LO: Describe the basic structure of the English legal system as it relates to medicine.

Law:

• Establish and define standard of acceptable behaviour
• Maintain standards and punish 'offenses'
• Protect the vulnerable
• Achieve the resolution of disputes

flowchart TD

	C[Medico-legal cases] -->D[Resolution of disputes]

	C -->E[Ethical Dilemmas]

Issues that will be covered during the course:

1. Consent - respect for autonomy
2. Acting in accordance with professional standards
3. What to do when things go wrong
4. Protecting patient confidentiality
5. Acting in the best interests of vulnerable patients - children, those lacking mental capacity and people with mental illness
6. Abortion and reproduction, infectious diseases and proper use of human tissue

LO: Describe basic legal principles, e.g. the common law system of precedent, tort, contract and the Human Rights Act (HRA).

flowchart TD

	C[Sources of Law] -->D[Statute]

	C -->E[Common Law/Case Law]

Statute:

1. Bill proposed
2. 1^st reading - Bill introduced and published
3. 2^nd reading - Bill debated and voted on
4. Committee Stage - line by line examination of the Bill
5. Report Stage - Changes can be suggested and debated
6. 3^rd reading - final debate and vote
7. Bill should then move to the House of Lords
8. House of Lords can make changes which needs to be considered by House of Commons
9. House of Lords $\rightleftharpoons$ House of Commons until agreement, if no agreement Bill will fail

Human Rights Act 1998 (HRA)

• Article 2 - Right to life
• Article 3 - Prohibition on torture and inhuman or degrading treatment
• Article 5 - Right to liberty and security
• Article 8 - Right to respect for private and family life
• Section 3(1) requires all 'public authorities' to act in compliance e.g. NHS

HRA in Healthcare

Case Law:

graph TD
A[Case] --> B[No relevant statute law]-->C[Case Law]

Regulation and Professional Guidance

• EU Directive - European Working Time Directive; consumer protection
• GMC - licensing of doctors
• Regulatory Bodies - HSE, PHSO, Human Tissue Authority, HFEA

Types of Law:

flowchart TD

	A[Types of Law] -->B[Civil]

	A -->C[Criminal]
	
	A --> D[Public]

Civil Cases:

• Contract law - exchange of 'legal consideration' in contracts
• Contracts of employment, for goods and services e.g. private health care
• Tort - Provide a remedy to persons who have been harmed by the conduct of others. e.g. car accidents, negligent accidents in healthcare

flowchart LR
	A[Breach of duty]-->Causation-->Damage

Clinical Negligence (Claimant, the patient, must establish 4 things):

1. They were owed a duty of care
2. The duty of care was "breached"
3. They have sustained and injury (loss)
4. Injury was "caused" by that breach of duty (causation)

The claimant has the burden of proof 'on the balance of probabilities' (51/49%) they suffered and injury as a direct cause of the sub-standard treatment

There will be a breach of duty of care if a doctor: "... fails to act in accordance with the standards of reasonably competent medical men acting in the relevant field at the relevant time" McNair J

Criminal Law:

• Consent issues
• End of life issues
• Gross negligence manslaughter
• Confidentiality

Civil Law v Criminal Law:

Public Law - Judicial Review:

• Lawfulness of policies concerning prescription
• Redesign of mental health services
• Hugely contentious

Public Inquiry:

• Major investigations - government minister
• Inquiries Act 2005
• Compel testimony and release of other forms of evidence

1. What happened?
2. Why did it happen and who is to blame?
3. What can be done to prevent this happening again?

English Court System:

flowchart BT
	A[Magistrates Court] --> B[Crown Court]
	C[Coroner's Court]
	D[County Court] --> E[High Court]
	B --> F[Court of Appeal]
	E --> F[Court of Appeal]
	F --> G[Supreme Court]
	G --> H[European Court of Human Rights]
	G ~~~ Parliament
	G --> J[European Court of Justice]

High Court (3 divisions):

1. King's Bench Division

• Deals with "common law" civil claims e.g. tort, contract.

2. Chancery Divison

• Deals with wide range of disputes: business, property/land, intellectual property issues, bankruptcy, tax and validity of wills.

3. Family Division

• Protecting children under the Children Act 1989
• Human fertilisation, embryology and surrogacy
• Forced marriage and female genital mutilation
• Inherent Jurisdiction e.g. authorise withdrawal of medical treatment for a child where dispute arises between the doctors and parents

Court of Protection:

• Established under the Mental Capacity Act 2005
• Decides whether a prson 'has capacity'
• Makes declarations, decisions or orders on financial or welfare matters
• Appoint a deputy to make decisions for people lacking capacity

Coroner's Court

• Coroner - specialist judge who investigates certain kinds of deaths
• Inquisitorial - cannot apportion blame
• Answer 4 questions: who, when, where and how the deceased die
• Balance of probabilities

Expect to be involved

• Complaints
• Claim
• Patient safety incidents
• Coroner's investigations
• Safeguarding
• Child protection
• GMC investigation
• Court of Protection