Medico legal and ethical issues in STI and HIV

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Medico legal andethical issuesin STI and HIV

• Dr Priya SinghLLB MBChB MRCGP

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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(Stat
  utes, Case Law, GMC guidance)
• Problems in clinical management
• Medication errors
• Administrative errors
• Failures of communication,including inadequate
  records

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The Six Cs

• Consent
• Confidentiality
• Clinical records
• Communication
• Competence
• Careful prescribing

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Consent

• For consent to be valid it must be

by a competent patient,
freely given,
making an informed decision

• 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

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Consent

• The test of a patients competence to give or
  withhold consent to treatment is based on case
  law. The three essential criteria to be met are
  that

• 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

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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

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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

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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

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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 childs wishes.
• Unconscious patients
• clinical interests
• exceptional circumstances

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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

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