Dubai: In keeping with the changing times, the Ministry of Health and Prevention’s new Medical Liability Law No 4 of 2016 bans human cloning, abortion, euthanasia, and sex change and stipulates the setting up of a Supreme Medical Liabilities Committee.
It also stipulates a mandatory medical liability insurance for all health-care establishments in the country to cover financial compensations, top officials said on Sunday.
Doctors found guilty of medical malpractice can be imprisoned for two to 10 years and compensations range from Dh10,000 to Dh1 million.
Dr Ameen Al Amiri, assistant undersecretary for Public Health and Licensing Sector at the ministry, who made a detailed presentation, lauded the UAE rulers for their foresight. “The existing Law No 10 of 2008 has been revised and reformulated in keeping with the times. The UAE is a country which likes to keep up with the developed and civilised world, update all the advanced medical diagnostic tools and techniques and comply with international rules and regulations,” he said.
The new law which has been drawn up after a detailed and comparative analysis of the medical liabilities and patient safety laws of the UK, USA, Netherland, Australia and Canada will come into effect within the next six months after which the existing law No 10 will stand repealed.
One of the main highlights of the new law is Article 7 which allows sex correction surgeries but bans sex change. Sex change is defined as any person with a clear gender identity and matching physical features seeking to change his or her physiological and genetic characteristics.
Sex correction, however, is described as a medical intervention to correct the sex of a person who suffers sexual obscurity, where his/her physical features are contrary to his/her physiological, biological and genetic characteristics.
A spokesperson from the ministry said that in every case where a person applies for sex change, a team of three competent physicians and surgeons from the field will examine the case, looking into all medical reports and then make a recommendation. “Each sex correction surgery decision will be given on a case-by-case basis,” she said.
Human cloning, also banned by the new law, has been defined as the production of a genetic duplicate of an existing human through somatic cell nuclear transfer involving putting the nucleus of a body cell into an egg from which the nucleus has been removed.
Similarly, euthanasia has been banned and is defined as the deliberate taking away of life of the patient upon the request of the patient, guardian or custodian.
Article 10 states that “resuscitation equipment may not be raised off the patient, unless heart and breathing had completely and terminally stopped or all brain functions had ceased completely and terminally, according to accurate medical standards for which a ministerial decree will ensue, and physicians have ruled that this stop is irreversible”.
Special Committee
In every case, be it of gender correction, or medical termination of pregnancy, a provision has been made for the convening of a three-member special committee to examine the case on its individual merit before making recommendations. Article 15 of the Law states: “No act or interference relating to birth control shall be carried out without the request or the consent of the spouses, nor any act or intervention related to women sterilisation shall be made without the proper advice of a specialised medical committee consisting of not less than three physicians agreeing that there is a serious threat to the mother’s life in case of pregnancy or delivery and after obtaining the wife’s written consent and notifying the husband.”
Chapter two of the law facilitates the formation of Medical Liability and Supreme Medical Liability Committees. Article (18) of Chapter two states: “An Expert Committee shall be established by a decree from the minister or the head of the health authority, composed of speciality physicians in all medical specialities, called the ‘Committee for Medical Liability’, and the executive decree shall determine rules and procedures of its work and establishment.
“These committees and not any others specialise in examining complaints referred to it by the health authority or the public prosecutor or the court and report the extent of the occurrence of medical error or not and its intensity and, in the case of multiple responsibility, determination of rate of liability by all those who are liable for this medical error, its causes, and the harm that occurred, and the causality relationship between error and harm and the proportion of the deficit in the organ affected if any. The committee might decide to call experts fit to carry out its functions.”
Penalties and punishment
Any compensation claims raised because of medical liability will not be accepted until presented to the committee of medical liability for investigation in accordance with the provisions of this law.
A separate section is dedicated to penalties and financial compensations if medical liability is proved. Article 28 states:
1. Any person violating any of the provisions of the article (12 clause 1) pertaining to human cloning and article (14) pertaining to implanting of foetus without written consent of both married partners shall be imprisoned for at least two years and not exceeding five years; and/or pay a fine at least Dh200,000 and shall not exceed Dh500,000.
2. Any person violates any of the provisions of the Article (12 clause 2 which is about carrying out cloning without written government consent) and article (15 which is about carrying out any birth control without consent of both married partners, will be imprisoned for at least six months; and/or pay a fine at least Dh100,000) and shall not exceed Dh200,000.
Article (29) sets the penalties for violation of article 13. Any person who violates any of the provisions of Article 13, which is to do with fixing of improper prosthesis, shall be imprisoned for at least three months; and/or pay a fine at least Dh50,000 and shall not exceed Dh100,000
The law also has provisions for punitive action against doctors. Article (30) states that subject to Islamic Sharia provisions, any person violating the provision of Article (10) that is to do with banning of euthanasia shall be imprisoned for at least ten years. Similarly, doctors found violating the rules about managing patients with communicable diseases or practising without honest and ethical means can also be granted imprisonment between three and 10 years.
Doctors found guilty of major medical errors can get a prison term of a year and a fine not exceeding Dh200,000. If the medical error has resulted in the death of the patient then the imprisonment shall not exceed two years and a maximum fine of Dh100,000 can be levied.
However, if the medical negligence was committed by the doctor under the influence of drugs or alcohol then the fine jumps to Dh1 million and imprisonment of up to two years.
Abortion
With the exception of the two following cases, physicians are not allowed to perform any abortions or to prescribe anything that would lead to abortion:
1 If the continuity of such pregnancy may threaten the pregnant woman’s life according to the following conditions:
A There is no other method to rescue the life of the pregnant woman except through abortion
B Abortion shall be done by a specialised physician in gynaecology and obstetrics and the approval of the treating physician for the justified abortion.
C- A report is released stating the inability of normal delivery and abortion justifications by the concerned physicians, provided that such report shall be signed by the pregnant woman and her husband or her guardian if it is impossible to obtain her approval in a way indicating such approval for abortion. Each of the concerned parties shall keep a copy of the report. The consent of the husband is not required in emergency cases requiring immediate surgery.
2 If the foetus is suffering malformation according to the following conditions:
a. Abortion is upon parent’s request.
b. Pregnancy period shall not exceed 120 days.
c. Malformation is proved by a report of a medical committee consisting of medical consultants in gynaecology, obstetrics, children and radiology.
d. The medical committee report shall be based on medical examinations and the use of accepted common scientific techniques.
e. The foetus is suffering serious malformation which is incurable that leads, if born alive, to a miserable and painful life to the foetus and its family.
Cardio Pulmonary Resuscitation
Article 11 describes what can be deemed as natural death of patient where the doctor can take the decision not to induce Cardio Pulmonary Resuscitation (CPR). “The occurrence of natural death may be allowed through not having to perform Cardio Pulmonary Resuscitation (CPR) for the patient in case of dying in the availability of the following conditions:
1. If the patient suffers from an incurable disease.
2. All methods of treatment were exhausted.
3. Proof of the ineffectiveness of treatment in such a situation.
4. The attending physician advised not to conduct CPR.
5. At least three consultants state that the patient’s best benefit is to allow the occurrence of natural death and not to perform CPR, and in this case a consent is not required to be obtained from the patient, guardian or custodian.
6- It is not allowed to refrain from resuscitation in the case of an explicit request from the patient, even if the resuscitation was not effective for his treatment.
The law clearly enunciates how a medical error is to be determined. Article 6 of the law states:
“Medical error that is committed by a profession practitioner as a result of any of the following reasons:
1- Ignorance of technical matters supposed to be familiar within similar qualification and specialisation.
2- Not following the accepted professional and medical standards.
3- Lack of exertion of the required care.
4- Negligence and lack of caution.
The executive decree of this law will define the criteria of major (profound) medical error.”
Box 4
Communicable Diseases
In case of communicable diseases while a separate Executive Decree has been issued, this law spells out the following dos and don’ts in Article 9 which states that without any opposition to provisions of communicable disease control law, the following should be regarded:
1- A patient is not allowed to be discharged from a health-care facility except in the following conditions:
Patient’s health condition allows discharge according to the common medical principles
Referral to another health facility for continuation of treatment in the condition of healthy safe transportation
Patient’s desire to be discharged if in full capacity although the consequences of discharge against medical advice were explained to him/her with a written consent from him for responsibility.
A written acknowledgement should be obtained from one of the physicians in the health-care facility in case of patients who lack the capacity and consent of his/her guardian for the responsibility of referral to another health facility.
2- Any person is not allowed to stay in a health-care facility without a medical reason without its approval.
