Anayo Unachukwu

ABSTRACT Healthcare by its very nature is complex. It comprises of not just one single integrated system, but consists of a large number of interrelated systems. Risk is inherent in the system. As a result of its complexity, it is also prone to errors due to concatenation of multiple small failures. Given the fore-going, it is unsurprising that a patient care pathway can be complex as regards the nature of care delivered and in the number of organisations that contribute to the care. In parallel to this is the mounting cost of healthcare, emergence of post approval hurdle-pricing reimbursement and health technology assessments-that are more stringent.

ABSTRACT The interests of the patient for medico-legal purposes have variously been depicted as, 'bests interests', best clinical judgment, welfare, and substituted judgement. For the purpose of this essay, the interests of the patient will be used interchangeably with best interests of patients. There are overarching ramifications of best interests not only to the patients but families; health care professionals and society at large and as such merit a little drift into the often overlooked philosophical underpinnings. Bioethics antedates the paradigm shift to autonomy seen in 1990s. For competent adults in most socio-medical situations, the law provides a good guide on how to proceed in decision making arising in the context of patient-doctor relationships. This is irrespective of whether the ethical argument is utilitarian or non utilitarian (Kantian) based.

ABSTRACT Historically medical profession is regarded as noble, ancient and learned; hence those that practice the profession cut a respectable presence and are well received. Medicine straddles both science and art. Its science is inexact and the creativity of its art is still evolving. Like any other profession, errors of judgment do occur but unlike most other professions such judgment could lead to enormous human suffering and even fatality. The law of negligence do apply to medicine but the interpretation of such negligence and causation of damages could often be complex and complicated. In adjudicating cases in medicine, the historical backdrop of medicine, its influential role in societies and sometimes the covert views held by juries and latterly by judges that the profession should not be driven into a defensive medicine tilt the balance in favour of defendant. This paper will review the paradigm shift in clinical negligence and the reluctance by judges to abandon Bolam due to deferential attitude towards medical opinion. It will also address in detail the Bolam principle, Bolitho and post Bolitho era with reference to standards of care and causation.

ABSTRACT The interests of the patient for medico-legal purposes have variously been depicted as, 'bests interests', best clinical judgment, welfare, and substituted judgement. For the purpose of this essay, the interests of the patient will be used interchangeably with best interests of patients. There are overarching ramifications of best interests not only to the patients but families; health care professionals and society at large and as such merit a little drift into the often overlooked philosophical underpinnings. Bioethics antedates the paradigm shift to autonomy seen in 1990s. For competent adults in most socio-medical situations, the law provides a good guide on how to proceed in decision making arising in the context of patient-doctor relationships. This is irrespective of whether the ethical argument is utilitarian or non utilitarian (Kantian) based.

ABSTRACT The interests of the patient for medico-legal purposes have variously been depicted as, 'bests interests', best clinical judgment, welfare, and substituted judgement. For the purpose of this essay, the interests of the patient will be used interchangeably with best interests of patients. There are overarching ramifications of best interests not only to the patients but families; health care professionals and society at large and as such merit a little drift into the often overlooked philosophical underpinnings. Bioethics antedates the paradigm shift to autonomy seen in 1990s. For competent adults in most socio-medical situations, the law provides a good guide on how to proceed in decision making arising in the context of patient-doctor relationships. This is irrespective of whether the ethical argument is utilitarian or non utilitarian (Kantian) based.