Medico legal and ethical issues in STI and HIV Dr Priya Singh LLB 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 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 Consent Confidentiality Clinical records Communication Competence Careful prescribing

For consent to be valid it must be by 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 to consider and discuss them’ 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 to consider 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 it in the balance and arrive at a choice 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 it in the balance and arrive at a 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 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 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’ 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 cannot be persuaded to inform a parent Gillick competence An under 16 year old with the maturity and intelligence to comprehend fully what is proposed and who cannot be persuaded to inform a parent

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 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 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