LEGAL MEDICINE

Patient’s Right
Dr-Atty. Malaya Capulong
4th Shifting
January16,2009
S.M.V.

PATEINT’S RIGHT • Provide enough information or choice, but not so

• Patients should receive treatment consistent with much as to coerce or frighten patients into
the dignity and respect they are owed as human compliance.
beings.
• The Physician Standard
• UNIVERSAL DECLARATION OF HUMAN RIGHTS  What a reasonable physician would consider
 Basis of Patient’s rights it necessary to disclose.
 Formalized in 1948
 Recognizes “the inherent dignity” and the • Reasonable Person Standard
“equal and unalienable rights of all members
 What a reasonable, prudent person in the
of the human family”
patient’s position would find material to
 Depends upon prevailing cultural and social know
norms
• The focus is on risk, both of following and not
• The right to receive information from physicians and
following medical options, including the physician’s
to discuss the benefits, risks, and costs of recommended option.
appropriate treatment alternatives.
 What the doctor is proposing
• The right to make decisions regarding health care
 Whether the doctor’s proposal is a minor
that is recommended by the physicians.
procedure or major surgery
 The nature and purpose of the treatment
INFORMED CONSENT
 Intended effects versus possible side effects
• The NUREMBERG CODE of 1947  The risks and anticipated benefits involved
 “the voluntary consent of the human subject  All reasonable alternative
is absolutely essential

• NAZI EUGENIC PROGRAM • Valid Informed Consent

 Forxed sterilizatuin
 Action T4 – systematically killed between
200,000 to 250,000 people with intellectual
or physical disabilities.
• The TUSKEGEE EXPERIMENTS, 1932-1972
 US Public Health Service study
- 400 Negro men
- diagnosis was withheld
- not given treatment
• Respect for a patient’s right to self-determination
• A choice can only be valid if it is based on adequate
knowledge.
• Medical Paternalism
 “the doctor knows best” and patients were
expected to follow “doctor’s orders.
• A patient knows best his own temperament and
disposition.
• Treating patients in a paternalistic manner
unethical because it demeans a patient.
 Disclosure of appropriate information to a
competent patient who is permitted to make
a voluntary choice.
• Strike a proper balance between respecting the
autonomy of patients who are capable of making
informed decisions and protecting those with
cognitive impairment.
• Elements of Disclosure
 The prognosis if the patient remains
untreated.
 Alternative treatment goals and accessible
means of treatment to serve such goals.
 Success and failure rates of treatment
options.
 Known effects and materials risks of
treatment options, and their likelihood to
occur.
 The limits of relevant knowledge.
• Even when a patient’s condition presents only one
choice of medical intervention, the patient still has
an option, namely to decline it.
is

MARY YVETTE ALLAIN TINA RALPH SHERYL BART HONEY PIPOY TLE JAM CECILLE DENESSE VINCE HOOPS CES XTIAN LAINEY RIZ KIX EZRA GOLDIE BUFF MONA AM MAAN ADI KC PENG
KARLA ALPHE AARON KYTH ANNE EISA KRING CANDY ISAY MARCO JOSHUA FARS RAIN JASSIE MIKA SHAR ERIKA MAQUI VIKI JOAN PREI KATE BAM AMS HANNAH MEMAY PAU RACHE
ESTHER JOEL GLENN TONI
 OPHTHALMOLOGY
• The legal duty of care requires specialists to conform
to the standard of knowledge and skill expected
within the specialty.
• Even successful treatments can have significant
adverse effects of which patients must be informed
and warned.
• Inform patient that not every possible effect of
treatment options is known
Physician should abandon any residual posture
of omniscience!
• Physicians are not guarantors of the effectiveness or
safety of their procedures, but may be liable for
appearing to claim that specific effects will be
achieved or, in particular, that certain feared results
cannot occur.
Evaluating the ethics of clinical research studies:
 Value
 Scientific validity
 Fair subject selection
 Favorable risk-benefit ratio
 Independent review
 Informed consent
 Respect for enrolled subjects
Consent is not an event or a signed form, but
an on-going process or quality in the physician-
patient relationship.
Phase1, 2, 3, 4 Drug Trials:
• Different stages of testing drugs in humans, from
the first application in humans (Phase 1)
through limited and broad clinical tests (Phase
3), to post-marketing studies (Phase 4)
Contents of an Informed Consent:
• A statement that the study involves research
• An explanation of the purposes of the research
and the expected duration of the subject’s
participation
• A description of the procedures to be followed
• Identification of the procedures that are
experimental
• A description of any reasonably foreseeable risks
and or discomforts to the subject
• A description of any benefits to the subject or
others
• A disclosure of appropriate alternative measures
or courses of treatment
• A statement describing the extent, if any, to
which confidentiality of the records identifying
the subject will be maintained
Preventive Ophthalmology
Page 2 of 3
• For research involving more than the minimal
risk, an explanation as to whether any
compensation and any medical treatments are
available if injury occurs
ADVANCE DIRECTIVES
• Written instruction recognized under state law
relating to the provision of health care when the
individual is incapacitated
• Karen Ann Quinlan – 1976, New Jersey Supreme
Court
• Nancy Beth Cruzan – 1990, US Supreme Court
Living Will
• A written, legal document that describes the
kind of medical treatments or life-sustaining
treatments a person would want if he were
seriously or terminally ill
• A living will doesn’t appoint someone to make
decisions for the patient
Durable Power of Attorney for Health Care
(DPAHC)
• A patient designates an agent to make health
care decisions for them if they become mentally
incapacitated
• It becomes active any time the patient is
unconscious or unable to make medical
decisions
• The agent is not empowered to make decisions
on behalf of the patient unless the patient is
deemed, usually by his or her physicians, to be
incapable of an informed consent or refusal
• The physicians are legally bound to respect an
agent’s wishes
• The agent must act consistently with the terms
of the DPAHC, as well as with the patient’s
known wishes
• The agent must act in the patient’s best
interests
Do Not Resuscitate (DNR) Order
• A request not to have cardiopulmonary
resuscitation (CPR) if the patient’s heart stops or
if he stops breathing
FILLER: Tips for a better year
Health:
• Drink plenty of water.
• Eat breakfast like a king, lunch like a prince and dinner
like a beggar.
• Eat more foods that grow on trees and plants and eat
less food that is manufactured in plants.
• Live with the 3 E's -- Energy, Enthusiasm, and
Empathy.
• Make time to practice meditation, yoga, and prayer.
• Play more games.
• Read more books than you did in 2008.
 OPHTHALMOLOGY
Preventive Ophthalmology
Page 3 of 3

• Sit in silence for at least 10 minutes each day. • When you awake alive in the morning, thank GOD for
• Sleep for 7 hours.
•
it.
Your Inner most is always happy. So, be happy.
• Take a 10-30 minutes walk every day. And while you
walk, smile.

Personality:
• Don't compare your life to others'. You have no idea
what their journey is all about.
• Don't have negative thoughts or things you cannot
control. Instead invest your energy in the positive
present moment.
• Don't over do. Keep your limits.
• Don't take yourself so seriously. No one else does.
• Don't waste your precious energy on gossip.
• Dream more while you are awake.
• Envy is a waste of time. You already have all you need.
• Forget issues of the past. Don't remind your partner
with his/her mistakes of the past. That will ruin your
resent happiness.
• Life is too short to waste time hating anyone. Don't
hate others.
• Make peace with your past so it won't spoil the
present.
• No one is in charge of your happiness except you.
• Realize that life is a school and you are here to learn.
Problems are simply part of the curriculum that appear
and fade away like algebra class but the lessons you
learn will last a lifetime.
• Smile and laugh more.
• You don't have to win every argument. Agree to
disagree.

Society:
• Call your family often.
• Each day give something good to others.
• Forgive everyone for everything.
• Spend time with people over the age of 70 & under the
age of 6.
• Try to make at least three people smile each day.
• What other people think of you is none of your
business.
• Your job won't take care of you when you are sick. Your
friends will. Stay in touch.

Life:
• Do the right thing!
• Get rid of anything that isn't useful, beautiful or joyful.
• GOD heals everything.
• However good or bad a situation is, it will change.
• No matter how you feel, get up, dress up and show up.
• The best is yet to come.