1. Dr.Abedalrahman Shqaidef

2. Introduction Negligence Risks Encountered as a Clinician Ethical Decision Making

3. A large variety of ethical questions (debate euthanasia and abortion). Developments in high technology medicine present us with many difficult medico-moral questions (defining death, withdrawing life-support, obtaining consent). The maintenance of standards of care and competence,

4. Risk management is about how to avoid being sued. It involves: Risk identification, Assessment of the severity of the consequences of that risk and Formulation of a policy to minimize the risk

5. Patients may bring a case against a clinician under the law of tort up to four years after the date of knowledge of the injury. A tort is a civil wrong rather than a criminal matter,

6. Intent, e.g. assault. Negligence. in diagnosis & in the delivery of treatment. Strict liability, e.g. problems arising from the use of dental products.

7. In order to prove Negligence a pt must prove A legal duty of care A breach of that duty Resultant loss or damage

8. Three need to be satisfied: A duty of care existed between the defendant (clinician) and the plaintiff (patient). That duty was breached. There is a close causal link between the breach of duty and injury

9. Used to to provide evidence of proper standard of care RCS England Management of the removal of wisdom teeth Management Of palataly ectopic canines Management Unerupted maxillary incisors

10. Consent Confidentiality Record keeping and storage Diagnosis Risks of treatment Delivery of care Termination of treatment Risks encountered as an employer or a selfemployed person

11. The case of West Norfolk and Wisbech AHA (1985) concerned a directive from the Department of Health to general medical practitioners that they were able to prescribe oral contraceptives to girls beneath the age of 16 years without parental knowledge and consent. Mrs Gillick objected strongly to this and the case was finally decided by the House of Lords.

12. ... parental right to determine whether or not their minor child below the age of 16 will have medical treatment terminates if and when the child achieves a sufficient understanding and intelligence to enable him or her to understand fully what is proposed.

13. Thus, a child could be competent at as young an age as 12 or 13 years, but the complexity/seriousness of the procedure/ operation proposed will obviously have an influence in assessing competence in such a minor.

14. Clinical records should be thorough, legible and complete. They should be contemporaneous and may be handwritten or recorded on a computer. a minimum of 11 years following the date of the last entry for adults and, in the case of minors, for 11 yrs or until the age of 25, whichever is the longer.

15. Incorrect Dx may include any aspect of patient care. It is important that medical history forms are updated regularly,

16. The test of negligence is the Bolam test, Did the clinician act as a body of responsible clinicians would have acted, and is that action good practice? This may be modified if the judge considers the expert opinion illogical

17. This highlights the importance of recording in the patient’s records every failed attendance and to co-operate It is prudent never to guarantee a result!

18. Introduction Negligence Risks Encountered as a Clinician Ethical Decision Making

19. Solving an ethical problem

20. The recent document released by the National Institute for Clinical Excellence pronounces on criteria to be used when assessing whether or not a patient should have 3 rd molars removed. Such documents should be read alongside anything else of relevance and a dispassionate analysis undertaken.

21. Autonomy, nonmaleficence, beneficence, and justice are four generally accepted ethical principles. All actions should demonstrate: Regard for self-determination (respect for autonomy); The avoidance of doing harm (nonmaleficence); The promotion of well-being (beneficence); Fairness in the distribution of goods and the reduction and avoidance of harms (justice).

22. Assess Is it true? Is it accurate? Is it fair? Is it quality? Is it legal?

23. Have you listened? Have you informed the patient? Have you explained outcomes? Have you presented alternatives?

24. Is now the best time? Is it within your ability? Is it in the best interests of the patient? Is it what you would want for yourself?

25. This highlights the importance of recording in the patient’s records every failed attendance and to co- operate It is prudent never to guarantee a result!

26. Thank you