Medico legal andethical issuesin STI and HIV

Dr Priya SinghLLB MBChB MRCGP

Managing the Risks in Hospital Practice

80% of errors arise from only about 20% of causes. The most important are:

Failure to appreciate legal responsibilities(Statutes, Case Law, GMC guidance)

Problems in clinical management

Medication errors

Administrative errors

Failures of communication,including inadequate records

The Six Cs

Consent

Confidentiality

Clinical records

Communication

Competence

Careful prescribing

For consent to be valid it must beby a competent patient,

GMC guidance

‘The information you provide when seeking consent should be appropriate to the circumstances and to the nature of the condition…. Some conditions, such as HIV, have serious social, financial, as well as medical implications…….you must make sure that the patient is given….. appropriate time toconsider and discuss them’

freely given,

Consent

making an informed decision

The patient understands the information presented to them and the implications of

accepting or rejecting the various treatment options

The patient believes the information provided

The patient is able to weigh itin the balance and arrive ata choice

Consent The test of a patient’s competence to

give or withhold consent to treatment is based on case law. The three essential criteria to be met are that

Consent

You have a significant concern that your patient may be HIV positive

He refuses a test

He lapses into unconsciousness

A healthcare worker sustains a needlestick injury

Consent

A mother of 4 children is likely to be HIV positive

She is divorced from the father of

a 2 year old

an 11 year old

a 15 year old

She is living with the father of her youngest child, a 4 month old whom she is breast feeding

Consent

Parental responsibility

GMC ‘You must decide whether the medical interests of the child override the wishes of those with parental responsibility’

Gillick competence

An under 16 year old with the maturity and intelligence to comprehend fully what is proposed and who cannotbe persuaded to inform aparent

Consent

Gillick competent under 16 year olds refusing treatment

The wishes of a competent child may be overruled if, inthe opinion of the court, the consequences of refusal are such that it would be inappropriate to comply with the child’s wishes.

Unconscious patients clinical interests

exceptional circumstances

Confidentiality

Patients have a right to expect that you will not disclose any personal information which you learn during the course of your professional duties, unless given permission

Other healthcare workers

Post mortems

Death certificates