Good Medical Practice: Professionalism, Ethics and Law

Half-title......Page 3
Title......Page 5
Copyright......Page 6
Foreword......Page 7
Contents......Page 11
Tables......Page 23
Preface......Page 24
References......Page 26
Preface to the 1997 edition......Page 27
Acknowledgments......Page 29
About the authors......Page 31
Table of cases......Page 33
Table of statutes......Page 34
1.1 SOME HISTORICAL CONTEXT......Page 41
1.3 AN INTRODUCTION TO ETHICAL THINKING......Page 42
1.4 A MODERN FRAMEWORK FOR DISCUSSING MEDICAL ETHICS......Page 44
1.5.1 Capacity for self-reflection......Page 45
1.5.2 Veracity (truthfulness)......Page 46
1.5.4 Fidelity/trustworthiness/integrity......Page 47
1.6 OTHER DESIRABLE QUALITIES......Page 48
1.7 MODERN CODES OF MEDICAL ETHICS......Page 49
1.8 THE RIGHTS OF PATIENTS......Page 50
1.10 THE MUTABILITY OF MEDICAL ETHICS......Page 52
1.12.1 Autonomy versus beneficence......Page 53
1.13 ETHICS BEYOND THE DOCTOR–PATIENT RELATIONSHIP......Page 54
References......Page 55
Additional reading......Page 57
2.1 CONSIDERATIONS BEFORE ENROLMENT......Page 58
2.2 CRITERIA FOR ENROLMENT: SELECTION PROCEDURES......Page 59
2.3 REGISTRATION OF MEDICAL STUDENTS......Page 60
2.5.1 Contact with patients and learning from patients......Page 61
2.5.2 Consideration and respect......Page 62
2.5.4 Recognition of the limitations of knowledge......Page 63
2.5.5 Infection control......Page 64
2.5.7 Sexual boundaries......Page 65
2.6 THE STUDENT AND THE HEALTH-CARE TEAM......Page 66
2.7.2 Drug and alcohol abuse......Page 67
2.8 RESPONSIBILITIES OF AND PROFESSIONAL ETHICS FOR MEDICAL TEACHERS AND SUPERVISORS......Page 68
References......Page 70
Additional reading......Page 72
3 Communication skills......Page 73
3.1.1 Doctor-related obstacles......Page 74
3.1.2 Obstacles in the clinical setting......Page 75
3.2.1 Starting a consultation: putting the patient at ease......Page 76
3.2.2 Active listening......Page 77
3.3 APPRECIATING PSYCHO-SOCIAL FACTORS IN PATIENTS WHO SEEK MEDICAL HELP......Page 78
3.5 TRANSCULTURAL ISSUES AND THE USE OF INTERPRETERS......Page 79
3.6 CONCLUDING THE CONSULTATION......Page 80
3.8 COPING WITH ANGRY PATIENTS......Page 81
3.11 TALKING ABOUT SEX AND SEXUALITY......Page 82
3.12 TALKING WITH THE DYING......Page 83
3.15 INTRA- AND INTER-PROFESSIONAL COMMUNICATION AND RELATIONSHIPS......Page 84
References......Page 85
Additional reading......Page 87
4 Consent and informed decision making......Page 89
4.2 IMPLIED, ORAL OR WRITTEN CONSENT......Page 90
4.3 CONSENT FOR SURGICAL OR OTHER MAJOR INVASIVE PROCEDURES......Page 92
4.4 THERAPEUTIC PRIVILEGE AND WITHHOLDING INFORMATION......Page 96
4.6 CONSENT OF CHILDREN AND TEENAGERS......Page 97
4.7 CHILDREN WHO ARE INTELLECTUALLY DISABLED......Page 100
4.8 SUBSTITUTE DECISION MAKERS......Page 101
4.9 CONSENT FOR SPECIAL PROCEDURES......Page 103
4.10.2 Non-urgent but necessary treatment in incompetent patients......Page 104
4.11 CONSENT AND THE MENTALLY ILL......Page 105
4.13 REFUSAL OF BLOOD TRANSFUSION......Page 106
References......Page 107
5 Confidentiality, privacy and disclosure......Page 109
5.2 THE ETHICAL BASIS OF CONFIDENTIALITY......Page 110
5.3 CONFIDENTIALITY IN THE DOCTOR\'S SURGERY......Page 111
5.4 CONFIDENTIALITY AND MEDICAL REPORTS AND CERTIFICATES......Page 112
5.5 SHARING INFORMATION IN THE HEALTH-CARE TEAM......Page 113
5.6.2 Exceptions in the community interest......Page 114
5.8 STATUTORY AUTHORISATION OF DISCLOSURE......Page 115
5.9 DISCLOSURE IN COURT......Page 116
5.11 DISCLOSURE TO THE POLICE......Page 118
5.12 THE LEGAL BASIS OF PRIVACY......Page 119
NPP1: the collection of information; and NPP10: the collection of sensitive information......Page 120
NPP2: the use and disclosure of information once it has been collected......Page 121
NPP6: access and correction......Page 122
5.12.2 Other legal requirements......Page 123
5.14.3 Disclosure of genetic information to at-risk relatives......Page 124
References......Page 125
6.1 THE IMPORTANCE OF MEDICAL RECORDS......Page 127
6.3 WHAT SHOULD BE RECORDED?......Page 128
6.4 GUIDELINES FOR MAKING MEDICAL RECORDS......Page 131
6.6 SAFETY AND SECURITY OF RECORDS......Page 132
6.7 OWNERSHIP OF MEDICAL RECORDS......Page 133
6.8 ACCESS TO MEDICAL RECORDS......Page 134
6.10 PATIENT ACCESS UNDER PRIVACY LAW......Page 135
6.11 RETENTION AND DESTRUCTION OF MEDICAL RECORDS......Page 136
6.12 RETENTION OF MEDICAL RECORDS WHEN A DOCTOR RETIRES OR DIES......Page 137
6.14 MEDICAL RECORDS AND RESEARCH......Page 138
6.16 MEDICAL CERTIFICATES......Page 139
6.16.1 Medical certificates of fitness to work......Page 140
6.16.4 Other certificates......Page 141
References......Page 142
7 Negligence, professional liability and adverse events......Page 143
7.1 CAUSES OF ACTION AGAINST DOCTORS......Page 144
7.2 ACTIONS FOR NEGLIGENCE......Page 145
7.3 THE DOCTOR\'S DUTY OF CARE......Page 146
7.3.3 Duty of care in an emergency......Page 147
7.4 THE REQUIRED STANDARD OF CARE......Page 149
7.5.1 Failure to disclose risks......Page 150
7.5.2 Therapeutic privilege......Page 152
7.5.4 Failure to provide sufficient advice......Page 153
7.6 ASSESSMENT OF DAMAGES......Page 154
7.8 VICARIOUS LIABILITY......Page 155
7.9 THE MEDICAL INDEMNITY CRISIS AND ITS OUTCOMES......Page 156
7.10 ADVERSE EVENTS AND THEIR PREVENTION......Page 157
7.11 PREVENTING CLAIMS FOR NEGLIGENCE/RISK MANAGEMENT......Page 158
7.12 OPEN DISCLOSURE......Page 159
7.13 THE ROLE OF MEDICAL INDEMNITY ORGANISATIONS......Page 160
References......Page 161
Additional reading......Page 163
8 The regulation of the medical profession......Page 164
8.1 HISTORICAL BACKGROUND......Page 166
8.3 FUNCTIONS OF MEDICAL BOARDS......Page 167
8.4 THE AUSTRALIAN MEDICAL COUNCIL......Page 168
8.5 MEDICAL REGISTRATION......Page 169
8.5.2 General registration......Page 170
8.5.3 Other categories of registration......Page 171
8.7 MUTUAL RECOGNITION OF REGISTRATION......Page 172
8.9 COMPLAINTS AND DISCIPLINARY HEARINGS......Page 173
8.11 THE INVESTIGATION OF COMPLAINTS......Page 174
8.13 FORMAL HEARINGS......Page 175
8.14 WHAT CONSTITUTES UNPROFESSIONAL CONDUCT?......Page 176
8.16 NATURE OF COMPLAINTS SUBJECT TO FORMAL HEARINGS......Page 179
8.19 THE IMPAIRED PRACTITIONER......Page 180
8.20 ILLNESSES LEADING TO IMPAIRMENT......Page 181
8.21 NOTIFICATION AND HANDLING OF POSSIBLE IMPAIRMENT......Page 182
8.24 DOCTORS WHO PRACTISE ALTERNATIVE MEDICINE......Page 183
References......Page 184
9 Health-care complaints systems......Page 185
9.2 HEALTH-CARE PROFESSIONALS COVERED BY LEGISLATION......Page 187
9.4 \'SHARING’ OF COMPLAINTS......Page 188
9.6 HOW COMPLAINTS ARE HANDLED AND RESOLVED......Page 189
9.6.4 Conciliation......Page 190
9.7 THE NATURE AND SOURCE OF COMPLAINTS AGAINST DOCTORS......Page 191
9.7.2 Quality of treatment issues......Page 192
9.7.6 Access to records......Page 193
9.8 PREVENTING COMPLAINTS AND RESPONDING TO THEM......Page 194
Reference......Page 195
10 The doctor and sexual boundaries......Page 196
10.1 WHAT CONSTITUTES SEXUAL MISCONDUCT......Page 197
10.2 THE INCIDENCE OF SEXUAL MISCONDUCT......Page 198
10.4 THE PSYCHODYNAMICS OF THE BREACH OF PROFESSIONAL SEXUAL BOUNDARIES......Page 199
10.5 WHY SEXUAL MISCONDUCT BY DOCTORS IS ETHICALLY UNACCEPTABLE......Page 201
10.7 HANDLING COMPLAINTS OF SEXUAL MISCONDUCT......Page 202
10.9 FALSE ACCUSATIONS......Page 203
10.11 PREVENTION OF SEXUAL MISCONDUCT BY DOCTORS......Page 204
10.13 SEXUAL ABUSE AND SEXUAL HARASSMENT OUTSIDE THE DOCTOR–PATIENT RELATIONSHIP......Page 205
References......Page 206
Additional reading......Page 207
11.1 ETHICAL AND LEGAL RESPONSIBILITIES......Page 209
11.2.3 Depression and suicide......Page 210
11.2.5 Stress and \'burnout’......Page 211
11.3.1 A predisposing personality......Page 212
11.4 EARLY WARNING SIGNS......Page 213
11.5 ASSISTING COLLEAGUES......Page 214
11.6 TREATMENT AND REHABILITATION......Page 215
11.7 CARING FOR YOURSELF AND YOUR FAMILY......Page 216
11.9 DOCTORS WHO CARRY A TRANSMISSIBLE DISEASE......Page 217
11.9.3 Other issues......Page 218
11.11 THE ELDERLY DOCTOR......Page 219
References......Page 220
Additional reading......Page 223
12 Maintenance of professional competence......Page 224
12.1.1 Maintenance of professional standards and continuing professional development......Page 225
12.1.4 Quality assurance......Page 226
12.1.8 Recertification and maintenance of professional standards programs in Australia......Page 227
12.1.10 Clinical practice guidelines......Page 229
12.3 OTHER ACCREDITATION OR CERTIFICATION PROGRAMS......Page 230
12.4 QUALITY ASSURANCE IN PRIVATE MEDICAL PRACTICE......Page 231
12.5 FUTURE DIRECTIONS AND CONTENTIOUS AREAS......Page 232
References......Page 233
13 Ethics and the allocation of health-care resources......Page 235
13.1.1 Macro-level......Page 236
13.2 NEW APPROACHES TO RESOURCE ALLOCATION......Page 237
13.3 COMPETING CONCEPTIONS OF JUSTICE IN ALLOCATING HEALTH-CARE RESOURCES......Page 238
13.4 OTHER ETHICAL VALUES IN THE ALLOCATION OF HEALTH-CARE RESOURCES......Page 239
13.4.3 Democratic responsiveness......Page 240
13.6 THE DOCTOR AND RESOURCE ALLOCATION......Page 241
References......Page 244
Additional reading......Page 246
14.1 AN OVERVIEW OF THE HEALTH-CARE SYSTEM......Page 248
14.2 GOVERNMENT HEALTH DEPARTMENTS......Page 250
14.3 MEDICARE AUSTRALIA (FORMERLY THE HEALTH INSURANCE COMMISSION)......Page 251
14.4 MEDICARE REGULATIONS RELATING TO DOCTORS......Page 252
14.4.1 Inappropriate provision of medical services......Page 253
14.4.2 Fraud......Page 254
14.6 THE PHARMACEUTICAL BENEFITS SCHEME......Page 255
14.8 THE ROLE OF UNIVERSITIES AND COLLEGES......Page 257
14.9 TEACHING HOSPITALS......Page 258
14.11 AUSTRALIAN COUNCIL ON HEALTHCARE STANDARDS......Page 259
14.14 ALTERNATIVE HEALTH-CARE PROVIDERS......Page 260
14.15 THE NATIONAL HEALTH AND MEDICAL RESEARCH COUNCIL......Page 261
Additional reading......Page 262
15 The doctor and interprofessional relationships......Page 263
15.2 NURSES......Page 264
15.2.2 Nursing education and training......Page 265
15.2.5 Nurse practitioners......Page 266
15.2.7 Ethical codes......Page 267
15.3 PHARMACISTS......Page 268
15.3.4 Career paths......Page 270
15.3.6 Ethical codes......Page 271
15.3.7 Mutual expectations and responsibilities......Page 272
15.4.1 Education and training......Page 273
15.5 ADVICE TO DOCTORS ABOUT REQUESTING AN AMBULANCE......Page 274
15.7.2 Career paths......Page 275
15.8 DIETITIANS......Page 276
15.9 OCCUPATIONAL THERAPISTS......Page 277
15.10 OPTOMETRISTS......Page 278
15.11.2 Registration......Page 279
15.12 PODIATRISTS......Page 280
15.13.4 Ethical codes, ethical and legal restraints......Page 281
15.15.2 Career paths......Page 282
15.16.2 Registration......Page 283
15.17 CHAPLAINS AND PASTORAL-CARE WORKERS......Page 284
15.18 INTERPRETERS......Page 285
15.18.2 Mutual expectations......Page 286
15.20.1 Education and training......Page 287
15.21 POLICE......Page 288
15.22 COMPLEMENTARY AND ALTERNATIVE MEDICINE PRACTITIONERS......Page 289
15.24 OSTEOPATHS......Page 292
References......Page 293
Additional reading......Page 296
16.1 IMPORTANCE OF GOOD PRACTICE MANAGEMENT......Page 297
16.2 CHOOSING YOUR CAREER......Page 298
16.4 SETTING UP A MEDICAL PRACTICE......Page 299
16.4.4 Equipping a practice......Page 300
16.6 MEDICAL INDEMNITY......Page 301
16.8 CARING FOR STAFF AND STAFF SAFETY......Page 302
16.12 MARKETING THE PRACTICE......Page 303
16.15 PLANNING FOR RETIREMENT......Page 304
Additional reading......Page 305
17.1 CODES OF ETHICS IN CLINICAL RESEARCH......Page 306
17.2 RESEARCH GOVERNANCE......Page 307
17.4 REQUIREMENTS FOR ETHICALLY ACCEPTABLE RESEARCH......Page 308
17.5 SPECIAL AREAS IN MEDICAL RESEARCH......Page 310
17.5.2 Research involving children and young people......Page 311
17.5.4 Medical records and research......Page 312
17.6.1 Publication and dissemination of research findings......Page 313
17.6.3 Conflicts of interest......Page 314
17.9 MISCONDUCT IN MEDICAL RESEARCH......Page 315
References......Page 316
Additional reading......Page 318
18 Prescribing and administering drugs......Page 319
18.1 STANDARD SCHEDULE OF DRUGS AND POISONS......Page 320
18.2 SOME RELEVANT TERMINOLOGY......Page 322
18.3 PRESCRIBING DRUGS – GENERAL ADVICE......Page 323
18.4 COMPUTER-GENERATED PRESCRIPTIONS......Page 324
18.6 PRESCRIBING DRUGS OF DEPENDENCE......Page 325
18.7 STORAGE AND RECORD KEEPING OF DRUGS OF DEPENDENCE......Page 327
18.10 PRESCRIBING FOR PATIENTS TRAVELLING ABROAD......Page 328
18.13 PRESCRIBING DRUGS OUTSIDE THEIR SPECIFIC INDICATIONS......Page 329
18.16 RESPONSIBILITIES OF PATIENTS......Page 330
18.17 RELATIONSHIPS WITH PHARMACEUTICAL AND MEDICAL DEVICE COMPANIES......Page 331
References......Page 332
19.1 RECENT DEVELOPMENTS IN THE DIAGNOSIS OF DEATH......Page 335
19.2 RESPONSIBILITIES OF DOCTORS ATTENDING A PERSON THOUGHT TO BE DEAD......Page 336
19.3 RESPONSIBILITY FOR COMPLETING THE DEATH CERTIFICATE......Page 337
19.4 THE CAUSE OF DEATH......Page 338
19.5.2 Perinatal death certificates......Page 339
19.6 PROVIDING THE DEATH CERTIFICATE......Page 340
19.7 DEATHS REPORTABLE TO CORONERS......Page 341
19.8 SURGICAL, ANAESTHETIC AND ADVERSE EVENT-RELATED DEATHS......Page 344
19.9 DEATH RELATED TO FRACTURED NECK OF FEMUR IN THE ELDERLY......Page 345
19.10 CREMATION......Page 346
19.11 THE DIAGNOSIS OF BRAIN DEATH......Page 348
19.12 BRAIN DEATH AND TRANSPLANTATION......Page 349
References......Page 351
Additional reading......Page 352
20.1 NOTIFICATION OF BIRTHS (INCLUDING STILLBIRTHS)......Page 353
20.2 REPRODUCTIVE TECHNOLOGY......Page 354
20.3 PARENTAGE ISSUES IN AID AND IVF......Page 357
20.4 SURROGATE MOTHERHOOD......Page 358
20.5 FAMILY LAW ACT 1975 (Cth)......Page 359
20.6 CHILD ABUSE AND CHILD PROTECTION......Page 360
References......Page 362
21.1 ABORTION – HISTORICAL BACKGROUND......Page 363
21.2 ABORTION LAW IN AUSTRALIA......Page 364
21.3 THE LAW IN AUSTRALIAN CAPITAL TERRITORY AND VICTORIA......Page 366
21.5 PROPORTIONALITY OF RISK......Page 367
21.6 LATE TERM (THIRD TRIMESTER) ABORTION......Page 368
21.8 CONCEALMENT OF BIRTH......Page 369
Additional reading......Page 370
22.1 TREATMENT DECISIONS FOR NEWBORN INFANTS......Page 371
22.2 WITHHOLDING OR WITHDRAWING TREATMENT FROM CHILDREN......Page 372
22.3 REFUSAL OF MEDICAL TREATMENT......Page 373
22.4 ADVANCE CARE PLANS AND DIRECTIVES......Page 374
22.5 POST-COMA UNRESPONSIVENESS......Page 376
22.6 \'NOT FOR RESUSCITATION’ ORDERS......Page 377
22.7.2 The terminology of euthanasia......Page 379
22.8 THE STATED POSITION OF THE MEDICAL PROFESSION......Page 380
22.8.2 The law in other countries......Page 381
References......Page 382
Additional reading......Page 383
23 The law and the mentally ill......Page 384
23.1 DEFINITION OF MENTAL ILLNESS......Page 386
23.3 INVOLUNTARY ADMISSION......Page 387
23.5 PEOPLE INCAPABLE OF CARING FOR THEMSELVES......Page 388
23.8 PATIENTS’ RIGHTS......Page 389
23.10 SPECIAL TREATMENT PROCEDURES......Page 390
23.12 REVIEW AND APPEAL PROCEDURES......Page 391
References......Page 392
24.1 SOURCES AND FORMS OF LAW IN AUSTRALIA......Page 393
24.3 THE AUSTRALIAN FEDERATION......Page 394
24.6 SCHEDULES......Page 395
24.8 COMMON LAW: THE PRACTICE OF PRECEDENT......Page 396
24.10 TYPES OF AUSTRALIAN LAW: CIVIL AND CRIMINAL LAW......Page 397
24.13 CIVIL WRONGS: CONTRACT AND TORTS......Page 398
24.14 CRIMES......Page 399
Criminal jurisdiction: preliminary committal hearings......Page 400
Children\'s Courts......Page 401
Courts of intermediate jurisdiction......Page 402
High Court of Australia......Page 403
Family Court of Australia......Page 404
24.17 COMMONWEALTH OMBUDSMAN......Page 405
Additional reading......Page 406
25.1.1 Treating doctors’ reports......Page 407
25.1.2 Medico-legal examinations......Page 408
25.1.3 Content of medico-legal reports......Page 409
25.2 PROBLEMS ARISING IN MEDICO-LEGAL EXAMINATIONS......Page 411
25.3 EXPERT WITNESS REPORTS......Page 412
25.5 THE ADVERSARIAL SYSTEM......Page 414
25.6.2 Cross-examination......Page 416
25.8.1 Some statements of patients......Page 417
25.8.4 Dying deposition......Page 418
25.10 SUBPOENA......Page 419
25.12 EXPERT EVIDENCE......Page 420
25.13 THE EXPERIENCE OF BEING A MEDICAL WITNESS......Page 422
References......Page 424
Additional reading......Page 425
26.1 SOCIAL SECURITY LEGISLATION......Page 426
26.3 STATUTORY DECLARATIONS......Page 427
26.5 WORKERS COMPENSATION AND REHABILITATION......Page 428
26.7 MOTOR VEHICLE ACCIDENTS......Page 430
26.8 FITNESS TO DRIVE A MOTOR VEHICLE......Page 431
26.9 DOCTORS’ RESPONSIBILITIES TO OTHERS AT RISK......Page 432
26.11.1 HIV/AIDS......Page 433
26.11.3 Infectious diseases that are not sexually transmitted......Page 434
26.13 NOTIFICATION OF CANCER......Page 435
26.15 BLOOD SAMPLES FROM PEOPLE ACCUSED OF SERIOUS CRIME......Page 436
References......Page 437
A1.2.1 Patient care......Page 439
A1.2.3 Clinical teaching......Page 441
A1.3.1 Professional conduct......Page 442
A1.3.3 Referral to colleagues......Page 443
References......Page 444
Index......Page 446