Medical Ethics and Law

Abstract

Background

“In Law, a man is guilty when he violates the rights of others. In Ethics, he is guilty if he only thinks of doing so.”—Immanuel Kant Medical ethics and law are integral components to ensure that healthcare is provided to the community with care and concern. It provides certain standards for health professionals to discharge the duties with utmost consideration to a suffering human being even as the society receives it with full faith and trust.

Purpose

Ethics and law are both complementary in nature .They serve similar purposes and establish certain ground rules which help in guiding human behavior. Law consists of rules and regulations that govern society and helps in maintaining the order. It is developed externally and enforced to protect the citizens. Ethics, by its very meaning, is more subjective and consists of certain principles that guide individual behavior. It is more dictated by one's morals, values and integrity. The purpose of the code of ethics is to serve as a guide for individuals to perform their duties with integrity.

Methods

There are 4 pillars of medical ethics which are defined as autonomy—respect for patient rights; beneficence—the duty to do good; non-maleficence—the duty to “not to do bad”; justice—to treat all people equally and equitably. This article is an attempt to introspect the relationship between medical ethics and law.

Results

Medical ethics have been present from the time of Hippocrates’ oath. Modern medicine codes of ethics ensure physicians strive for the highest possible standards of ethical behavior. In this world where modern tools are available for diagnostics at a price where the majority of the Indian population find it unaffordable, decision-making has become difficult.

Conclusion

Although ethics and law are closely related, they are not the same. Ethical consideration may many times exceed the need of the law especially in health care. It is adherence to ethical principles that help in creating trust between the public and the health professional. However, certain behavior perceived as ethical for few may not be considered in the same manner by others. In the present modern environment, there may be certain challenges for ethical behavior, and perhaps, the law of the land helps in effectively maintaining certain decorum and ensuring minimal trust deficit.

Introduction

In the last five decades, medicine evolved with significant changes in treatment procedures and advanced technology. Quality of care became a prerequisite, with utmost importance given to improved patient experience and clinical outcomes. The advent of private organizations paved the path for futuristic healthcare options. Advanced healthcare options made them even more expensive. However, flourishing health-insurance services helped patients to access expensive services. But, the majority are still deprived of the same.

The higher investment costs for premium hospital facility and infrastructure meant the commercialization of healthcare services. This transformation shifted the service-based healthcare sector to a business industry. Aggressive marketing strategies became inevitable to ensure investment returns. In addition, efforts to accomplish patients’ expectations burdened physicians and other healthcare personnel. Frequently, they resulted in healthcare professionals involving awkward situations. In the process, good ethical practices were often compromised.

Medical Ethics

Legal and ethical considerations are integral to medical practice to achieve desired patient care. Despite overlapping in many areas of medical practice, law, and ethics are unique with distant focus. Notably, medical ethics has transformed into a well-established discipline that bridges bioethics and bedside [1]. Medical ethics aims to improve the quality of patient care by identifying, analyzing, and attempting to resolve the ethical problems that arise in practice [2]. The legal framework and official etiquette restrain physicians from unethical practices. Furthermore, medical errors, confidentiality breaching, biomedical research, and organ donation share a regulatory framework.

A uniform, universal consensus between legal and ethical frameworks is a prerequisite for following good medical practices. They should be considered inseparable aspects of medical practices. However, moral and ethical failings among healthcare professionals are often observed [1].

Decision-Making in Clinical Practice

In regular healthcare practice, three types of decisions are made: legal, ethical, and moral. In a legal decision-making scenario, the law mandates that the choice of medical practice relies on the patient's opinion but not the health care practitioner's. However, the law providers empower the medical profession as the executive in an ethical decision-making situation. An ethical decision is a collective opinion rather than an individual where professionalism is the pivotal player [3]. The conscience of the treatment provider is crucial, and the decision is taken by oneself in a moral decision. The decision is entirely an uninhibited individual opinion, and the collective view of the medical profession was not considered. Notably, the law recognizes moral decisions with due respect, and acknowledging the right to conscientious objection to abortion is a perfect example.

Medial law and ethics are dynamic and are adaptable to the ever-changing healthcare advancements and societal values. The concerned bodies regularly address the challenges emerging due to technology, legal, and other influences. New legislation is often positioned to address the same. However, these legislations are not universal and vary per country due to cultural and societal differences [4].

What is Consent: Law or Ethics or Both?

Obtaining consent is not only an ethical obligation but also a legal compulsion. A standard consent form does not exist, and the disclosure level must be case-specific. Despite obtaining consent, doctors certainly cannot avoid legal liability. As the California Supreme Court stated, “One cannot know with certainty whether consent is valid until a lawsuit has been filed and resolved.” While taking informed consent, taking adequate precautions, and acting with care and diligence are essential. Furthermore, having a great relationship with the patient is better than well-curated informed consent. In addition to regulating medical behavior, the law should recognize the informed consent associated with legal complications.

Medical ethics and law are closely related, but far enough to be perceived uniquely by the doctors. Time and time again, ethics provided higher behavioral standards than the law. Unlike law, which varies with the nation, ethics are universal and exists beyond boundaries. Medical ethics are built on respect for fundamental human rights, core values of medical practice, and patient care [4].

The Interaction of Law and Ethics in Medical Practice

Roles of law and medical ethics overlap in many areas, and it is often difficult to dissociate the legal and ethical basis of the professional duties of doctors. For example, in addressing confidentiality issues, euthanasia, abortion, use of dangerous drugs, and medical malpractice, their roles extend to one another. Remarkably, both aspects thrive on safeguarding good medical practices to achieve the health and welfare of humanity. Abiding by the law is a prerequisite for doctors, and failing will lead to civil/criminal consequences as prescribed. In comparison, legal propositions could not enforce abiding by ethical considerations. While crafting medical laws, the opinions of medical ethics are highly regarded [5–7].

Changing Trends in Legal and Ethical Issues in Medical Practice

Novel medical advancements like human genome projects, Cloning, end-of-life care, and women’s health have attracted conflicting ethical issues against ever-changing public values. These issues are highly debatable among the medical community and other disciplines and with gained remarkable media attention. The recent increase in litigations could be attributed to improved legal and human rights awareness among the general public.

Infringement of patient rights, malpractice, and medical negligence are appealing to the media, eventually leading to a rise in medical lawsuits. The lawyers cannily utilized the thinnest legislative margins between complication and negligence in filing lawsuits with tremendous monetary value. The cascading effect led doctors to practice “defensive medicine,” waiting for the clinical reports instead of clinical judgment, leading to high medical costs. Even an unsuccessful medical trial in proving negligence can devastate a doctor’s career. The trend of so-called “Ambulance Chasers" in filing medical trials against healthcare personnel in the USA is a serious concern [8].

Scope of Law and Ethics in Medical Practice

The scope of medical laws and ethics is ever-expanding, and attempting to list vital aspects could be an inconceivable effort. The horizons of the law and ethics vary by geographical boundaries and governing bodies. Legal councils like NMC, NABH, ICMR, and Pollution Board have constituted cardinal principles and mandates for healthcare professionals and healthcare bodies in India. However, the following scope is based on the consensus statement of the medical ethics and law teachers and could be of interest to doctors as per their specialties [9, 10].

1. Official regulations & statutes of the medical practice of the country

2. Foundations of doctor-patient relationship.

3. Death and related issues

4. Reproductive medicine and genetics

5. Biomedical human research and experimentation

6. Special issues in psychiatry

7. Special issues in pediatrics.

8. Healthcare delivery and resource

9. Quality assurance

10. Technology & AI

Conclusion

All healthcare personnel and bodies should abide by medical law and ethics. Considering the constant values of doctors obliging to patient needs, the healthcare professional should clearly understand the ever-changing of their legal and ethical responsibilities [2]. In addition, their constant upskilling is a prerequisite in health care delivery. Educating patient's legal rights are equally important. Medical professionals should be able to recognize complex legal and ethical issues arising from clinical practice. A sound decision-making attitude is an essential element in contemporary medical practice. As the laws were laid out to be followed, a medical professional has to oblige, and any non-compliance may attract lawful action (10). Besides, legal fraternity should acknowledge that patient treatment, in an emergency, is not an exact science but an outcome that considers numerous variables to arrive at a decision. Failing that, healthcare will become even more expensive, and medical practice may transform into a defensive medicine strategy. Practicing defensive medicine by investing more time in documentation instead of clinical treatment will become fatal for the patient.

Furthermore, excessive workload, limited personnel, and constant fear of violence put additional stress on healthcare professionals. They may potentially endanger patient health and lead to risky situations. Doctors should be vigilant that situations exist without a single or universal answer. So, doctors should be prudent and resourceful in the current views and changes. They should be ready to consult their peers, lawyers, and ethicists when in doubt.

Data availability

Not applicable.

Declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical standard statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed consent

For this type of study informed consent is not required.