8/18/2019 Medicolegal Ethics

1/4

MEDICOLEGAL & ETHICS

ConsentLegal age of consent in Oz - 16yo- 16 yo & above - treat as an adult- 14 - 16 yo - use Gillick Rule (this rule

means that you will test for the maturity ofa child aged 14-16)

MCQ: 14F comes for OCP prescription,what to do? Do Gillick scoring

Gillick scoring - ask questions like are youliving alone or with family?

IF LIVING ALONE: this means that thechild is independent - called a matureminor - give OCP.IF LIVING WITH PARENTS: informparents

Also ask:- what was the age of the partner with

whom you had sex (if gap is more than 2years, example BF is 19yo, need toinform police, this is consider abuse)

MCQ: 14 year old, mature minor who hadsex with Teacher - INFORM POLICE- you have to inform a police if the minor’srelationship is with a Teacher, Relative andPriest

MCQ: 16 yo, she’s been raped or sex wasdone without consent, what to do next?Get consent!- consent is very important for informingpolice (if she says yes, inform police)

- if she says NO (cannot inform police)1. anytime rape patient comes - takesample for future hospital records2. FULL screening for sexually transmitteddisease3. Give Azithromycin (stat dose for STI)4. Emergency contraception

MCQ: A lady wants to have OCP, comes toGP clinic and on her file, it is written, donot give OCP by husband. What to donext? Give her OCP because that’s whatthe patient’s wish.

In Vasectomy or Tubal Ligation - inform thepartner, consent is by the patient. Youdon’t need consent of partner.

MCQ: Husband calls you and he want toknow the results of her wife’s report? What

to do? Ask him to talk with wife (firstoption) OR say we cannot disclose theresults (2nd option).

12F, brought to ED, by 14-year old brother.Brother has been living independently.(Brother is mature mind). 12 year oldneeds appendicectomy. Who will giveconsent if parents are away? Brother(because brother is a mature minor).- But if there is an option call the parents,

call the parents.

CONSENT PRIORITIES:1. Patient wishes2. Parents or Partner3. First Degree Relative4. Second Degree Relative - aunt/ 

grandmother5. Call another primary caregiver - teacher6. Apply guardianship court

In an emergency situation, if the relativesgo against the benefit of the patient, 2doctors will decide what to do to thepatient.

*Jehovah’s witness - Pregnant lady comingto the emergency department for APH,Jehova’s witness. She does not wanttransfusion, what to do next? - Answer:Ask the patient to sign no transfusion form

(consent of no transfusion).

Until the child is inside the uterus, motherwill decide for the child.HOWEVEROnce the child is born, and he belongs tofamily who’s Jehova’s and soon after birthhe needs BT, 2 doctors will decide.

Under the MENTAL HEALTH LAW, we canadmit the patient involuntarily if there’s achance that he is gonna commit suicide oris dangerous to others.

8/18/2019 Medicolegal Ethics

2/4

Patient’s own wishes:MCQ: 50M, comes to ED and had cardiacarrest. He does not want to go forresuscitation. What to do? Assess MMSE.

Scenario A - if MMSE find next of kin (partner)and he/she will decide.Scenario B - if MMSE >24 - DNR

MCQ: Patient comes to ED who hadcardiac arrest, says resuscitate me, buthas previously written DNR. --> CheckMMSE.

--> if MMSE if >24 (Resuscitate)

50Man comes to ED, he needs surgery,wife says don’t go for surgery, son says nosurgery. What to do next? Follow patient’sREVIOUS WISHES (first option).

If asked in MCQ about Conflict of FamilyMembers --> arrange family meeting (2ndoption)

3rd option: apply guardianship (3rd

option).

Resuscitation:50M, comes to ED, in cardiac arrest,previously given DNR, now he saysresuscitate me. MMSE is poor. Beforeresuscitating him, call a family meeting.

ASK patient for consent especially inbreaking the bad news in front of therelatives. Or even telling the results of

laboratory in front of other family members.

Consent about brain death:Suspecting brain death, who’s gonnadecide to wean off the patient? 2 doctorswill make the decision. 1 doctor should beICU registrar, 1 doctor any registrar, noneof them should be member of thetransplant team.

Organ donation:Patient should given consent + familyconsent.

MCQ: Patient is brain dead, previouslydecided for organ decision, family agreedto it. - HARVESTMCQ: Patient previously agreed to donateorgans and now just recently died, what todo next? Ask family.

Euthanasia/Mercy Killing/PhysicianAssisted SuicideOld lady comes to GP clinic and she saysshe’s tired of her pancreatic cancer, lifewants to be ended, what to do next?Check MMSE.

Euthanasia is NOT legal in Australia. 

Old lady and she says she’s havingterminal pancreatic ca and wants to die.What to do next? Do MMSE.

- If suicidal ideation are there. -Admit.

ABOUT Doctors & Nurses

MCQ: You are working in hospital department,colleagues is taking Valium. What to do?

Advice her and ask her to seekconsultation.: You are working in hospital department,your colleague, a female surgeon, is takingoverdose of valium. What to do? Informmedical board.

: You are working in hospital department,your consultant is asking for morphine, yousaw Dr. David prescribing morphine forhim, what to do next? - Inform Medical

Board

Doctor - any misconduct on their part --Inform Medical Board/AHPRA

:Your colleague has been prescribingbenzodiazepine for himself, what to donext. - Inform medical board

:Colleague comes to your GP clinic and hewants to have sleeping pill and has acoming exam, what to do next? Ask himfor assessment.

8/18/2019 Medicolegal Ethics

3/4

Brain Death Criteria: (Handbook of clinicalassessment no 14,16)• Body Temp >35• Patient should have not taken any

CNS depressant >48• Irreversible apnoea

• No endocrine problem• No neuromuscular blocking agent for

48h• No hypoglycemia• PaCO2 >50• Major Criteria:• Pupil fixed and dilated• Absent corneal reflex• absent pain reflex• absent gag reflex• Irrevesible apneoa• absent doll’s eye reflex• no nystagmus

:Your colleague informed you that he’staking alcohol before coming to work, whatto do next? Inform medical board

NURSESYour doing rounds in the aged care, nurseis interfering with your management. WHat

to do next? Talk to her first OR Talk tonurse manager (2nd option).

Working in aged care center, other nurseinformed you that the other nurse iscrushing the tablet (that’s supposed to betaken as a whole), what to do next? Informnursing manager.

Interns working in a hospital, you find thatthe intern is stealing products from the

hospital. What to do next? Inform theintern coordinator.

You are working as a GP, patient ask youto go for a coffee. REFUSE. (not allowed)

Working in a GP practice, patient attractedto you. What to do next? Tell her that nopatient-doctor relationship is allowed.

Working in a GP practice, patient isattracted to you and you are also attractedto you. What to do next? Ask her tochange GP.

Conspiracy of Silence:- patient wants MD to lie to relative OR

patient wants MD to lie to patient- YOU cannot lie to patient (not allowed)

Relatives come, patient wants MD to lie to

relative.- if patient does not want MD to tell

relatives the results - this is OK(confidentiality)

- If MD is asked to lie - Thi is NOT OK -conspiracy of silence

Patient comes with the knife in hand, whatto do first? Remove your self in place.

If there is a patient comes to ED and nooption of remove yourself, call the security.

Anytime after breaking the bad news,make another appointment to follow up thepatient.

Patient comes to ED, he is holding a knifein hand, now he has calm down and toldyou that he has a psychiatric illness. Whatto do next? Talk to him about his

psychiatric illness when he’s calmed down.

If aggressive - call security/restrain/secureyourself

Old man in an aged care center is found tobe masturbating, if in private (OK)- if in public (call security)***

Working in a GP practice, patient offer youGP coffee - don’t accept it.

DRIVING RULES:Seizure1. New onset epilepsy: 1 year seizure free

(if holder of a license already)  - if applying for a learner’s permit

and newly diagnosed: 2 yearsseizure free seizure free2. Isolated seizure - cannot drive for 6

months3. Chronic Epilepsy - 2 years4. Patient with bitemporal hemianopia -

can never drive

8/18/2019 Medicolegal Ethics

4/4

If a patient with decreased VA continuedriving (despite being told not to), informVIC Road or licensing authority.

VA cut off for driving in Australia: 6/12

DOMESTIC ABUSE:A lady comes, has multiple bruises in thecheeks, victim of domestic abuse. What todo next? - Give her the no of socialservices and domestic violences services,- GP is not suppose to inform the police- you can only give number- but never forget to take pics

Same scenario: take photos as a witness(after giving numbers)

CHILD ABUSE:MCQ: mother brings child to emergencydepartment because child is crying more,examine child there are multiple bruises inthe body with different age, what is themost important line of investigation?Skeletal Xray.

If mother is not willing to admit the child,

call the police and admit child.

*** patient is for thyroidectomy and it wasfound that consent has not been taken,what to do next? PERSON WHO ISOPERATING HAVE TO TAKE THECONSENT