Dr Panduleni Itula
Healthcare professionals and their allied colleagues are daily faced with difficult professional responsibilities in the care of their patients. From the moment of entering a health facility, a relationship between the healthcare professional and the patient develops, that of a duty to take care of the ailments that formed the basis of the patient’s reason for attending the healthcare facility, with an intention to be appropriately managed and treated.
Relying upon sound judgment, clinical training and medical knowledge of disease processes and their aetiologies, a healthcare professional is duty bound to elicit the causes of disease and institute the most appropriate treatment regime, in the best interest of the patient, based on their best clinical judgment that will bring about resolution of the patient ailment.
These relationships are not occurring in a vacuum but are subject to a set of rules and codes of conduct overseen by lawyers and Judges, as arbiters of fact in the event of disputes concerning the best and appropriate clinical care based on clinical judgment, in the best interest of their patients.
The fundamental duty of doctors is however, qualified and subject to best clinical judgment and no doctor is required to treat a patient against their best clinical judgment, neither are the courts under any duty to force doctors to treat patients against their best medical and clinical judgment.
Similarly the patients, their parents and their guardians have no legal authority to dictate to the doctors the treatment that need to be given to any patients, if this is thought not to be in the best interest of the patient by the doctors. The doctor on the other hand, in relation to minors or incompetent patients, is not allowed in law to treat a minor or an incompetent adult (for whatever reason) without valid authority from the competent individual authorised to give such consent.
However, such consent from a Gillick competent minor will absolve the doctor from criminal liability in the tort of battery.
With this said, this series of articles will examine these relationships and the interpretation of the facts that forms the basis of ethical, legal and clinical decision making process, in the care of patients, and the dilemmas solved or left unsolved.
It is recognised that, to a certain degree, it may be argued, that these dilemmas have been created because of advances in medical technologies, especially in the last 40 years or so.
This is to the extent that life that was once nonviable has been made viable and physiological functions necessary to sustain life, which relied on healthy functional components of the human body.
But the brain, has now been replaced by technologically advanced machines and or transplantation of organs, often allowing normal function of the human body, occasionally independent of the technological adjunct to life or in the worse situation prolongation of life in permanent neurological defects, to continue as reasonably normal.
The series of articles to run in a few weeks will establish the basic principles, which are considered the hub of the ethical and legal dilemmas, patient autonomy and consent to medical treatment.
Given the numerous areas of public concerns in clinical decision-making process, it is not possible to cover all possible disputes that created dilemmas in hospitals and courts.
Such a task, given the limited space, would not only be impossible but it will do injustice to the numerous issues that are of fundamental importance in understanding the issues involved.
As such, a few selected cases that formed legal landmarks have been selected as demonstrative of the ethical and legal dilemmas.
This piece is an introduction to a series of articles on ethical and legal dilemmas in clinical decision-making processes.
* Dr Panduleni Filemon Bango Itula is a Dentist with a Master’s Degree in Medical Law.