Legal Responsibilities of Physicians
Expertise Duty
• Physicians have a duty of expertise in health-related matters.
• The nature of the lesions occurring in the human body, how they may have occurred, and the examination of all kinds of biological evidences are made by the expert physician.
Burial of the Dead and Autopsy
• The burial license should be issued by a physician, accompanied by a health personnel, after the corpse is completely stripped.
• No funeral can be buried unless a burial license is obtained and presented.
• A burial license should be issued in such a way as to specify the mode of death, cause of death or death mechanism.
• In places where there is a municipal physician, the burial license is issued by these physicians. In places where there is no municipal doctor, it is given by government doctors (by the family health center doctor) after the body is examined.
• In cases where death occurred naturally, the body can be buried after the burial permit is issued.
• If there is a suspicion that the death did not occur naturally, the situation is reported to the Public Prosecutor's Office and the burial is subject to the written permission of the prosecutor's office.
• Burial licenses are not issued for cases that are described as forensic, and they are reported to the Public Prosecutor's Office.
• Autopsy is performed when deemed necessary.
Death cases that should be evaluated legally
All cases with accident, suicide and murder in origin
Recent history of trauma or detection of traumatic lesions on examination
Contradictory-inconsistent story
All deaths in detention and prison
Cases with accusations and allegations regarding the cause of death
Cases in which the cause of death could not be determined
Autopsy
It is the process of opening all the cavities of the deceased person's corpse and examining all the systems and organs with the available methods in order to determine the cause of death. It is done by opening the head, body and abdomen. There are 3 types of autopsies.
Pathological Autopsies (Hospital autopsies, medical autopsies):
• Autopsies performed for medical reasons in natural deaths that are not forensic cases.
• Permission from the family is required for the autopsy.
• It can be done for these reasons:
Determine the cause of death.
To investigate the compatibility of clinical diagnosis and symptoms.
To see how effective the treatment is.
To be able to evaluate the general course of the disease.
For the education and academic research of students and physicians.
For epidemiological studies.
For the purpose of detecting congenital conditions and communicable diseases and transferring information on these issues to their closest relatives.
Autopsies performed in infectious patients:
• Similar to pathological autopsies.
• It is applied in cases where communicable diseases are suspected.
• It is applied without the family's permission.
Forensic autopsies (medicolegal autopsies)
• Autopsies performed in forensic cases.
• It is done for these reasons:
Determination of cause, manner and time of death.
Finding, diagnosing and storing evidential material.
Identification of the deceased.
• It is performed by two physicians, one of whom is a forensic medicine specialist or a pathology specialist, in addition to the public prosecutor. In case of necessity, it can also be done by a single physician.
• The doctor who deals with the disease before death cannot be assigned the task of autopsy.
• The decision for exhumation and examination of a buried corpse is made by the public prosecutor or the court.
• The images of the corpse are recorded during the autopsy.
• There is no need to get permission from the family for forensic autopsies.
Physician's Emergency Intervention Obligation
• Physicians must comply with the call in a timely manner if they are invited to treat a patient or injured person whose life is in danger.
The invitation must be made by the patient's relatives or official officials (police, gendarmerie).
• If there is an official doctor, health center or a hospital close to the area where the patient in need of first aid is located, he or she may suggest that he be taken to the hospital upon invitation.
• Physicians and other healthcare professionals in public institutions and institutions with legal personality must accept the patient.
Obligations of Physicians to Keep Confidential and Notify (Notification)
• The physician is obliged to keep the information obtained about the confidential and private secrets of the patient as "professional secret".
• Physician can publish about the patient without using the patient's identity information (name, surname and address).
• Situations such as case discussions, consultations, and the physician's informing the physician are not included in the scope of confidential disclosure.
• However, the fact that the physician treating an injured, poisoned or attacked person reports the incident to the justice does not mean that a secret of the victim is disclosed.
• If the patients they treat are accused or wanted individuals and they do not report, they are guilty.
• It is obligatory to announce some infectious diseases and poisonings that are dangerous for public health.
• Cases that will be considered as judicial cases and that are required to be reported:
• All kinds of firearms, explosives, cutting-penetrating and crushing tool injuries.
• Traffic accidents, falls, assaults and work accidents.
• Intoxications.
• Burns.
• Electric and lightning strikes.
• Oral or anal foreign matter entry into the digestive tract.
• Mechanical asphyxia cases (hanging, drowning by hand or rope, drowning).
• Suicide attempts and abortions.
• Allegations of sexual assaults, domestic violence, child abuse, torture.
• All deaths suspected of homicide, suicide, accidental origin (suspicious deaths).
Physician's Criminal Liability Due to Medical Interventions
Physicians have responsibilities for their medical interventions.
Responsibility in Medical Practices
• The person performing the medical practice must be a person (physician) who is legally authorized to practice the medical profession. Requirements for conducting the medical profession in our country:
1- To be a citizen.
2- To have a medical school diploma.
3- For foreign nationals: To have a special permission of the Ministry of Health or to have an equivalence diploma.
4- For physicians working in private institutions: Being registered with the medical chamber
5- Not having a temporary or permanent disability in order to practice my medical profession.
There is an obligation to comply with the conditions of the country and the minimum conditions of science so that physicians who perform medical interventions and practices are not defective in their practices.
Physicians must comply with applicable legal practices, ethical principles, scientific diagnosis and treatment standards in their professional practices.
Since ignorance of the law is not an excuse, it is necessary to know the responsibilities in terms of law.
Physicians have criminal responsibilities as a result of faults made during medical practices.
Mistake
• It is the emergence of responsibility in case of not acting in that way when there is the possibility and it is necessary to act in a different way.
• There is no fault in situations that cannot be foreseen or prevented even if foreseen.
• Defects in medical practice; it is caused by will, negligence, lack of knowledge and care.
• Penalties vary according to the level of fault.
• According to the Penal law, faults are classified under 4 headings:
1- Intention: It is the knowing and willful realization of the elements in the legal definition of the crime.
2- Possible intent: It is the realization of the elements in the legal definition of the crime by foreseeing it.
3- Negligence: It is the realization of a behavior without foreseeing the result specified in the legal definition of the crime due to the violation of the duty of attention and care.
4- Conscious negligence: It is defined as the occurrence of the result even though the person does not want the expected result.
• Conditions necessary for physicians to be held responsible for their medical practices:
1- To commit an act against the personal rights of the person
2- The application must be against the law.
3- The defect must be detected.
4- Damage must occur.
5- As long as the damage does not occur, even if the physician is at fault, there is no legal liability.
6- There must be a cause-effect relationship between the damage and the defect.
Identification of a medical problem
First of all, the Supreme Health Council does the duty of knowing whether there is a fault in medical practices.
However, the courts may also seek opinions from the relevant departments of the Faculty of Medicine and the Specialization Boards of the Forensic Medicine Institute.
The prerequisite for not being against the law in physician practices is to obtain permission for practice.
Informed consent is obtained from the patient to obtain permission before medical applications.
Informed Consent
• Ensuring that the patient can freely decide on the treatment method that is intended to be applied with the information given is defined as enlightenment, and the patient's conscious consent for the medical procedures to be performed is defined as consent (consent).
• All kinds of health-related interventions can only be made with the free and informed consent of the person.
• Every adult person with a normal state of consciousness can freely accept or reject the treatment to be applied.
• If the patient is over 18 years old and conscious, it is taken from him.
• Permission must be obtained from the mother, father or guardian who is responsible for the child's care in the 0-18 age period.
• For unconscious persons, permission must be obtained from the nearest person.
• The patient himself determines the people to be informed outside the patient.
• The physician enlightens the patient on the following issues:
Health status and diagnosis.
Type of treatment proposed.
Chance and duration of success.
Risks of the treatment method for the patient's health.
Use of given drugs and possible side effects.
The consequences of the disease if the patient does not accept the recommended treatment.
Possible treatment options and risks.
• Lighting should be appropriate for the patient's social and mental state, education and socio-cultural level.
• Information should be given in a way that can be understood by the patient.
• When the treatment is necessary, if it is not done or delayed, it will cause loss of life or organs;
If the parents or relatives do not want to be treated, do not accept the treatment and want to remove the patient from the health institution, the physician must notify the public prosecutor on duty.
If the relatives of the patient want to take the patient to another health institution, this statement should be taken in writing from the relatives of the patient.
If the relatives of the patient do not want to give in writing, a report stating the situation should be prepared.
• Since the diseases whose treatment is mandated by law threaten the public health, the necessary treatment is given even if the informed consent of the patient or his legal representative is not taken.
• Legal consent is not required in the following cases:
Simple medical interventions (tacit consent = implicit consent).
Emergency attempts where the person is not conscious and his relatives cannot be reached (implied consent = implicit consent).
Interventions applied for the benefit of public health, such as vaccination campaigns in epidemics.
Attempts to save a person's life, such as suicidal poisoning.
Treatment of people who use drugs and stimulants.
Cholera, plague, spotted fever, black fever, smallpox, diphtheria, meningitis, polio, sleeping sickness, dysentery, puerperal fever, diarrhea, scarlet fever, anthrax, measles, leprosy, maltese fever, food poisoning, rabies, trachoma, venereal diseases, treatments for diseases such as tuberculosis.
Patient rights
According to the 1981 Lisbon Declaration on patients' rights and the 1994 Bali Declaration:
0 The patient has the right to quality medical care.
0 The patient has the right to freely choose his doctor.
0 The patient has the right to be cared for by a physician who can freely make clinical and ethical decisions without any external influence.
0 The patient has the right to accept or reject the recommended treatment after being adequately informed.
0 The patient has the right to expect the physician to respect the confidentiality of all medical and private information.
0 Every patient has the right to die with dignity.
0 The patient has the right to accept or refuse spiritual and spiritual comfort, including the assistance of an appropriate religious representative.
