Medical and Dental Practitioners Disciplinary Tribunal v. Okonkwo

(2002) AHRLR 159 (NgSC 2001); [2001] WRN 1
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The Medical and Dental Practitioners Disciplinary Tribunal (“the Tribunal”) brought charges to determine whether a practitioner is guilty of punishable “infamous conduct” when in deference to a patient’s religious views which he failed to provide live-saving blood transfusions, refer the patient to another practitioner, or terminate his medical contract.

The patient, Martha Okorie, and her husband were Jehovah’s Witnesses who believed that receiving blood transfusions would violate their beliefs. A week after giving birth, Okorie was admitted to a hospital for difficulty walking and severe pain in the pubic area but rejected a recommended blood transfusion. She was discharged and taken on the same day to Dr. Okonkwo (respondent). She produced a document stating that she would refuse any blood transfusions and that she released doctors from liability. Her husband produced a similar document as a witness in the event that she lost consciousness. Okonkwo proceeded to treat the patient without providing any blood transfusions, and she died shortly afterwards.

The Tribunal charged Okonkwo with attending to the patient in a negligent manner and consequently conducting himself in an “infamous” manner contrary to medical ethics, punishable under section 16 of the Medical and Dental Practitioner’s Act. It also charged him with acting contrary to his oath as a medical practitioner and thereby also conducting himself in an infamous manner under the same act. On the first count, the Court of Appeal held that the Tribunal did not have jurisdiction to make such a determination. On the second count, the Court of Appeal held that the practitioner did not violate any particular code of ethics and that the existing code did not adequately provide how a practitioner should act in the absence of a patient’s informed consent.

The Court held that the Court of Appeal was correct in determining that the Tribunal is competent to try the specific offenses under the Act and that it had charged the respondent for conduct beyond the Act. The negligence charge failed on this point, as did the charge of violating the code of ethics as nothing in the code explicitly stated that a practitioner who has been denied informed consent should carry on a medical live-saving measure.

The Court held that the practitioner was not obligated to terminate the medical contract nor had a duty to transfer the patient to another hospital merely because the patient had refused a blood transfusion on the grounds of religious belief. The Court noted that a practitioner is best suited to determine whether to terminate a medical contract, a choice that depends on personal attitude rather than on professional ethics and that Rule 5 of the Act requires transfer only when an examination or treatment is beyond the capabilities of the practitioner.

“[72.]  … Where, for instance, the health and safety of society is under threat, for instance in an epidemic, public health and safety may be given a higher weight than the individual's human rights. Where, however, the direct consequence of a decision not to submit to medical treatment is limited to the competent adult patient alone, no injustice can be occasioned in giving individual right primacy.”

“[73.] … The right to privacy implies a right to protect one's thought, conscience or religious belief and practice from coercive and unjustified intrusion; and, one's body from unauthorised invasion. The right to freedom of thought, conscience or religion implies a right not to be prevented, without lawful justification, from choosing the course of one's life, fashioned on what one believes in, and a right not to be coerced into acting contrary to religious belief. The limits of these freedoms, as in all cases, are where they impinge on the rights of others or where they put the welfare of society or public health in jeopardy. The sum total of the rights of privacy and of freedom of thought, conscience or religion which an individual has, put in a nutshell, is that an individual should be left alone to choose a course for his life, unless a clear and compelling overriding state interest justifies the contrary.”

“[75.]  Since  the  patient's  relationship  with  the  practitioner  is  based  on  consensus,  it follows that the choice of an adult patient with a sound mind to refuse informed consent to  medical  treatment,  barring  state  intervention  through  judicial  process,  leaves  the practitioner helpless to impose a treatment on the patient. … If a competent adult patient exercising his right to reject life-saving treatment on religious grounds thereby chooses a path that may ultimately lead to his death, in the absence of judicial intervention overriding the patient's decision, what meaningful option is the practitioner left with, other, perhaps, than to give the patient comfort?”