Doctor's Duty Research Articles

The Doctor's Duty to Maintain Confidentiality ("Medical Secret") in Switzerland; What Attitude Should the Practitioner Adopt When Authorities or Outside People Ask for Information About a Patient?

AbstractNo Abstract

Patient compliance: the doctor's duty

Compliance with glaucoma treatment and treatment plans have been difficult to obtain since the initiation of the medical management of glaucoma. There have been many definitions of noncompliance put forth and multiple reasons for this noncompliance isolated. If doctors hope to improve compliance in their patients, they must take a more active role in educating their patients and modifying treatment plans to inspire greater compliance.

Methadone and driving regulations

UK legislation concerning a person's medical fitness to drive is drawn up so that road safety is the paramount concern. The supervising authorities consider certain medical illnesses as too dangerous and disqualify drivers who have them. Drug misuse is a condition included in this category of medical illness but many drug users continue to drive unaware of these regulations.This study undertaken in a group of 209 drug users on a methadone programme showed that of 81 driving licence holders, only four had informed the authorities that they were drug users and that 25% of those who had driven in the previous year did so without a licence.Recently introduced European legislation further restricts the possibility of allowing drug users to drive, but it appears that this does not deter many from driving illegally. Physicians' responsibilities in this area remain unclear, but those involved in the care of drug users should advise their patients of the doctor's duty to inform the Driver and Vehicle Licensing Age...

An Ethical Dilemma: Commentary: Disciplinary processes should not be used to solve ethical problems

The report suggests that managerially, it was apparently “wrong” for the nurse to deceive the patient (which justified the final warning) but not “wrong” for the doctor to have ordered the deception. This suggests that the ethical duties of doctors and nurses are perceived as different. However, it seems hard to argue that nurses should be more honest than doctors in their clinical practice unless it is important to protect a tradition of strong medical paternalism. The author also raises concerns about a style of nursing management. Some of these concerns are not peculiar to nursing: the …

Informed consent by children and adolescents to psychiatric treatment.

The concept of competency to consent to psychiatric treatment is discussed as a multi-faceted complex interaction involving: the developmental stage of the child and its effect on cognitive ability and rationality; their social environment and previous experience; their relationship with the professional as well as with their own family; the information presented to them about treatment as well as their understanding of that information; and their mental state at the time of deciding. All of these factors exist on a continuum or spectrum (i.e. in shades of grey and not in black and white) and therefore the application of rigid arbitrary limits is inappropriate. What is not in doubt is that the child deserves to be considered as an individual and its rights protected. The doctor's main duty is to the child, as the patient, and every opportunity to allow them to give proper informed consent must be provided. In the event of the child being found to be incompetent to consent, then the issue of proxy consent is also discussed, including the dangers of assuming that the parents will act in the child's best interests.

Measuring the effects of casemix on outcomes

Participation in the measurement of population health and health care outcomes has become an explicit professional duty for doctors, but comparisons are difficult to make because outcomes are conceptually complex and largely qualitative. Observational data, particularly from routine hospital statistics, are useful complements to experimental data provided that their variable quality is taken into account and adjustments are made to minimize bias and confounding and to allow for the effects of differences in casemix, which are problematic because of the nature of severity.

Creating a dignified option: ethical considerations in the formulation of prehospital DNR protocol.

Increasing numbers of states are recognizing the importance of developing policies to allow Do Not Resuscitate (DNR) orders to be recognized in the prehospital setting, especially by emergency medical personnel. The ethical issues involved in creating such policies have not been widely addressed. Using the experience of developing such a policy for the District of Columbia as a model, we discuss six major ethical issues involved in prehospital DNR order policy development. 1) Can the justification for the policy be grounded in the doctor's duty of beneficence? 2) Should the concept of futility be applied to prehospital DNR orders? 3) How specific should prehospital DNR orders be? 4) How can one maximize patient participation in the prehospital DNR decision? 5) How much consideration ought to be given to the scarcity of health care resources in the development and justification of such policies? 6) Should paramedics be empowered to pronounce DNR patients dead in the field? This discussion ought to be of benefit to all those involved in developing or revising prehospital DNR policies.

Informed Refusal: The Patient's Influence on Long-term Treatment

Outpatient studies in private practices revealed that psychiatric treatments often do not meet therapeutic standards. One possible explanation for this is that the autonomous patient substantially participates in therapeutic decision-making. Basic preconditions for the therapeutic decision-making are the patient's right of self-determination, the doctor's duty to inform, and a risk-benefit assessment on the part of patient and doctor. However, ethical and possibly also legal problems may result if the physician has to be responsible for a treatment decision which was influenced by the autonomous patient, but which is less effective and less safe than the treatment he recommends to the patient. Two outpatient examples will be given where doctor and patient come to different risk-benefit assessments. Emerging ethical problems will be discussed.

Justice for gatekeepers

Fundholding schemes in UK general practice force doctors to consider the moral implications of gatekeeping. The view that doctors can avoid involvement in rationing is unrealistic and ignores the doctor's duty to act justly. Rather, doctors need to cultivate the virtue of justice, while health-care systems should encourage just action and not create temptations.

Fetal Abuse: An Exploration of Emerging Philosophic, Legal, and Policy Issues

IN APRIL 1987, a judge in a San Diego court heard a case against a woman, Pamela Stewart Monson, whose baby was born braindead after she ignored her doctor's warnings about her behavior and its potential effects on the fetus. Her doctor had warned her to refrain from street drugs and sex and to seek medical care in case of vaginal bleeding. But prosecutors charged that on the day she delivered, she took amphetamines, had sex with her husband, and didn't call paramedics until twelve hours after bleeding began. Her son was born brain-dead with amphetamines in his system. The judge's decision to throw out the case is perhaps less significant than the fact that criminal charges were brought against the mother in the first place.' Cases like this raise important ethical, legal, and medical questions about personal responsibility in an era of increasing knowledge concerning health risks, about the moral and legal liability of parents who ignore the advice of their doctors when their actions result in death or serious deformities for their newborns, and about the duties of doctors toward patients who ignore their advice. Ultimately, lawmakers must design policy which confronts questions about the kinds of protection to which the fetus is entitled, if any, and the means for reconciling the interests of mother and fetus when they clash. In the Roe v. Wade decision, the Court avoided direct confrontation with some of the most difficult issues surrounding fetal responsibility. It provided a time frame, specified by viability, which limits the extent of state interference with the maternal right to privacy. But the Court did not and could not address a host of related policy issues. For example, it did not specify exactly what constitutes compelling state interest in the rights of the fetus. It did not indicate the obligations the mother has, if any, to the fetus if she chooses not to abort.

Incompetent Adults and Consent to Treatment

An Appeal Court review, brought by the Official Solicitor of Great Britain of a justice's declaration that sterilization of a mentally handicapped woman would not be unlawful only by reason of her incapacity to consent to it, is chronicled. In cases where the patient is not able to give an informed consent to any treatment, such as when the patient is unconscious or mentally incapable, the doctor's duty to preserve life remains paramount. In nonemergency situations court approval is required before procedures such as sterilization, abortion, organ donation, or experimental treatment can be carried out. If the House of Lords supports this holding, the medical profession will need to establish ethical guidelines that indicate the requirements for consultation with other doctors and disciplines and criteria for care of incompetents who cannot consent to treatment.

An Indiana doctor's duty to warn non-patients at risk of HIV infection from an AIDS patient.

An Indiana doctor's duty to warn non-patients at risk of HIV infection from an AIDS patient.

Health economics: the end of clinical freedom?

A British professor of economics enters the debate within the medical profession over whether it is the doctor's duty to take costs into account when deciding what course of action to recommend for a patient. He surveys differing views on the subject, and concludes with an analysis of Raymond Hoffenberg's thesis in his book Clinical Freedom (London: Nuffield Provincial Hospitals Trust; 1987), and the presentation of Williams' own position that doctors have absorbed economic considerations within what they would still regard as their own clinical judgment rather than recognizing such economic considerations as an external responsibility to society.

Child Abuse and the Doctor's Duty of Care

Child Abuse and the Doctor's Duty of Care

Doctor's Duty of Care to Give Advice in Therapeutic and Non-therapeutic Contexts

Doctor's Duty of Care to Give Advice in Therapeutic and Non-therapeutic Contexts

Failure to warn.

In Great Britain, two recent Court of Appeal decisions have clarified further the extent of the doctor's duty to inform a patient of the risks of a proposed medical or surgical procedure. Blyth v. Bloomsbury Health Authority, decided in February 1987, involved the administration of Depo-provera for contraceptive purposes and raised the issue of whether the duty of disclosure differs when the patient expressly asks questions. Gold v. Haringey Health Authority, decided by the Court of Appeal in April, was a failed sterilization case in which the point at issue was whether the doctor's duty differs if the context is nontherapeutic rather than therapeutic. In both cases, the Court of Appeal firmly declared that the Bolam test applied, i.e., if a responsible body of colleagues would have given no more information at the time, the doctor would not be held negligent.

Doctor's Duty to Answer Patients' Inquiries

Brahams reports on a British informed consent case, Blyth v. Bloomsbury Health Authority, decided 5 February 1987 by the Court of Appeal. The plaintiff charged negligence on the part of hospital staff in informing her about the side effects of the drug Depo-provera. Although a lower court had decided in her favor, the Court of Appeal ruled that the wrong standard had been applied to a physician's duty to respond to a patient's questions. The appeal judges upheld the standard that the defendants were obliged to disclose all appropriate information concerning a treatment rather than all available information, even in response to direct patient inquiries. Appropriateness was to be judged according to prevailing medical standards. Remarks made by judges in the earlier landmark Sidaway case were not to be interpreted as creating a legal duty on the part of physicians to respond fully when questioned by patients.

AIDS: a doctor's duty

AIDS: a doctor's duty

AIDS: a doctor's duty

AIDS: a doctor's duty

Parents, doctors and children: the Gillick case and beyond.

Abstract “The [Gillick] case is the beginning not the conclusion of a legal development in a field glimpsed by one or two judges in recent times but not yet fully explored. Mrs. Gillick, even though she may lose the appeal, has performed a notable public service in directing judicial attention to the problems arising from the interaction of parental right and a doctor's duty in a field of medicine unknown to our fathers but of immense consequence to our society.”