MEDICAL LAWS IN THE U.K.

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This article is written by Areesha Beg of 1^st Semester of Dr. B.R. Ambedkar National Law University, Sonipat, an intern under Legal Vidhiya

ABSTRACT

This article examines the essence of medical laws in the United Kingdom, highlighting their importance in a rapidly evolving healthcare landscape. Starting with an introduction explaining the need for medical laws, the article goes on to discuss various statutes enacted in the U.K., such as the Medical Act 1983, the National Health Service Act, etc., for safeguarding patients’ rights and setting a standard of procedure for medical practitioners. It critically analyzes these laws by putting forward relevant sections dealing with the issues. Furthermore, the study explores the realm of case law in the U.K. and how it not only helped in the legal interpretation of statutes but also enriched the understanding and application of informed consent, ethical behavior, patient autonomy, and professional conduct. The study also highlights the importance of landmark cases that had a widespread impact on reforming medical practices across the world. It reveals how judicial precedents, alongside legal principles, guide and govern medical practices, underscoring the relationship between law and medicine. Lastly certain suggestions have been put forward which would help in handling public health issues in the future.

Keywords: Medical laws, United Kingdom, Statutes, Patients’ rights, Healthcare, Procedure standards, Ethical behavior, Bolam test, Bolitho test, Consent, Case laws

INTRODUCTION

As people have become more conscious of their rights, the need for comprehensive laws on intricate and advanced issues has become apparent in order to release the government from its obligations. This is especially true in the field of healthcare and medicines, where there is a great demand for specialized and clear-cut legal frameworks that would safeguard the rights and ethnic integrity of patients as well as professionals. These laws are essential as they serve as a guide for informed consent and assure patients about the potential risks of medical procedures. In addition, they also protect the information of patients from being misused, as there is widespread use of digital devices across healthcare centers. Apart from protecting the rights of patients, the laws are also used to provide a comprehensive framework for healthcare professionals about their responsibilities and accountability. Besides this, the laws also protect medical practitioners from patient misbehavior and any incidents that occur beyond their control.

For a country as large as the United Kingdom, it is highly essential to enact laws for the regulation of medical practices in order to make its healthcare system reliable, accountable, and excellent in quality. To ensure this, the lawmakers of UK have passed various legislations, which will be discussed later in the paper.

NEED FOR MEDICAL LAWS

Medical laws are necessary for a number of reasons, including patient safety and the regulation of the practices of medical professionals. Some justifications for having a medical law are:

Safety of Patients – Medical laws provide safety to patients by ensuring proper treatment. It governs medical procedures and helps in reducing harm and negligence. It protects the person from unauthorized medical checkups and maintains their privacy.
1. Quality healthcare – Medical laws help in providing high standard healthcare services by mandating the proper qualification, license, and training required for practicing as a professional.
1. Ethical practice – Medical legislation helps prevent unfair practices by doctors and surgeons such as high treatment costs, refusal of treatment facilities, uninformed consent, misdiagnosis etc. It gives the patients right to sue the doctors in such cases and provides for adequate compensation.
1. Confidentiality – Medical laws help in maintaining confidentiality and protect the sharing of a patient’s record with third parties without consent. Additionally, it makes sure that patients’ digital databases are preserved securely and prevents their misuse.
1. Access to healthcare – The laws ensure access to healthcare for those who cannot afford it. It provides healthcare security to individuals in cases of chronic diseases and provides financial support.
1. Emergency control – Medical laws help in regulating emergency conditions and ensure public safety by providing guidelines for the control and prevention of widespread diseases. It empowers the government to impose travel restrictions and take other measures during pandemics.

MEDICAL LAWS IN UK

The United Kingdom has enacted various laws regulating medical practices in the country. These laws act as fundamental aspects of regulating medical practices, protecting patients’ rights, encouraging moral principles, and maintaining the credibility of the healthcare system in the country. Some of these laws are discussed below:

Medical Act 1983 – The Medical Act aims to protect, promote, and uphold public health, safety, and welfare by establishing a body known as the General Medical Council[1]. This body must work to instill public confidence in medical professions while maintaining proper conduct and standards for the professionals. Section 2 of the act calls for the registration of medical practitioners by the registrar[2], and Section 49 imposes penalties on those who practice their profession without a proper license[3]. The act explicitly states that only those who have completed full registrations are authorized to practice the medical profession.
1. National Health Service Act 2006 – The act directs the Secretary of State to work in promotion of England’s health care system designed to improve both the public’s mental and physical health[4]. Section 2 of the act states that the service provided to the public must be free of cost except when otherwise stated[5]. It has provisions for certain services, which include providing for hospital accommodation, medical and ambulance services, facilities for pregnant women, prevention of illness, diagnosis, treatments, and after-care[6]. The act gives power to the Secretary of State to give direction to other health service bodies and establishes a Primary Care Trust[7]. One of the important provisions of this act is that it gives patients more choice and control over their healthcare. It directs the healthcare body that the person to whom the service is provided must be involved and consulted either directly or through representatives[8].
1. Health Care and Social Act 2008 – The act created the Care Quality Commission (CQC), a regulatory agency tasked with enhancing nation’s health and social care services[9]. It specifies quality requirements that service providers must comply with. It necessitates the service providers to register with CQC[10] and grants authority to the body to issue warnings, impose fines, and take any other appropriate action that it deems necessary in the event of non-compliance with the code of conduct. The act also defines “health care” as all forms of health care provided to individuals, whether physical or mental, and “social care” as personal care provided to individuals who are in need of it due to their age, illness, pregnancy, childbirth, or addiction to alcohol or drugs[11].
1. Health and Care Act 2022 – The new Health and Care Act of 2022 is thoughtfully designed to address contemporary issues, ensuring its relevance to today’s problems. The act establishes an Integrated Care Board, a statutory body responsible for making strategies for meeting public’s health needs, managing budgets, and setting up health services in different areas covering the whole country[12]. The act imposes a new £86,000 lifetime cap on the personal expenses of every English citizen, which he spends on personal care[13].

CASE LAWS: IMPACT ON MEDICAL PRACTICES AND LEGAL REFORMS

Landmark Judgments – U.K. case laws had a significant impact on medical laws. It has had a lasting impact on medical practices and legal reforms. Here are various laws that helped in reshaping the ethical framework within the healthcare system:

Bolam v. Friern Hospital Management Committee [1957][14] – In this case, the plaintiff, John Hector Bolam, was given electro-convulsive therapy [E.C.T.] treatment at the defendant’s mental hospital. The treatment involved passing current through the brain of the patient, which could result in bone fractures, tooth damage, or muscle damage if given unmodified, i.e., without relaxant or manual restraint. During the treatment, the plaintiff sustained fractures, which, according to his allegation were due to the negligence of the doctor. He alleged that the doctors were negligent in failing to provide him with any relaxant before the treatment and did not even give manual restraint. He further claimed that the defendants did not inform him about the risk involved. The Friern Hospital Management Committee, the defendants, claimed that giving relaxants could have increased the risk of mortality while the risk of fracture from unmodified E.T.C. was minimal. Regarding the absence of manual restraint, it was argued that, according to their experience, less restrain lowers the risk of fractures. They claimed that it was not necessary to warn the patient unless they asked about it. The judgment was in favor of the defendants. The court held that the doctors acted in a way which was consistent with standards acknowledged as appropriate by a group of professionals in the same field, and it doesn’t matter if there are a group of practitioners who disagree with the practice.
Bolitho v. City and Hackney Authority [1996][15] – This case provided clarity to the principles established by the Bolam test. In this case, a 2-year-old child suffered breathing problem and was admitted to the defendant’s hospital. The doctors examined the situation and decided not to call the pediatrician, after which the child’s condition worsened and he died due to acute respiratory failure. The child’s parents brought a suit against the negligence of doctors, claiming that if the child had been given timely intubation, he could have survived. The court delved into the matter and decided that the doctors’ decision to not consult the pediatrician was not logically indefensible. The House of Lords held that it was not proved that the breach of duty by the defendant was the reason for the child’s death. This reinforced the Bolam principle in addition to the fact that the reason provided by the medical experts must not only be medical opinion but should also withstand logical scrutiny.
Chester v. Afshar [2004][16] – In this landmark case, the claimant named Chester had been experiencing severe back pain for several years. After the medical examination, it was revealed that she had a problem with the spinal cord, after which her doctor advised her to undergo surgery. The claimant reluctantly consented to the operation after finding that there was no other option. The surgery involved a minor risk (1-2%) that the condition could become even worse, but this was not revealed to her by the doctor. Unfortunately, the result was bleak and left the claimant severely disabled. She later said that she would not have consented to the surgery if she were aware of the risk and accused the doctor of being negligent. The judges gave a split verdict of 3-2, and it was held that the defendant failed to discharge his professional duty of care by not informing the patient about the risk. They came to the conclusion that had the date of surgery been altered or the doctor been changed, this minor risk might not have been exacerbated. This case reaffirmed the right of patients to be informed. It highlighted the critical need for healthcare professionals to fully and carefully disclose all the relevant facts to their patients so that they can make informed choices about their medical care.
Montgomery v. Lanarkshire Health Board [2015][17] – This is another case of the patient’s right to be informed. It was this case that overruled the Bolam v. Friern case on the question of informed consent. The claimant in this case was a pregnant woman with a diabetic condition. The doctors didn’t inform her about the risk of shoulder dystocia, where the baby’s shoulder is unable to pass during delivery in a diabetic woman. Subsequently, the newborn suffered from disabilities after the birth. The court ruled that the doctor was negligent in not disclosing the risk involved and awarded the plaintiff compensation as prayed for.

BEYOND BOUNDARIES: SHAPING MEDICAL PRACTICES ACROSS THE GLOBE

The landmark judgments in the U.K. not only improved comprehension of the laws but also had a significant impact across the globe by reshaping legal practices and encouraging reform. The Bolam Test, established in the aftermath of the Bolam v. Friern case, set the standard for medical operations. Despite being overruled on the question of informed consent, it played a pivotal role in establishing guidelines. It helped in determining that a person is not negligent if he exercises in accordance with the commonly accepted practices, even if there is a group of people in the same field who would take a contrary view. The Bolitho test evolved after Bolitho v. Hackney Authority established the fact that medical opinions would not be accepted by the court if they did not stand up logically. This came into widespread use after the Bolam test became outdated. Cases like Chester v. Afshar and Montgomery v. Lanarkshire helped assert the rights of patients. It helped the patients to proclaim their right to make informed decisions about their healthcare and treatment choices. It bound the medical professionals to disclose the slightest risks involved in the treatment.

While addressing similar medical and healthcare cases, courts in other countries have often referred to these well-reasoned judgments. Often, countries have accepted the legal precedents with minor adjustments to the judgments while retaining the core jurisprudence. As the journey of legal transformation continues, these case laws serve as beacons, guiding us towards a future where patient welfare and ethical standards remain of utmost importance.

FUTURE TRENDS AND SUGGESTIONS

Since the landscape of medical laws is changing, there is a need of changes which would reflect the advancement of society. Several significant patterns and changes have emerged as we look into the future, pointing to the path that medical laws in the UK should go in the coming years. The same are discussed in the following points:

Technological integration – The rapid pace of technology advancement has transformed the medical practices around the globe. Practices such as gene editing, use of AI in medical science, robotics or nanotechnologies are rapidly growing. While these technologies provide improved healthcare, they also involve complex ethical questions such as patient privacy, consent for AI diagnosis etc. Therefore, medical laws would need to address the ethical issues by integrating the provisions related tot them and regulating them for the benefit of the public.
Health inequalities – addressing health inequalities and making sure that everyone has a fair access to healthcare services is a persistent issue. Future medical regulations must be developed to lessen these inequalities based on racial, ethnic, gender, and geographical factors. Policies, just distribution of resources, and culturally competent care would all be crucial in achieving this.
Education and awareness – the ongoing evolution in medical practices and laws necessitates education and awareness at both the ends, the practitioners as well as the patients. The professionals must be trained of ethical dilemmas such as the use of advanced technologies and the importance of patients’ consent. On the other hand, the general public must be made aware about their rights by organizing campaigns on medical literacy. There must be a user-friendly online source to explain medical laws, rights, and responsibilities in order to enhance public awareness.
Climate change and public health – The impeding problem of climate change has necessitated proactive legal responses to safeguard public health. As the threats from climate change has become more challenging, legal framework must be adapted to ensure safety from emerging health risks. In order to tackle this, the government must focus on developing a strong environmental regulation policy that could have a direct impact on public health.

CONCLUSION

The medical laws of the U.K. are like a strong framework that holds together a wide range of obligatory strands. It helps in establishing a strong legal infrastructure that deals with various nuances of healthcare and safeguards both patients and medical practitioners. Medical laws play an important role in setting standards of procedure for professionals and cover various issues such as informed consent, patients’ confidentiality, affordable treatment, medical malpractice, etc. They help in protecting the rights of patients and give them the choice of making decisions, along with ensuring effective and ethical care.

The case laws discussed above help in the proper implementation of laws. The doctors and other medical practitioners know their duty and act in accordance. The laws provide a sense of security for the patients. They know that laws have been put in place to safeguard them from any harm. They have a mechanism to seek justice in case of any mishap and hold the personnel accountable. Moreover, these laws, along with the judicial precedents, have a greater impact; they are not there just to provide compensation but to help in creating a culture of accountability within the medical field. Professionals are likely to act more cautiously while discharging their duties while hospitals would be aware of their responsibilities and implement powerful protocols in order to provide quality care to the public.

[1] S.1, Medical Act 1983 (The United Kingdom of Great Britain)

[2] S.2, Medical Act 1983 (The United Kingdom of Great Britain)

[3] S.49, Medical Act 1983 (The United Kingdom of Great Britain)

[4] S.1, National Health Service Act 2006 (The United Kingdom of Great Britain)

[5] S.2, National Health Service Act 2006 (The United Kingdom of Great Britain)

[6] S.3, National Health Service Act 2006 (The United Kingdom of Great Britain)

[7] S.18, National Health Service Act 2006 (The United Kingdom of Great Britain)

[8] S. 242, National Health Service Act 2006 (The United Kingdom of Great Britain)

[9] S. 1, Health and Social Care Act 2008 (The United Kingdom of Great Britain)

[10] S. 10, Health and Social Care Act 2008 (The United Kingdom of Great Britain)

[11] S. 9, Health and Social Care Act 2008 (The United Kingdom of Great Britain)

[12] S. 14Z25, Health and Care Act 2022 (The United Kingdom of Great Britain)