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★ Medical Law

Medical Law: see Law & Medicine & Doctor & Nurse & Hospital & Hurt & Harm & Damage & Surgery & Negligence & Consent

Alderson B & Blyth v Birmingham Waterworks 1856 - Alexander Capron - Robins JA & Malette v Shulman 1990 - Goff LJ & J Donaldson & Sidaway v Governors of Bethlem Hospital 1985 - I Kennedy & A Grubb - Lord Fraser & Gillick v West Norfolk & Wisbech AHA 1986 - McNair J & Bolam & Friern Hospital Management Committee 1957 - Supreme Court of Canada & Reibl v Hughes 1980 - A Montrose - Horizon TV - R Gillon - Crime of the Century TV - World in Action TV - Tell Them You Love Me TV - Accused: Guilty or Innocent? TV -  

 

 

 

Negligence is the omission to do something which a reasonable man, guided upon those considerations which ordinarily regulate the conduct of human affairs, would do, or doing something which a prudent and reasonable man would not do.  The defendants might have been liable for negligence, if, unintentionally, they omitted to do that which a reasonable person would have done, or did that which a person taking reasonable precautions would not have done.  Alderson B, Blyth v Birmingham Waterworks 1856 11 Ex R781   

 

 

In 1972 a journalist uncovered a research project that had been going on for 40 years among black men in rural Alabama.  Several hundred men had been involved in this government-sponsored study of untreated syphilis, but it continued up until the time that it was revealed to the public, which was plainly shocked to discover that scientific curiosity had apparently won out over medical care in the treatment of the victims of this disease in the study group.  Professor Alexander Capron

 

 

The right of a person to control his or her body is a concept that has long been recognised at common law.  Robins J A, Malette v Shulman (1990) 67 DLR (4th) 321 (Ont CA)

 

The right of self-determination ... obviously encompasses the right to refuse medical treatment.  A competent adult is generally entitled to reject a specific treatment or all treatment ... If a doctor were to proceed in the face of a decision to reject the treatment, he would be civilly liable for his unauthorized conduct notwithstanding his justifiable belief that whatever he did was necessary to preserve the patient’s life or health.  The doctrine of informed consent is plainly intended to ensure the freedom of individuals to make choices concerning their medical care.  ibid.

 

 

I start with the fundamental principle, now long established, that every person’s body is inviolate ... in the case of medical treatment, we have to bear well in mind the libertarian principle of self-determination.  Goff LJ, Sidaway v Governors of Bethlem Hospital [1985] AC 871

 

 

The definition of the duty of care is not to be handed over to the medical or any other profession.  The definition of the duty of care is a matter for the law and the courts.  John Donaldson MR, Sidaway v Governors of Bethlem Hospital [1985] AC 871

 

 

A legally valid, or real, consent consists of the following elements: (a) it is given by a competent person; (b) it is given voluntarily; (c) it is an informed consent.  (Medical Law & Doctor & Consent)  I Kennedy & A Grubb, Medical Law (2nd ed)  

 

The issue for the court, in essence, is to untangle the reasons offered by the differing medical experts, rather than to be concerned superficially with the description of the practice.  ibid.

 

 

Provided the patient, whether a boy or a girl, is capable of understanding what is proposed, and of expressing his or her own wishes, I see no good reason for holding that he or she lacks the capacity to express them validly and effectively and to authorise the medical man to make the examination or give the treatment he advises.  Lord Fraser, Gillick v West Norfolk and Wisbech AHA [1986] AC 112, [1985] 3 ALL ER 402  

 

 

In the realm of diagnosis and treatment there is ample scope for genuine difference of opinion, and one man clearly is not negligent merely because his conclusion differs from that of other professional men, nor because he has displayed less skill or knowledge than others would have done.  The true test for establishing negligence in diagnosis or treatment on the part of a doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of it acting with ordinary care.  McNair J, Bolam v Friern Hospital Management Committee [1957] 2 All ER 118  

 

 

To allow expert medical evidence to determine what risks are material and, hence, should be disclosed and, correlatively, what risks are not material is to hand over to the medical profession the entire question of the scope of the duty of disclosure, including the question whether there has been a breach of that duty.  Supreme Court of Canada, Reibl v Hughes (1980) 114 DLR (3d) 1  

 

 

Experts may blind themselves by expertise.  The courts should protect the citizen against risks which professional men and others may ignore.  Professor A Montrose, Is Negligence an Ethical or a Sociological Concept? 1958  

 

 

The weakest link in the room isn’t usually the drugs or the equipment, it’s us – the surgical team.  Horizon: How to Avoid Mistakes in Surgery, BBC 2013

 

Elaine Bromiley case: a routine sinus operation 2005: intubation failed ... their decision-making had become fatally compromised ... they had lost their situational awareness.  ibid.

 

By concentration on a single task or activity its [brain] capacity to actually monitor other things by the passage of time is severely compromised.  ibid.

 

Their checklist doesn’t just catch simple human mistakes ... it helps to flatten the traditional hierarchy.  ibid.

 

Medicine is waking up to the experience of others.  ibid.

 

 

The first important point to emerge from this symposium is that information is essential for autonomous and therefore rational decision-making.  One cannot reason or deliberate about alternative courses of action if one has no information about them ... Patients are likely to make irrational decisions if their doctors gives them inadequate information.  R Gillon (1983), 9 Journal of Medical Ethics 131

 

 

Since 2000, more than 500,000 Americans have died of opioid overdoses.  Millions of Americans have become addicted.  Every 25 minutes a baby is born with opioid withdrawal.  The US government estimates that the cost of opioid abuse is over $1 trillion.  We call this ‘the opioid crisis’.  But a crisis is something that just ‘happens’.  What if we discovered that the opioid crisis was caused by businesses seeking to profit from pain?  What if behind the crisis there was a spectacular crime?  Alex Gibney, The Crime of the Century I ***** Sky Documentaries 2021

 

No American family has profited more from controlled substances, from Valium and Oxycontin, than the Sacklers.  ibid.

 

In the 1960s Sackler became incredibly rich by expanding the market for addictive tranquillizers.  ibid.  

  

Controlled-release Oxycodone, or Oxycontin, would be the drug that triggered what we call the ‘opioid crisis.’  ibid.

 

Johnson & Johnson also genetically altered the nature of the plant to create a super-poppy … Soon 74,000 acres of Tasmania were devoted to opium.  ibid.  

 

1Blinn was taking the equivalent of 200 hits of heroin a day.  He kept the prescription bottle for 20 years because he felt something was not right.  ibid.  

 

A nationwide criminal conspiracy that included Fraud, Pills Mills, doctors trading drugs for sex, false statements to Congress, and attempts to target key officials of the Bush administration … The FDA was used to falsely and fraudulently market Oxycontin.  ibid.

 

None of them would spend a day in prison.  ibid.

 

Lifetree Pain Clinic prescription: 60 x Amitriptyline 50mg; 30 x Celexa 40mg; 224 x Oxycodone 30mg; 112 Percocet 10/325mg; 60 x Requip 1mg; 60 x Xanax 1mg; 60 x Zanaflex 4mg.  ibid.

 

Starting in 2013 a powerful synthetic opioid surged in popularity: Fentanyl.  It’s a 100 times more powerful than morphine.  Rather than reckoning with its dangers, companies sold it as aggressively as drug cartels.  But instead of gun-toting dealers on street corners, men and women in suits and lab coats pushed opioids and cash bonuses and power-point presentations at pain management jamborees.  Flush with campaign cash from Big Pharma, Congress would look the other way.  ibid.

 

 

‘40 people every day die from Prescription overdoses.’  Alex Gibney, The Crime of the Century II ***** news

 

‘The opioid crisis started with prescriptions, prescriptions and patient care.  This idea that we weren’t adequately treating pain.  Drugs like Oxycontin … began to preach the gospel of the opioid … They developed new medical terms like pseudo-addiction … As you get stronger drugs, it’s more expensive.  ibid.  Joe Rannazzisi, insider whistleblower gives evidence   

 

Fentanyl byproducts is killing a lot of people … It was a natural progression … Overdose deaths is under-reported, we know that for sure so we don’t know really how many people died.  We started seeing massive amounts of death … prescriptions: 250 million.  ibid.

 

An onslaught of pills, hundreds of thousands of deaths.  Who is accountable?  ibid.  The Washington Post online article 20 July 2019 

 

Some of America’s biggest pharmaceuticals were not only profiting from the opioid crisis, they may have been manufacturing it.   ibid.

 

We have had many run-ins with the Sacklers lately.  The crisis began when Oxycontin hit the streets.  Their man point of contention is that they did not ignore the opioid crisis single-handedly.  Whether you believe that or don’t believe that, there is voluminous evidence the crisis began when Oxycontin hit the streets.  Purdue [Pharma] led the charge.  ibid.  Bernstein, Washington Post

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