This is mu observation and confession there is no subject that is so poorly taught in Nigerian Medical Schools and whose produce deoctors and paramedics - have very limited exposure to as that of "medical ethics and medical jurisprudence."
As a matter of fact, in a number of our medical schools, it is a recurring omission in the curriculum and where it is taught, it comes in disjointed forms, which make whatever was taught to be basically inadequate to arm the medics for future challenges in medicolegal related matters.
It is in light of the above that the book on "Ethics and Medicolegal Aspects of Medical Practice with Annotations on Military Medicine and Geneva Conventions" is seen as a welcome development when there is a crying need for a concise and yet 'loaded' publication on key aspects of medical jurisprudence with special references to the Nigerian clime. The book is authored by Dr. Emmanuel Mbonu Osuagwu, a medical graduate of the University of Nigeria, Nsukka, a retired Colonel of the Nigeria Army and a law graduate of the Ahmadu Bello University, Zaria. The Colonel is also a Fellow of the Royal College of Surgeons (FRCS) in the specialty of Anaesthesia. Although, he retired from the Nigerian Army as a Colonel in 2006, he also got engaged as Assistant Registrar and Head, Professional Discipline Department at the Medical and Dental Council of Nigeria (MDCN) soon after.
A journey through the 26 chapters in the book revealed a mastery package and an embodiment of a great insight into the subject of medical jurisprudence. Naturally, nothing less is expected from an author who had gone through life-time (:~in-l) training in the medical, legal and military disciplines.
Reading through the 250-page book not only brings to the immediate purview of the reader an in-depth understanding of the subject at hand but also alerts the reader to the potential pitfalls per professional and criminal negligence that may occur in the course of medical practice; this is especially so with those things that doctors, patients and relatives commonly take for granted. The book covers interesting and wide ranging topics in medicolegal aspect of medical practice which include - but not limited to - Regulation of medical practice in Nigeria; Ethics and ethical principle in clinical. practice; Doctor-patient relationship; Confidentiality; Consent to medical treatment; Medical malpractice/negligence; Criminal liabilities/negligence and how doctors can run into contempt of the law court in the course of practice. The book expectedly went to details on related issues in Medical Practice in Regimented Organizations like the Nigerian Armed Forces and contains some interesting annotations on the law covering the forces in armed conflict e.g. the Geneva Conventions, which has Nigeria as a signatory.
Also included in the Osuagwu's book are discussions and medicolegal considerations on some controversial issues like the 'religious' objection to blood transfusion, with particularly references to the Jehovah witnesses insistence on not getting transfusion even if medical judgment thinks otherwise; on this, the author's accounts were quire clearr and aptly unsentimental, emphasizing that the rights to receive or to reject medical treatment ultimately belong to the patient or their proxies provided he/she is of age and of sound mind. Mercy killing, abortion, etc Furthermore, in chapter 10, the book equally dwelt elaborately on the subject of Euthanasia, emphasizing the fact that though 'merry killing' could be permissible and lawful in some other climes, in Nigeria it remains a crime to take life whether mercilessly or mercifully on account of poor quality of life by medical practitioners or anybody for that matter.
In the same vein, the lawyer in the Colonel, perhaps related Catholicism too, was up in argument again on the controversial subject of Abortion, here emphasizing the illegality 'immmorality' associated with this rather not uncommon practice, in Nigeria, of terminating against the pro-choice standpoint for an extension of the right of patient's autonomy to a pregnant woman to solely determine what happened to her body and by extension the pregnancy she's carrying.
However, beyond individual's disposition, this portion of the book gives a good lead to the Criminal aspect of abortion in the environment with relevant and cogent legal citations.
Moreover, it also warned on the implication for a doctor convicted by a law court on account of participating in the act of abortion as this might be seen by the Medical and Dental Council of Nigeria as an infamous act incompatible with the status of a medical doctor and can lead to striking out the name of the doctor from the Register of Medical Practitioners in Nigeria.
Other treated topics in the 'new bible' on medical jurisprudence in Nigeria include Death, dying and dying declaration; Good Samaritan Law and the limiting factors against offering unsolicited medical services in emergency cases; Torture and capital punishment; Telemedicine; Ethical questions on Organ transplanting and medically assisted. conception.
The book also dwelt on the Coroner's law and on relevant ethicolegal issues associated with the National Health Insurance Scheme (NHIS).
Consent to medical treatment 'For me, however, my favourite take among the lots in the book is the elaborately discussed topic Practitioners in Nigeria
on "consent to medical treatment" and related issues. Particularly interesting to me here is the elaborate treatment given to understanding the importance of the patients' right to any form of medical treatment. The following extracts from the book makes an interesting reading;
Consent is the act of giving approval or acceptance to something done or proposed to be done, and is an exact conduct flowing from the person giving it.
"Consent is express when the patient authorises the practitioner orally or in writing that he consents to the modality of treatment being proposed. It is most advisable for procedures involving anaesthesia and surgery or where a procedure is very risky. Consent need not be in writing but documentation of consent may serve as a defense for the physical against a future claim that the patient was coerced.
"In cornmon law, consent to medical treatment may be express or implied.
"Consent is implied in cimnnstances where the doctor and patients without saying so directly, understand that the patient has agreed to an intervention, be it medical examination or a form of treatment.
'Thus when a patient voluntarily seeks medical attention it implies that he has given consent for doctor to treat him using the necessary care skills and expected of the ordinary medical man. Indeed the voluntary self-offer for professional care by the patient to the practitioner is an expression of consent corning from the patient It is the more common type of consent in medical practice.
"Although consent could be implied in certain situations, consent to amputate a part of the body should be exact an unequivocal. There should be no doubt that the amputee gave his consent for a part of his body to be amputated. In Okekearu V Tanko the plaintiff had his left middle finger injured following a freak accident The finger was amputated at the defendant's hospital. No effort was made at the instance of the defendant to obtain directly the consent of the plaintiff who was 14years age at the marital time before the amputation.
Rather, the defendant sought to rely on consent he purportedly obtained from the plaintiff's aunt couched in these words, 'carry on with whatsoever treatment necessary'. Dissatisfied with the resultant incapacitation in handling objects, Tanko sued, claiming damages for batter resulting from the amputation. The defendant denied negligence and pleaded that, in any case, he had consent from the plaintiff's aunt.
"The Supreme Court found that the respondent was already 14years of age by the time of the amputation of his finger and was rational enough to have given a valid consent. The Supreme Court held that effort should have been made to obtain his consent even before seeking the consent of the aunt which did not amount to a valid consent"
The above quotation typified the simple language of communication largely expressed in the book. Legal terminologies are presented in easily comprehended language for those of us 'non-learned'. This book should make an interest ing reading and it is strongly recommended to all practicing Medical Practitioners in Nigeria and beyond, Lawyers, Military personnel and the general public who as potential patients stand to benefit from knowing their rights and expectations with respect to medical treatments.
By: Goke T. Akinrogunde
Sorce : This Day News
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