Who can give consent?

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Dr KK Aggarwal

Informed consent is an integral and crucial part of medical treatment today. It is not only a procedural requirement, but also a legal requirement. Not taking consent is gross negligence. Consent has to be taken before starting a treatment or a procedure.

For consent to be valid, it should be voluntary i.e. given without coercion, informed and the patient should be competent to understand the information given.

Consent indicates a respect for patient autonomy, a very important principle of medical ethics. This means that patients have the decision making capacity and doctors need to respect their right to make decision regarding their care. And, no doctor treats a patient without informed consent.

Who can give the consent?

Informed consent must ideally be taken from the patient himself/herself.

In a traditional Indian setting, if the husband is hospitalized, the wife, at times, may not be taken into confidence by the relatives about the gravity of the situation or otherwise. Most often, it is one of the family members who usually sign the consent in such cases.

If the patient is unconscious, then the spouse should authorize one person as a legal heir to take legal decisions, in case the spouse does not want to take decisions or is not informed.

In an emergency situation when the patient is not able to give consent, then treatment may be given without consent, if there is no other person available to give consent. But, the onus lies on the doctor to prove that the treatment given was lifesaving. The facts of the case must be documented.

The Medical Council of India (regulation 7.16) states that “Before performing an operation the physician should obtain in writing the consent from the husband or wife, parent or guardian in the case of minor, or the patient himself as the case may be. In an operation which may result in sterility the consent of both husband and wife is needed”.

The MCI should revisit the regulation 7.16 and come out with a clause of “next of kin” consent or “surrogacy” consent, which should also include “all legal heirs” and not just one as part of the consent.

Disclaimer: The views expressed in this write up are entirely my own

Can NRI doctors barred abroad work in India? IMA writes to MCI

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At Delhi High Court, a bench of Acting Chief Justice Gita Mittal and Justice VK Rao, took a suo moto note to examine the issue whether Indian-origin doctors, barred from practicing by a foreign country, can practice in India?

Based on news reports that an Indian-origin doctor, who has been barred from practicing by a US court, is now treating patients in Delhi and Gurgaon, the court directed the member secretary of Delhi State Legal Services Authority, Sanjeev Jain, to verify the name and address of this doctor, carry out an immediate probe and file a report within four days; issued notice to the MCI to file a report on the mechanism, statutory regime as well as rules and regulations in place to scrutinize and check such practices and also made Ministry of Health and Family Welfare a party. The next date of hearing was on May 15.

As per the US court, the doctor has been ordered “not practice medicine in any form within the United States or any other country”

IMA Response: IMA is for a defined policy in such cases. IMA wrote to the MCI on 9th in this regard.

To
The President
Medical Council of India
New Delhi

Sub: imposing the condition of Good Standing Certificate for those who are Registered with registering authorities in other countries

Respected Madam

Greetings from Indian Medical Association!

We deem it fit to bring it to your kind notice that any Graduate or Post Graduate from our country whenever intends to register with registering authorities for practicing modern medicine in the concerned countries, he/she is required to furnish a Good Standing Certificate for their verification issued by the Medical Council of India.

This is solely to ensure that the concerned registered medical practitioner has a good track record and there is nothing against him/her, especially with reference to ethical breach and/or violation. In the same breath and vein, it is necessary that a similar condition needs to be imposed for Indian doctors who are practicing in other countries after getting registered in that country and intend to come back to India.

Imposition of similar conditions would be required for Indian students getting their MBBS or equivalent course outside India and coming back for registration in India; foreigners to India and asking for temporary license to practice and also for Indian doctors seeking multiple registrations in different states.

This would mean that before they are registered or re-registered with the registering authorities in India, they will have to furnish the similar Good Standing Certificate as a condition precedent.

This will serve the similar purpose as the Good Standing Certificate issued by the MCI serves in respect of Indian Doctors seeking registration to the competent registering authority practicing modern medicine in foreign countries.

Hence the suggestion. We are sure that the required decision will be taken, in this regard for the enforcement by all concerned.

With kind regards

Dr KK Aggarwal
National President, IMA
Padma Shri Awardee

Dr RN Tandon
Hony Secy General, IMA

Plea filed in SC against MCI Oversight panel led by Justice Lodha

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(The Hindu) A petition has been filed in the Supreme Court accusing an apex court-appointed Oversight Committee led by former Chief Justice of India R.M. Lodha of over-stepping its given job of monitoring the work of Medical Council of India (MCI).

A Constitution Bench of the Supreme Court led by Justice Anil R. Dave, in a judgment in May 2016, had invoked its rare and extraordinary powers under Article 142 of the Constitution to set up a three-member committee, headed by Justice Lodha, to oversee the functioning of the Medical Council of India (MCI) for at least a year. The 165-page verdict had endorsed a Parliamentary Standing Committee report of March 2016 that medical education and profession in the country is at its “lowest ebb” and suffering from “total system failure” due to corruption and decay.

The Committee, also comprises Professor (Dr.) Shiv Sareen (Director, Institute of Liver and Biliary Sciences) and Vinod Rai (former Comptroller & Auditor General of India).

In his writ petition, Vyapam whistleblower Anand Rai, alleged that the Committee overshot MCI and the Health Ministry’s disapproval of hundreds of applications made by medical colleges without conducting any “fresh” inspection or assessment.

The petition claimed that the panel, in August, went on to grant recognition and allowed colleges to increase student intake and even extended the time schedule for colleges to remove deficiencies based on which MCI had recommended disapproval of their applications.

Besides its actions being in violation of the strict orders of the Supreme Court, the petition claimed that the Committee acted “not only in contravention of Articles 14 and 21 of the Constitution” but also exhibited its failure to “take decisions which fulfil the test of reasonableness and which are in the larger interest of the public”.

“The impugned decisions of Respondent No 3 (Lodha Committee) have the effect of compromising the standards in medical education and training in India and shall have an adverse influence on the career interests of students undertaking the undergraduate and post-graduate courses in the field of health and medicine,” the petition alleged.

The petition said that MCI had processed several proposals from medical colleges – varying from establishment of new medical colleges to renewal of permissions to increase in seats to grant of recognition to medicine courses for 2016-17.

Of this around 150 proposals for new undergraduate courses and 118 for super-specialty courses for 2016-17 were disapproved by the ministry on the recommendations of MCI after independent verifications had found several deficiencies in the colleges.

On June 13, the petition said, the Oversight Committee intervened to give these colleges a fresh opportunity to furnish their compliances by June 22 to deficiencies pointed out by the MCI.

The MCI was then asked to conduct inspections and send reports of each of these colleges to the ministry before July 20. The MCI did so, reiterating its disapproval.

The petition alleged that the Committee, at this juncture, without conducting any fresh inspection, proceeded to approve the applications of these medical colleges.

Further, the petition alleged, the Committee, on August 12 and 13, approved a “majority” of applications by medical colleges seeking renewal of permission for 2016-17, grant of recognition for undergraduate courses and increase in intake for 2016-17.

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