Laws, ethics and professional regulation
Because the practice of medicine is so intimately concerned with people’s bodies, personal vulnerabilites and wellbeing, it is subject to legal and ethical restrictions, all of which have evolved or been designed to protect patients’ interests. They constrain healthcare practitioners to behave competently and ethically, and to conduct themselves with probity.
Although in many respects intertwined, there are three distinct sources of legal and ethical principles that inform medical practice:
Under the Constitution, all citizens enjoy certain rights, and – as a doctor – you have a responsibility to ensure that those rights are respected
- The Constitution, and all the statutes and regulations stemming from it that embody its principles
- Case law
- The Health Professions Council of South Africa, which is mandated to set and maintain standards.
Patients’ constitutional rights
The Constitution is the supreme law of the Republic. Therefore all statutes and conduct must support and reflect its principles and aims. Under the Constitution, all citizens enjoy certain rights, and – as a doctor – you have a responsibility to ensure that those rights are respected; patients also have responsibilities, which are set out in the Patient’s Charter. The Patient’s Charter is an explicit statement of the rights and responsibilities implied by the Constitution.
A patient’s rights
- A healthy and safe environment
- Participation in decision-making
- Access to healthcare services, which include:
- Receiving timely emergency care
- Treatment and rehabilitation
- Provision for special needs
- Palliative care
- A positive disposition
- Health information
- Knowledge of one’s own health insurance/medical aid scheme
- Choice of health services
- Be treated by a named healthcare provider
- Confidentiality and privacy
- Informed consent
- Refusal of treatment
- Be referred for a second opinion
- Continuity of care
- Complain about health services.
A patient’s responsibilities
- To take care of his or her health
- To care for and protect the environment
- To respect the rights of other patients and health providers
- To utilise the healthcare system properly and not abuse it
- To know his or her local health service and what they offer
- To provide healthcare providers with the relevant and accurate information for diagnostic, treatment, rehabilitation or counselling purposes
- To advise the healthcare providers of his or her wishes with regard to his or her death
- To comply with the prescribed treatment or rehabilitation procedures
- To enquire about the related costs of the treatment and/or rehabilitation and arrange for payment
- To take care of health records in his or her possession.
Many of the principles and ideals expressed in the Constitution have been encoded in legislation
Many of the principles and ideals expressed in the Constitution have been encoded in legislation, some of which has a direct bearing on the work and business of general practice. The Promotion of Access to Information Act of 2000, for example, gives everyone a right of access to their records (including health records) if they need them to exercise or protect their rights, even if the holder of the information is a private business.
Other statutes and regulations that may affect general practice (see Box 1) include the Children’s Act, which clarifies children’s rights and parental responsibilities; the Communicable Diseases Regulations, which set out medical practitioners’ responsibilities regarding notifiable diseases; and various regulations under the Health Professions Act governing the licensing of practices, among other things.
Box 1: Examples of statutes and regulations relevant to general practice
- Children’s Act Regulations 2010
- Choice on Termination of Pregnancy Act 1996
- Communicable Diseases Regulations 2008
- Criminal Law (Sexual Offences and Related Matters) Amendment Act 2007
- Domestic Violence Act 1998
- Health Professions Act 1974
- Mental Health Care Act 2002
- National Health Act 2003
- Older Persons Act 2006
- Promotion of Access to Information Act 2000
- Sexual Offences Act 2007