Emedinews:Insights on Medicolegal issues: The Therapeutic privilege of a doctor

• When two or more persons agree upon the same thing in the same sense, it is a valid consent as per the definition of the consent given in Section 13 of the Indian Contract Act. The Doctor who performs an intervention without the patient’s consent commits an offence for which he is liable as per law. Consent may be express or implied.
• Express consent in an oral or written authority by the patient to render the proposed medical/surgical treatment. Consent may be implied to conduct medical examination from the conduct of the patient who voluntarily submits to treatment under circumstances which would indicate awareness of the planned treatment impliedly authorizes the treatment, even without express consent.
• The patient has a legitimate right to determine what medical/surgical, diagnostic or therapeutic intervention has to be done on his/her own body and the doctor has to obtain a valid consent after giving full information of medical procedure to be done to the patient.
• A patient who presents himself or herself at the doctor’s clinic/hospital after appointment/purchasing OPD Card/paying doctors fee for consultation/routine medical procedure/examination by way of palpation/auscultation implies his/ her consent to treatment by the doctor/hospital.
• It is now recognized that the patient has the right to full information in patient as consumer terms, concerning his diagnosis, treatment and prognosis. He/she should also be informed about the alternative treatments/methods and its possible complications. Informed means the consent of a patient to the performance of the health care services provided by a registered medical practitioner, that prior to the consent having been given, the doctor/team of/hospital authority has informed the patient of the nature of the purposed procedure or treatment of those risks and alternative treatment or diagnosis that a reasonable patient would consider material to the decision whether or not to undergo treatment or diagnosis.
• In standard ethical/prudent practice of medicine, the doctor has a duty to disclose the information/complete information. There are  two exceptions: No disclosure is required, if the patient indicates a preference not to be informed or if the physician or surgeon believes in the exercise of sound medical judgment, that the patient’s personality is so anxiety-prone or disturbed that the information would not be processed rationally or that it would probably cause significant psychological harm or is not in the interest of his/her mental and physical health or it will cause adverse effect on good prognosis of health of the patient.
• This exception to the legal duty of full disclosure to patient as informed consent in medical care delivery is called the ‘therapeutic privilege’ of a doctor. The consultation/share the information with legal heirs another physician familiar with the patient/family doctor, with a close relative or friend of patient, or all is advisable for a treating doctor in good faith and must be documented as an extended informed consent under heading of therapeutic privilege