Medical Ethics, Patient Safety and Professionalism
Ethics questions test the application of law and professional norms to a short scenario. Consent, confidentiality, the PCPNDT Act, the MTP Act, negligence and reporting duties are the main areas.
Core rules
- Valid informed consent needs capacity, adequate information and voluntariness. In a life-threatening emergency, treat under the doctrine of necessity without waiting for consent.
- Confidentiality yields to notifiable diseases, court orders, serious risk to an identifiable partner and child protection duties.
- Negligence requires duty, breach, causation and damage; res ipsa loquitur shifts the burden when the injury could not occur without negligence.
- MTP is permitted up to 20 weeks on request; 20-24 weeks for special categories such as rape, incest, major fetal disability, minors and humanitarian grounds. Minors and the mentally ill need guardian consent.
- The PCPNDT Act prohibits sex determination and its advertisement.
Worked example
A 16-year-old presents at 10 weeks with pregnancy following an alleged rape. She is a minor, so guardian consent is required for the MTP in addition to her own assent. The pregnancy falls within the 20-week limit. Because the history is of rape, mandatory reporting to the police under child protection law applies even though general confidentiality is maintained otherwise. Disclosure to other family members without her agreement is not justified.
Traps
- Assuming spousal consent is needed for MTP in an adult married woman; it is not.
- Breaching confidentiality more widely than the law requires when a single disclosure would suffice.
- Recording a procedure as consented when only verbal permission was obtained from a relative.