Introduction to Law

CikguOnline
CikguOnline









Introduction to Law and






medicine
















By




MADAM JULIE JAMES ABDULLAH

CikguOnline
CikguOnline


Learning Outcome













1. Basic concepts of law and medicine



2. Differences between civil and criminal law.



3. Outline laws related to healthcare in Malaysia

CikguOnline
CikguOnline

































Basic concept of laws






i. Definition of law


ii. Medicine Susceptibility


iii. Regulatory body in MOH

CikguOnline
CikguOnline


i.Definition of Law













 The earliest notion of law was relation to the rules of human

conduct, established and enforced by authority, which prohibit

extremes in behavior so that one can live without fear for oneself or

one property (Ramachandran, 2012).

CikguOnline
CikguOnline


Sources of Law













 The laws affect Assistant Medical Officers personally such as constitutional

amendments, whereas other laws such as administrative law regulates the

assistant medical officers professional acts.






 In a democratic country like Malaysia, who formulates and enforces the

laws? The ruling government in Malaysia, who is elected by the people, is

the one tasked to formulate and enforce laws.

CikguOnline
CikguOnline
ii. Medicine susceptibility











1. Dealing with life and health


2. Systems constrain



➢ Staffing problem


➢ Burn out/ fatique


➢ Communication and continuity of care



3. Public expectation and demands

CikguOnline
CikguOnline


ii. Medicine susceptibility













What does susceptible to medication mean?






 Susceptible means they can't grow if the drug is present. This means

the antibiotic is effective against the bacteria.







 Resistant means the bacteria can grow even if the drug is present.

This is a sign of an ineffective antibiotic.

CikguOnline
CikguOnline


ii. Medicine Susceptibility













1. Dealing with life and health


Medicine act in a variety of ways; some can cure illness by killing or

halting the spread of organism, some used to treat cancer by killing

cells-dividing or prevent from multiplying.






Overdoses can occur : accidently or intentional, either by recreational


or over-the counter drugs






[Akta Jualan Dadah 1952 & Peraturan Kawalan Dadah dan Kosmetik

1984]

CikguOnline
CikguOnline


ii. Medicine Susceptibility













2. Systems Constrain







a. Staffing problem

✓ Unsatisfactory quality care; patient safety has been linked to staff


shortage impact


✓ Lower patient satisfaction scores


✓ Higher patient mortality

CikguOnline
CikguOnline


ii. Medicine Susceptibility













b. Burnout & fatigue


✓ Dissatisfaction


✓ Patient experienced higher mortality and failure to rescue than

facilities with lower patient –to-nurse ratios

CikguOnline
CikguOnline


ii. Medicine Susceptibility













c. Communication & continuity of care


✓ Better communication can reduce medical errors & patient injury


✓ Poor communication can results in negatives outcomes e.g. decreased

adherence to treatment, patient dissatisfaction & in-efficient use of

resources

CikguOnline
CikguOnline


ii. Medicine Susceptibility








3. Public expectation & demands






 Patient expectation continues to increase, this need to be managed to

improve outcome



 Poor communication can results in negatives outcomes e.g. decreased

adherence to treatment, patient dissatisfaction & in-efficient use of

resources


 Understanding patient’s expectations can enhanced their satisfaction

level


 Demands for health care in case of facing illness/injury in accordance

with demand factors e.g. income, cost of care, education, social

norms and tradition, and the quality & appropriateness of service

provided

CikguOnline
CikguOnline


iii. Regulatory body in MOH






There are about 150 Acts governing the practice of medical professional


The main Acts include:



i. Medical Act 1971 (Act 50)


ii. Dental Act 1971 (Act 51)



iii. Nurses Act 1950 (Act 14) & Nurses Registration Regulations 1985



iv. Akta Pembantu Perubatan (Pendaftaran) 1977 (Akta 180)


v. Registration of Pharmacists Act 1951 (Act 371) & Registration of

Pharmacists Regulations 2004



vi. Akta Tisu Manusia 1974 (Akta 130)


vii. Akta Profesion Kesihatan Bersekutu (Akta 774)



viii.Akta pengawalan & Pencegahan Penyakit Berjangkit 1988 (Akta

342) etc

CikguOnline
CikguOnline



















Differences between






civil and criminal law

Differences Between Civil And Criminal Law
CikguOnline
CikguOnline




What is civil law? What is criminal law?




 Concerned with cases between  Relates to offences that negatively

individual person where one affect the society, rather than just

person commits offence which one person

is harmful towards another

person, their rights or property

 It’s put in place by Parliament to

prevent breaches of conduct which

 Settles disputes between they deem as harmful to the

individuals and organisations society






 Person breaches criminal law will

face criminal prosecution by the

state and will be heard in

Magistrate Court

Differences Between Civil And Criminal Law
CikguOnline
CikguOnline




What is civil law? What is criminal law?




 If you’re convicted, you’re not  Convict will received prison

likely to be sent to prison but sentence

most often liable to

compensation Example

 murder
Example

 Personal injury  manslaughter
 fraud
 Breaches of contract  assault


 Employment tribunals  sexual offences

 burglary
 Negligence

CikguOnline
CikguOnline
Civil Law vs Criminal Law









Civil Law Criminal Law




 Putting a person who has  Aim of punishing the offender in


suffered harm back in position a way that is designed to
they were in before the harm prevent them from carrying out


occur- in other words, the aim is the offence again
to set right an unfair situation
 Preventing crime has a more

general aim of creating a stable

and law-abiding society

CikguOnline
CikguOnline
Civil Law vs Criminal Law









Civil Law Criminal Law




 Less serious mistakes  Serious mistake



 Involving individual interests  Involving public interest and

safety
 Claims to court are brought by

the individuals or single  Prosecution is made by federal

organisation involved attorneys


 Out-of-court settlement is  There is NO out-of-court

encouraged settlement


 Begins when a person's privacy is  Begins when a person is accused


violated of a criminal offense

CikguOnline
CikguOnline



























Laws Related To Medical &




Healthcare In Malaysia






i. Medicine Impacting Law


ii. Law impacting medicine


iii. List of laws and regulations related to healthcare delivery


iv. Commonly used terminology in Medical Law

CikguOnline
CikguOnline


i. Medicine Impacting Law













1. Determine life/death


2. Sanity



3. Forensic medicine


4. Organ donation/preservation/transplantation


5. Consent & Confidentiality

CikguOnline
CikguOnline


1. Determine Life/Death













 Brain Death is a term which defines the clinical state by which a

person is recognized as dead when the function of the brain as whole,

including that of the brain stem, is irreversibly lost.







[GUIDELINE OF THE MALAYSIAN MEDICAL COUNCIL MMC Guideline

008/2006]

CikguOnline
CikguOnline


2. Sanity













 The Malaysian position on insanity should also be scrutinised.




 The relevant provision shall be section 84 which provided “Nothing is

an offence which is done by a person who, at the time of doing it, by

reason of unsoundness of mind, is incapable of knowing the nature of

the act, or that he is doing what is either wrong or contrary to law.”




[Akta Kesihatan Mental 2001]

CikguOnline
CikguOnline


3. Forensic Medicine













 Forensic medicine refers to the application of medical knowledge in

resolving medico-legal cases.



▪ The main function of the field is to conduct post-mortem

examinations on bodies brought in by the police to determine the

cause of death.




 A medicolegal autopsy can only be performed in a Government

hospital by a fully registered Government Medical Officer according

to Section 330 Criminal Procedure Code e.g. homicide cases, death

in suspicious, skeletal remains, living detainees or suspects & victims

of crimes

CikguOnline
CikguOnline


4. Organ donation / preservation /



transplantation








 Cardaveric donor- organ donation, that is taking organs from brain

death people as well as tissue donation from brain death people as

well as heart dead people




 Living donor: someone who is healthy & chooses to donate a kidney

to a person who needs a kidney

▪ as directed donor or non-directed donor (altruistic or Good

Samaritan)

[Malaysian Human Tissues Act 1974]

CikguOnline
CikguOnline


6. Consent And Confidentiality













➢ Malaysian male & female attaining at the age of 18 years shall be the

age of majority






[Malaysian Medical Council Guideline: Consent for Treatment of Patients

By Registered Medical Practitioners]







➢ Infant [Guardianship of Infants Act 1961]

CikguOnline
CikguOnline


Confidentiality













 Patients have the right to expect that there will be no disclosure of

any personal information, which is obtained during the course of a

practitioner's professional duties, unless they give consent.






 The justification for this information being kept confidential is that it

enhances the patient- doctor relationship.











[Confidentiality Guidelines: Malaysian Medical Council]

CikguOnline
CikguOnline


Confidentiality





 Why confidentiality is important






Confidentiality is central to the development of trust between doctors
and patients.



Patients must be able to expect that information about their health is

kept confidential unless there is a compelling reason that it should not

be.






 How do you maintain confidentiality in healthcare?



Record and use only the information necessary. Access only the
information you need.



Keep information and records physically and electronically secure

and confidential (e.g. leave your desk tidy, take care not to be overheard

when discussing cases and never discuss cases in public places.

CikguOnline
CikguOnline


ii. Law impacting medicine








 Medical law is the body of laws concerning the rights and

responsibilities of medical professionals and their patients.


▪ The main areas of focus for medical law include confidentiality,

negligence and other torts related to medical

treatment (especially medical malpractice), and criminal law and

ethics.

CikguOnline
CikguOnline


ii. Law impacting medicine








 Medicine Law is dealing with medico legal issues.


▪ It is related to court decisions, and legislation on: Medical Law,

forensic medicine, sexology and law, psychiatry and law,

psychology and law, dentistry and law, nursing law, pharmaceutical

law, medical ethics, clinical criminology, drugs, alcohol, child

abuse, medical experimentation, genetic engineering, organ

transplantation, abortion, contraception, sterilization, euthanasia,

religion, AIDS, etc.

CikguOnline
CikguOnline


ii. Law impacting medicine







 Health laws are used to formalize commitment to goals, such as the

goal of universal health coverage, creating a drive for action.







 To enable cooperation and achieve health goals, people use law to

create different organizations (such as hospitals) and relationships

(such as contracts for providing health services)

CikguOnline
CikguOnline


iii. List of laws and regulations related



to healthcare delivery








 There are about 150 Acts governing the practice of Medical
Professionals.






 Refer to List of Medical Professionals under MOH, Acts, Regulators and

APC [Source : MPC, 2014]









https://www.mpc.gov.my/wp-content/uploads/2016/10/C4-2.pdf






https://www.mpc.gov.my/wp-content/uploads/2016/04/Appendix-2-RURB-
Medical-Professional-Issue-Paper.pdf

CikguOnline
CikguOnline


iii. List of laws and regulations related



to healthcare delivery





➢ The Poison Act 1952

https://www.pharmacy.gov.my/v2/sites/default/files/document-

upload/act-366_0.pdf





➢ Poison Regulations 1952

https://www.pharmacy.gov.my/v2/sites/default/files/document-

upload/poison-regulations-1952-21082019_0.pdf

https://www.pharmacy.gov.my/v2/sites/default/files/document-

upload/poisons-act-1952-act-366.pdf




➢ Sales of Drugs Act 1952 (Revised – 1989)


http://extwprlegs1.fao.org/docs/pdf/mal189820.pdf

CikguOnline
CikguOnline


iii. List of laws and regulations related



to healthcare delivery






➢ Mental Health Act 2001


https://medicalprac.moh.gov.my/v2/uploads/mental%20health%20act%2

02001.pdf






➢ Private Healthcare Facilities and Services Act 2006



https://www.mma.org.my/images/pdfs/Link-LawOfMsiaAct/private-
healthcare-facilities-and-services-act-1998.pdf







➢ MMC Guidelines = Consent 2013; Confidentiality 2011


https://mmc.gov.my/wp-

content/uploads/2019/11/Consent_Guideline_21062016.pdf

CikguOnline
CikguOnline


iii. List of laws and regulations related



to healthcare delivery





➢ Pathology Laboratory Act 2007


https://www.patologi.gov.my/assets/policy/01_Pathology_Lab_Act.pdf





➢ Traditional and Complementary Medicine Act 2016

https://tcm.moh.gov.my/en/upload/aktaBI2016.pdf





➢ Human Tissues Act 1974


https://www.ummc.edu.my/files/ethic/MCHRS/7%20Human%20Biological%20
Materials/Act%20130%20Human%20Tissues%20Act%20(1974).pdf





➢ Personal Data Protection Act 2010


https://www.kkmm.gov.my/pdf/Personal%20Data%20Protection%20Act%2020
10.pdf

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Adjudicate: To decide a legal case.





 Affidavit: A voluntary statement or declaration of facts that has been

written down and confirmed under oath.






 Allegation: A statement made in a pleading by one of the parties to

the action which tells what that party intends to prove.






 Answer: Written response in which the defendant admits or denies
the allegations contained in the complaint.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Arbitration: A process for deciding a legal dispute without having to

go to court.






 Assumption of Risk: A defendant’s allegation that the injured plaintiff

recognized the danger of the plaintiff’s course of action but,

nonetheless, willingly chose to risk such danger.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Cancer Misdiagnosis: Caused by medical negligence when a medical

specialist fails to follow the acceptable standard of care required of

his/her medical specialty. Cancer misdiagnosis related to medical

negligence can occur when a medical professional fails to do any of

the following: pay attention or respond to a patient’s complaints or

symptoms, order the proper tests that would lead to correct

diagnosis, refer a patient to a specialist in a timely manner, or treat a

patient in the appropriate manner given their medical condition.






 Case Law: Law based on previous decisions of appellate courts.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Civil Lawsuit: Civil: Generally a lawsuit pertaining to disputes, not
involving crimes, including family matters, contracts, medical

malpractice, collection of debts, and compensation for personal

injury or property loss.


 Collateral Source Rule: Under this rule, compensation awarded to an
injured party shall not be reduced by the jury by the amount of

compensation available to him from his insurance company or other

independent sources. If there have been payments made by an
insurance company or other source for the injuries suffered, the judge

will reduce the verdict accordingly.


 Common law: Law that derives its authority solely from usages and

customs of the past.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Comparative Negligence: The doctrine of comparing degrees of fault
among the responsible parties.


 Compensation: Monetary award transferred from defendant to plaintiff to
make up for some wrong, damage or injury caused by the defendant’s

actions or inaction.


 Complainant: Also known as the plaintiff.


 Civil Complaint: The first pleading in a civil case filed by the plaintiff. It
alleges the material facts and legal theories to support the plaintiff’s

claim against the defendant.


 Contingency Fee: A fee arrangement in which the plaintiff and his or her
attorney agree that the fees due to the attorney will be determined by

the amount of the judgment granted if in the favour of the plaintiff.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Continuance: A delay of a scheduled session of a court.


 Cross-Examination: The questioning of a witness of one party by the

opposing party during a trial, hearing or deposition.


 Damages: Monetary compensation claimed by a person who has

suffered a loss or injury to his person, property or rights as a result of

the negligence or unlawful conduct of another.



 Decedent: A person who has passed away. In a medical malpractice
case, it is the person who has died due to the negligence of a medical


provider.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Decree: An order of the court. A final decree is one that fully disposes

of the litigation.


 Default: Failure of either party to file required documents or appear

in a civil case within a certain period of time.


 Defendant: The person or party sued in a civil case or accused in a

criminal case.



 Deposition: The sworn testimony of a witness, taken out of court and
usually prior to trial.



 Direct Examination: Questioning of a witness by the party who calls

the witness.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law






 Directed Verdict: A judgment entered by the judge without allowing
the jury to participate.



 Disciplinary Hearing: A hearing or professional review conducted by

any state or federal administrative agency, licensing or regulatory

authority responsible for regulating professional conduct.


 Discovery: The pre-trial process in which each party discovers the

evidence that will be relied upon at trial by the opposing party.


 Dismissal with Prejudice: An order to dismiss a case in which the court

bars the plaintiff from suing again on the same cause of action.



 Dismissal without Prejudice: An order to dismiss a case in which the
court preserves the plaintiff’s right to sue again on the same cause of


action.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Eligible Survivor: In a medical malpractice lawsuit, this term can

include living spouse and children under the age of 25 years of age.


 Evidence: A fact presented in court through the testimony of a

witness, an object or written documents.


 Exhibit: A document or object that is offered into evidence during a

trial or hearing.



 Failure to Diagnose: A form of medical malpractice committed on
behalf of a medical doctor. Failure to diagnose has the potential to


cause serious damage and even death to patients who do not receive
prompt and adequate medical care as needed because of medical


malpractice.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Fraud: Intentional deception resulting in damage to another, whether

to his or her person, rights, property or reputation. Fraud usually

consists of a misrepresentation, concealment or non-disclosure of a

material fact. Can also be misleading conduct, devices or

contrivance.


 Greater weight of the evidence: the more persuasive and convincing

force and effect of the entire evidence in the case.


 Incompetence: The inability or lack of legal qualification or fitness to

discharge the required duty.


 Illness Period: For insurance purposes, this normally begins when


covered expenses are incurred.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law







 Indemnity: An agreement wherein one party financially protects another

against an anticipated loss.

 Interrogatories: A form of discovery in which one party submits a series of
written questions to the other party, and to which the latter is bound to

answer under oath.

 Judgment: The official decision by a court, or certification by the court
of a jury’s verdict. The more formal definition is the determination or

sentence of the law, pronounced by a competent judge or court, as the
result of an action or proceeding instituted in such court, affirming that,
upon the matters submitted for its decision, a legal duty or liability does
or does not exist.


 Judgment notwithstanding the Verdict: A judgment entered by order of
the court for one party, although there has been a jury verdict for the

other party.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Liability: A legal responsibility or obligation.


 Liability Risk: Liability loss or exposure where negligent acts may

occur for which an organization may be held responsible. The act

must be injury to or property damage of others. Insurance coverage

for this type of risk is called, “third party insurance.”


 Lien: An encumbrance, upon real or personal property, that secures

the payment of a debt or the performance of a duty.


 Litigant: One of the parties involved in a legal action.



 Litigation: The process of settling a dispute through the court system.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Medical Incident: Any act, error or omission during the providing of

professional services.


 Medical Lien: The right of a hospital, doctor or health insurance

company to assert an interest in a personal injury recover to the

extent of the cost of the treatment or service provided.


 Medical Malpractice: Improper or negligent medical treatment of a

person under a medical professional’s care, which results in injury or

death.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Medical Negligence: An act or omission (failure to act) by a medical

professional that deviates from the accepted medical standard of

care. Those standards are based on what a reasonable person with the

requisite knowledge and skills would or would not do under the same

or similar circumstances.


 Misdiagnosis: A medical professional’s failure to properly identify and

diagnose a patient’s medical condition. A doctor can be held liable for

any damages that result from a misdiagnosis if the medical mistake

was a result of negligence.


 Mistrial: An erroneous invalid trial that cannot stand in law.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Negligence: Failure to exercise that degree of care that a reasonable

person would exercise under the same circumstances. When that

failure causes another person to suffer an injury or financial loss, that

person may be entitled to just compensation through our civil justice

system.


 Negligence action: a civil action for damages based upon a theory of

negligence, strict liability, products liability, professional malpractice

whether couched in terms of contract or tort, or breach of warranty

and like theories. The substance of an action, not conclusory terms

used by a party, determines whether an action is a negligence action.

CikguOnline
CikguOnline


iv. Commonly used terminology in



Medical Law








 Nursing Malpractice: An intentional act or negligence committed by a

member of the nursing profession that causes physical, financial,

cognitive, emotional or psychosocial damage to a patient under their

care.


 Nursing Home Malpractice: Any intentional act or negligence

committed by a nursing home professional which causes injury to a

resident.