Medical negligence and the Hippocratic Oath: Do the patients know their rights?

The Hippocratic Oath is an oath taken by doctors swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, the father of western medicine, in Ionic Greek late 5th century BC. Hippocratic Oath hastens the moral conduct of physicians, assuming the respect for all human life, even the unborn. Medical profession is one of the oldest professions of the world and is the most humanitarian one. Inherent in the concept of any profession is a code of conduct, containing the basic ethics that underline the moral values that govern professional practice and is aimed at upholding its dignity. Medical Ethics underpins the values at the heart of the practitioner-client relationship. Medical negligence and malpractices by doctors are grey areas in health care where legal issues arise. Medical malpractice occurs where a medical practitioner acts in a negligent manner when treating a medical condition or deviates from accepted standards of practice in the medical community and causes injury or death to the patient. Malpractice can occur from an action taken by the medical practitioner, or by the failure to take a medically appropriate action. Examples of medical malpractice include: failure to diagnose, or misdiagnosis of a disease or medical condition; failure to provide appropriate treatment for a medical condition and finally, unreasonable delay in treating a diagnosed medical condition. The laws and rules governing malpractice lawsuits in each state can vary significantly. A medical practitioner may be legally liable if a patient does not give “informed consent” to a medical procedure that results in a harm to the patient, even if the procedure is performed properly. For example, if a doctor does not tell a patient that a surgical procedure has a 50% chance of causing paralysis, the patient does not have the necessary information to make an informed choice to either have or refuse the operation. If the patient has the operation, and is paralyzed as a result, the doctor may be liable even if the operation was performed flawlessly, as the patient might have refused the surgery if the risks were known. The charter of patients from the Ministry of Health provides that all Rwandans, regardless of gender, sexual orientation, age, religion, cultural belief or handicap, are equally entitled to receive health services to promote and maintain good health. Patients also have a right to complain if services delivered are not up to standard. Law N°30/2001 of 12/116/2001 creating the Medical Council is the only instrument that so far provides deterrent measures to medical malpractice in Rwanda. Art.10 stipulates that one of the responsibilities of the Council is to punish doctors’ offences whenever they are likely to abuse the honour or dignity of the medical profession. The sanctions include a warning, a reprimand, a penalty (fine), a temporary suspension and removal from the list.(Art.33). This article comes at an opportune moment when the Rwandan penal code is under review to include in a penal clause that would severely punish medical mal practices. The Evidence Act in Rwanda provides that a person who makes an allegation must prove it. This leaves the victim (patient) in a disadvantage to the detriment of the doctor. Besides, it is also difficult for the victim to figure out the right party to sue in medical negligence cases because doctors and pharmacists have complementary roles. Whereas a doctor treats and prescribes drugs to a patient basing on the symptoms of the disease, a pharmacist provides clear information and advice about the rational use of the drug to avoid drug abuse that may lead to adverse effects of medications. It is not clear who can be held liable if a doctor prescribes a wrong drug and dosage and the pharmacist gives out the drug to the patient when he/she is more trained in that area than the doctor himself. To my opinion, both parties could be jointly and severally liable. Medical negligence cases have been highly attributed to commercialization of the medical profession. Due to long queues of patients and the need to make more money, some doctors in private practice give little attention to patients. Peer bodies like medical councils are powerful tools of discipline and rendering justice to reduce this vice but the situation in the whole world leaves much to be desired. Medical professionals are also required to maintain professional liability insurance to offset the risk and costs of lawsuits based on medical malpractice. justhappy2006@yahoo.com Happy E. Mukama is a graduate law student in the Netherlands