P-171: A Review of The Patient Consent Satisfaction) in Medical Procedures and The Legal Responsibility of Physicians Toward Patients

s:6941:"Background: Consent (satisfaction) of patient is effective in criminal responsibility of physician and his/her compurgation. Consent in word means agreement or permission. Before discussion about the effect of patient consent or his/her parents in medical responsibility, there is a question that “if victim (patient) accepted crime against himself with free will all its consequences, is this a reason for the legitimacy of the crime and staying the proceeding in jurisdictions or not?”. According to the views of legal experts, since the criminal law is one of the peremptory rules and related to the public order, the victim’s will, cannot disrupt the law enforcement, so the consent of victim is ineffective in the crimes which are harmful for his/her life, health or physical integrity such as murder, assault and battery. Thus the default is “The consent of victim has no effect on the nature of crime”. One of the main conditions for modifying or manipulating one’s body is not only necessity of treatment but the permission of patient or his/her parents to the surgeon or physician for surgery operation. Now it is the question that “How the consent of patient can affect the responsibilities of physician?”Criminal legislator of Iran in the articles 495, 496 and 497 of Islamic Penal Code (adopted on 21.04.2013) stipulates that the physician responsibility in the event of abuse, wastage and lack of technical standards, despite the patient's consent or knowledge, is established.So if the doctor proceeds to treat the patient by permission of him or his legal guardian if has no aggression and no-fault, then he would have no liability, because he himself is a legislator. Another issue is the separation surgery into general surgery that is important or necessary and cosmetic surgery. Such question is discussed. What is known as Surgery and located against the general or necessary surgery, and only be legitimated with the permission of the patient, in this kind of surgery how patient satisfaction is effective in the doctor's responsibility? Current practices did not see such surgeries as illegal but the doctor's responsibility in such a case is heavier than normal operation. Because the necessity factor makes many risks lawful and such practices (which is necessary for the progress and well-being) may be traditionally given by common sense. But "fun and whimsy" has not the power of "necessity”. Thus, some people who consider commitment of the physician in patient treatment as a care commitment, consider the commitment of physician in unnecessary plastic surgery as a obligation of result, and they consider the physician as responsible for injury or death of patient. The patient’s consent is either implicitly or explicitly, and nowadays explicit consent is written. To announce the patient consent it is expected the following conditions, which consent is ineffective in the absence of them. The first condition is the existence of the intellect, maturity and capacity in consent provider. The second condition of the consent of the patient or his legal representative is that it should be provided before surgery or in contemporaneous with it, because consent of patient or his legal representatives after the offense cannot remove the criminal fault of the offender and it is only a forgiveness. The third requirement for consent is that it is free from defects and freely expressed. The main purpose of this subject is that many people believe that can not ask the doctor to explain his activates. So discussing about this theme in a professional and scientific way can help to fix this misconception. Because this vision not only cause to violate the patient’s rights but make some doctors, who think only for their own profits rather than patients recovery, to be more insolent. Materials and Methods: Regarding the library nature of topic, the research method in this article is to refer the sources in libraries and National Documents Center of Iran by taking note. Of course we should consider the role of internet and its sources in this research. Results: Since the injured patient is incapable in proving fault or negligence of a doctor, legislator supports the weak party in this contract and for establishing responsibility of a doctor, suffered person is deferred from the proof of guilt, unless the patient or his parents give a written permission to doctor in the contract, which in this case should prove the violation suffered by the doctor. Meanwhile in cosmetic surgery discussion, the unnecessary surgery, the doctor is obliged to conclude. Therefore, if any injury or death is applied by his actions, he has responsibility. Consent, cannot negate the responsibility of the doctor because it is so original that no one has a lien on the property and lives of others, unless it is sentenced by the religious or law. Consent is only valid to permit the doctor for examination and treatment of his body. In other words, Patient or his parents are not satisfied for crimes against themselves. Innocence does not means that the doctor citing to the contract’s condition, release him from his legal responsibility against his fault. But, given the doctor take acquittance from the patient or his legal parents, the physicians are obliged to observe caution and scientific aspects and legal regulations. If the violation of these things is led to patient death or injury, the doctor is responsible for it. Conclusion: One of the important discussion in this context and focuses on the surgeries in hospitals, is the issue of consent(satisfaction)and acquittal, which due to unawareness of patient to the provisions and their rights, and above all, since patients and their companions are in the passivity and the need position and thus cannot explain their actual demands clearly, so it is necessary that a committee including representatives of judiciary, medical council and public associations be formed and undertake the obtain of these consents and acquittals and explain the perspective of the problem clearly to the patients and their family, in order to perform the consent and acquittal perfectly. On the other hand, in the private clinics, e.g. a dentist’s clinic, there is no comment or word about consent and acquittal or the medical responsibility domain, and always physician has significantly more chance. First of all the physician gets his fee, and if the patient has any claim, he should be confused between the clinic, the medical council and the court. So it is better that the quality of the relation between patient and physician and the responsibilities of each be written on a board and install in a place in sight of patients, in private and public clinics, hospitals, and authorized medical centers to make contract consciously.";