Скачать или смотреть HEALTH CARE LAW AND ETHICS- DOCTOR- PATIENT RELATIONSHIP - Part 2

DOCTOR–PATIENT AND HEALTH-PROFESSIONAL–PATIENT RELATIONSHIPS (PART 2)

This lecture examines the legal and ethical foundations of the doctor–patient relationship, highlighting Ghana’s Patient Charter under the Public Health Act 2012 (Act 851), the fiduciary principles that govern clinical encounters, the risks of exploitation, and modern shifts from medical paternalism toward patient-centred care. Comparative insights from Canada and the UK illustrate how different jurisdictions frame duties of disclosure, trust, and autonomy in healthcare.

1. Legal Foundations: Ghana’s Patient Charter
The Patient Charter in the Sixth Schedule to Act 851 sets out binding rights and duties of patients. It guarantees access to quality healthcare, full disclosure of diagnoses, treatment options, risks, and the identities of caregivers. Patients must give informed consent and may seek second opinions. Privacy and confidentiality are strictly protected, except where public interest or law demands disclosure. Patients also bear responsibilities: providing accurate information, complying with treatment, respecting staff and facilities, and maintaining personal and environmental hygiene to support public health.

2. Trust, Vulnerability and Fiduciary Principles
The doctor–patient relationship is built on trust. In Canada, courts characterise it as fiduciary, obliging the doctor to act with loyalty, honesty, and in the patient’s best interests. In Norberg v Wynrib, the Supreme Court held that a doctor who exploited a patient's addiction for sexual favours breached fiduciary duty. The Court stressed that true consent cannot arise where power imbalances and dependency undermine voluntariness.

3. Power Imbalance and Risks of Exploitation
Doctors possess specialised knowledge, control over treatment, and institutional authority—conditions that may expose patients to exploitation if proper safeguards fail. Moore v Regents of the University of California illustrates this risk: a doctor used a patient’s cells for lucrative research without disclosure. The Court held that doctors must reveal personal or financial interests that may influence clinical judgment. Transparency is central to protecting autonomy and informed consent.

4. UK’s Approach: From Bolam to Montgomery
UK courts historically resisted defining the relationship as fiduciary. In Sidaway, the House of Lords applied the Bolam test, holding that non-disclosure of a rare risk was not negligent if consistent with responsible medical practice. Lord Scarman’s dissent foreshadowed a shift toward patient autonomy. That shift crystallised in Montgomery v Lanarkshire Health Board (2015), where the Supreme Court held that doctors must disclose all material risks and reasonable alternatives. A risk is material if a reasonable patient would attach significance to it or if the doctor should know that the particular patient would do so. Montgomery firmly establishes a patient-centred standard of informed consent.

5. Evolving Dynamics: From Paternalism to Shared Decision-Making
Modern healthcare embraces autonomy, shared decision-making, and holistic care. Patients are no longer passive recipients of medical authority; they actively participate in choices about their health. Doctors must communicate openly, present risks and alternatives clearly, and respect patient values. Patients, in turn, must engage honestly, ask questions, provide accurate histories, and adhere to agreed treatment plans.

6. Other Health Professional–Patient Relationships
Nurses, pharmacists, physiotherapists, and allied professionals also sustain ethical duties grounded in respect, confidentiality, and patient welfare. Pharmacists educate patients on drug use, side effects, and interactions, while avoiding conflicts of interest arising from pharmaceutical incentives or commercial pressures. The Health Professions Regulatory Bodies Act 2013 (Act 857) mandates high standards of professional conduct. Nurses and allied professionals often maintain prolonged, holistic interactions with patients, addressing not only clinical but emotional and psychosocial needs. Team-based care requires coordination, clear boundaries, respect for professional roles, and communication that prioritises patient outcomes.

7. Collaborative Care and Ethical Challenges
Multidisciplinary care enhances quality but introduces challenges, including differing professional judgments and ethical dilemmas. Conflicts must be resolved using principles of autonomy, beneficence, and justice. Professionals must maintain boundaries while working cooperatively to achieve comprehensive, patient-centred outcomes.

References: Pozgar (2019); Owusu-Dapaa (2018); White & Corey (2017); Farrell et al. (2017).