Abstract

If a patient goes for medical treatment, he has the right to be informed of the nature of treatment, procedure, and the prescription. The risks associated with the treatment must be disclosed. The patient will then be able to consent or withhold consent to the treatment. Can the doctor override the decision of the patient when he withholds consent to a medical treatment on the cover of medical ethics without liability for breach of fundamental rights and damages in tort? This paper discusses the legal position in Nigeria and other common law jurisdictions to evaluate the responsibility and limit to the discretion of the doctor. It examines the peculiar cases of minors. While adopting a doctrinal methodology, this paper discusses the need for respect of the fundamental rights of the patient and the balance of the conflicting interest of the patient and that of the medical ethics, the state interest in public health and welfare. It posits that where a doctor disregards the decision of the patient, he will be liable for breach of fundamental rights or damages in tort irrespective of whether he perceives such decision unreasonable.

Keywords:

Informed Consent, Medical ethics, Fundamental rights, Medical Negligence, Minor, Implied consent.

References:

1) CO Okonkwo, ‘Medical Negligence and the Legal Implications’ in B C Umerah (ed), Medical Practice and the Law in Nigeria (Longman Press) 131-133

2) John Ademola Yakubu, ‘Medical Law in Nigeria’ (Demyaxs Press Limited, 2002) 44-45

3) Okonkwo v Medical & Dental Practitioners Disciplinary Tribunal (1999) 9 NWLR (Pt 617) 1, 26

4) Sidaway v Board of Gov. of Bethlem Royal Hospital (1985) 2 WLR 480

5) ibid at 488

6) (1990) 47 DLR (4th ed) 18

7) ibid at 24

8) (1985) 2 WLR 480

9) Ibid at 483

10) (2001) 7 NWLR (Part 711) 206

11) ibid at 255 C-D

12) John Ademola Yakubu, ‘Medical Law in Nigeria’ (Demyaxs Press Limited, 2002) 44

13) Sidaway at 488F

14) A Medical Alert Card as in Malette, a Durable Power of Attorney (DPA) Card. In MDPDT v Okonkwo (2001) 7 NWLR (Pt 711) 206 (SC), the card used was titled ‘MEDICAL DIRECTIVE/RELEASE’. The content is set out on page 226. A ‘Release from Liability’ was also signed by the patient’s husband restating the refusal of blood transfusion releasing the hospital from responsibility and liability from the effect of the decision.

15) (2002) 15 NWLR (Pt 791) 657

16) ibid at 670-671

17) See O F Emiri, Medical Jurisprudence (Jeroiliromah Press Lagos) 196 - 212

18) Esabunor v Faweya (2019) 7 NWLR (Pt 1671) 316

19) In taking out an action in our Courts, for instance, actions are commenced by next friend and may be defended by Guardian ad litem appointed for that purpose under the Civil Procedure Rules. See: Order 13 Rules 11 & 12, High Court of the Federal Capital Territory, Abuja (Civil Procedure) Rules 2018; Order 14 Rules 9 and 10 High Court of Lagos State (Civil Procedure) Rules. Order 9 Rules 10 & 11, Federal High Court (Civil Procedure) Rules 2019. Section 2, Children and Young Persons Act defines a ‘child’ as a person below 14 years. In the USA, the doctrine of ‘mature minor’ has been developed to deal with the question of informed consent of minors to medical treatment. Where it can be shown that a minor is mature enough to make an informed decision or to appreciate the nature, extent and consequences of his action, the Courts have treated such persons not as minors but mature minors with a right to determine the type of medical treatment they wish to be subjected to. See the case of Re: Ernestine Gregory 133 III 2d 98, 549 NE 2d 322 (1989) noted by O.F. Emiri (ibid), at p. 200.

20) Okekearu v Tanko (2002)15NWLR (Pt 791) 657 at 670.

21) O.F. Emiri, Medical Jurisprudence (Jeroiliromah Press, Lagos) 191 - 192

22) Paris, ‘Compulsory Medical Treatment and Religious Freedom: Whose Laws Shall Prevail’? 10 University San Francisco Law Review. 1, at 26; Byre ‘Compulsory Lifesaving Treatment for the Competent Adult’ (1975) 44 Fordham Law Review 1 at 29.

23) John Ademola Yakubu, ‘Medical Law in Nigeria’ 44, Sidaway 488

24) (2008) 12 NWLR (Pt 1102) 794 (CA); (2019) 7 NWLR (Pt 1671) 316 (SC)

25) The parties before the magistrate court were Commissioner of Police v Rita Esabunor Suit No. M/73/97

26) (2008) 12 NWLR (Pt 1102) 794 (CA)

27) (2019) 7 NWLR (Pt 1671) 316 (SC)

28) See Grace Abraham Ahiakwo, ‘Case Comment on Esabunor & Anor v Faweya & 3 Ors’ (2022) Vol.8 (1) International Journal of Law 40-46

29) FCSC v Laoye (1989) 2 NWLR (Pt 106) 652; Adigun v AG Oyo State (1987) 11 NWLR (Pt 53) 678; Ovunwo v Woko (2011) LPELR 2841(SC); Chitra Knitting & Weaving manufacturing Co. Ltd v Akingbade (2016) LPELR 40437 (SC)

30) (2019) 7 NWLR (Pt 1671) 316 at 338

31) See Court of Appeal decision (2008) 12 NWLR (Pt 1102) 794 at 809

32) 331F.2d1010(D.C.Cir.1964

33) Grace Abraham Ahiakwo, ‘Case Comment on Esabunor & Anor v Faweya & 3 Ors’ (2022) Vol.8 (1) International Journal of Law 40 at 42

34) Supreme Court decision (2019) 7 NWLR (Pt 1671) 316 at 338 at 340 D-F

35) https://www.lawinsider.com/dictionary/life-threatening-emergency assessed 04/11/2022

36) CO Okonkwo, ‘Medical Negligence and the Legal Implications’ in B C Umerah (ed), Medical Practice and the Law in Nigeria (Longman Press) 131 at 133

37) Grace Abraham Ahiakwo, ‘Case Comment on Esabunor & Anor v Faweya & 3 Ors’ (2022) Vol.8 (1) International Journal of Law 40 at 44

38) ‘Abortion’ is a criminal offence under section 328, ‘Aiding suicide’ is an offence under section 326, ‘Euthanasia’ is an offence under section 311, Criminal Code Act, Cap C38 LFN 2004

39) John Ademola Yakubu, ‘Medical Law in Nigeria’ 45, Bolan v Friern Hospital Management Committee (1957) 1 WLR 583

41) See the following cases: Re: Osborne (1972) Dist. Col App 294 A 2d 3726; Re: Yetter (1973) 62 Pa D & C 2d 619 noted with approval by the Supreme Court in Okonkwo (Ibid) at 245 - 246.

42) ibid at 244A

43) 501 NYS 2d 837, 841 (App. Div. 1986) See also: Superintendent of Belchertown State School v. Saikewicz 370 N.E. 2d

417, 426 - 27 (Mass 1977) referred to and approved in MDPDT v. Okonkwo (Ibid) 245.

44) 495 N.E. 2nd 373, 343 n-6 (N.Y. 1986)

45) ibid at 245A.

46) ibid at 247C. This is an obiter dictum