Professional Practice, Ethics and Health Systems Management
Domain 5 - Professional Practice, Ethics and Health Systems Management
This domain tests the legal, ethical and managerial framework within which Sri Lankan doctors work.
Core rules
- The four principles (Beauchamp and Childress) - autonomy, beneficence, non-maleficence, justice - are used to justify and to critique a decision, not to rank options mechanically.
- Valid consent requires capacity, adequate information (material risks, alternatives, consequences of refusal) and voluntariness, and must be documented. Emergency treatment of an unconscious patient proceeds on necessity.
- Confidentiality is a duty, not an absolute: disclose with consent, or where required by law (notification, court order), or where necessary to prevent serious harm to an identifiable third party.
- Negligence needs duty of care, breach of the standard of a reasonable practitioner, causation and damage - all four.
- The system runs from the Ministry of Health (national curative and preventive services, teaching hospitals) through Provincial Directors of Health Services, RDHS and MOH for field preventive work; patients move upward through designated referral levels. Clinical governance covers audit, morbidity and mortality review, guidelines and incident reporting.
Worked example. A 17-year-old requests contraception and refuses parental involvement. She has capacity to understand the information; the age of consent in Sri Lanka is 16, and maintaining confidentiality serves her duty of care. You counsel, provide the service, encourage family involvement and record the discussion. You do not disclose to the parents, and you do not refuse care.
Traps
- Breaching confidentiality without a legal basis or necessity.
- Withholding notification of a notifiable disease because the patient did not consent.
- Alleging negligence with no demonstrable damage, or overlooking the employer's vicarious liability.
- Discussing resource allocation while ignoring free health policy, the essential medicines list and opportunity cost.