Physician leaders reaffirm opposition to IAAF rules

The World Medical Association has reaffirmed its opposition to IAAF gender rules for classifying female athletes as ‘contrary to medical ethics’.

In a letter to the International Association of Athletic Federations, the WMA says ‘we stand firm against any practice requiring physicians to use their competence and skills for any other purpose than providing medical care in the best interest of their patients and in respect of their dignity’.

The IAAF rules require women athletes with specific differences in sex development to medically reduce their natural blood testosterone.

The letter from WMA leaders is in response to last week’s open letter from the IAAF which ruled that Olympian Caster Semenya must take drugs to suppress her testosterone levels to compete in certain women’s races, or she can compete with men in “any competition at any level” and “without restriction.”

The WMA letter from WMA President Dr. Leonid Eidelman and WMA Chair Dr. Frank Ulrich Montgomery notes the controversy surrounding the IAAF scientific arguments, but says its opposition to the regulations is based solely on strict ethical considerations.

They write: ‘A medical treatment (with a few legal exceptions, which do not apply here) is only justified when there is a medical need. The mere existence of an intersex condition, without the person indicating suffering and expressing the desire for an adequate treatment, does not constitute a medical indication.

‘The days when doctors or society would determine which gender a person should have are definitely over. It is the ethical duty of physicians to respect the dignity and integrity of people, regardless of whether they are female, male, intersex or transgender. Medical treatment for the sole purpose of altering the performance in sport is not permissible’.

Insight into medicolegal issues - a conference

 A first ever National Conference on “Insight on Medicolegal Issues” will be organized in New Delhi at Chinmaya Mission Auditorium, Lodhi Road on Sunday, 10th July, 2011. Over 300 doctors from across the country will be participating. The faculty will include eminent doctors and advocates. Senior advocates who will be participating in the conference are Mr. Mukul Rohtagi, Mr. Ajay Agrawal, Ms Priya, Ms Meenakshi Lekhi, Mr. M C Gupta, Mr. Sidhartha Luthra and Ms Indu Malhotra. The Medical Faculty will include Dr. Ranjit Roy Chaudhury, Dr. H S Risam, Dr. Naveen Dang, Dr. Neelam Mohan, Dr. N P Singh, Dr. Sanjiv Malik, Dr. Anupam Sibal, Dr. Ajay Gambhir, Dr. Vijay Aggarwal, Dr. Girish Tyagi and Dr. Sudhir Gupta and others. 

 The conference will be inaugurated by Justice A K Sikri, Hon’ble Judge Delhi High Court. Justice Vipin Sanghi, Hon’ble Judge Delhi High Court will be the Guest of Honour. Justice Sikri will also deliver a keynote address on the subject.

 Among the important subjects to be discussed include: Ethical issues concerning clinical trials, ethical issues for organ transplantation, Understanding court procedures, Medical negligence versus medical accidents, Doctor-Pharma relationship, handling medicolegal cases etc.

 Addressing a press conference, Padma Shri & Dr. B.C. Roy National Awardee Dr. KK Aggarwal, President Heart Care Foundation of India, said that to err is human. The Supreme Court of India has also observed that ‘Mere accident is not evidence of negligence’. It has also clarified that difference of opinion or error of judgment cannot be termed negligence and likewise, adverse reactions and medical accidents cannot be put under medical negligence. Negligence cannot be attributed to a doctor as long as he performs his duties with reasonable skill and competence.

 But, there are certain errors which are preventable but still occur. An example is wrong surgical site surgery, a sentinel event, and involves operation of a wrong site, wrong side, wrong patient and wrong surgery. In one of the recent studies of 8 hospitals, 44 such events were reported every week in the US alone. These events come under ‘never events’. The number will be much larger in our country. Never events are medical negligence unless proved otherwise, he further added.

 A doctor must always maintain the highest standards of professional conduct. He should be careful that he does not violate any rule laid down under the Code of Ethics that define uniform standards of practice.  He also has several legal responsibilities and is often required to deal with issues like consent, insanity, consent, fitness to stand trial etc. So, he needs to be aware of the law.

Dr. Girish Tyagi, Registrar Delhi Medical Council said that every effort is being made by Delhi Medical Council to reduce the gap between patients and doctors.

 Dr Vinod Khetarpal, President Delhi Medical Association said that no doctor should practice without an indemnity insurance as any medical error will require a compensation to be paid to the patient.

 The conference proceedings will be converted in the form of white paper and will be sent to Medical Council of India, Delhi Medical Council and the Government for implementation.

Can a doctor disclose his patient’s information to the relations?

As per Medical Council of India Code of Ethics Section Clause 7.14, "The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the exercise of his/her profession except – i) in a court of law under orders of the Presiding Judge; ii) in circumstances where there is a serious and identified risk to a specific person and/or community; and iii) notifiable diseases." It is his duty that he should inform public health authorities immediately about any communicable or notifiable disease. However, the MCI Act does not define all secretes of patient."

As per American Medical Association Code of Ethics (Opinion 5.05), the information disclosed to the patient, "The information disclosed to a physician by a patient should be held in confidence. The patient should feel free to make a full disclosure of information to the physician in order that the physician may most effectively provide needed services. The patient should be able to make this disclosure with the knowledge that the physician will respect the confidential nature of the communication. The physician should not reveal confidential information without the express consent of the patient, subject to certain exceptions which are ethically justified because of overriding considerations.

When a patient threatens to inflict serious physical harm to another person or to him or herself and there is a reasonable probability that the patient may carry out the threat, the physician should take reasonable precautions for the protection of the intended victim, which may include notification of law enforcement authorities." When the disclosure of the confidential information is required by the law or the court, it is the duty of the doctor to inform the patient about the same.

When a doctor is summoned by the court, he or she should disclose the minimal information required by the law and not voluntary additional information.

The AMA Code of Ethics Opinion 5.051 also talks about confidentiality of medical information after death. As per their ethics, the law does change about confidential information where the person is alive or death. Even the post mortem report is confidential information and should not be leaked to any unauthorized relation of the patient. It is the duty of the doctor who is treating a patient to ask the patient about possible names to whom he can disclose about his sickness and to what extent. In the Prabha Manchanda case, Supreme Court of India has clearly decided that even a mother has no right to give extended consent for her daughter who happens to be under anesthesia. In America, confidentiality is defined under the HIPAA Privacy Act.

The privacy rules required a doctor to make reasonable efforts to limit the amount of protected health information of the doctor used or disclosed to the minimum amount that is necessary to accomplish purpose of use or disclosure. Under the HIPAA Private Rules, a hospital is not supposed to announce the name of a patient in the OT list containing the name of a person in open or accessible to the public or disclose any information by which a third person may be able to know that a particular person is undergoing surgery or a medical treatment in the hospital. In no way the diagnosis or reasons of the disease should be disclosed to an unauthorized relation or a person. A doctor should not share the patient information with the patient’s family or friends if the patient has asked the doctor not to or if the treating doctor believes, in his or her professional judgment, the disclosure would be inappropriate.

The privacy rules, however, allow the doctor to share patient’s information with the patient’s family members or friends so long the information is limited, the information directly relevant to that person’s involvement in patient’s care. For example, a doctor may tell a person living with the patient that the patient needs plenty of rest and lots of fluids or that the patient need to be checked twice daily. A doctor is not supposed to share more information than the person needs to assist with the patient’s care.

HIPAA also prohibits doctor providing patient’s list to any representative or a device provider as this would automatically leak the patient’s disease condition to an unwanted person.