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Introduction to Medical Ethics - Forensic Medicine    

Apr 24, 2023

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Medical Negligence / Professional Malpractices, Consent

List of unethical acts

Punishment by SMC (State Medical Council)

MEDICAL NEGLIGENCE / PROFESSIONAL MALPRACTICES

Cases filed under consumer court

MEDICAL Maloccurrence

Professional Secrecy

Vicarious Liability

CONSENT     

Previous Year Question

Q. Punishment of perjury is given by? (NEET - Jan - 2019)

Q. Punishment for causing death due to medical negligence is given by?

Q. While doing hysterectomy after informed consent for uterine fibroids. Ureter is damaged intraoperatively even after diligent measures. A doctor is not responsible under which doctrine? (FMGE - DEC - 2020)

Q. In case of professional misconduct, patient records are demand should be provided with? (AIIMS - Nov - 2018)

Q. A doctor takes consent before surgical procedures and also, he may go beyond the consent if he feels the need for patients benefit? (AIIMS - Jun - 2020)

Q. A doctor who is drunk, while performing the surgery, injured a major vessel & death of patient. This is? (NEET PG -2022)

Medical ethics

Medical ethics is an essential aspect of medical practice that guides the behavior of healthcare professionals in their interactions with patients, colleagues, and the broader community. Medical ethics is concerned with the moral principles and values that underlie medical practice, and it encompasses a wide range of issues, including medical negligence, professional malpractices, consent and more. 

Medical ethics in FMT is particularly important because it addresses the ethical dilemmas unique to forensic medicine and toxicology. Forensic medicine and toxicology involve the application of medical knowledge and expertise to legal issues, such as the investigation of crimes, the identification of human remains, and the determination of cause of death. As such, forensic medicine and toxicology raise complex ethical issues.

Therefore, understanding medical ethics in FMT is essential for healthcare professionals to ensure that they practice medicine with integrity, professionalism.

Let’s learn more about this important FMT topic for NEET PG exam preparations.


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Medical Negligence / Professional Malpractices, Consent

Medical negligence occurs when healthcare workers violate their ethical obligations. All medical practitioners have a duty to treat patients with the same amount of respect. If they don't fulfil their duty, it can be considered medical negligence. Although not always. This could sometimes lead to a malpractice suit.

Determining whether a healthcare provider upheld the appropriate standard of care and whether you are entitled to financial compensation as a result depends on your understanding of what is meant by medical negligence.

  • Set of moral principles given by MCI. Violation is punishable.              
  • Infamous/unethical act by doctor – Punishable, by state medical council

List of unethical acts

Below are mentioned list of some unethical acts:

List of unethical acts

Punishment by SMC (State Medical Council)

  • SMC appeal to Central health ministry + MCI
  • 1. Warning
  • 2. Penal Erasure of Name
    • Temporary
    • Permanent → For serious offences Aka professional death sentence

MEDICAL NEGLIGENCE / PROFESSIONAL MALPRACTICES

Commission of wrong things and omission of right things causing damage to the patient is known as medical negligence.

  • Commission of wrong things and omission of right things causing damage to the patient.
  • 4 D’s
    • Duty owed to patient 
    • Dereliction of duty
    • Damage
    • Direct causation

Cases filed under consumer court 

  • Types:
    • Civil negligence 
    • Criminal negligence: cases filed under criminal court.
      • Punishment: fine or Imprisonment
  • Contributory negligence
    • Punishment reduced depending upon individual contribution to negligence this is doctrine of comparative negligence
CivilCriminalContributory
ActDue to simple lack of care / skillGross negligence sometimes causing deathDoctor negligent but patient also negligent
Burden of proofPatientProsecutionDoctor
CourtConsumerCriminalCivil cahrges
PunishmentFineFine, imprisonmentAmount of fine is reduced

These two doctrine are used for Contributory Negligence 

  • Last clear chance doctrine rule 
    • If the doctor fails to avoid the damage in the last clear chance. 
    • Doctor is liable
  • Avoidable consequences rule 
    • Patient could have avoided the damage but fails to do so
    • Patient is liable
  • Res Ipsa Loquitur (The thing speaks for itself)
    • Negligent factor is so obvious that the thing (Act) speaks for itself.
    • No need for expert evidence.
    • Burden of proof lies on the Doctor
      • e.g. Surgery on the wrong side of the body.

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MEDICAL Maloccurrence

Medical malpractice is when a healthcare provider fails to deliver the right care, fails to act appropriately, or gives the wrong care, which results in harm, injury, or death to the patient.

  • Accidental damage to the patient – doctor is not liable for this

Professional Secrecy

  • Doctor has to keep patient information confidential
  • Disclosure is punishable
  • Exception of professional secrecy: Privileged communication
    • In the interest of society like in notifiable disease.
    • In court of law.
    • In patient interest like in severe depression.

In case of crime: inform police - 39 CrPC

Vicarious Liability

  • Let the master answer / Respondent Superior
  • Senior who is in charge of the junior should be answerable.
  • Applicable only if 
    • Employee – Employer relationship 
    • Employee’s conduct should be within the scope of employment
    • Act should occur when he was on job    

RES INDICATA (LIMITATION PERIOD) = It describes the time duration till which one can file a case against negligence of the doctor. It is 2 Years from the date of discovery of the negligence.

Forensic Medicine Related Articles:

Forensic Autopsy: Types, Incisions & TechniquesNEET PG 2023: High-Yield Topics For Forensic Medicine & Toxicology
How to Prepare Forensic Medicine and Toxicology for PGMEE

CONSENT     

  • For physical examination: min age 12 yrs.
  • For surgery: 18 yrs.
  • Doctrine of full disclosure: complete info given to the patient
  • Doctrine of extended consent
    • In an unanticipated situation where doctor has to respond considering the risks associated with it for the benefit of the patient 
    • Doctor is not liable for it 
  • Doctrine of informed refusal 
    • Pt. has the right to refuse and the doctor has to document it in writing. Seen usually in examination (sexual assault examination)
  • Therapeutic privilege - Doctors can decide how much info needs to be given. Usually applicable in psychiatry disease
  •  Emergency Doctrine – 92 IPC, consent is not needed for emergency cases to save the life of a patient.
  • Loco parentis: On vacation, if a child gets ill, the consent for treatment given by the teacher. Person in charge will give consent.        
  • Therapeutic waiver: Patient waived his right to give consent
  • Consent Invalid (under section 90 IPC) in cases of
    • Child <12 yrs
    • Insanity
    • Under the influence of someone
    • Intoxication
  • No need of consent
    • In emergency condition: 92 IPC
    • Therapeutic waiver
    • Medicolegal autopsy

Previous Year Question

Q. Punishment of perjury is given by? (NEET - Jan - 2019)

A. 191 IPC

B. 193 IPC

C. 197 IPC 

D. 198 IPC

Q. Punishment for causing death due to medical negligence is given by?   

(FMGE - DEC - 2020)

A. 304 A IPC

B. 304 B IPC

C. 302 IPC

D. 338 IPC

Q. While doing hysterectomy after informed consent for uterine fibroids. Ureter is damaged intraoperatively even after diligent measures. A doctor is not responsible under which doctrine? (FMGE - DEC - 2020)

A. Medical maloccurrence

B. Novus actus interveniens

C. Physician error

D. Res ipsa loquitur

Q. In case of professional misconduct, patient records are demand should be provided with? (AIIMS - Nov - 2018)

A. 36 hrs.

B. 48 hrs.

C. 72 hrs.

D. 7 days

Q. A doctor takes consent before surgical procedures and also, he may go beyond the consent if he feels the need for patients benefit? (AIIMS - Jun - 2020)

A. Doctrine of extended consent

B. Doctrine of conjugated consent

C. Res ipsa loquitur

D. Doctrine of anticipation

Q. A doctor who is drunk, while performing the surgery, injured a major vessel & death of patient. This is? (NEET PG -2022)

A. Civil negligence 

B. Criminal negligence 

C. Therapeutic misadventure 

D. Dichotomy

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