MEDICAL

JURISPRUDENCE
Medical Ethics and its historical emergence

NMC & SMC - Functions & Role

Indian Medical Register

Rights & Privileges of Doctor

Oath
 TERMINOLOGY
Forensic medicine (Legal medicine): It is the application of principle
and knowledge of medical sciences to legal purposes and legal
proceedings so as to aid in the administration of justice.

Medical jurisprudence (Latin juris: law, prudentia: knowledge or

skill): It is the application of knowledge of law in relation to practice of
medicine. It deals with legal aspects of practice of medicine. It includes:
i. Doctor-patient relationship
ii. Doctor-doctor relationship
iii. Doctor-State relationship.
 TERMINOLOGY
Medical jurisprudence deals with:
1.Regulation of the medical profession
2.Legal aspects of medical care.
It defines contractual obligations existing between a practitioner and
his patient.
Duties imposed upon a practitioner by the state.
Defines the status of a member of the medical profession, his/her
rights , obligations and duties.
Medical ethics

 Moral principles for the members of the medical profession in their

dealings with
• Each other
• Their patients
• The State.

 It is a self-imposed code of conduct assumed

voluntarily by medical professionals
Historical Emergence of Medical ethics

 1803 – The English physician Thomas Percival published Medical

Ethics and reportedly coined the phrase ‘medical ethics’

1847 – the American Medical Association adopted its first code of

ethics

The Nuremberg Code – was the first international code laying

ethical principles for clinical research. (outcome of inhuman
experiments by Nazi)
Historical Emergence of Medical ethics

 1964 - The World Medical Association (WMA) developed the

Declaration of Helsinki for clinical research.

1979 – US enunciated three basic ethical principles for research

involving human subjects (after Tuskegee’s Syphilis study)

 Respect for persons

 Beneficence (to act for the benefit of others)
 Justice
Historical Emergence of Medical ethics

 Tuskegee’s Syphilis study

Historical Emergence of Medical ethics

 1982 – the council for International Organizations of Medical

Sciences (CIOMS) developed ‘International Ethical Guidelines for
Biomedical Research Involving Human Subjects’
Historical Emergence of Medical ethics

 In India

 1980 – ICMR issued a Policy relate to ethical aspects of human research (updated in
2000 and 2006)

 2002 – the Medical Council of India (MCI) brough out the code of ethics for all
medical professionals ‘Indian Medical Council (Professional Conduct, Etiquette and
Ethics) Regulations

 2017 – ICMR issued the ‘National Ethical Guidelines for Biomedical and Health
Research Involving Human Participants.’ The purpose of these guidelines is to
safeguard the dignity, rights, safety and well-being of the human participants
involved in biomedical and health research.
 Code of Medical Ethics 2002
[Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002]
(amended in 2009 and 2020)

 The Indian Medical Council (Professional Conduct, Etiquette, and

Ethics) Regulations, 2002 lays down certain duties and responsibilities
of medical practitioners towards their patients, to the general public,
towards each other and to paramedical professionals.

At the time of registration all the doctors are self-warned about
certain unethical practices (infamous conduct) and the disciplinary
action by the SMC (warning notice).
Infamous Conduct / Professional Misconduct

 The act of a medical man which would be reasonably regarded as

disgraceful or dishonorable by his professional brethren of good
repute and competence.

 The act where the personal or professional behavior falls below that
which is expected of a doctor.
Unethical Acts

A – Alcohol
A – Association (commission)
A – Advertisement
A – Addiction
A – Abortion
A – Adultery
B – Bribery
C – Covering
D – Dichotomy (cut practice)
Medical etiquette

Conventional laws and customs of courtesy

Followed between members of same profession.
Behavior with colleagues, as he would like to have them behave with
him
Ex - he should not charge another doctor or members of his family
for professional service.
National Medical Commission

1.National Medical Commission Act 2019 (NMC Act)

2.Repealed the Indian Medical Council Act, 1956 (IMC Act)
3.NMC established in place of MCI
4.Reasons:
a. Issues with respect regulatory role of MCI
b. Allegation of corruption against MCI
c. Lack of accountability of MCI

5. Board of Governor (BoG) appointed & MCI Superseded.

6. NMC became operational from 25th Sep 2020

Constitution of NMC

33 Members
•01 Chairman
•10 Ex-officio members
•22 Part time members (19 nominated by State & UT)

Chairperson, Certain part-time members & secretory to be

appointed by the Central Govt.
Constitution of NMC

 Autonomous boards constituted by Central Govt under supervision

of NMC

1. Undergraduate Medical Education Bord (UGMEB)

2. Postgraduate Medical Education Board (PGMEB)

3. Medical Assessment & Rating Board (MARB)

4. Ethics & Medical Registration Board (EMRB) professional misconduct and

negligence cases
Powers/Functions/Role Of Nmc

1. Lay policies for:

a.Maintaining high quality & standard in med education

b.Regulating Med institutes, research, professionals

2.Assess requirements in healthcare, HR, infrastructure & develop a road map for
meeting these.

3.Ensure coordination among the autonomous boards and exercise appellate

jurisdiction above decisions of autonomous boards.
Powers/Functions/Role Of Nmc

4. Ensure compliance by the SMCs of the guidelines framed and regulation

made under this Act for effective functioning.

5. Exercise appellate jurisdiction with respect to decisions of the Autonomous

Boards

6. Frame guidelines for determination of fees and other chares in respect of 50

% seats in private medical institution and deemed to be universities.
Powers/Functions/Role Of Nmc

7. Entrance and Exit tests – NEET UG and PG, NEXT (National Exit Test)

8. Recognition of medical qualifications granted by statuary or other body - i.e.

DNB

9. Withdrawal of recognition of qualification granted by medical institutions

10. Recognition/derecognition of medical qualifications granted by medical

institution outside India
State Medical Council (SMC)

Composition of SMC –

 Medical teachers from different Universities of the State elected by

the teachers of different medical institution
 Members elected by registered medical practitioners of the state.
 Some members are nominated by the State Government.
State Medical Council (SMC)

Functions of SMC –

 Maintenance of Medical Register

 Renewal if registration
 Disciplinary control
 Removal of name of medical practitioner
 Restoration of name of medical practitioner
 State Medical Council
(SMC)

Disciplinary Control –

(As per the NMC Act, 2019 a RMP

aggrieved by the decision taken by
a SMC may appeal to the Ethics and
Medical Registration Board (EMRB)
against such action, and if further
aggreived by the decision of EMRB
may appeal to the Commission
within 60 days.)
State Medical Council (SMC)

Warning – If it is a case of first offence, doctor may be sent back

merely with warning not to repeat the same.

Penal erasure – removal of a medical practitioner’s name from the

Medical Register temporarily or permanently.

 If the name removed permanently, doctor can not practice for life. This is
known as Professional Death Sentence.
Indian Medical Register

The National Register contains the name, address and all recognized
qualifications possessed by all licensed medical practitioners.

It is duty of NMC to ensure electronic synchronization of the National

and the State Register
Rights and Privileges of Registered Medical Practitioner

Right to choose his patient (not emergency)

Right to use title and description of the qualification to his name
Right to practice medicine
Right to dispense medicine to his patient
Right to possess and supply dangerous drugs to his patients
Right to give evidence at any inquest or in the court of law, as an expert
witness
Right to issue medical/fitness certificates and medico-legal reports
Right to recovery of fees – if the patient does not pay the justified fees
Professional Oaths

A number of lofty principles have inspired and guided medical students

and practitioners since times immemorial.

They define the conduct of students, teachers and practitioners in

medicine.

The respect this profession enjoys amongst all professions owes much
to them.
Professional Oaths

Principal codes of ethics are embodied in the following oaths: -

 Charak’s Oath
The Hippocratic Oath
The Declaration of Geneva
The Pledge of Florence Nightingale
The Pharmacists’ Oath
Declaration before the Medical Council Of India
Charak’s Oath

In the eighth century B.C. Charak or Charaka the famous ancient
Indian physician enunciated an oath.

It was administered to students at the initiation of their studies in the

presence of their teacher or ‘Guru’, other teachers or ‘Adhyapaks,
members of the profession or ‘Vaidyas’ and the sacred flame of learning
or ‘ Agni’.

It was administered in Sanskrit

Charak’s Oath

A translated version is reproduced here.

“ Thou shall from envy, not cause another’s death, and pray for the welfare of all
creatures. Day and night, thou shall be engaged in the relief of patients.

Thou shall not desert a patient or commit adultery, be modest in thy attire and
appearance, not be a drunkard or sinful and not associate with abettors of crime.

Thou shall whilst entering the patient’s house, be accompanied by a person known
to the patient. The customs of a patient’s household shall not be made public”
Hippocratic Oath

Hippocrates (460-377 B.C.), the most celebrated physician in the

ancient western world, was born and practiced medicine in the island of
Cos in Greece.

He was so renowned that by common consent he is regarded as the

‘Father of Medicine’.

Medical students and practitioners pay homage to Hippocrates by

acknowledging that the principles of the Hippocratic Oath are worthy of
emulation from the moment they enter the profession.
Hippocratic Oath

I will use treatment to help the sick according to my ability and

judgment, but I will never use it to injure or harm them.
I will not give poison to anyone though asked to do, nor will I suggest
such a plan.
Similarly, I will not give a pessary to a woman to cause abortion. But in
purity and holiness I will safeguard my life and my art.
I will not use the knife either on sufferers from stone, but I will give
place to such, as are craftsmen.
Into whatsoever houses I enter, I will do so to help the sick, keeping
myself free from all intentional wrongdoing and harm, especially from
fornication with woman or man, bond or free.
Hippocratic Oath

Whatsoever in the course of practice I see or hear that ought never to

be published abroad, I will not indulge, but consider such things to be
purely secret.
Now, if I keep this oath and break it not, may I enjoy honor in my life
and art, among all men for all time; but if I transgress and forswear
myself, may the opposite befall me.”
 The Declaration Of Geneva
(As Amended By The WMA, Sydney, Australia In Aug 1968)

“At the time of being admitted as a member of the medical profession:

I solemnly pledge myself to consecrate my life to the service of humanity;
I will give to my teachers the respect and gratitude which is their due;
I will practice my profession with conscience and dignity;
The health of my patient will be my first concern;
I will respect the secrets, which are confided in me;
I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;
My colleagues will be my brothers;
I will not permit considerations of religion, nationality, race, party politics or social standing to intervene
between my duty and my patient;
I will maintain the utmost respect for human life from the time of conception; even under threat, I will not
use my medical knowledge contrary to the laws of humanity;
I make these promises solemnly, freely and upon my honour.”
Declaration Before The Medical Council Of India At
The Time Of Registration

I solemnly pledge myself to consecrate my life to service of humanity.

Even under threat, I will not use my medical knowledge contrary to the
Laws Of Humanity.
I will maintain the utmost respect for human life from the time of
conception.
I will not permit considerations of religion, nationality, race, party
politics or social standing to intervene between my duty and my patient.
I will practice my profession with conscience and dignity.
Declaration Before The Medical Council Of India At
The Time Of Registration

The health of my patient will be my first consideration.

I will respect the secrets, which are confined in me.
I will give to my teachers the respect and gratitude which is their due.
I will maintain by all means in my power, the honour and noble
traditions of medical profession.
I will treat my colleagues with all respect and dignity.
I shall abide by the code of medical ethics as enunciated in the Indian
Medical Council (Professional Conduct, Etiquette and Ethics)
Regulations 2002.
I make these promises solemnly freely and upon my honour.