Medical legal ethics I

Course outline

• Definition of medical legal issues, ethics, morals, values

• Importance of understanding legal and ethical issues
• Principles of ethics
• Key ethical issues in health
• Roles and responsibilities – assignment
• Medical legal and ethical issues
• Medical legal guidelines
• Medical legal regulations
• Sources of law
• Laws relating to labour
• Employment act
• Laws of contracts
• Patients right
• The judiciary system
• Public health act
Introduction
• OBJECTIVES
• By the end of the lesson, the learner should be able to;
• Define ethics
• State importance of ethics
• Explain the key ethical issues in the society today
Definition of terms
• Morals – standards of behavior, principles of right and wrong
• Values – principles or standards of behavior, one’s judgement of what
is important in life
• Ethics are the principles of conduct governing one's relationship with
others, basic beliefs about right or wrong
• Medical ethics are the rules of etiquette adopted by the medical
profession to regulate professional conduct with each other, also
towards their individual patients and towards the society
• Professional ethics is the inter-relationship of people working
together to achieve a certain goal
Importance of ethics
• Provides standards for the behaviours of professionals and provide
general guidelines for action
• Help to distinguish between right and wrong
• Enables a correct decision making
• Protect rights of individuals
• Contributes towards empowerment of individuals to become
responsible for their health and well – being
• Informs the individuals, families, community and other professionals
about expectations of certain profession
Principles of ethics
• Beneficence – doing good, acting for the benefit of the patient.
There’s balancing of harm and good
• Non – maleficence – not harming the patient ,choose the best
intervention for your patient. Avoid emotional, social and physical
injury
• Autonomy – freedom of choice or accepting responsibility for one’s
choice. So healthcare personnel has to obtain informed consent for
treatment. This principle does not extend to those who lack capacity
(competence) to act; - infants and children
-mental and physical disorders
• Justice – a person should be treated equally and fairly
• Confidentiality – duty to respect privileged information. Caregivers
should respect patient’s needs for privacy and use personal
information about him/her only to improve care
• Veracity / honest – obligation to tell the truth. You should provide
accurate, reality based information about their health status to the
patient
• Informed consent – provide adequate and accurate information about
a disease someone is suffering from to enable them make beneficial
decision regarding their health
Key ethical issues in health
• DNR – Do not resuscitate, from ethical standpoint. DNR orders must
balance the degree of pain involved to the potential benefits
• Patient confidentiality –
• Mandatory covid vaccination – is it ethical to force someone into
treatment?
• Healthcare accessibility – insurance policy
• Allocation of limited donor organs -
Roles and responsiblity
• Assignment.
• What is your role and responsibilities as HSS/ PTT
Medical legal & ethical issues
• Medical Issues:
• Diagnosing medical conditions and providing appropriate treatment
• Ensuring patient safety during medical procedures
• Maintaining patient confidentiality
• Prescribing medication and managing medication use
• Preventing the spread of infectious diseases
• Legal Issues:
• Adhering to laws and regulations related to healthcare
• Protecting patients' rights, including informed consent and privacy
• Addressing medical malpractice and negligence
• Managing medical records and data security
• Dealing with end-of-life care and decisions
• Ethical Issues:
• Respecting patients' autonomy and self-determination
• Avoiding discrimination based on race, ethnicity, gender, religion, or sexual
orientation
• Ensuring fairness and justice in healthcare access and distribution
• Maintaining honesty and transparency in medical communication
• Addressing conflicts of interest and ethical dilemmas in healthcare decision-
making
• It is important for healthcare professionals to be aware of these issues and to
address them appropriately to ensure the best possible care for their patients
Medical legal guidelines
• Assignment ;
• What are the medical legal guidelines in Kenya
Medical legal regulations
• Medical legal regulations refer to the laws and rules that govern the practice of
medicine and healthcare. These regulations cover a wide range of topics, including
patient privacy and confidentiality, medical malpractice, informed consent, and
medical record-keeping.
• One of the key medical legal regulations is medical malpractice law, which holds
healthcare providers accountable for any harm caused to patients as a result of
negligence or misconduct. This law helps ensure that healthcare professionals
provide high-quality care and act responsibly in their practice.
• Another important regulation is informed consent, which requires healthcare
providers to inform patients about the benefits and risks of a medical procedure or
treatment before obtaining their consent. This regulation helps ensure that
patients have the information they need to make informed decisions about their
healthcare.
• Other medical legal regulations include laws related to patient privacy
and confidentiality, such as the Health Insurance Portability and
Accountability Act (HIPAA), which sets standards for the privacy and
security of patient health information.
• Additionally, medical record-keeping regulations require healthcare
providers to maintain accurate and complete records of patient
care.Overall, medical legal regulations help ensure that healthcare
providers deliver safe and effective care to patients, while also
protecting patients' rights and privacy.
Medical legal regulations
• refer to the laws and regulations that govern the practice of medicine,
healthcare, and related fields. These regulations are put in place to protect
patients, healthcare providers, and the public as a whole. There are many
different types of medical legal regulations, including:
• Licensing and Certification: This includes the requirements for healthcare
providers to obtain a license or certification to practice medicine or
healthcare, as well as the regulations around renewing and maintaining these
licenses.
• Malpractice and Negligence: This refers to the laws and regulations that
govern medical malpractice and negligence, which occur when a healthcare
provider fails to provide a standard level of care, resulting in harm to the the
patient.
• Privacy and Confidentiality: These regulations cover the protection of
patient information and medical records, as well as the procedures for
obtaining patient consent for treatment and sharing medical
information.
• Informed Consent: This involves ensuring that patients fully
understand the risks, benefits, and alternatives to any proposed
medical treatment before providing their consent.
• Medical Ethics: This includes the ethical principles and standards that
healthcare providers must follow, including respect for patient
autonomy, beneficence, non-maleficence, and justice.
Continuation
• End of Life Care: These regulations govern the management of
terminal illnesses, pain management, and end-of-life care, including
the use of palliative care and euthanasia.
• Medical Research: These regulations govern the ethical conduct of
medical research, including the protection of human subjects,
informed consent, and scientific integrity.
• Overall, medical legal regulations are crucial to maintaining the safety,
confidentiality, and ethical conduct of healthcare providers and
ensuring the well-being of patients
Rights of a patient
• 1. Right to Appropriate Medical Care and Humane Treatment. - Every
person has a right to health and medical care corresponding to his
state of health, without any discrimination and within the limits of the
resources, manpowerand competence available for health and
medical care at the relevant time
• 2. Right to Informed Consent. - The patient has a right to a clear,
truthfuland substantial explanation, in a manner and language
understandable to the patient, of all proposed procedures, whether
diagnostic, preventive, curative, rehabilitative or therapeutic
• . Right to Privacy and Confidentiality. - The privacy of the patients
must be assured at all stages of his treatment.
• Right to Information. - In the course of his/her treatment and
hospital care, the patient or his/her legal guardian has a right to be
informed of the result of the evaluation of the nature and extent of
his/her disease
• The Right to Choose Health Care Provider and Facility. - The
patient is free to choose the health care provider to serve him as well
as the facility except when he is under the care of a service facility
• Right to emergency treatment
• right to refuse treatment
• Right to be treated with equality
• Right to seek second opinion
The law
• OBJECTIVES
• By the end of the lesson, the learner should be able to;
• Differentiate between statutory and non-statutory laws
• Describe the different sources of laws
Definition
• The law of state consists of those rules of conduct and standards
prescribed by people in authority for governing and regulating
peaceful relations between members of a particular community or
state
Purpose of law
• To promote peaceful relations among the members of community
• To ensure peace and harmony
• To prosecute those who commit criminal wrongs
• To restore wrongfully taken property
• To regulate interactions of commercial dealings among individuals
• To promote good governance
• To maintain peace and order
Sources of law in Kenya
• Are classified as statutory (written) and non-statutory (unwritten)
Statutory sources
1. The Constitution
• It is a formal document that defines rules and regulations, functions and
roles of the various government state bodies and the relation between
them and the public. A constitution is a body of fundamental principles
according to which a state or other organization is acknowledge to be
governed.
Article 2(1) of the constitution provides that the constitution is supreme
law of the republic and binds all persons and all state organs at both
level of government.
2. Acts of Parliament.
• They are also referred as legislations .Prior to the adoption of the
Constitution of 2010, Kenya was a unicameral state with only one
legislature. However, after the 2010 constitution Kenya is now a
bicameral state.
3. Subsidiary/Delegate/Subordinate.
• They refer to those laws made by persons or bodies to which
government has delegated. For example the civil procedure rules.
4. County Assembly Legislations.
• Chapter 11 of the Constitution introduced a devolved system of
government .As such the county government are empowered to make
individual county laws as per their jurisdiction.
• Article 191 of the Constitution applies to resolving of conflicts
between national and county legislation in respect of matters falling
within the concurrent jurisdictions of both levels of government
5. Foreign legislations.
• These are Acts of parliament from other countries. They include the
following
• -Acts of parliament of United Kingdom cited in Part 1 of the Schedule
in Judicature act and modified in accordance with part 11 of that
schedule.
• -Statutes of General Applications enforced in England on 12th August
1897.e.g the Indian Transfer of Property Act 1882
6. Treaties and conventions.
• Article 2(6) of the Constitution provides that any treaty and
convention ratified by Kenya shall form part of the law. E.g. the Rome
Statute.

7. General rules of international law.

• This is as per Article 2(5) of the Constitution.
Non-statutory sources
1) English common law – was developed by judges on principle of
standing by tings decided. Kenyan courts find them to be compatible
with the needs of the people.

2) Doctrine of equity – to provide a remedy for situations where the law

is not flexible enough for the usual court system to deliver a fair
resolution.

3) International customary law – consist of rules that came from a

general practice accepted as la and exists independent of treaty law.
4) African customary law – guided by various customs of Kenyan tribes,
it originates from traditions and practices of people of Kenya.

5) Islamic law – derived from Muslim religious book Quran, applied in

Kadhis court

6) Judicial Precedents – a principle or a rule that was laid downin a

previous legal case
Classification of law
1) Written and unwritten
Written- are rules that has been reduced into a written form. Are
embodied into a formal document e.g the constitution of Kenya
Unwritten- are not reduced into a written form e.g African customary
law
2) National and international
National-laws operational within the boundaries of a country
International-a body of rules that regulate relations between countries
and other international persons e.g united nations
3. Public and private laws
Public- consist field of branches which the state has an interest as
sovereign e.g criminal law, the constitution
Private- laws in which state has no directive interest e.g law of contract
4. Substantive and procedural law
Substantive- establishes the rights and obligations that govern people
and organizations
Procedural- establishes the legal rules by which substantive law is
created, applied and enforced in a court of law
5. Criminal and civil law
Criminal law involves regulations enacted and enforced by government
action, while civil law provides a remedy for individuals who need to
enforce private rights against other individuals. Some examples of civil
law are family law, wills and trusts, and contract law.
Organization of the judiciary system
• Hierarchy of courts
-superior courts
- subordinate courts
- administrative tribunals
Superior courts
• These are regarded as superior courts of records since they make law.
• Examples;
1. The supreme court – consist of the chief justice, deputy chief justice
and five other judges
2. The court of appeal – consist of not less than 12 judges with a
leader elected from them
3. The high court – consist of a number of judges prescribed by the
government
Subordinate courts
1. Resident magistrate courts – presided over by a magistrate
2. The court martial
3. Kadhis court
4. Magistrate court
Administrative tribunals
• Industrial court – consist of a judge and four other members
appointed by ministry of labour
Decides issues concerning trade disputes
• Rent tribunals – established by the minister for housing
Determines rent for certain statutory unfurnished houses
Nature of the law of tort
• Definition of tort – is an act which causes harm to a determinate
person , whether intentionally or not
• TYPES OF TORTS
• Trespass
• Nuisance
• Negligence
• Defamation
1. Trespass
Forms of trespass
• Trespass to land – committed where the plaintiff possession of land is
wrongfully interfered with it. E.g wrongful entry
• Trespass to person – any direct interference with someone
i. Assault – it is conduct or threat of violence to another that puts
someone in real danger, there must be means of carrying out the
threat into effect, it must be intentional
Examples, holding a fist, shaking a stick when near a person, pointing a
gun when loaded
I. Battery – is the actual striking of a person or mere touching in a
rude manner. Force maybe applied directly or indirectly
Examples, pouring water, touching a person in a rude manner,
unwanted kissing, spat on the face
• Trespass to goods – wrongful interference with another person’s
possession. Must be intentional
2. Nuisance
• Wrongful interference with person’s enjoyment of land or some righ
over in connection to it.
Types
• Private – smoke, noise
• Public – act which interferes with the enjoyment of right which all
members of the community are entitled to e.g right to fresh air
3.Negligence
• Is the breach of duty caused by omission to do something which a
reasonable
• man-guided upon those considerations which regulate conduct of
human affairs would do or doing something which a prudent and
reasonable man would not do.
4. Defamation
• Publication of false statement regarding another person without
lawful justification which tends to lower the reputation in the
estimation of a right thinking
Types
• Slander – this is defamation in transient or non – permanent form i.e
by word of mouth
• Libel – defamation on permanent form e.g written, tapes, film
The public health act
• Refers to all measures public or private to prevent disease, promote
health and prolong life among the population as a whole

• Its goal is to improve health outcomes for productions through the

achievement of the objective of preventing disease and health
consequences of environmental hazards and natural or manmade
disasters
Composition of PHA
• Water safety
• Food safety
• Sanitation and Housing
• Community health
• Communicable and non-communicable diseases
Public health personnel
• Health commissioners/ directors
• Public health technicians or engineers
• Public health nurse
• Epidemiologist
• Public health educators
• Doctors
• Nutrionist
Functions of public health
• Deals with issues relating to food handling
• Deals with issues relating to communicable diseases
• Deals with issues relating to housing and sanitation
• Advice local government on matters relating to communicable disease
and control
• Carry out research relating to public health
• Notification of infectious disease
Food safety
• Reducing the potential for food borne illness caused by chemical
additives, microbiological pathogens and environmental contaminants
• It consist of;
• Praparation/production
• Handling
• Packaging
• storage
Production
• Refers to the process that food goes thro before consumption
• Requirements
• Ensure there is no contaminant or pollutant present in the food after
production
• All staffs have a food handling certificate issued by a registered hospital
• High standards of cleanliness
• Production area must be well ventilated with water points and fire
extinguishing equipment
• Use ppes- remove ear rings, cover hair, dress appropriately
Handler
• Must have food handling certificate
• Dressed in appropriate PPES
• Should have short nails, put on flat shoes or rubber shoes
• Observe high level of hygiene
Packaging
• Wrapping and sealing of products to make them safe from damage
during transportation and storage
• Should use specific packaging materials
• Must be sanitized and sterilized
• Production and expiry date must be indicated
• Ink used should be quick to dry and not fade
Storage
• Must be well ventilated
• Residing in the storage area is prohibited
Sanitation and housing
• Secure shelter and basic sanitation are essential to giving a healthy
and stable life
• Poor housing is associated with increase risk of depression
• Poor sanitation is linked to transmission of communicable diseases
Importance of sanitation and hygiene
• Protect individual and family from illnesses and diseases
• Maintain good mental health
• Improve self image and self confidence
• Improve individual social status
• Increase an individual focus and productivity
• Provide better quality of life
Employment law
• Employment contract may be made orally or in writing
Elements of an employment contract
• An employment of over a month must be made in writing
• It should get the consent of the employee
• It should provide job description
• State the date of commencement of employment and the form of
duration of contract
• Employee should provide his/her particulars and fill the document of
contract and assent to it
EMPLOYMENT ACT 2007
Employment act 2007
Parts of the employment act
1.Regulation of wages – provides a manner in which wages are to be
paid, disposal and recovery of wages
Regulation orders
• Employer shall pay the employee the entire amount of wages earned
in currency of Kenya in cash or cheque or deposit to bank
• Wages should not be paid in any place where intoxicating liquor is
sold or available for supply
2. Workmen’s compensation act
• An employee has aright to be compensated for injuries suffered while
at work on any accident either in Kenya or outside Kenya
• Incase of incapacity or death the dependants has right for
compensation
• Compensation for injuries during training
• Compensation for temporally or partial or permanent disability
3. Rights and duties in employment
Responsibilities of employer
• Obtain and maintain insurance policy
• Provide basic minimum favorable conditions
• Regulate working hours
• Provide housing, water and food
• Provide medical attention
4. Termination and dismissal on employment
• where the contract is to pay wages daily terminated any day without
notice
• When the contract is to pay wages periodically a contract is
terminated at the end of the period next following the giving of notice
in writing
Grounds under which an employee maybe
dismissed
• Gross misconduct
• Redundancy
PROFESSIONAL MISCONDUCT
• Professional misconduct is unethical or unprofessional behavior that
falls short of the ethical or professional standards, guides or codes of
conduct, accepted by a particular profession.
TYPES
• 1. MINOR MISCONDUCT : which includes
• Persistent lateness
• Not completing a piece of work on time
• Not following a manager's instruction
• Doing a piece of work incorrectly
• Not managing your attendance correctly
• Not following procedures properly
2. Gross Professional Misconduct
• Gross misconduct is an employee's behavior, which is serious enough
to potentially destroys the relationship between an employer and
employee.
• The conduct must be deliberate or amount to gross negligence, and
entitles an employer to dismiss the employee with immediate effect,
without any notice.
Examples of Gross Misconduct
• Theft or fraud
• Physical violence or bullying
• Deliberate and serious damage to property
• Serious misuse of an organization's property or name
• Deliberately accessing internet sites containing pornographic or
offensive material
• Serious insubordination
• Discrimination or harassment
PROFESSIONAL STANDARDS AND
CODE OF CONDUCT
• Professional standards help meet legal responsibilities, ethics and
patients’ rights.
• By following certain standards at all times, the health care worker can
protect themselves, their employer and the patient. Some of the basic
standards are
Examples of professional standards and code
of conduct
1. Perform only those procedures for which you have been trained and
are legally permitted to do (scope of practice);
2. If asked to perform procedure for which you are not qualified,
decline;
3. Use approved, correct methods while performing any procedure
4. Follow procedure manual
5. Obtain correct authorization before performing any procedure;
6.Identify patient and obtain consent before performing any procedure;
7.Check wrist band if available: State patient’s name clearly and repeat
if necessary, ask patient their name and birth date;
8.If patient refuses, do not perform procedure;
9. Obtain written consent where needed;
10. Observe all safety precautions;
11. Keep all information confidential;
12. Think before you speak and watch everything you say;
13. Treat all patients equally;
14. Accept no tips or bribes for care;
15. If error occurs or you make a mistake, report it immediately to your
supervisor;
16. Behave professionally in dress, language, manners and actions