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ELOM16 Ethical, Legal, and Organizational Medicine Ethical and Legal Issues in Canadian Medicine Toronto Notes 2019
CanMeds Competencies
• Communicator • Collaborator
• Health Advocate • Leader
• Professional
• Scholar
• Medical Expert
CPSO Policy: Ending the Physician-Patient Relationship
Discontinuing services that are needed is an act of professional misconduct unless done by patient request, alternative services are arranged, or adequate notice has been given
■ suddenly and unexpectedly
■ from disease which was not treated by a legally qualified medical practitioner ■ from any cause other than disease
■ under suspicious circumstances
■ deathfromMAiD
• coronerinvestigatesthesedeaths,aswellasdeathsthatoccurinpsychiatricinstitutions,jails,fosterhomes, nursing homes, hospitals to which a person was transferred from a facility, institution or home, etc.
• inconsultationwithforensicpathologistsandotherspecialists,thecoronerestablishes: ■ the identity of the deceased
■ where and when the death occurred
■ the medical cause of death
■ the means of death (i.e. natural, accidental, suicide, homicide, or undetermined)
• coronersdonotmakedecisionsregardingcriminalityorlegalresponsibility
• whiletheSupremeCourtofCanadanotedthatnothingintheCarterv.Canadadecisioncompelleda
physician to participate in MAiD, the College of Physicians and Surgeons of Ontario mandatory referral policy, which has been upheld by the courts, requires physicians in Ontario to provide an effective referral if the physician conscientiously objects to MAiD
■ the impact of MAiD on religious institutions’ obligation towards patients is not yet clear
Physician Competence and Professional Conduct
CanMEDS Competencies (Ethical/Policy Statement)
• aframeworkofprofessionalcompetenciesestablishedbytheMedicalCouncilofCanada(MCC)as objectives for the MCC Qualifying Exam
• furtherinformationonMedicalCouncilofCanadaobjectivescanbefoundatwww.mcc.ca
Legal Considerations
• physicians’conductandcompetencearelegallyregulatedtoprotectpatientsandsocietyviamandatory membership to provincial governing bodies (e.g. the CPSO)
• physiciansarelegallyrequiredtomaintainalicensewiththeappropriateauthority,andarethuslegally bound to outlined policies on matters of conduct within his/her medical practice
• theultimateconstraintonMDbehaviourwithregardstounprofessionalismis‘conductunbecoming a physician’, such as inappropriate behaviour with colleagues, conflicts of interest, untruthfulness, unethical billing practices, and sexual impropriety with patients
Common Policies on Physician Conduct
• physiciansmustensurethatpatientshaveaccesstocontinuouson-callcoverageandarenever abandoned
■ physicians are required to comply with the law, which include human rights laws. A failure to accommodate a disability in violation of human rights legislation, can result in the regulatory body sanctioning the physician in addition to any penalties assigned by the human rights tribunal
• sexualconductwithpatients,evenwhenconsentedtobythepatient,isaseriousmatterthatcanlead to accusations of battery by the patient and provincial governing body. Important notes on this topic include:
■ inappropriate sexual conduct includes intercourse, undue touching, references to sexual matters, sexual jokes, and physician presence when capable patients undress or dress
■ in specified situations, physicians may have a personal relationship with a patient provided a year has passed since the last therapeutic contact
■ physicians are permanently prohibited from personal relationships with patients whom they saw for psychotherapy
■ in Ontario, physicians must report any colleagues of whom they have information regarding sexual impropriety (as per CPSO Code of Ethics)
• physicians must maintain adequate records for each patient, which include: ■ demonstration that care has been continuous and comprehensive
■ minimal standards for record-keeping, including readability, diagnosis, differential diagnosis,
appropriate tests and referrals, and a coherent patient record, including drugs, a cumulative patient profile, all aspects of charting that are required for safe patient care (full standards available at www. cpso.on.ca). Another physician should be able to take over the safe care of the patient based on the record
■ records stored for 10 years in most jurisdictions
■ although the medical record is the property of the physician or an institution, the patient or the
patient’s delegate must be allowed full access to information in the medical record in a reasonable
period of time, and can charge a reasonable fee, upon (usually written) request
• inthehospital,physiciansmustensuretheirowncompetence,respecthospitalby-lawsandregulations,
practice only within the limits of granted privileges, cooperate with other hospital personnel, and maintain adequate hospital records
CMA Code of Ethics
Report any unprofessional conduct by colleagues to the appropriate authority
CPSO Policy: Treating Self and Family Members
Physicians will not diagnose or treat themselves or family members except for minor conditions or in emergencies and then only if no other physician is readily available