— Dr KK Aggarwal
501: Can one refuse to treat a COVID patient ?
MCI Ethics Regulation India
2.1 Obligations to the Sick 2.1.1 Though a physician is not bound to treat each and every person asking his services, he should not only be ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of his mission and the responsibility he discharges in the course of his professional duties. In his treatment, he should never forget that the health and the lives of those entrusted to his care depend on his skill and attention. A physician should endeavour to add to the comfort of the sick by making his visits at the hour indicated to the patients. A physician advising a patient to seek service of another physician is acceptable, however, in case of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient. However, for good reason, when a patient is suffering from an ailment which is not within the range of experience of the treating physician, the physician may refuse treatment and refer the patient to another physician.
To be read with
5.2 Public and Community Health: Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine regulations and measures for the prevention of epidemic and communicable diseases. At all times the physician should notify the constituted public health authorities of every case of communicable disease under his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs, a physician should not abandon his duty for fear of contracting the disease himself.
Read together: with WMA Geneva ethics (below) a doctor is bound to look after his health first, tackle emergencies and refer the non-emergent care
502: Can a Physician refuse to treat a patient from any cult community ?
No. MCI declaration 4 “I will not permit considerations of religion, nationality, race, party politics or social standing to intervene between my duty and my patient.”
503: Can a doctor refuse to treat any other doctor with COVID symptoms ?
MCI ethics: 4.1 Dependence of Physicians on each other: A physician should consider it as a pleasure and privilege to render gratuitous service to all physicians and their immediate family dependants
504: what is World Medical Association Declaration of Geneva
The Physician’s Pledge
• Adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland, September 1948
and amended by the 22nd World Medical Assembly, Sydney, Australia, August 1968
and the 35th World Medical Assembly, Venice, Italy, October 1983
and the 46th WMA General Assembly, Stockholm, Sweden, September 1994
and editorially revised by the 170th WMA Council Session, Divonne-les-Bains, France, May 2005
and the 173rd WMA Council Session, Divonne-les-Bains, France, May 2006
and the WMA General Assembly, Chicago, United States, October 2017
AS A MEMBER OF THE MEDICAL PROFESSION:
• I SOLEMNLY PLEDGE to dedicate my life to the service of humanity.
• THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration.
• I WILL RESPECT the autonomy and dignity of my patient.
• I WILL MAINTAIN the utmost respect for human life.
• I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient.
• I WILL RESPECT the secrets that are confided in me, even after the patient has died.
• I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice.
• I WILL FOSTER the honour and noble traditions of the medical profession.
• I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due.
• I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare.
• I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard.
• I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat.
• I MAKE THESE PROMISES solemnly, freely, and upon my honour.
505: Does the declaration of Geneva talks about doctor’s health ?
A: yes.” I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard”
506. Should doctors provide emergency care without any ifs and buts ?
Up to the 1994 version of that influential document doctors promised to provide emergency care, without any ifs or buts. However, you won’t find that promise repeated in the current version of that document, so that approach doesn’t address the question at hand.
507: Is it not unethical on the part of government for not anticipating the needs of acute respiratory care ?
Democratically elected governments across have left hospitals woefully unprepared for the current onslaught of patients, not only in terms of ICU beds and ventilators, but also in terms of PPE.
If the lack of available PPE for frontline health care professionals would have been due to a natural occurrence, one could argue that doctors should be prepared to accept a certain higher degree of risk, but in the current situation that lack of protective equipment is by human ( government and the private sector) as a cost-cutting design.
There is no reason why doctors and nurses should oblige to risk their well-being today, because the government has starved them of the necessary resources to do their job safely.
508: is it ethical to create awareness about COVID 19 ?
A: MCI ethics: 7.11 A physician should not contribute to the lay press articles and give interviews regarding diseases and treatments which may have the effect of advertising himself or soliciting practices; but is open to write to the lay press under his own name on matters of public health, hygienic living or to deliver public lectures, give talks on the radio/TV/internet chat for the same purpose and send announcement of the same to lay press.
509: What are the legal implications of COVID 19 in India ?
Sec 188 IPC:* Violation of order promulgated by Govt.
Negligently doing any act known to be likely to spread infection of any disease dangerous to life
Imprisonment for 6 months or fine, or both.
Sec 270 IPC*
Malignantly doing any act known to be likely to spread infection of any disease dangerous to life
Imprisonment for 2 years, or fine, or both
Knowingly disobeying any quarantine rule:
Imprisonment for 6 months, or fine, or both *Non-cognizable.
510: What is Force majeure ?
Vis major (Latin) – meaning “superior force”, also known as cas fortuit (French) or casus fortuitus (Latin) “chance occurrence, unavoidable accident”, is a common clause in contracts that essentially frees both parties from liability or obligation when an extraordinary event or circumstance beyond the control of the parties, such as a war, strike, riot, crime, epidemic or an event described by the legal term act of God (hurricane, flood, earthquake, volcanic eruption, etc.), prevents one or both parties from fulfilling their obligations under the contract.
LIC: the clause of ‘Force Majeure’ will not apply in case of COVID-19 death claims.
Under Indian law, one of the first decisions to deal with the concept of force majeure was the Madras High Court decision in Edmund Bendit And Anr. vs Edgar Raphael Prudhomme. In this case, the Court cited with approval the passage from Matsoukis v. Priestman and Co, wherein the definition given by an eminent Belgian lawyer of force majeure as meaning “causes you cannot prevent and for which you are not responsible”, was adopted.
Under both Indian and English law, force majeure does not simply mean anything outside the control of the parties to a contract. Its meaning, and applicability, depends on the particular contract, and the particular wording used. It is contractual language intended to anticipate unforeseen events and provide for what happens on their occurrence [Chitty on contracts, Volume I, (31st Edition), Sweet & Maxwell].
511: What is Section 56 in The Indian Contract Act, 1872 ?
A: 56. Agreement to do impossible act.—An agreement to do an act impossible in itself is void. —” Contract to do act afterwards becoming impossible or unlawful.—A contract to do an act which, after the contract is made, becomes impossible, or, by reason of some event which the promisor could not prevent, unlawful, becomes void when the act becomes impossible or unlawful”.
512: Leave entitlement in Covid era ?
There is no legal requirement under Indian law to grant leave for COVID-19 patients in excess of what is statutorily mandated or contractually agreed upon.
Given the communicable nature of the disease, it may be advisable for the employers to allow affected employees to proceed on paid leave.
513: can you terminate the services of a person who is COVID positive ?
Termination – It is advisable that the employers do not terminate any employee on the ground of he/she being a COVID-19 patient or suspected patient.
514: What is entry into workplace Rule ?
A: An employer has a legal right and an obligation to prevent an employee who is suffering from communicable diseases like COVID-19 from entering the workplace for the protection of other employees.
515: What is the duty of the employer ?
A: Make provision of specific equipment such as hand sanitisers and face masks.
516: A checklist for reopening full healthcare ?
1. Crisis management: review existing policies and ensure key employees and management are familiar with them.
2. Employment issues: employers owe a duty to ensure that reasonable care is taken to safeguard the health and safety of employees at work.
3. Health care services continuity: Businesses in the health are retail and hospitality industries may be particularly affected by a lack of patients and staff in the event of widespread quarantine arrangements.
4. Dispute resolution and prevention of violence: Any epidemic will have cases of sudden expected deaths, resource limitation and delay in attending emergencies.
5. Consider carefully commercial contract terms, including force majeure and notice requirements,
6. Communication is key: clear communications will be needed with key stakeholders as to the impact of the spread of coronavirus on the healthcare business. Investors, customers, suppliers, vendors, and staff will all need to be informed about how the business is dealing with the issue and what it means for them.
7. Booking appointments and digital payment gateways as early as possible.
((The writer is President, CMAAO, HCFI and Past national President IMA))