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Professional behaviour, ethics and legal
issues in Gynecology
Dr. Teresita Cadiz-Brion, MD, FPOGS 17 June 2015

OUTLINE: LEGAL ISSUE: ABANDONMENT

I. Professional Behavior
II. Medical Ethics  Situations:
III. Professionalism o Unilateral dismissal of the patient by the physician
A. Old Professionalism without
B. New Professionalism o proper notice to the patient
IV. Legal Issues
o Failure to keep an express promise
A. Informed consent
B. Legal obligations to protect the patient’s interest o Failure to give proper discharge instructions
V. Common Legal Issues o Abrogating your authority to a less qualified individual
VI. Medical Malpractice Law  Strategies:
A. Types of torts o Explain coverage assignments and extent of involvement of
VII. Elements of negligence
other doctors in patient care
VIII. Physician-Patient Relationship
IX. Ethical Concerns and Principles o Do not endorse to partially trained doctors
A. Socioeconomic issues o Do not make specific promises
B. Patient preferences
C. Quality of life LEGAL ISSUE: FRAUD
D. Medical Indication
X. Issues Unique to Obstetrics  Situations
o Making false statements or representation in seeking
any benefit or payment
o Concealing or failing to disclose information affecting
PROFESSIONAL BEHAVIOUR ones right to payment
 Defined as appropriate behaviour in one’s profession o Converting any benefit or payment to another
 Basically the same in all professions: o Presenting a claim for physicians service who was not a
o Skill licensed physician
o Accountability  Strategies
o Transparency o Don’t do the above
 Establish rapport with patient and their family o Have patients sign in
 Work cooperatively and dependably with other members of the o Don’t charge for procedures for another licensed
health team physician or charge even if the physician is not
 Recognize personal limitations physically present

MEDICAL ETHICS LEGAL ISSUE: CONFIDENTIALITY

 About professional behavior  Central to trust between doctors and patients
 A study of moral values as they apply to medicine  Information is readily available to patients explaining that, unless
 Practice of the profession of medicine reflects the core values of they object, their personal information may be disclosed for the
the profession sake of their own care and for local clinical audit
 Confidentiality is an important duty, but it is not absolute. You
PROFESSIONALISM can disclose personal information if:
o It is required by the law
Old professionalism  Detachment
o He patient consents- either implicitly for the sake
 Paternalism
o of their own care
 Restricted communication with
o It is justified in the public interest
patients
o When disclosing information about a patient, you must:
 Use anonymized or coded information if practicable and if
 The most prominent ethical
it will serve the purpose
principle: Medical beneficence
 Get the patient’s express consent if identifiable information
New professionalism  Empathy
is to be disclosed for purposes other Than their care or
 Emotional engagement local clinical audit
 Open communication  Keep disclosures to a minimum necessary
 Patient-centered
COMMON LEGAL ISSUES
 The most prominent ethical
 Medical Records- the malpractice witness that never dies
principle: Patient autonomy
o Legible handwriting, events or course of cases are
described, SOAP notes (subjective, objective,
LEGAL ISSUES aassessment, and plan), avoid abbreviations
 Informed consent  Prescriptions- adverse drug events
o Right to accept or refuse care o Appropriate dose, drug, directions etc., legible, and
o Outcomes abbreviations
o Options  When things are not going as expected
o Capacity to choose o Physicians get angry or lose perspective on important
o Surrogate decision makers issues
 Legal obligations to protect the patient’s interest  Hold temper in check
o Abandonment o Do not blame patients, review your management
o Fraud o Get help early- establish good relationships with quality
o Confidentiality consultants and other paramedicals
o Advanced directives for health

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 Professional behaviour, ethics and legal issues in Gynecology 1.2

MEDICAL MALPRACTICE LAW  Legal and Ethical Obligations of the Obstetrician-Gynecologist

 Civil law empowers judges to exercise jurisdiction over the
redness of personal injuries resulting from the acts or omissions
of others.
 These injuries may arise out of a contractual agreement between
the 2 parties or from the duties to conform to a certain standard
of behavior (tort*)
o The physician must give accurate information to
the patient and not withhold any vital information
o Provide specific and in-depth information when
necessary
o Consistent with the doctrine of informed consent

* A tort is a civil wrong which unfairly causes someone else to suffer loss or harm
resulting in legal liability

THREE TYPES OF TORTS

 Intentional Tort- an act such as a battery when there is touching
of another person without permission
o Ex: surgery that is unwanted or beyond the scope of
permission
 Negligence
 Strict liability or liability without negligence-not for MD

ELEMENTS OF NEGLIGENCE
 Duty of due care established by some established –
standard of care
 Breach of duty of due care
 Compensable injury or damages
 Causal link between the breach of duty and injury or damages

All four elements must be present to prove negligence

PHYSICIAN – PATIENT RELATIONSHIP

 Duty of the physician starts when the physician patient
relationship is created
 Implied warranty that has and will exercise the
requisite skill expected of a similarly-situated health
care professional
 If a physician exercised due skill and diligence in
attending to a patient and adhered to the prevailing
standard of care, outcome does not control liability
 Includes informed consent

ETHICAL CONCERNS AND PRINCIPLES

ETHICAL CONCERN
Medical Indication
What is the best treatment?
What are the alternatives?
Quality of life
What impact will the
proposed treatment, or lack of harm or injury
it, have on the patient’s life?
Patient preferences
What does the patient want?
Socioeconomic issues
What does the patient want?
What are the needs of the
society?
ETHICAL PRINCIPLE
Beneficence
The duty to promote the
good of the patient
Non-maleficence
The duty not to inflict
Autonomy
Respect for the patient
is right for self-determination
Justice
The patient should be given
what is due

ISSUES UNIQUE TO OBSTETRICS

 Abortion or Partial birth abortion
o Life vs. Choice
o Fetus vs. Woman
o Constitutional right vs. State right
o Physician and patient vs. Legislature
 Government vs. Physician
o Government regulation of medical procedures
o Government interference with individual decision making
o What is or is not a legitimate medical procedure

 Genetic counseling and Prenatal Diagnosis

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