Forensic Medicine and Medical Ethics
Items test legal and ethical reasoning in ordinary clinical situations: consent, confidentiality, negligence, documentation, poisoning, and the Nepali legal framework for abortion and organ donation.
Core rules
- Valid consent: informed, voluntary, given by a person with capacity; in Nepal the legal age is 18. For a minor, take consent from a parent or guardian.
- Emergency exception: treat a life-threatening condition without consent when no one can give it, and document the reasoning.
- Negligence requires four elements: duty, breach, causation, and damage.
- Confidentiality may be broken with patient consent, by legal requirement, or in the public interest.
- Poisoning: organophosphate poisoning causes bradycardia, miosis and bronchorrhoea - treat with atropine and pralidoxime. Kerosene ingestion: no gastric lavage and no induced vomiting.
- Abortion: legal up to 12 weeks on request in Nepal, and up to 28 weeks for rape, incest, fetal anomaly or risk to the mother's health.
Worked example
An unconscious road traffic victim needs emergency laparotomy; no relative can be reached. The surgeon may proceed under the emergency exception, documenting the necessity and later informing the guardian. Withholding treatment for lack of a signature would be negligent.
Traps
- Taking consent from a minor as if legally valid.
- Equating a bad outcome with negligence.
- Inducing vomiting after kerosene ingestion.
- Disclosing diagnosis to relatives without the patient's consent when the patient has capacity.