INTRODUCTION
It
is my pioneer work in the field of law and being a doctor by profession for the
last 15years it is something that’s very unique for me.
Have
taken the thought subject since have a very unique experience during my early
years of practice in this area
My experience:
Dr.Fatema
personal experience during practice year 2006-2010
Informed
consent my experience with this,
I
was a fresher and just started handling case,
I
had a case of Cervical and Uterine Cancer (which was diagnosed very late in
regards to its onset; which is very difficult to point out.)
The
Female was trying to conceive and in the race for a child was having recurrent
abortions since 3years of marriage and had a history of oral contraceptives as
well .During one Dilatation and Curettage (D&C) procedure, a tumor was
doubted by the doctor. She did not take a biopsy because the patient had only
given consent for D&C and when this was communicated to the patient, the
presence of a tumor doubted by the doctor was told to the patient, which was also
asked to be checked by a Ultrasound test, the gravity of the situation was
ignored in the race for a child.
Only after 1year and finally conceiving it was
found that a tumor of unknown quality was growing along with the child inside
the uterus of the patient and was doubted for a twin first which was ruled out
upon the sonography report. It was informed and advised during child birth that
a total hysterectomy be done to save the patient from any future complications
and avoid further medical complications
but the patient only gave consent to remove
the child and not the uterus which was importantly pointed by the doctor , the
doctor was left with no scope we had to
follow the patient’s wishes , here one important point was the husband of the
patient was in favor of the total removal of organs after one child. Yet the
patient herself wanted to keep a chance of having a second child in
future,
The
case thus progressed and after child birth the tumor alone was removed and the organs
left untouched. The biopsy of the tumor was taken and a Stage III Cancer of
endometrium was diagnosed.
SIMPLE DIFINATION OF ENDOMETRIAL CANCER
IS AS FOLLOWS:
Endometrial
cancer is a type of cancer that begins in the uterus. The uterus is the hollow,
pear-shaped pelvic organ in women where fetal development occurs.
Endometrial
cancer begins in the layer of cells that form the lining (endometrium) of the
uterus. Endometrial cancer is sometimes called uterine cancer. Other types of
cancer can form in the uterus, including uterine sarcoma, but they are much
less common than endometrial cancer.
Endometrial
cancer is often detected at an early stage because it frequently produces
abnormal vaginal bleeding, which prompts women to see their doctors. If endometrial
cancer is discovered early, removing the uterus surgically often cures
endometrial cancer.
The
life expectancy in Cancer is a dangerous question; the doctor was asked what the
life expectancy in the case is? The patient had not followed the recurrent
advises given in this case,
And
the patient succumbed to cancer in the next 1 year.
Informed
consent as in this case I experienced; is a two way weapon. The patient was so assertive
and in the contest of having a child lost her own life, which was preventable,
and the child born today is left without a mother. The doctor would stand
helpless because diagnosis in certain conditions is seriously difficult, after
6months when this patient returned with classic symptoms of endometrial cancer
it was very late, the family and the patient has no business blaming the doctor
here because the doctor simply followed his patients consent. Had the patient
consented for a complete hysterectomy at the first instance everything would be
avoided.
Medicine
and Practicing are two values which have different parameters. Medicine will
say “WHEN IN DOUBT, CUT IT OUT”.
Practicing
would state “TAKE THE CONSENT OF THE PATIENT”.
As a doctor for us it is part of the
regular practice of medicine to measure the mental anguish and physical
discomfort of a patient with respect to his treatment surgery or any other
interventional and non-interventional procedure. Treatments of any form can be
mentally and physically exhausting and therefore the patient who is supposed to
undergo the treatment should have knowledge of the possible outcomes that might
arise out of the said treatment. The role of a doctor or a medical practitioner
is to provide the patient with adequate treatment regardless of his age or
his/her mental state, acting in fiduciary capacity for his patient. However
even though autonomy has been of crucial importance when it comes to making
such decisions, we find that the voluntariness of the decision making of the
patient is being subjected to various restrictions over various jurisdictions.
It is to be noted that the basic principle of medical ethics is that the people
whose body has to be interfered with should be fully informed about the procedure
that is to be conducted on them, without any form of coercion.
In the above
mentioned context, in this paper I seek to understand and analyze the extent of
the scope of the doctor’s duty to disclose to the patient. This paper shall
probe on the basic understanding and history of the doctrine of informed
consent which every patient is entitled to while receiving treatment or
therapy. The paper shall then proceed on to the scope of the doctor’s duty to
disclose and discuss various elements relating to the disclosure that is
supposed to be made to the patient. The paper shall also discuss if a doctor or
medical practitioner has to disclose every possible risk or alternative
treatment and shall proceed along the lines if the doctor can be sued for his
breach of duty to disclose. The paper shall also discuss the various
circumstances which could compel a doctor to disclose a patient’s medical
information to parties other than the patient. The paper shall finally make a
comparative study of the doctrine of duty of disclosure between India and
United Kingdom.
RESEARCH METHODOLOGY:
Aims and Objectives of the Paper
In this project I would like to
extend the understanding of the term ‘Informed Consent ’,
Its origin and its implication on the
present day scenario in Indian Medical Practice. The object of this project is
to determine the duty of doctor’s to disclose Medical Information to patient
and his family and the necessary implications of failing to do so.
I have concentrated on the concept of
Informed Consent and the liability incurred by a doctor in not following the
same.
Its scope also extends to find the
current regulation and the code of ethics that are supposed to be followed by our
medical practitioners.
This project has also emphasized in making a
comparative study between the code of conduct followed by Medical Practitioners
of both India and UK.their work environments and conditions of the medical
facilities which make a way for Human Rights and its needs.
Also the paper is pointing the stark
importance of INFORMED CONSENT in areas of Alternative therapies and Treatments
available a very exhaustive study in this regards is portrayed in the paper;
and a very elaborate process of informed consent in Homoeopathy Practice.
The paper also pinpoints on the
Religion aspect of informed consent and case of Halal law to be followed by
certain religions, in this part I will show the importance of ethics over
everything and importance of religion in medical field.
Methodology:
This project is mainly based upon
research and reading and personal experiences.
I have relied upon all the secondary sources available to me. The books,
newspaper articles, news & journals published on the websites regarding the
issue were of maximum help in formulating and understanding the topic in
greater detail.
Meeting some practicing lawyers was
helpful too. They helped me understand the topic from practical point of views.
Personal experience as a doctor for 6years was of very deep importance and
helped me understand the various aspects of which are important from the doctor
point of view and patient point of view, with my experience extending to
practice overseas it makes it easy for me to see the difference between
different cultures and patients and education levels between India and Abroad
and a very exhaustive knowledge of rules and regulations and their differences
here and overseas.
In the course of this project I have
come across the following questions:-
1. What
is the history and evolution of doctrine of informed consent?
2. How
and Which Medical Historian and Practitioners has worked upon the evolution of
doctrine of informed consent?
3. What
is the extent of the scope of the doctor’s duty to disclose to the patient
4. What
are the various circumstances which could compel a doctor to disclose a
patient’s medical information to parties other than the patient?
5. What
is the scope of Disclosure in other developed Countries like that of U.K?
6. What
the scope of Alternative Therapies and the doctrine of Informed consent?
7. How
does a physician deal with daily life issues which would arise during practice
such as HALAL and NON-HALAL drugs and its usage?
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