disaster. Mitigation or reduction of risk of any disaster or its
severity or consequences. Capacity building including research and knowledge management.
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Preparedness to deal with any disaster. The comprehensive approach to disaster management
comprises four phases: prevention, preparedness, response and recovery (PPRR) to ensure a balance
between the reduction of risk and the enhancement of community resilience, while ensuring effective
response and recovery capabilities. Disaster Management
• Prevention of danger or threat of any disaster.
• Mitigation or reduction of risk of any disaster or its severity or consequences.
• Capacity building including research and knowledge management.
• Preparedness to deal with any disaster.
• Prompt response to any threatening disaster situation or disaster.

63 Medico legal aspect of road accident, discuss what investigation must include
Ans:- The entries should include name, age, sex, address, occupation, and telephone number of the
patient, as well as of the person who brought him and a detailed history. This detailed document
becomes the medio-legal report and is commonly referred to as the Medico-Legal Case (MLC).
Medicolegal is something that involves both medical and legal aspects, mainly: Medical jurisprudence, a
branch of medicine. Medical law, a branch of law. Instances of MLC are:
• Cases of injuries and burns that suggest the commission of an offence.
• Unnatural accident cases of grievous hurt or death.
• Sexual assault.
• Criminal abortion.
• Unnatural unconsciousness.
• Poisoning or intoxication.
• Cases referred by the courts.

Medico-legal case (MLC) refers to a case of injury or illness that indicates investigation by law
enforcement agencies to establish and fix the criminal responsibility for the case according to the law of
the country.

64 “For any type of cold, rely on Caphoor Vaporub” This advertisement was published in a local news
paper. Some patient got relief. The unsatisfied ones, filed a case for compensation? Is advertisement
liable for action. If yes mention the Act and Define it giving appropriate Case Law? Does the Act infringes
any Constitutional Right?/
Ans:- Do Oral discussion

65 Discuss Charaka Samhita and Sushruta Samhita?

Ans:- The Charaka Samhita (IAST: Caraka-Saṃhitā, “Compendium of Charaka”) is a Sanskrit
text on Ayurveda (Indian traditional medicine). Along with the Sushruta Samhita, it is one of the
two foundational texts of this field that have survived from ancient India. It is one of the three
works that constitute the Brhat Trayi. Charaka Samhita is the Sanskrit text that is written on
Ayurveda. It is the two foundational Hindu texts of the field that survived ancient India. Sushruta
Samhita is the one that ancient text written on the medicine and surgery that also survived the
ancient world.
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66 Mention the circumstances in which patient‟s Right to Determination is overruled give case laws

Ans:- The principle of self-determination plays a crucial role in contemporary clinical ethics. Somewhat
simplified, it states that it is ultimately the patient who should decide whether or not to accept suggested
treatment or care. Obtaining informed consent in medicine is process that should include: (1) describing
the proposed intervention, (2) emphasizing the patient's role in decision-making, (3) discussing
alternatives to the proposed intervention, (4) discussing the risks of the proposed intervention and (5)
eliciting the patient's . Why do doctors need determination?If a patient knows there is something wrong
and is determined to find answers, a doctor should show the same determination to fight for their patient
to receive the correct diagnosis and treatment.
To set the context for an analysis of the consent and property models, the concept of patient self-
determination is discussed in this chapter. Firstly, the conception of self-determination adopted in this
book is clarified; then the basis for protecting self-determination (that patients want it, that it is associated
with better clinical and health outcomes, and that it is a fundamental right) is outlined. As conceived in this
book, patient self-determination comprises (a) the right to bodily integrity and (b) the right to make
decisions regarding treatment.
The ways in which patient self-determination may be suppressed or expressed are described. Patient self-
determination may be suppressed by medical paternalism or by instrumentalisation (the use of persons
as instruments to achieve the doctor’s goals, as happened in the Tuskegee and Willowbrook scandals3).
The latter could be regarded as a crime, and so it has been excluded from further discussion, and attention
is focused on paternalism.
Self-determination is expressed when the patient, rather than the doctor, is the ultimate arbiter of what
treatment may or may not be given, and when. It is shown in this chapter that this decisional authority is
moving from the hands of the doctor to those of the patient, but a lot more needs to be done. The
progression from paternalism to ‘patient-centred care’ is described and current initiatives to promote
patient self-determination in the UK National Health Service are outlined.
The protection of patient self-determination entails the following elements: (a) recognition of, and respect
for, the patient’s right to decide what treatment to have or not to have; (b) provision of an enabling climate
for the patient to make self-determined choices (ensuring effective communication and building trust); and
(c) having regard for the context (social, cultural, emotional, etc.) in which the patient has to make his or
her decision. In keeping with the ecology paradigm adopted in Chapter 1, self-determination is viewed not
in isolation but in the context of the doctor–patient relationship. This relationship is critical to the fulfilment
of the three elements listed above. The literature on various models of the relationship is briefly reviewed
and it is concluded that the ‘collaborative’ approach to doctor–patient consultation offers the best
protection for patient self-determination as defined in this book.
Patient Sovereignty

The underlying principle of this book is that every person has a right to self-determination in respect of the
medical treatment that they receive. This right was famously affirmed by Cardozo J in the landmark US
case of Schloendoff v. Society of New York Hospital:

… every human being of adult years and sound mind has a 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.4

It was reaffirmed by Lord Donaldson MR in the UK case Re T:

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An adult patient who … suffers from no mental incapacity has an absolute right to choose whether to
consent to medical treatment, to refuse it or to choose one rather than another of the treatments being
offered … This right of choice is not limited to decisions which others might regard as sensible. It exists
notwithstanding that the reasons for making the choice are rational, irrational, unknown or even non-
existent.5

In the same vein, Butler-Sloss said in Re MB that:

A mentally competent patient has an absolute right to refuse to consent to medical treatment for any
reason, rational or irrational, or for no reason at all, even where that decision may lead to his or her own
death.6

This right is commonly referred to in legal and other texts as ‘autonomy’ but the term is somewhat
amorphous, each school of thought moulding it to suit their purpose. For example, philosophers view
autonomy as an attribute of personhood, while psychologists regard it as a behaviour.7 Even among
philosophers, concepts of autonomy vary. Autonomy could refer to freedom from control by others. It could
also mean freedom from any factor which prevents one from making a choice consistent with one’s values.
In health care, the word autonomy is used with various interpretations.8 As Switankowsky put it, autonomy
is ‘a philosophical concept that is riddled with psychological complexities and individual peculiarities’.9

When a judge uses the term he/she probably takes it as no more than a shorthand for the right of the
patient to decide what may or may not be done to his/her body. It is unlikely that the judge has considered
any philosophical analyses of the term or anticipates that his/her use of the term will be subjected to such
analysis. Coggon, for example, has noted that ‘[i]t is rare for a judge to provide an explicit, philosophical
investigation of autonomy’.10

In order to avoid (to the extent that this is possible) some of the confusion associated with the diverse
interpretations of the word ‘autonomy’, the term self-determination is used as an alternative to autonomy
in this book. The essence of self-determination is the notion of a person who is able to decide, choose or
act on the basis of his/her own volition rather than the dictates of another person or group of persons.
Self-determination in health care is the antithesis of paternalism. As Lord Scarman put it, patient self-
determination is ‘no more and no less than the right of a patient to determine for himself whether he will
or will not accept the doctor’s advice’.11

At this juncture, it is worth clarifying the relationship between self-determination and the principle of bodily
integrity, the latter being a common starting point for defining consent to treatment. The principle of bodily
integrity holds the human body to be inviolate; a person’s body cannot be interfered with by another
without that person’s willing agreement. It is protected by Article 3 of the Universal Declaration of Human
Rights which states that ‘[e]veryone has the right to life, liberty and security of person’, and by
constitutional provisions in some countries.12 This principle is one of the two components of self-
determination (as defined in this book), the other component being decisional control. As Petersen puts
it:
Self-determination is broader than bodily integrity in the sense that it concerns not only an individual’s
body but also his or her actions and choices – including whether to engage in sexual relations, to marry
or to bear children.13

The distinction between bodily integrity and self-determination was made in passing by Robert Walker LJ
in an English case:
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Every human being’s right to life carries with it, as an intrinsic part of it, rights of bodily integrity and
autonomy – the right to have one’s own body whole and intact and (upon reaching an age of
understanding) to take decisions about one’s body.14

This distinction is important in the context of this book because self-determination could be expressed (or
suppressed) in clinical situations that do not necessarily entail touching the body. In such situations, there
may be no physical violation of the patient’s bodily integrity, but decisional control is taken away from the
patient, thus breaching his/her right to self-determination.
All accounts of self-determination have one thing in common: the individual should have a right to make
his/her own decision/choice and should be allowed to exercise that right. Where they differ is in relation
to two other elements: firstly whether a decision has to be rational for it to be a true expression of self-
determination; secondly, whether, in expressing self-determination, the individual is obliged to consider
third party interests.
Accounts that make rational decision-making a prerequisite for self-determination are excluded from
further consideration in this book because the law, as it currently stands (see quotes above), does not
require a patient’s decision to be rational in order for it to be accepted as legitimate, and any argument for
this aspect of common law to be changed is outside the scope of this work.
Taking account of third party interests is presented in the literature as a key difference between the
individualistic model of autonomy and the relational model.15 One could, however, argue that, in practice,
the difference between the two accounts is not as substantial as is sometimes portrayed. In Chapter 6 the
point is made that the notion of property in a coconut anywhere on an island is, at least in practical terms,
meaningless to the man who is the sole inhabitant of that island – property is a function of
the relationship we have with persons around us. In a similar way, self-determination is a function of our
social interactions and experiences. The very idea of having individuals make their own decisions stems
from the fact that each individual has different life experiences, interests, priorities, values and so on, all
the result of interactions with other members of the community. There would be no basis for recognising
individualism if we were all just individual anatomical and physiological entities (in other words, biological
clones), devoid of any social identity. The idea of self-determination being a function of the patient’s social
interactions and experiences fits with the ecology paradigm adopted in Chapter 1. It goes without saying,
therefore, that any absolutely and purely individualistic notion of self-determination is rejected by this
author.
The pragmatic question is to what extent should individuals be allowed to make their own decisions,
unfettered by what the rest of the community thinks or wants? In other words, where should the balance
between individual rights and communal interests lie? Lord Mustill referred to this balance in R v. Brown,
albeit without specifying where the line is drawn:
… the state should interfere with the right of an individual to live his or her life as he or she may choose
no more than is necessary to ensure a proper balance between the specific interests of the individual and
the general interests of the individuals who together comprise the populace at large.16

Few in the western world would contest the right of the individual to self-governance.17 What is
controversial, however, is where the line is drawn between this right and the interests of the community.
In other words, to use a term that I return to in my adopted model of property (Chapter 6), what should be
the stringency of protection of this right?

The extremist views on this question are moral individualism at one end and communitarianism at the
other. Moral individualism18 holds that persons are egoistic and each person should determine what
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counts as moral good on his/her own, without reference to objective standards.19 To some minds (but not
to this author) moral individualism could be taken as homologous with self-determination. As stated above,
this notion of self-determination is rejected.
At the other end is communitarianism (as a philosophical concept rather than a political ideology) which
emphasises the need to balance individual rights and interests with those of the community as a whole,
and argues that individual people (or citizens) are shaped by the cultures and values of their communities.
Unlike classical liberalism, which construes communities as aggregates of atomistic and egoistic
individuals, it emphasises the role of the community in defining and shaping individuals.20

McLean regards the gap between these extremes as narrower than portrayed in the literature.21 Further
she points out (and this is consonant with the ecology paradigm adopted in this book) that:
The lessons that the individualistic account can learn from the relational one are that the moral worth of
decisions is predicted not only by the mere exercise of choice but potentially also by the impact of that
choice on others.22

Studies have shown that patients make treatment decisions based on their social experiences, emotions,
relationships and values.23 The question is not whether decision-making should be influenced by other-
regarding considerations; we expect the individual’s decision to be influenced by experiences and
relationships. Rather the question is whether the individual having made their decision, the decision should
be followed to the letter or be modified by the doctor in the light of communitarian considerations. The
issue becomes less contentious if contextualised against the predominant political tradition. In the western
world this tradition is democracy, which gives each individual the same right to elect the political leadership
and encourages equal participation of all citizens in governance. In democracies, the individual is the unit
of society, but individuals are also subject to the laws and customs of society.
The conception of self-determination adopted in this book can therefore be encapsulated as follows. The
patient has a right to determine what shall be done with his/her own body. Recognition of this right should
manifest as proactive involvement of the patient in decision-making regarding his/her treatment.
Acknowledging and acting in accordance with the extent to which a patient wishes to participate (or not
participate) in making decisions is part of regard for that patient’s self-determination. In making their
decisions, patients will be guided to varying degrees (from zero to maximum, as self-determined) by the
opinion of their doctor and their personal experiences, values and relationships, but ultimately the decision
should be theirs except where they have specifically and voluntarily opted to have the decision made for
them by the doctor (excluding cases of incapacity, which are outside the scope of this book).
67 Why doctor resist the Consumer Protection Act, Discuss?
Ans:-Refer YOUTUBE Video of Consumer Protection Act, 2019 and Healthcare Professionals. Do
doctors come under the ambit of CPA?

68 Mention the four components of negligence with appropriate case laws

Ans:- To be successful, any medical negligence claim must demonstrate that four specific elements
exist. These elements, the “4 Ds” of medical negligence, are (1) duty, (2) deviation from the standard
of care, (3) damages, and (4) direct cause. Different types of medical negligence

• different types of medical negligence.

• Misdiagnosis.
• Delayed Diagnosis.
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• Surgical Error.
• Wrong Site Surgery.
• Unintentional Laceration or Perforation.
• Unnecessary Surgery.
• Negligent Anesthesia Preparation.

69 “Have a child of your Choice. Come to “X” clinic. Sex of the foetus is assured”. This advertisement was
published in a local newspaper. Many pregnant visited the clinic. Can action be taken under any Act?
Mention appropriate case ? What Propositions were laid down in the case of Canterbury v. Spence?
Which Doctrine the case relate to?
Ans:-

Question No 70 To 82—Repeted Question

70 Define Magic Remedy under DMR (OA) Act, 1954
Ans:-

71 Give two Examples of Medico Legal Case

Ans:-

72 Write Short Note – Female Foeticide

Ans:-

73 Define Donor under TOHO Act 1994

Ans:-

74 What is meant by “Privileged communication”

Ans:-

75 What is meant by a patient's rights to self-determination?

Ans:-

76 Define „Genetic Counselling Centre‟ according to PCPNDT Act, 1994

Ans:-

77 State any three important provisions of Helsinki Declaration with respect to human experimentation of
drugs
Ans:-

78 What is difference between ECH and EEG?

Ans:-
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79 Write Short Note – Brain Stem Death

Ans:-

80 Explain international agencies and their role in disaster management.

Ans:-

81 Explain Appropriate Authority under the Transplantation of Human Organs Act. .

Ans:-done

82 Explain the Medico-legal aspects of road accidents.

Ans:-done

83 What is medical negligence and explain contributory negligence

Ans:- A person is guilty of contributory negligence if he ought reasonably to have foreseen that if he did
not act as a reasonable prudent man he might be hurt himself and in his reckonings he must take into
account the possibility of others being careless[13]. Contributory negligence basically means ignorance
from both the parties involved. If a person is driving a car without any breaks met with an accident
with another person who was driving on the wrong side of the road. This results in contributory
negligence. Different types of medical negligence

• different types of medical negligence.

• Misdiagnosis.
• Delayed Diagnosis.
• Surgical Error.
• Wrong Site Surgery.
• Unintentional Laceration or Perforation.
• Unnecessary Surgery.
• Negligent Anesthesia Preparation.

84 What are the rights of a registered medical practitioner

Ans:- Doctors have the right to reasonable accommodation of their religious beliefs, short of
undue hardship to others. Doctors also have the right to clinical independence. To freedom of
expression which includes the right to express themselves and their opinions without
victimisation.

85 Write a short note on Homeopathy.

Ans:- A system of complementary medicine in which ailments are treated by minute doses of
natural substances that in larger amounts would produce symptoms of the ailment. Refer Detailed
Note
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86 Explain privileged communication and confidentiality in a doctor-patient relationship with case study.
Ans:- When two individuals are in a legally recognized relationship, they are not bound to disclose any
details of the communication that happened between them by virtue of this relationship. Such a
relationship is referred to as a protected relationship and this form of communication is known as
‘Privileged Communication’. Here are some examples of confidential information:
• Name, date of birth, age, sex, and address.
• Current contact details of family.
• Bank information.
• Medical history or records.
• Personal care issues.
• Service records and file progress notes.
• Personal goals.
• Assessments or reports.

Confidentiality is one of the core duties of medical practice. It requires health care providers to keep a
patient's personal health information private unless consent to release the information is provided by the
patient. Confidentiality means the state of keeping secret or not disclosing information. It comes from
confide, meaning to trust someone or tell secrets to them. Confidential information, therefore, is
information that should be kept private or secret. Confidentiality is simply the act of keeping that
information private.

87 Discuss the medico-legal aspects of sexual assaults.

Ans:-done

88 Explain the Nuremberg Code.

Ans:-
1. This means that the person involved should have legal capacity to give consent; should
be so situated as to be able to exercise free power of choice, without the intervention of
any element of force, fraud, deceit, duress, over-reaching, or other ulterior form of
constraint or coercion; and should have sufficient knowledge and comprehension of the
elements of the subject matter involved, as to enable him to make an understanding and
enlightened decision. This latter element requires that, before the acceptance of an
affirmative decision by the experimental subject, there should be made known to him the
nature, duration, and purpose of the experiment; the method and means by which it is to
be conducted; all inconveniences and hazards reasonably to be expected; and the effects
upon his health or person, which may possibly come from his participation in the
experiment. The duty and responsibility for ascertaining the quality of the consent rests
upon each individual who initiates, directs or engages in the experiment. It is a personal
duty and responsibility which may not be delegated to another with impunity.
2. The experiment should be such as to yield fruitful results for the good of society,
unprocurable by other methods or means of study, and not random and unnecessary in
nature.
3. The experiment should be so designed and based on the results of animal
experimentation and a knowledge of the natural history of the disease or other problem
under study, that the anticipated results will justify the performance of the experiment.
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4. The experiment should be so conducted as to avoid all unnecessary physical and mental
suffering and injury.
5. No experiment should be conducted, where there is an a priori reason to believe that
death or disabling injury will occur; except, perhaps, in those experiments where the
experimental physicians also serve as subjects.
6. The degree of risk to be taken should never exceed that determined by the humanitarian
importance of the problem to be solved by the experiment.
7. Proper preparations should be made and adequate facilities provided to protect the
experimental subject against even remote possibilities of injury, disability, or death.
8. The experiment should be conducted only by scientifically qualified persons. The highest
degree of skill and care should be required through all stages of the experiment of those
who conduct or engage in the experiment.
9. During the course of the experiment, the human subject should be at liberty to bring the
experiment to an end, if he has reached the physical or mental state, where continuation
of the experiment seemed to him to be impossible.
10. During the course of the experiment, the scientist in charge must be prepared to
terminate the experiment at any stage, if he has probable cause to believe, in the
exercise of the good faith, superior skill and careful judgement required of him, that a
continuation of the experiment is likely to result in injury, disability, or death to the
experimental subject.

89 Explain Doctor-patient contractual relationship.

Ans:- Aside from those sentinel events, there are generally two key elements required for a physician-
patient relationship to be initiated: 1. Contract — There must be a written or non-written contract between
the physician and patient. In the Contractual Model of collaboration, physician and patient forge a
mutually agreeable contract, more like biblical covenant than legal construct. There is true sharing of
decision making in such a way that both physician and patient can be confident of retaining their moral
integrity.

90 "At a private nursing home in Beed run by a well-known gynaecologist, some patients are discreetly
informed about the gender of the foetus by use of colour code on payment of heavy fees. Briefly highlight
the relevant legal provisions applicable.
Ans:- If you have a prenatal blood test (NIPT), you may be able to find out your baby's sex as early as
11 weeks of pregnancy. Ultrasounds may reveal sex organs by 14 weeks, but they aren't considered fully
accurate until 18 weeks. If you have CVS at 10 weeks, the results will reveal your baby's sex by 12
weeks.

91"Disha, aged 35, suddenly falls unconscious on a staircase of her building. Her neighbours immediately
rush her to a hospital, where at the time of admission she is still unconscious.
Explain the concept of Informed Consent and Implied Consent. Which of these will be applicable in the
instant case? Explain with reasons.
Ans:- There is no formal agreement. For example, a patient who calls to make an appointment is
giving implied consent to treatment. While implied consent is informal, informed consent is a legal term
that requires seven elements to be valid: The individual is competent and can understand what they're
consenting to. What's the Main Difference Between Expressed and Implied Consent? The essential
difference between expressed and implied consent is that expressed consent is typically given with
words, either on paper or verbally, while implied consent is usually understood through actions. Listen
to pronunciation. (in-FORMD kun-SENT) A process in which patients are given important information,
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including possible risks and benefits, about a medical procedure or treatment, genetic testing, or a
clinical trial. Types of consent include implied consent, express consent, informed consent and
unanimous consent. Informed Consent. Except in emergencies, healthcare practitioners must generally
obtain the patient's informed consent before providing treatment. If the patient lacks capacity due to
age or incompetence, consent must be obtained from a personal representative authorized by law to
provide consent.
Consent when surrounding circumstances exist that would lead a reasonable person to believe that this
consent had been given, although no direct, express, or explicit words of agreement had been uttered.
Implied consent is consent which is not expressly granted by a person, but rather implicitly granted by a
person's actions and the facts and circumstances of a particular situation (or in some cases, by a person's
silence or inaction).

92 What is meant by Hospital under the Transplantation of Human Organs Act,1994?

Ans:- The Transplantation of Human Organs Act, 1994 - Regulation of Hospitals. (c) no place
including a hospital registered under sub-section (1) of Section 15 shall be used or cause to be
used by any person for the removal, storage or transplanation of any human organ except for
therapeutic purposes.

93 "What is a clinical trial?

Ans:- Clinical trials are research studies performed in people that are aimed at evaluating a medical,
surgical, or behavioral intervention. They are the primary way that researchers find out if a new treatment,
like a new drug or diet or medical device (for example, a pacemaker) is safe and effective in people.

Types of clinical trials

• Pilot studies and feasibility studies.
• Prevention trials.
• Screening trials.
• Treatment trials.
• Multi-arm multi-stage (MAMS) trials.
• Cohort studies.
• Case control studies.
• Cross sectional studies.

94 What is meant by Female Foeticide?

Ans:-DONE

95 What is meant by Magic Remedy under the Drugs and Magic Remedies (Objectionable?
Advertisements) Act, 1954?

Ans:- The act defines "magic remedy" as any talisman, mantra, amulet or any other object which is
claimed to have miraculous powers to cure, diagnose, prevent or mitigate a disease in humans or
animal. Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954. Long Title: An Act to
control the advertisement of drugs in certain cases, to prohibit the advertisement for certain purposes of
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remedies alleged to possess magic qualities and to provide for matters connected therewith. The Drugs
and Magic Remedies (Objectionable Advertisement) Act was enacted in 1954. to prohibit the
advertisement of treatments which are supposed to hold magic qualities, to prevent self-medication of
harmful drugs. The Act lists the diseases and disorders in respect of which advertising is banned.

96 Sumandevi, aged 85 who is bedridden for over 2 years at her home, is taken to a hospital. On
admission, the doctor informs her family that she is brain-stem dead. Explain the concept of Brain Stem
Death.

Ans:-DONE

97 What is Self-Regulation through Code of Conduct?

Ans:- Self-regulatory codes of conduct are used to control the promotional practices of the pharmaceutical
industry, but the effectiveness of these codes in controlling pharmaceutical representatives' presentations
has not been examined. What is self regulation through code of conduct under law and medicine?
A new self regulatory code of conduct for doctors and hospitals, in the process of being formulated,
could hold investors and members on the boards of medical establishments responsible for unethical
practices in the establishment such as giving cuts to doctors and diagnostic facilities or taking bribes from
Self-regulation — an association of participants within the same profession or market sets ethical rules of
conduct and punishes violators. What is the best model for regulating unethical behaviour? What are self
regulatory guidelines?
Self-regulation is the process whereby an organization is asked, or volunteers, to monitor its own
adherence to legal, ethical, or safety standards, rather than have an outside, independent agency such
as a governmental entity monitor and enforce those standards.
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98 "Pushpa has undergone a surgery and is subsequently discharged from hospital. Thereafter, as she
complains of excruciating pain,she is readmitted to the hospital. A surgical instrument is discovered at the
operation site.Briefly state the relevant legal provisions and enumerate the legal recourses applicable to
Pushpa.

Ans:-

99 "A pedestrian is knocked down by a vehicle at a junction in a town. A group of people immediately
rushed him to a nearby private hospital. The hospital administration refuses to provide treatment.
Whether refusal is legally permissible? Cite relevant precedent.

Ans:-