MEDICOLEGAL & ETHICS

Consent
Legal age of consent in Oz - 16yo
- 16 yo & above - treat as an adult
- 14 - 16 yo - use Gillick Rule (this rule
means that you will test for the maturity of
a child aged 14-16)
MCQ: 14F comes for OCP prescription,
what to do? Do Gillick scoring
Gillick scoring - ask questions like are you
living alone or with family?
IF LIVING ALONE: this means that the
child is independent - called a mature
minor - give OCP.
IF LIVING WITH PARENTS: inform
parents
Also ask:
- what was the age of the partner with
whom you had sex (if gap is more than 2
years, example BF is 19yo, need to
inform police, this is consider abuse)
MCQ: 14 year old, mature minor who had
sex with Teacher - INFORM POLICE
- you have to inform a police if the minors
relationship is with a Teacher, Relative and
Priest
MCQ: 16 yo, shes been raped or sex was
done without consent, what to do next?
Get consent!
- consent is very important for informing
police (if she says yes, inform police)
- if she says NO (cannot inform police)
1. anytime rape patient comes - take
sample for future hospital records
2. FULL screening for sexually transmitted
disease
3. Give Azithromycin (stat dose for STI)
4. Emergency contraception
MCQ: A lady wants to have OCP, comes to
GP clinic and on her file, it is written, do
not give OCP by husband. What to do
next? Give her OCP because thats what
the patients wish.

In Vasectomy or Tubal Ligation - inform the

partner, consent is by the patient. You
dont need consent of partner.
MCQ: Husband calls you and he want to
know the results of her wifes report? What
to do? Ask him to talk with wife (first
option) OR say we cannot disclose the
results (2nd option).
12F, brought to ED, by 14-year old brother.
Brother has been living independently.
(Brother is mature mind). 12 year old
needs appendicectomy. Who will give
consent if parents are away? Brother
(because brother is a mature minor).
- But if there is an option call the parents,
call the parents.
CONSENT PRIORITIES:
1. Patient wishes
2. Parents or Partner
3. First Degree Relative
4. Second Degree Relative - aunt/
grandmother
5. Call another primary caregiver - teacher
6. Apply guardianship court
In an emergency situation, if the relatives
go against the benefit of the patient, 2
doctors will decide what to do to the
patient.
*Jehovahs witness - Pregnant lady coming
to the emergency department for APH,
Jehovas witness. She does not want
transfusion, what to do next? - Answer:
Ask the patient to sign no transfusion form
(consent of no transfusion).
Until the child is inside the uterus, mother
will decide for the child.
HOWEVER
Once the child is born, and he belongs to
family whos Jehovas and soon after birth
he needs BT, 2 doctors will decide.
Under the MENTAL HEALTH LAW, we can
admit the patient involuntarily if theres a
chance that he is gonna commit suicide or
is dangerous to others.

Patients own wishes:

MCQ: 50M, comes to ED and had cardiac
arrest. He does not want to go for
resuscitation. What to do? Assess MMSE.
Scenario A - if MMSE <24 (patient cannot
give consent) --> find next of kin (partner)
and he/she will decide.
Scenario B - if MMSE >24 - DNR
MCQ: Patient comes to ED who had
cardiac arrest, says resuscitate me, but
has previously written DNR. --> Check
MMSE.
!
--> if MMSE <24 (DNR)
!
--> if >24 (Resuscitate)
50Man comes to ED, he needs surgery,
wife says dont go for surgery, son says no
surgery. What to do next? Follow patients
REVIOUS WISHES (first option).
If asked in MCQ about Conflict of Family
Members --> arrange family meeting (2nd
option)
3rd option: apply guardianship (3rd
option).
Resuscitation:
50M, comes to ED, in cardiac arrest,
previously given DNR, now he says
resuscitate me. MMSE is poor. Before
resuscitating him, call a family meeting.
ASK patient for consent especially in
breaking the bad news in front of the
relatives. Or even telling the results of
laboratory in front of other family members.
Consent about brain death:
Suspecting brain death, whos gonna
decide to wean off the patient? 2 doctors
will make the decision. 1 doctor should be
ICU registrar, 1 doctor any registrar, none
of them should be member of the
transplant team.
Organ donation:
Patient should given consent + family
consent.

MCQ: Patient is brain dead, previously

decided for organ decision, family agreed
to it. - HARVEST
MCQ: Patient previously agreed to donate
organs and now just recently died, what to
do next? Ask family.
Euthanasia/Mercy Killing/Physician
Assisted Suicide
Old lady comes to GP clinic and she says
shes tired of her pancreatic cancer, life
wants to be ended, what to do next?
Check MMSE.
Euthanasia is NOT legal in Australia.
Old lady and she says shes having
terminal pancreatic ca and wants to die.
What to do next? Do MMSE.
!
- If suicidal ideation are there. !
Admit.
ABOUT Doctors & Nurses
MCQ
: You are working in hospital department,
colleagues is taking Valium. What to do?
Advice her and ask her to seek
consultation.
: You are working in hospital department,
your colleague, a female surgeon, is taking
overdose of valium. What to do? Inform
medical board.
: You are working in hospital department,
your consultant is asking for morphine, you
saw Dr. David prescribing morphine for
him, what to do next? - Inform Medical
Board
Doctor - any misconduct on their part -Inform Medical Board/AHPRA
:Your colleague has been prescribing
benzodiazepine for himself, what to do
next. - Inform medical board
:Colleague comes to your GP clinic and he
wants to have sleeping pill and has a
coming exam, what to do next? Ask him
for assessment.

Brain Death Criteria: (Handbook of clinical

assessment no 14,16)

Body Temp >35

Patient should have not taken any

CNS depressant >48

Irreversible apnoea

No endocrine problem

No neuromuscular blocking agent for

48h

No hypoglycemia

PaCO2 >50

Major Criteria:

Pupil fixed and dilated

Absent corneal reflex

absent pain reflex

absent gag reflex

Irrevesible apneoa

absent dolls eye reflex

no nystagmus
:Your colleague informed you that hes
taking alcohol before coming to work, what
to do next? Inform medical board
NURSES
Your doing rounds in the aged care, nurse
is interfering with your management. WHat
to do next? Talk to her first OR Talk to
nurse manager (2nd option).
Working in aged care center, other nurse
informed you that the other nurse is
crushing the tablet (thats supposed to be
taken as a whole), what to do next? Inform
nursing manager.
Interns working in a hospital, you find that
the intern is stealing products from the
hospital. What to do next? Inform the
intern coordinator.
You are working as a GP, patient ask you
to go for a coffee. REFUSE. (not allowed)
Working in a GP practice, patient attracted
to you. What to do next? Tell her that no
patient-doctor relationship is allowed.
Working in a GP practice, patient is
attracted to you and you are also attracted
to you. What to do next? Ask her to
change GP.

Conspiracy of Silence:
- patient wants MD to lie to relative OR
patient wants MD to lie to patient
- YOU cannot lie to patient (not allowed)
Relatives come, patient wants MD to lie to
relative.
- if patient does not want MD to tell
relatives the results - this is OK
(confidentiality)
- If MD is asked to lie - Thi is NOT OK conspiracy of silence
Patient comes with the knife in hand, what
to do first? Remove your self in place.
If there is a patient comes to ED and no
option of remove yourself, call the security.
Anytime after breaking the bad news,
make another appointment to follow up the
patient.
Patient comes to ED, he is holding a knife
in hand, now he has calm down and told
you that he has a psychiatric illness. What
to do next? Talk to him about his
psychiatric illness when hes calmed down.
If aggressive - call security/restrain/secure
yourself
Old man in an aged care center is found to
be masturbating, if in private (OK)
- if in public (call security)***
Working in a GP practice, patient offer you
GP coffee - dont accept it.
DRIVING RULES:
Seizure
1. New onset epilepsy: 1 year seizure free
(if holder of a license already)
!
- if applying for a learners permit
!
and newly diagnosed: 2 years
seizure free seizure free
2. Isolated seizure - cannot drive for 6
months
3. Chronic Epilepsy - 2 years
4. Patient with bitemporal hemianopia can never drive

If a patient with decreased VA continue

driving (despite being told not to), inform
VIC Road or licensing authority.
VA cut off for driving in Australia: 6/12
DOMESTIC ABUSE:
A lady comes, has multiple bruises in the
cheeks, victim of domestic abuse. What to
do next? - Give her the no of social
services and domestic violences services,
- GP is not suppose to inform the police
- you can only give number
- but never forget to take pics
Same scenario: take photos as a witness
(after giving numbers)
CHILD ABUSE:
MCQ: mother brings child to emergency
department because child is crying more,
examine child there are multiple bruises in
the body with different age, what is the
most important line of investigation?
Skeletal Xray.
If mother is not willing to admit the child,
call the police and admit child.
*** patient is for thyroidectomy and it was
found that consent has not been taken,
what to do next? PERSON WHO IS
OPERATING HAVE TO TAKE THE
CONSENT