Legal Duties and Liability of

the Doctor in Nigeria

Dr. O G Olupona
FM 505
 Declaration by a prospective medical or dental practitioner
• I, Doctor......................... (The doctor being inducted publicly announces his name
here) do sincerely and solemnly declare that as a Registered Medical/Dental
Practitioner of Nigeria, I shall exercise the several parts of my profession to the best
of my knowledge and ability for the good, safety and welfare of all persons
committing themselves to my care and attention, and that I will faithfully obey the
rules and regulations of the Medical and Dental Council of Nigeria and all other laws
that are made for the control of the medical and dental professions in Nigeria.
• Furthermore, I hereby subscribe to the PHYSICIANS' OATH as follows: I SOLEMNLY
PLEDGE to consecrate my life to the service of humanity; I WILL GIVE to my teachers
the respect and gratitude which are their due; I WILL PRACTISE my profession with
conscience and dignity; THE HEALTH OF MY PATIENT WILL BE my first consideration; I
WILL RESPECT the secrets which are confided in me, even after the patient has died; I
WILL MAINTAIN by all means in my power the honour and the noble traditions of the
medical (dental) profession; MY COLLEAGUES will be my brothers and sisters;
Legal Duties and Liability of the Doctor in Nigeria 2
• I WILL NOT PERMIT considerations of religion, nationality, race, party
politics or social standing to intervene between my duty and my
patient; I WILL MAINTAIN the utmost respect for human life from the
time of conception; Even under threat, I WILL NOT USE my medical
knowledge contrary to the laws of humanity;
• I MAKE THESE PROMISES solemnly, freely and upon my honour.
a. The Declaration of Geneva (Physicians' Oath Declaration) adopted by the
General Assembly of the World Medical Association at Geneva,
Switzerland, in September 1948 and amended by the 22nd World Medical
Assembly at Sydney, Australia in August 1994.
b. Signature of the Doctor or Dentist who has taken the Oath, Signature of
the Provost or Dean of the College or Faculty of Medical or Health Sciences
and signature of the Registrar of the Council
Legal Duties and Liability of the Doctor in Nigeria 3
Most recent Physician’s Pledge
• Please see attachment named
wma-declaration-of-geneva.pdf

Legal Duties and Liability of the Doctor in Nigeria 4

 THE INTERNATIONAL CODE OF MEDICAL ETHICS (DECLARATION OF VENICE 1983)
• (A) Duties of Physicians in General:
A physician shall always maintain the highest standards of professional
conduct.
A physician shall not permit motives of profit to influence the free and
independent exercise of professional judgement on behalf of patients.
A physician shall deal honestly with patients and colleagues, and strive
to expose those physicians deficient in character or competence or who
engage in fraud or deception.
• (B) Duties of Physicians to the Sick:
A physician shall always bear in mind the obligation of preserving
human life.
A physician shall owe his patients complete loyalty and all the resources
of his science.
Legal Duties and Liability of the Doctor in Nigeria 5
 Whenever an examination or treatment is beyond the physician's
capacity, he should summon another physician who has the
necessary ability.
A physician shall give emergency care as a humanitarian duty
unless he is assured that others are willing and able to give such
care.
• (C) Duties of physician to each other:
A physician shall behave towards his colleagues, as he
would have them behave towards him.
A physician shall not entice patients from his colleagues.

Legal Duties and Liability of the Doctor in Nigeria 6

 ALLEGIANCE TO THE PROFESSIONS
1. Every member of the medical or dental profession must endeavour to
abide by the dictates of the Physicians' Oath, the modern version of
the Oath of Hypocrates, which is the foundation of the code of Ethics
of the profession.
Embodied in this oath are the guidelines for behavioral interaction between
practitioners and their patients, practitioners and their colleagues, practitioners
and their teachers as well as practitioners and the public as represented by the
law and the government.
2. Fundamental to these ethical guidelines is an allegiance which every
doctor or dentist mandatorily owes to the corporate body of the
profession.
This corporate body of the profession by tradition or convention through the
ages has assumed the responsibility for maintaining and constantly enhancing
the standard of service provided to the public by the profession as well as
protecting the profession from unwarranted encroachment by charlatans and
quacks.

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 There are two arms to this corporate body, namely, a statutory arm
represented by the Medical and Dental Council of Nigeria, the regulatory
body set up by law and the Nigerian Medical Association, a quasi-voluntary
association of all medical doctors and dentists. Both bodies consist of
medical doctors and dentists. They share the same objectives as stated in
these Codes and command the allegiance of all doctors and dentists in the
land.
3. The authority of the Council over all medical doctors and dental
surgeons in Nigeria is statutory and backed by Law.

Legal Duties and Liability of the Doctor in Nigeria 8

 What Medical Doctors & Dentists Need to Know
• A. The laws setting up the Medical and Dental Council of Nigeria and
which spell out its functions and modus operandi (Medical and Dental
Practitioners Act, Cap 221 Laws of the Federation of Nigeria 1990).
• (B) The Code of Medical Ethics, i.e., rules of professional conduct for
medical and dental practitioners in Nigeria prepared by the Council.
• (C) The constitution of the Nigerian Medical Association, all its bye-
laws and standing orders at national and relevant state levels.
• All medical doctors and dentists who have paid their annual practising
fees become, automatically, financial members of the Nigeria Medical
Association and for the purpose of the Medical and Dental Practitioners
Act are entitled to all rights and privileges appertaining to members. All
registered practitioners are therefore encouraged to participate actively
in the affairs of the Association.
Legal Duties and Liability of the Doctor in Nigeria 9
 Duty to Expose Professional Misconduct
• Medical practitioners and dental surgeons should expose without fear or favour,
before the Medical and Dental Council of Nigeria, either directly or through the
Nigerian Medical Association, any corrupt, dishonest, unprofessional or criminal
act or omission on the part of any doctor or dentist.
• Such exposure must be motivated by the greater good of the entire profession
and should be without malice.
• The Council may, on the recommendation of either of its disciplinary organs,
communicate to a foreign Medical Council when appropriate, relevant
information on a registered practitioner when it is obvious that the Medical and
Dental Council of Nigeria is being ignored on a matter for disciplinary process, by
a registered practitioner who has been duly notified but who decides to practise
medicine or dentistry in another country.
• The purpose of such communication will be to compel the registered practitioner
to assist the disciplinary organs in treating such a matter before them, in which he
is involved.

Legal Duties and Liability of the Doctor in Nigeria 10

 RESPECT TO COLLEAGUES
• Medical practitioners and dental surgeons should always endeavor
to accord the senior members of the professions their due respect
whenever junior interact or interrelate with them, either
professionally or socially.
• Older members of the profession should also consider the junior
ones as their brothers and strive to set good examples and give
guidance at all times.
• This duty should manifest itself in all health care institutions in the
context of continuing medical education such as during ward
rounds, clinical conferences and medical care audit sessions, with
both the senior and junior colleagues interacting to achieve and
maintain a high standard of patient care.
Legal Duties and Liability of the Doctor in Nigeria 11
 LEGAL BASIS FOR MEDICAL AND DENTAL PRACTICES
• Registration Any person who practises medicine or dentistry anywhere in
Nigeria without being appropriately registered with the Council
contravenes the law, and so does his employer.’
• Categories of Registration
1. Provisional Registration: This registration entitles a qualified medical
practitioner or dental surgeon to undertake internship under the
supervision of registered consultants or specialists in a hospital
approved by the Council for internship training.
1. This registration lapses automatically when the registered practitioner is
signed off from the internship. While it subsists, it does not entitle the
practitioner to set up and run an independent practice on his own.
2. Every new medical or dental graduate 'is required to complete his
internship within two years of his graduation, or he may unless he gives
a satisfactory reason, be subjected to an assessment examination by the
Council.
Legal Duties and Liability of the Doctor in Nigeria 12
2. Full Registration: A practitioner should obtain this registration after
a satisfactory completion of his internship and this confers on him
the legal right to practise on his own. However, the practitioner is
expected to be able to recognize his limitations in the management
of certain types of cases.
3. Registration as a Specialist: Every practitioner who has acquired
specialist qualification after undergoing the requisite training as
prescribed by the National Postgraduate Medical College, or any
other training deemed to be the equivalent, is required by law to be
registered with the Council as a specialist before he can practise
and be recognized as such.
A practitioner who is not registered with the Council as a specialist
cannot validly sign off interns and his opinion, as a specialist will not
be backed up by the Council upon enquiry.

Legal Duties and Liability of the Doctor in Nigeria 13

4. Limited or Temporary Registration: This is the type of
registration issued to expatriate practitioners.
Unlike the Full registration, it has a specific period of validity
after which it must be renewed, or the practitioner must leave
the country.
It is also tied to a specific employment. Any change of
employment invalidates the registration and the practitioner
must then process a new registration for the new job.
A practitioner on Limited Registration cannot set up or run a
clinic or hospital on his own.
A practitioner on the Limited or Temporary Register is not
allowed to work privately on his own. He must work with
Nigerian practitioners in the clinic or hospital.

Legal Duties and Liability of the Doctor in Nigeria 14

 PRACTISING FEES AND ANNUAL LICENSING
• All practitioners must bear in mind at all times that by law, as
stipulated in Sections 14 and 18 of the Medical and Dental
Practitioners Act cap 221, Laws of the Federation of Nigeria 1990
(as amended):
1. A person shall not hold an appointment or practise as a medical
practitioner or dental surgeon, in Nigeria, unless he is registered with the
Council.
2. No registered medical practitioner or dental surgeon shall practise as a
medical practitioner or dental surgeon, as the case may be in any year
unless he has paid to the Council in respect of that year the appropriate
practising fee.
3. Any medical practitioner or dental surgeon who in respect of any year
and without paying the prescribed fee practises as such shall be guilty of
an offence and shall be liable on conviction

Legal Duties and Liability of the Doctor in Nigeria 15

4. In the case of first offence, to a fine of twice the prescribed practising
fee, and
5. In the case of a second or subsequent offence, to a fine of not less than
ten times the prescribed practising fees;
6. Also late payment shall attract a surcharge as may be determined by the
Council from time to time, without prejudice to any other penal
provisions in the statute.

Legal Duties and Liability of the Doctor in Nigeria 16

• All doctors are advised to meet this commitment promptly, as conviction
under this section will be viewed seriously by the Council.
• By the Regulations of the Council, practitioners are expected to pay their
practising fees for the ensuing year before the 31st December of the
preceding year in order to be currently licensed on the first day of the new
year.
Current rates are practitioners <10 years ₦10,000 and practitioners ≥10 years ₦20,000
• The law further stipulates as follows:
1. Where a practitioner who is in employment has defaulted from payment of the
practising fee; and if the medical practitioner or dental surgeon is in the
employment of any person, that person shall also be guilty of an offence and
punished in like manner as the medical practitioner or dental surgeon unless he
proves that the failure to pay the practising fee was without his knowledge, consent
or connivance.
2. All members of the medical and dental professions who employ medical doctors or
dental surgeons or who are professional heads of medical institutions, either public
or private, are to take due notice of this aspect of law.

Legal Duties and Liability of the Doctor in Nigeria 17

 GENERAL PRINCIPLES OF THE ETHICS OF MEDICAL AND DENTAL PRACTICES IN NIGERIA
1. The principal objective of the medical or dental practitioner shall be the
promotion of the health of the patient. In doing so, the practitioner shall also
be concerned for the common good while at the same time according full
respect to the human dignity of the individual.
2. Practitioners have a responsibility in promoting not only individual health but
also the general health of the community and in pressing for an equitable
allocation of health resources.
3. Practitioners must strive at all times not only to uphold the honour and to
maintain the dignity of the profession, but also to improve it. Practitioners shall
deal honestly with colleagues and patients at all times.
4. Practitioners shall always strive to observe the laws of the land but may
participate, individually or collectively, in accordance with citizenship rights to
bringing pressure to bear on governments or authorities, to change or modify
laws or actions considered inequitable or inimical to the interest of the
profession or the society.

Legal Duties and Liability of the Doctor in Nigeria 18

5. Medical and dental practitioners shall try at all times to safeguard the public, the
medical and dental professions against incompetent or unethical practitioners
and should expose without hesitation, any instance of professional malpractice
and misconduct in a professional respect to the Medical and Dental Council of
Nigeria.
6. All communications between the patient and the practitioner made in the course
of treatment shall be treated in strict confidence by the practitioner and shall not
be divulged unless compelled by law or overriding common good or with the
consent of the patient.
7. Practitioners shall be at liberty to choose whom they will serve in rendering their
professional service, but they shall endeavour to render service without
discrimination in an emergency to the best of their ability and according to the
prevailing circumstances.
8. Practitioners shall have absolute discretion and authority, free from unnecessary
non-medical interference, in determining when to give their services, the nature
of care to be given to a patient under their care and must accept responsibility
for their actions.

Legal Duties and Liability of the Doctor in Nigeria 19

9. Practitioners must always strive to improve their medical knowledge and skill, and
practise according to accepted scientific principles in rendering care to patients.
10. Practitioners must work with colleagues to monitor and maintain their awareness
of the quality of the care they provide. In particular, they must take part in regular
and systematic medical and clinical audit.
11. Practitioners must not hesitate to seek the consultation of more experienced or
appropriate specialist colleagues whenever they are in doubt or lacking
competence with regard to the medical needs of their patients.
12. Practitioners may associate professionally with non-medically qualified people
where this is relevant to the proper care of patients but they must ensure that in
any collaboration with any of the allied professions or para-professions, the
persons involved are recognised members of their disciplines and are competent
to perform the tasks to be required of them. In all such relationships, the
practitioner shall retain the absolute authority and responsibility for the patient
and should not delegate any exclusive professional medical or dental
responsibility to any non-medical or non-dental person.

Legal Duties and Liability of the Doctor in Nigeria 20

13. Practitioners must not certify what they have not personally verified; they
must desist from compulsory treatment of a patient in the absence of
illness and must not collaborate with other agencies to label somebody ill
in the absence of any illness, but must always obtain consent of the patient
or the competent relatives or seek another professional opinion, before
embarking on any special treatment procedures with determinable risks.
14. In performing biomedical research involving human aspects, practitioners
must conform to generally accepted scientific and moral principles and
must obtain informed consent from their subjects and take responsibility to
ensure the protection of their integrity and confidence.
15. Practitioners shall be entitled to charge fees for their professional services
but such income should be limited to professional services actually
rendered, supervised or for missed appointments and should be
commensurate with the service rendered and the patient's ability to pay.
Fee-splitting and payment for referrals are forbidden.

Legal Duties and Liability of the Doctor in Nigeria 21

16. A Practitioner should safeguard against any publicity in the media that
may imply that he has special skills or that exposes the identity of a
patient. He should be circumspect in the announcement of any new
special procedures or discoveries and must always strive for
anonymity for himself and the patient in any public forum where
these are being discussed.
17. Practitioners shall be entitled to inscribe their professional and
academic titles after their names but in doing so care must be taken to
avoid unethical advertising or any attempt to solicit for patients.

Legal Duties and Liability of the Doctor in Nigeria 22

 RIGHTS AND RESPONSIBILITIES OF MEMBERS OF THE MEDICAL AND DENTAL PROFESSIONS
1. Only persons who have undergone the course of training based on the curriculum
for medical and dental education as approved by the Medical and Dental Council of
Nigeria and have obtained the certificates approved or recognized by the Council,
and who beside all these have been registered and licensed by the Council shall
practise as a physician or dental surgeon in Nigeria.
2. In the context of a health institution, other members of the health team may
perform appropriate para-professional or professional functions required in the
process of healthcare, provided that these functions are performed at the request,
or under the supervision, of the medical practitioner or dental surgeon who is in a
position to obtain and appropriately interpret the health database that provides
the indications for these functions.
3. In circumstances where the doctor is not available, the use of Standing Orders that
provide clear guidelines for action will suffice as authority for initiating these
actions by the appropriate members of the health team. In these situations, any
actions outside the scope of the Standing Orders are illegal and render such other
professionals or para-professional liable. Such Standing Orders must be prepared in
the first instance by the supervising doctors, the institution, or the corporate
medical profession.
Legal Duties and Liability of the Doctor in Nigeria 23
4. Subject only to accepted standards of care as determined by corporate
professional opinion, a doctor must exercise absolute discretion and
authority in determining the nature of care given by him including
appropriate utilization of men, materials, money and time in order to
achieve the best possible results for his patients. By the same token, he
must accept the responsibility for the results obtained under his
management. To this end, he must refrain from doing anything repugnant
to his sense of honour or against his considered judgement, even in the
face of unreasonable demand from the patient or other persons, whether
individual or corporate.
5. Similarly, in the face of inadequate or inappropriate resources and facilities
he must exercise ingenuity and initiative to secure the best possible results
for his patient. He must not however, embark on any treatment for which
he does not have the requisite knowledge, competence or resources.
6. Registered practitioners are advised to protect their professional practice
by regularly taking professional indemnity.
Legal Duties and Liability of the Doctor in Nigeria 24
 ADDITIONAL CONSIDERATIONS
• PRACTISING AS A SPECIALIST: No medical or dental practitioner shall practise as a
specialist, or pass himself off as a specialist, without having a specialist qualification
which is registrable with the Medical and Dental Council of Nigeria. Every
practitioner who is a specialist should know that it is a contravention of the
regulations for him to practise as a specialist without having been registered as a
specialist by the Council.
• SELF-MEDICATION BY REGISTERED PRACTITIONERS: A medical or dental
practitioner can offer first aid treatment to members of his family. Severe ailments
are best referred to colleagues who can treat the afflicted person with a mind
devoid of distracting emotions. Similarly, a doctor should avoid self-treatment and
self-medication unless the ailment is clearly minor or there is no access to a
colleague.
• PROFESSIONAL SERVICE TO COLLEAGUES: It is the norm that no professional fee is
charged when a doctor looks after a colleague. By this is meant that when a
colleague is seen by a doctor, such a colleague would not be expected to pay for
registration (card) and consultation or the professional skills or expertise of the
attending doctor. However, the cost of consumables may be borne by the doctor
who is treated.

Legal Duties and Liability of the Doctor in Nigeria 25

• NOTICE TO PRACTITIONERS IN THE LOCALITY: A practitioner who is qualified and
available to act as a consultant to other doctors in any branch of medicine or
dentistry, may send to practitioners in his locality or publish in his local medical
journal a brief and dignified announcement of his availability to serve other doctors
in that capacity.
• MUTUAL REGARD AMONG REGISTERED PRACTITIONERS: Registered practitioners
must give due respect to their senior colleagues and acknowledge their seniority
always, whether in a professional or in a social setting. Senior colleagues should be
mindful of the interest of junior colleagues in all their interactions and should offer
them appropriate guidance.
• DISCOVERY OF DECEPTION: When a doctor discovers that some fraud or deception
had been practised on him to accept a patient, particularly when a criminal act is
involved, he should make every effort to bring such discoveries to the notice of
appropriate authorities. Doctors must be careful to distinguish between criminal
deception and a clinical situation that is symptomatic of some personality defect in
the patient. The latter should be treated as a symptom requiring appropriate clinical
management.

Legal Duties and Liability of the Doctor in Nigeria 26

 INFORMED CONSENT
• Practitioners involved in procedures requiring the consent of the patient, his
relation or appropriate public authority must ensure that the appropriate
consent is obtained before such procedures, either for surgery or diagnostic
purposes, are done, be they invasive or noninvasive.
• Consent forms should be in printed or in written form either as a part of case
notes or in separate sheets with the institution's name boldly indicated.
• Explanations to patients from whom consent is being sought should be simple,
concise and unambiguous about expectations.
• Proper counselling should precede the signing of the consent form.
• Where the patient is under age, (below eighteen years (18) by Nigerian law),
or is unconscious, or is in a state of mind constituting a mental impairment, a
next-of-kin should stand in.
• In the absence of a next-of-kin, the most senior doctor in the institution can
give appropriate directive to preserve life.
Legal Duties and Liability of the Doctor in Nigeria 27
 APPROVED PROFORMA FOR OBTAINING CONSENT FOR ANAESTHESIA, SURGICAL
OPERATIONS AND CLINICAL PROCEDURES
......................................................................................................................................Hospital Clinic
Address...........................................................................................................................................................
CONSENT FOR SURGERY/PROCEDURES
I...................................................................................................... of.............................................................................................
(full names, surname first) (full address not P.O. Box) hereby, after detailed explanation of the advantages
and disadvantages to me by
Dr.....................................................................................................................................................
(full names, surname first) willingly consent to the procedure of.................................................................................................. [Specify] on
myself / child / spouse / mother / father / others ........................................................... (indicate as applicable)
I affirm that I clearly understand the language of presentation. The option to think over the procedure for a period before assenting was also
presented to me.
I further affirm:
(A) that the extent of the procedure and mode of anaesthesia are left to the discretion of the physician. (B) that any additional surgery or procedure to
that described above will only be carried out if necessary and in my best interest and can be justified for medical reasons.

Signature:...................................................... Signature:........................................................
or Thumb print. Address:...........................................................
Full Names:...................................................... ………………………………………………………………………
(Patient or Guardian) Date:......................................
Date:......................... (Witness)

Form MDCN/COMEIN/R19

Legal Duties and Liability of the Doctor in Nigeria 28

• In special situations, a court order may need to be procured to enable
life-saving procedures be carried out.
• In some cases, which may involve surgical procedures that are difficult
to reverse or involving removal of organs e.g. sterilization, amputation
of limb, etc. counseling sessions should be undertaken at a minimum of
three sittings to give the patient ample time to take an informed
decision before a consent form is signed.
• Time interval for counselling should be at least four weeks if the clinical
situation permits.
• Care should be taken to ensure that all consent forms are also signed by
witnesses. Discussion and explanation to the patient must be in the
language in which the patient is fluent and when necessary, through a
competent interpreter.
Legal Duties and Liability of the Doctor in Nigeria 29
• The attendant benefits and risks are to be clearly laid before the
patient. Appropriate professional advice on options must be given.
• The preferred option is to be chosen by the patient who will then
authorize the clinician by completing the Form
MDCN/COMEIN/R19.
• An essential element of Good Medical Practice, is the recognition
by the attending physician or dental surgeon, of the inherent right
of the patient to his own body and life.
• Practitioners in the line of duty has the privilege of access to the
body and even the corporal depths of the patient. He is also
privileged to access the social secrets as might be conferred on
him by the patient, his relation or friend.
Legal Duties and Liability of the Doctor in Nigeria 30
• In the process of clinical encounter, the physician or dental
surgeon may need to conduct, by physical approach or
invasive means certain investigations, procedures or
therapeutic manoeuvres on the patient.
• In such a situation, it is imperative and considered as good
practice to obtain some form of formal consent from the
patient. This professional manner of relationship universally
distinguishes situations of good practice from what may
otherwise amount to an assault on the patient. This further
enhances the protection of fundamental rights of the patient.

Legal Duties and Liability of the Doctor in Nigeria 31

 CONSENT TO SCREENING AND RESEARCH
A. Consent to Screening:
• Screening involves the testing of healthy or symptomatic people to
detect somatic abnormalities. This process carries uncertainties.
1. There is the risk of false positive or negative results.
2. It should be noted that some findings may potentially have serious
medical, social or financial consequences not only for the individual but
also for relatives e.g. in HIV/ AIDS, genetic determination, cancer etc.
3. Screening therefore has serious implications.
4. Practitioners should therefore ensure that - patients for screening can
make properly informed consent
5. Screening should not be contrary to the patient's interest. Proper
explanation is offered - The information the patient wants or ought to
have is identified before screening.

Legal Duties and Liability of the Doctor in Nigeria 32

B. Consent to research:
• Research is a scientific adventure seeking to achieve something
from the unknown, i.e. an adventure into searching for new drugs
or treatment or detecting hitherto unknown entities. For any
practitioner participating in research or clinical trials involving
patients or volunteers, it is important to ensure that
1. - full information is presented in terms and forms they can understand
2. - full information about possible benefits and risk are given
3. - participants have the opportunity to read and consider the research
information leaflet.
4. - sufficient time is allowed for participants to make up their mind
5. - participants' consent must be in writing
6. - approval is obtained from properly constituted research ethics
committee.

Legal Duties and Liability of the Doctor in Nigeria 33

 TERMINATION OF SERVICE BY PATIENTS
• Patients who are not in a defective state of judgement, or in their stead
their competent relatives, may be at liberty to terminate service against
medical advice upon a formal undertaking to that effect: but such services
should be restored without prejudice if they return for help.
• A medical or dental practitioner should normally take positive steps to
apply appropriate treatment and save the lives of special categories of
patients who cannot make informed decisions for themselves e.g.
1. all paediatric patients;
2. patients below the age of eighteen (18) whose parents belong to some types of
religious sects;
3. adult members of those sects who do not carry specified cards and who come in
unconscious.
• This may include getting a court order to permit treatment
Legal Duties and Liability of the Doctor in Nigeria 34
 MANAGEMENT OF HIV/AIDS AND OTHER SOCIALLY DREADED INFECTIOUS DISEASES
• The prevalence of highly hazardous (contagious) ailments should be noted by
practitioners.
• It is therefore worthy of note that practitioners should in no way discriminate in
handling and treating such patients, that they maintain appropriate confidentiality
and apply a multi-disciplinary approach.
• Referral of such patients should be strictly based on professional competence.
• The psychological and social consequences associated with HIV/AIDS, Hepatitis B,
Lassa fever, Ebola fever, COVID-19 etc. should be up in the minds of practitioners
handling such cases.
• Practitioners should ensure that they are not used as agents by employers or
others to deny infected patients their jobs where there is no clinical indication for
removal of such employees from their jobs.
• Where investigations are clinically indicated, it becomes ethical for the
practitioner to give pre and post test counselling.
• When a patient is seeking a diagnosis, consent is not needed to conduct an
investigation.
Legal Duties and Liability of the Doctor in Nigeria 35
 CLINICAL MANAGEMENT OF RELIGIOUS ADHERENTS
• At the moment of induction, all qualified doctors subscribe to the
Hippocratic Oath (Declaration of Geneva) part of which reads thus: "I will not
permit consideration of religion, nationality, race, party, politics or social
standing to intervene between my duty and my patient".
• In clear terms, whatever the religious orientation of the practitioner or the
patient, it must not determine the quality of treatment so offered. Often
times, this commitment has led many practitioners into conflict with patients
and relatives who cling to their religious tenets, and in some cases to
litigation.
• Practitioners should therefore be aware that society, and indeed the law,
recognizes the individual's right to accept or refuse medical treatment.
• Of all the religions, the Jehovah's Witnesses are the most prominent group in
respect to choice of medical treatment.
Legal Duties and Liability of the Doctor in Nigeria 36
• While objections by the other groups are focused on dietary components which do
present little or no problem to the practitioners, the Jehovah's Witnesses in
equating blood transfusion to the eating of blood, present a challenging dimension
in offering to them medical treatment in the fields of surgery, anesthesiology or
medicine.
• In managing such patients, it becomes essential to establish the religious views held
by them and fully record same in the notes. Their acceptance or rejection of
treatment should likewise be recorded and witnessed.
• The practitioner should decide if he is willing to accept the limitations in
management and, if so, the practitioner should plan and offer optimal care. If not,
the practitioner should withdraw care and refer such patients for further opinion or
to other health care centre which might be willing to handle such cases.
• A practitioner who accepts such referrals simply because he shares similar religious
tenet or is in sympathy should ensure that proper informed consent is obtained.
Failure to do so, may result in the practitioner facing the Disciplinary Tribunal if
found wanting in the care rendered, and thus be liable for malpractice
Legal Duties and Liability of the Doctor in Nigeria 37
 MANAGING THE UNCONSCIOUS PATIENT OR CHILDREN OF
UNCOMPROMISING RELIGIOUS INDIVIDUALS
• Children: Those within the ages of 16 to 18 years have a statutory right of their own to
consent to procedures and this takes precedence over parental objections, but does not
invalidate the right of others to consent on their behalf.
• However, where the child of this age group objects, and parental consent is obtained in
an emergency situation, appropriate treatment or procedure can be given.
• Children younger than 16 but not below 13, though considered as minors, but of clear
mind and can grasp the benefits and consequences of accepting or rejecting a proposed
treatment, "Gillick-competence", can give an acceptable consent.
• In respect of children under 13, the well-being of the child is paramount and if after full
parental consultation, treatment is refused, the practitioner should make use of the law
by obtaining an order from the Court-to protect the child's health interest.
• A child who needs blood transfusion or procedures in any emergency should be so
given.
• A practitioner who stands by and allows his minor patient to die in circumstances which
might be avoidable may be charged with negligence and is also vulnerable to criminal
prosecution.
Legal Duties and Liability of the Doctor in Nigeria 38
The Unconscious Patient:
• It is not uncommon for some religious sects to carry cards (advance directives)
containing treatment instructions.
• The practitioner should be meticulous in receiving unconscious religious
adherents.
• Their clothings should be searched for such cards.
• Even if accompanying relatives present such cards, clinicians should convince
themselves that such cards truly belong to the patient before them.
• In the absence of such cards, the priority of the practitioner in an emergency
situation is to save life first.
• If long intervention is envisaged, a court permit for continuous management
should be obtained.

Legal Duties and Liability of the Doctor in Nigeria 39

 RESPONSIBLE MEDICAL OFFICER
• The responsible medical officer shall be regarded as the practitioner who
takes ultimate responsibility for the care of the patient in a private or public
institution.
• This shall be the Consultant or the Principal Medical Officer, depending on
which of the two exists in the institution.
• Where neither is available, the next most senior officer is descending
hierarchy shall be deemed the responsible medical officer.
• All patients are registered in the name of the Responsible Medical Officer
and he takes full responsibility for the care of the patient.
• He, of course, must be open to suggestions from other members of the team
based on their expertise and experience, but the final decision about the
care of the patient rests with him.
Legal Duties and Liability of the Doctor in Nigeria 40
 CONFIDENTIALITY
• The profession takes very seriously the ethics of professional
secrecy whereby any information about the patient that comes to
the knowledge of the practitioner in the course of the patient-
doctor relationship constitutes a secret and privileged
information which must in no way be divulged by him to a third
party.
• The medical records are strictly for the ease and sequence of
continuing care of the patient and are not for the consumption of
any person who is not a member of the profession.
• Practitioners are advised to maintain adequate records on their
patients so as to be able, if such a need should arise, to prove the
adequacy and propriety of the methods, which they had adopted
in the management of the cases.
Legal Duties and Liability of the Doctor in Nigeria 41
• Disclosure of information on the patient by the doctor can only be
made following an informed consent of the patient, preferably in
writing.
• It is clear that the ethics covers even such information as on
criminal abortion, venereal disease, attempted suicide, concealed
birth and drug dependence but would exclude situations in which a
discretionary breach of confidentiality is necessary to protect the
patient or the community from danger.
• Where statutory notification of disease is involved, the consent of
the patient is not required.

Legal Duties and Liability of the Doctor in Nigeria 42

 ADHERENCE TO THE ETHICS OF CONFIDENTIALITY
• Information about patients is requested for a wide variety of purposes
including education, research monitoring and epidemiology, public health
surveillance, clinical audit, administration and planning.
• Every practitioner has a duty to protect patients' privacy and respect their
autonomy. When asked to provide information, a doctor should follow the
following principles:
1. Seek the patient's consent to disclosure of any information whenever
possible, whether or not you judge that the patient can be identified from
the disclosure.
2. Anonymise the data where unidentifiable data will serve the purpose.
3. Keep disclosures to the minimum necessary.

Legal Duties and Liability of the Doctor in Nigeria 43

PRINCIPLES TO APPLY WHEN FACED WITH DISCLOSURE OF INFORMATION
1. Protection of patient's medical records;
2. Release of information only following the granting of informed
consent by the patient, except where disease notification is
required by statute
3. Cryptic utilization of anonymised clinical material for teaching or
publication in professional journals;
4. Maintenance of confidentiality in the process of further
consultation;
5. Clear advice to patients on the breach of confidentiality which will
necessarily be attendant on their consenting to undergo medical
examination for the purpose of employment, insurance, security
or determination of legal competence;
Legal Duties and Liability of the Doctor in Nigeria 44
6. Discretionary breach of confidentiality to protect the
patient or the community from imminent danger;
7. Judicious balance between maintenance of confidentiality
for an under-aged patient and simultaneously making
available necessary information to the parent or guardian;
8. Breach of medical confidentiality in a court of law upon
being directed by the presiding judge, which must
thereafter be done strictly under protest;
9. Presentation of a patient at a scientific meeting only
following informed consent of the patient and acceptance
by the audience to maintain confidentiality.
Legal Duties and Liability of the Doctor in Nigeria 45
• It is the duty of a doctor to preserve his patient's confidences.
• This duty out-lasts the doctor's employment, and it extends as
well to his employees; and none of them should accept
employment which involves, or may involve the disclosure or
use of these confidences, either for the private advantage of the
doctor or his employees, or to the disadvantage of the patient
without the patient's knowledge and consent, and even if there
are other available sources of such information.
• This duty to maintain a patient's secrets subsists even after the
patient has died and a doctor should not continue in a particular
employment when he discovers that this obligation prevents the
performance of his full duty to his former or to his new patient.
Legal Duties and Liability of the Doctor in Nigeria 46
• If a doctor is accused by his patient, he is not
precluded from disclosing the truth with respect to
the accusation.
• The announced intention of a patient to commit a
crime is not included within the confidences which
the doctor is bound to respect. He may properly
make such disclosures as may be necessary to
prevent the act or protect those against whom it is
threatened.

Legal Duties and Liability of the Doctor in Nigeria 47

 RIGHT TO WITHDRAW SERVICE
• Once a doctor assumes the responsibility to care for a patient, his
right to withdraw such service would arise only for a good cause.
• Even the desire or consent of the patient is not always sufficient.
• The doctor should not relinquish the management of a patient to
the detriment of the patient. When he has reason for doing so on
grounds of honour or self-respect, he should hand over the
patient properly to another medical practitioner for further
management.
• If the patient insists upon an unjust or immoral course in the
process of his treatment, or if he deliberately disregards an
agreement, or obligation as to fees or expenses, the doctor may
be warranted in withdrawing on due notice to the patient,
allowing him time to employ another doctor.

Legal Duties and Liability of the Doctor in Nigeria 48

• Other instances as they arise may justify withdrawal. It would be
permissible for a doctor to withdraw his services in pursuit of his
rights under the Labour Laws of the Federal Republic of Nigeria,
provided that any doctor wishing to take that course of action must
have made satisfactory arrangements for the continuing care of his
patients and must have given adequate notice of his intention to
these patients and to the hospital authorities.
• In embarking on withdrawal of services under any circumstance, a
doctor must conduct himself in such a manner as to avoid suffering
and loss of life for the helpless patients, such as children and
accident victims, who had not in any way contributed to the
dissatisfaction which has made the withdrawal of service
necessary.
Legal Duties and Liability of the Doctor in Nigeria 49
• Upon withdrawing from the management of a case
after a fee has been paid, the doctor should refund
such part of the fee as has not been clearly earned.
• Interns: Before participating in withdrawal of services,
doctors undergoing internship training must bear in
mind the registration requirement for them to have
completed specified periods of posting in the major
disciplines during the internship.

Legal Duties and Liability of the Doctor in Nigeria 50

 MINIMUM PROFESSIONAL FEES AND SERVICE CHARGES
• A medical or dental practitioner is expected to charge corporate
bodies not below the minimum fee approved by the generality of
members of the profession in the locality where the practitioner
practises.
• A practitioner is however allowed a discretion in the fees he charges
socially indigent patients or private individual patients.
• A practitioner is permitted to take reasonable steps, which may
include instituting a lawsuit, to recover his fees from a defaulting
patient. He must however avoid such controversies, with patients
that may be incompatible with his self-respect and honour as a
medical or dental practitioner.
Legal Duties and Liability of the Doctor in Nigeria 51
• A practitioner who contravenes this provision by deliberately
under-cutting colleagues within the locality of his practice in
the fees he charges corporate bodies, or by inducing other
colleagues' patients by consistently charging ridiculous fees
whether to corporate or private patients, or otherwise
behaving in a disgraceful manner on the issue of fees to be
paid by or on behalf of a patient, shall be deemed to have
conducted himself infamously in a professional respect and
be liable to an appropriate sanction if charged before the
Medical and Dental Practitioner Disciplinary Tribunal.
Legal Duties and Liability of the Doctor in Nigeria 52
 NEW CLIENT AND UNPAID BILLS TO COLLEAGUES
• Registered medical practitioners and dental surgeons shall maintain brotherly
decorum in entering into professional business relationships, contracts and
agreements with corporate bodies, families, social groups or individuals.
• It is the duty of a registered practitioner to ascertain that in taking up new
professional business relationships - contracts and agreements, the
prospective client had paid all the earned fees that are due to any registered
medical practitioner or dental surgeon with whom he had an earlier
professional business relationship.
• It is unethical for a registered practitioner to accept or go into any new
professional business contract or agreement and proceed to give professional
service to a client who is in debt to a colleague from whom the client had
obtained professional care and services, unless he has obtained a written and
verified undertaking from the prospective client stating its non-indebtedness
to the doctor.
Legal Duties and Liability of the Doctor in Nigeria 53
AIDING CRIMINALS IN CLINIC OR HOSPITAL PREMISES

• Registered practitioners have a duty, to ensure that

professional practice premises are not used as bases or hide-
outs for criminals.
• A breach of this ethic, either by omission or commission
constitutes infamous conduct in a professional respect.

Legal Duties and Liability of the Doctor in Nigeria 54

 RETAINERSHIP, CAPITATION RATES AND PRE-FIXED FEES FOR
PROFESSIONAL SERVICES
• Members of the medical and dental professions, in pursuit of normal
economic interactions by giving professional services, may accept general
retainerships, capitation rates and pre-fixed fees for the care of the
personnel of corporate organizations, members of the specified group or
family, either directly or through intermediaries such as health
maintenance organizations (HMOs).
• However, in accepting a general retainership listing by intermediaries and
HMOs, practitioners must ensure that they are not trapped with terms of
retainership that
1. defy generally accepted economic concepts or,
2. would make them compromise ethics of the profession, such as compelling
them to undertreat patients to meet costs or
3. appear in any proceedings, which are detrimental to the interests of their
patients.
Legal Duties and Liability of the Doctor in Nigeria 55
• Terms of relationship must include regular payment of
retainer fee as applicable in respectable segments of the
national economic activities.
• Retainerships, capitation and pre-fixed fees must be accepted
only in such a manner and on such terms that the medical
interest of patients and the dignity and self-respect of the
profession and practitioners are not jeopardized.

Legal Duties and Liability of the Doctor in Nigeria 56