Law > Medical Jurisprudence > Contractual Doctor-Patient Relations
A doctor–patient relationship (DPR) is considered to be the core element in the ethical principles of medicine. A good doctor–patient relationship is necessary for a good practice of healthcare. DPR is usually developed when a physician tends to a patient’s medical needs via check-up, diagnosis, and treatment in an agreeable manner. The trust that a patient places on a doctor or surgeon is important because this trust is directly linked with the health of a person. Due to the relationship, the doctor owes a responsibility to the patient to proceed toward the ailment or conclude the relationship successfully. In this article, we shall discuss contractual nature of doctor-patient relationship and very important concept called informed consent.
Elements of Valid Contract:
- There are Two Parties: In a contract minimum, two parties are involved. A contract can only be bilateral and the same party cannot be a party on both sides.
- It is An Agreement: An agreement occurs when two minds meet for a common purpose. i.e. the same thing in the same sense at the same time. This meeting of the mind is called consensus ad idem, i.e., consent to the matter. The consent to the proposal should be free (free from coercion, fraud, misrepresentation, mistake and undue influence).
- It is An Agreement With Consideration: It is an agreement with legal consideration.
- Other Essentials: The agreement should be among competent parties and should be for lawful acts.
- It is an Obligation: An obligation is a legal duty to do or abstain from doing something. The agreement enforceable by law is obligatory on all the parties involved in the contract. Thus social, religious and domestic obligations cannot be termed as a contract because in such obligation there is no intention to give rise to any legal obligation. An agreement to agree in the future is not a contract because unless all important terms of the contract are settled, there cannot be any binding obligation. The parties that are subject to a contract must have clear intentions of creating a legal relationship between them.
Before understanding contractual nature of doctor-patient relationship, we have to understand some terms related with valid contract.
- Contract: Under Section 2(h) of the Indian Contract Act, contract is anything that is an agreement and enforceable by the law of the land.
- Consideration: According to section 2(d) of the Indian Contract Act “when at the desire of the promisor, promisee or any other person has done or abstained from doing or does or abstains from doing or promises to do or to abstain from doing something, such act or abstinence, or promise is called a consideration for the promise.”
- Consent: According to Section 13 of the Indian Contract Act, ” two or more persons are said to be in consent when they agree upon the same thing in the same sense (Consensus-ad-idem). According to Section 14, Consent is said to be free when it is not caused by coercion or undue influence or fraud or misrepresentation or mistake.
Contractual Nature of Doctor-Patient Relationship (DPR):
Doctor-Patient Relation as Contract:
- Proposal and Acceptance: Patient goes to doctor, seeking treatment for illness (proposal). Doctor gives him an appointment and accepts him as a patient (Acceptance)
- Competencies of the Parties: According to the Contract Act, contracting parties should be major, and of sound mind. If patient is minor, the doctor is entering in contract with parents or guardians of minor.
- Free Consent: Here parties are agree on the same thing in the same sense and the consent is not caused by coercion or undue influence or fraud or misrepresentation or mistake.
- Lawful Consideration and Object: In Doctor-Patient contract both the consideration and object are lawful. There is no unlawful in the treatment of a patient.
- The agreement should not be expressly prohibited by Ss. 27 to 30 of the Indian Contract Act: The Contract between patient and Doctor is not prohibited by these provisions.
Thus doctor-patient relation has all the requisites of a valid contract. Hence Doctor-Patient relation is a Contractual Relationship.
Case Laws: Everett v. Griffiths, Morris v. Winsburry White, Edwards v. Mullan.
Consent:
Consent is when one person agrees to or gives permission to another person to do something. According to Section 13 of the Indian Contract Act, ” two or more persons are said to be in consent when they agree upon the same thing in the same sense (Consensus-ad-idem). The consent may be expressed or implied. Oral consent is sufficient in the eyes of law, but is often difficult to prove in the Court. Hence such consent is taken by doctor in presence of nurse or another doctor, who can testify to the same in case of litigation.
Expressed Consent:
It is valid consent given in writing or orally. Express consent is when the patient directly communicates their positive and explicit consent to the doctor or healthcare provider. This is usually done in writing by signing papers. It can also be supported through oral or verbal communication with the doctor. Express consent is not time-limited unless the user withdraws their consent.
Expressed consent includes:
- The condition or illness which requires treatment
- The name of the proposed procedure or treatment
- A detailed description of the treatment or procedure, including a discussion of the potential benefits and risks
- Description of risks associated with choosing non-treatment
- The anticipated results of having the procedure or treatment
- The possible alternative forms of treatment or the lack of any alternative forms of treatment
- Why the doctor believes this treatment or procedure is the best choice
Implied Consent:
Implied consent is more difficult to prove than express consent. Implied consent occurs through the actions or conduct of the patient rather than direct communication through words. For example, informed consent can be implied from patient’s nodding of the head, or by them showing up at the agreed upon time for surgery. If the patient has prepared themselves for surgery by fasting for the previous 24 hours, this might also serve as proof of implied consent.
Implied consent is sufficient in the eyes of law, but is often difficult to prove in the Court. Hence such consent is taken by doctor in presence of nurse or another doctor, who can testify to the same in case of litigation.
Distinguish between express consent and implied consent.
| Express Consent | Implied Consent |
| It is valid consent given in writing or orally. | Implied consent occurs through the actions or conduct of the patient rather than direct communication through words. |
| This is usually done in writing by signing papers. It can also be supported through oral or verbal communication with the doctor. | This is usually is shown by the conduct and behavior of both the parties. |
| It is comparatively easy to prove in Court, as a witness can be placed at the time of consent. | It is comparatively difficult to prove in Court. |
Informed Consent:
Informed consent is defined as voluntary acceptance by a competent patient of a plan for medical care after physician adequately discloses the proposed plan, its risks and benefits, and alternative approaches. This requires a process of effective communication and education between the physician and patient. Informed consent is a process with the elements of autonomous authorization, free from coercion or manipulation, decision-making capacity, disclosures to the patients, and comprehension.
There are four major components of informed consent:
- That the patient has the capacity to make the decision.
- The medical provider discloses information on the treatment, test, or procedure in question. This includes explaining the expected benefits and risks, as well as the probability of these benefits and risks occurring.
- The patient must comprehend the information told to them.
- The patient must voluntarily give their consent, without any coercion from the healthcare professional.
An informed consent agreement should include the following information:
- diagnosis of patient’s condition
- name and purpose of treatment
- benefits, risks, and alternative procedures
- benefits and risks of each alternative
Informed consent for research or clinical trials is also required. It informs the participants about the trial and lets them make educated decisions about taking part in the study. The process is similar to informed consent in healthcare. It should include the following:
- purpose and procedure of the study
- relevant information about the study, including risks and benefits
- your ability to understand this information
- your voluntary decision to participate
Informed consent continues until the study is completed.
The informed consent may be express or implied. Before the procedure, the patient / patient’s next keen has to complete and sign a consent form. This form is a legal document that shows their participation in the decision and your agreement to have the procedure done. In emergencies, when a decision must be made urgently, the patient is not able to participate in decision making, and the patient’s next keen is not available, physicians may initiate treatment without prior informed consent. In such situations, the physician should inform the patient/the next keen at the earliest opportunity and obtain consent for ongoing treatment in keeping with these guidelines.
Termination of DPR
Innumerable situations might bring about a physician’s discharge of patients and the ending of DPR. The relationship may come to an end when:
- the physician concludes that the patient needs the care of different specialists;
- successive missing of appointments by the patient;
- the physician refuses treatment due to nationality, religion, and other causes;
- neglecting a patient from prompt professional care without making arrangements for the continuance of such care (patient abandonment).