Forensic Medicine

1. Consent in Medical Practice
Dr Nikita Prabhakaran MBBS, MD
Assistant Professor

2. Consent
• ‘free and voluntary agreement, approval or
permission for compliance of some act’

4. Types of consent
• 1. Implied consent
when a patient comes to a doctor for medical
examination and treatment, consent is implied.
no separate written or oral consent for physical
examination

5. • 2. Expressed consent
consent which is expressed
written/ verbal

6. 3.Informed consent
Patient is given sufficient information
Nature and quality of all possible risks
He has the opportunity to exercise a
knowledgeable and informed decision

7. Doctor should explain:
• Condition and nature of illness
• About the diagnostic tests
• Nature and procedure of treatment which is to be
done
• Risk or benefits

8. • Calculated success rate
• Alternate treatment or procedure and its risk
and benefits
• Prognosis of treatment
• Right to refuse or accept
Above rules are called: RULES of DISCLOSURE

9. Exceptions for informed consent
• 1. Therapeutic privilege
• 2. Emergency doctrine
• 3. Therapeutic waiver
• 4. Loco parentis

10. 1. Therapeutic Privilege
• Privilege of the doctor to withold from the patient
• Certain information
• if the disclosure would cause
• serious psychological threat to the patient

11. • Note:
• matter has to be informed to the relatives
• written consent should be obtained from them

12. 2. Emergency doctrine
• Doctor can do the surgery in an unconscious
patient
• Without consent (Sec 92 IPC)
• If it is necessary to save the life of the patient

13. 3. Therapeutic waiver
• Sometimes the person may give
up his right to give consent
• By waiving it
• Any communication made to
anyone in good faith is not an
offence (Section 93 IPC)

14. 4. LOCO Parentis
• In place of a parent
• In an emergency involving children
• When parent/ guardian is not available
• consent may be given by a person who is
in charge of the child

15. Consent in medico-legal cases
• Accused:
– Usually arrested
– Law believes that his
examination would
provide sufficient
evidence
– Consent not necessary
– Can use reasonable force
(Section 53 CrPC)

16. • Victim
- cannot be examined without his consent
- if it is under a court order consent not
required

17. Is age important in giving consent???

18. Consent and age
• Child below 12 years cannot give valid consent
(Section 89 IPC)
• > 12 years for physical examination
• >18 years for surgical procedures (Section 87 and
88 IPC)

19. Invalid consent
• Section 90 IPC
• Given under fear/ misconception
• Insane person
• Of a child < 12 years of age

20. Special situation????
• Under the influence of alcohol?????

21. • Fear/ fraud / misinterpretation?????

22. • Simply written in a white paper???????

23. How ????????
• 1. Format
• 2. Signed and dated
• 3. Witnesses
• 4. If not willing,
informed refusal taken

24. • Hostel inmate < 12 years???????

25. • Artificial insemination???
• Sperm donor??
• Surrogacy???
• Husband and wife……………

26. • Any surgery on a wife???
• Husbands permission?????

27. • Organ transplantation????
• After death…. Relatives??????

28. • Medico-legal autopsy?????

29. • Sexual intercourse?????
• After 18 years….
• Otherwise statutory rape

30. Blanket consent
• Without any specification
• Not a valid defence at all

31. Exceptions of consent
1. Emergencies
2. Therapeutic privilege
3. Therapeutic waiver
4. Examination of arrested
5. Court order
6. Treatment of notifiable diseases

32. THANK YOU