Medico legal and
ethical issues
in STI and HIV
Dr Priya Singh
LLB MBChB MRCGP
Managing the Risks in Hospital Practice
80% of errors arise from only about 20%
of causes. The most important are:

Failure to appreciate legal
responsibilities
(Statutes, Case Law, GMC guidance)

Problems in clinical management

Medication errors

Administrative errors

Failures of communication,
including inadequate records
The Six Cs

Consent

Confidentiality

Clinical records

Communication

Competence

Careful prescribing
Consent

For consent to be valid it must be
freely given,by a competent patient,
making an informed decision

GMC guidance
‘The information you provide when seeking consent
should be appropriate to the circumstances and to
the nature of the condition…. Some conditions,
such as HIV, have serious social, financial, as well
as medical implications…….you must make sure
that the patient is given….. appropriate time to
consider and discuss them’
Consent

The test of a patient’s competence to
give or withhold consent to treatment is
based on case law. The three essential
criteria to be met are that

The patient understands the information
presented to them and the implications of
accepting or rejecting the various
treatment options

The patient believes the information
provided

The patient is able to weigh it
in the balance and arrive at
a choice
Consent

You have a significant concern that your
patient may be HIV positive

He refuses a test

He lapses into unconsciousness

A healthcare worker sustains a
needlestick injury
Consent

A mother of 4 children is likely to be HIV
positive

She is divorced from the father of


a 2 year old

an 11 year old

a 15 year old
She is living with the father of her youngest
child, a 4 month old whom she is breast feeding
Consent

Parental responsibility

GMC ‘You must decide whether the
medical interests of the child override
the wishes of those with parental
responsibility’
Gillick competence
An under 16 year old with the maturity
and intelligence to comprehend fully
what is proposed and who cannot
be persuaded to inform a
parent
Consent

Gillick competent under 16 year olds
refusing treatment


The wishes of a competent child may be
overruled if, inthe opinion of the court,
the consequences of refusal are such that
it would be inappropriate to comply with
the child’s wishes.
Unconscious patients

clinical interests

exceptional circumstances
Confidentiality

Patients have a right to expect that you
will not disclose any personal
information which you learn during the
course of your professional duties,
unless given permission

Other healthcare workers

Post mortems

Death certificates