Seminar is ‘first step towards required amendments in the medico-legal area’ - 3/10/2004
Gerald Fenech

Yesterday’s seminar organised by the Medical Association of Malta dealing with the “Recent Developments in the Ethical and Legal Aspects of the Medical Profession”, is the first step towards a more sound assessment in the relationship between the medical and legal profession.

It is a well-known fact that the doctor-patient relationship is a central component of any health care system and goes far beyond the normal provider-client relationship. The patient puts absolute trust in the doctor while the doctor’s prime interest remains the patient’s well being.

However, even in the best of hands and with the best intentions, adverse events do occur in the medical field. This is not always due to errors but can also be a result of the disease itself or complications of treatment that require high risk procedures which offer the best chances of survival. Doctors, like everyone else, are not infallible and one also has to realise that doctors often work within a system and that adverse events can also be due to system failures.

Thus, the medico legal system has to ensure that the conscientious doctor is protected against unjustified legal proceedings as well as protecting patient’s rights. In Malta there are no specific laws dealing with criminal negligence and this has thus resulted in a number of frivolous cases. The situation becomes a complex one when indiscriminate civil and/or criminal action without adequate preliminary filtering creates unnecessary tension and anxiety for the doctor and can lead to irreparable harm to his/her reputation. This situation also spreads unnecessary alarm among the general public and undermines confidence in the public health service.

In this climate, costs are expected to escalate alarmingly as it is known that the amount of civil damages being claimed are steadily increasing although this is still only the tip of the iceberg. Unless something is done urgently, the phenomenon of “defensive medicine” will come to the fore. This can be defined as “an act of omission of a health care provider which is intended to minimise the incidence of professional liability even though this may not be clinically necessary for the patient”.

In Malta, the exceedingly high number of criminal proceedings is providing an additional and extremely strong force driving defensive medicine. The present medico-legal climate is expected to result in spiralling health care costs, increased waiting lists for many procedures and an increased load on the already overburdened Accident and Emergency Department. To sum up, there will be an exponential rise in costs with a worsening of the service in general.

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