In the Name of Allah, the Entirely Merciful, the Especially Merciful

All praise is due to Allah, Lord of the worlds, may the blessings and peace of Allah be upon our master Muhammad, the seal of prophets, on his family, and all his companions.

Resolution No. 223(7/23)

on

The Doctor’s Responsibility for Non-Intentional Medical Errors from an Islamic Perspective

The Council of the International Islamic Fiqh Academy of the Organization of Islamic Cooperation, held in its twenty-third Session in al-Madinah al-Munawarah on 19-23 Safar 1440, corresponding to 28 October-01 November 2018.

Having reviewed the resolution of the scientific conference on the Doctor’s Responsibility for Non-Intentional Medical Errors from an Islamic Perspective, held by the Islamic Organizations for Medical Sciences in Kuwait on 5-7 Jumada al-Akhira 1436, corresponding to 26-28 March 2015.

Having listened to the extensive discussions,

Resolves the following

First: Non-Intentional Medical Errors

1) Approved definition of a ‘medical error’: a failure in achieving a planned action as intended due to negligence or shortening, and so forth.

2) Approved definition of a ‘medical accident’: damage that occurs due to medical intervention, and which is not caused by the patient’s principal health conditions.

3) Approved definition of ‘institutional accidents’ as accidents caused by the synchronous occurrence of factors on different levels leading to the error, in addition to the internal causes related to the health system, which raise a high chance for risks occurrence due to a chain of extenuating circumstances.

4) Approved definition of the ‘foundations of the medical profession’: “scientifically and practically recognized constant rules and principles.”

5) Establishing scientific programs based on extensive studies and research regarding causes and circumstances leading to medical errors, so as to develop appropriate solutions and reduce medical errors as much possible.

6) The need to establish an appropriate environment, and external as well as internal conditions to ensure successful health care.

7) Patients safety must be the principal concern for all medical policies.

8) Workshops should be organized for all employees in the health sector, in order to train and nurture their religious awareness and to overcome mistakes they face, with the necessity to consider workshops as an essential part of health practice.

9) Providing necessary means such as machines, laboratories, and knowledge, with the commitment to international professional protocols, in order to contribute to and assure an accurate characterization and diagnosis of the disease.

10) Commitment to international labour rules and laws by not increasing working hours of the medical board more than eight hours per day, particularly during alternation, in order to preserve doctor’s concentration which affects the patient’s health.

11) Commitment to reduce the number of patients per doctor as possible, in order to give the patient sufficient time to explain his health issues.

12) The need to periodically review laws and decisions concerning safety guarantees and patients protection from medical errors.

13) Confirming the importance of periodic maintenance of medical equipment by its competent professionals, to ensure its safety and sufficiency.

14) Work on establishing a higher authority on medical errors which gathers professionals of different specialities with credited expertise, honesty, and sincerity, affiliated to the specialized minister. One of its missions is to investigate medical incidents, whether they have caused damage or not, as quick as possible before its symptoms and effects disappear.

The investigation should be complete in order to determine the cause and effect of the error if damage occurs. Its reports should be submitted to the concerned authorities attached with recommendations in order to avoid such errors in the future.

15) Encourage doctors to disclose errors, in order to show transparency and clarity that provide a valuable service to the future of medical practice and its success, and in order to find legal outlets to reduce their prosecution.

16) Encouraging insiders who are aware of medical errors to report them while ensuring their legal protection against harassments and damage.

17) A medical errors databank need to be established by a select committee of medical doctors, fuqaha (Islamic jurists), and law experts, and passing a law that requires all operating departments in health ministries to report errors, and provide the bank with information leading to its causes and circumstances.

18) A special authority should evaluate the medical board member if the latter is involved in severe errors that resulted in damage, in order to find out more about his working equipment and its sufficiency.

19) Urge the responsible authorities to record and supervise pharmaceuticals, so as to confirm the sufficiency of its procedures in this regard, and to track these pharmaceuticals after their usage, especially dangerous ones, and to record any observation on the secondary effects or drug interactions, or the damage level, if any, and to take necessary measures.

20) Raising awareness to change the social perception of medical errors, and to accept the possibility of medical errors in the medical practice.

21) Working on the creation of a digital card with the barcode system for every human being in the world, which will be used for all medical transactions, while confirming the need to verify the barcode device validity from time to time.

22) Work on the publication of research, protocols, and work guides to reinforce patients information database, health conditions and history.

23) The need to make a commitment to gather and classify medical practice errors, to utilize them in elaborating scientific reports, and to analyze every type of these errors.

24) Distinguishing between medical errors resulting from doctors’ negligence, and medical errors resulting from the shortage inside medical institutions, the underdevelopment of their systems and devices which are indispensable for medical treatment.

25) Distinguishing between medical errors, and the undesirable medical accidents out of the control of doctors; as well as between medical errors and predictable medical complications that could follow the medical practices.

26) Considering the doctor as a guarantee giver in cases of shortages and infringements contrary to medical treatment principles agreed among medical experts; as well as in cases when the doctor treats the patient without his permission or the permission of his guardian, or the ruling authority, in cases which require permission.

27) Bearing assurance (compensation) is on the person responsible for transgression or negligence, as per both Shariah, and common law.

28) Work on preparing a textbook on medical practice ethics, and on defining medical errors in all specialities, and how to prevent them, and implement this textbook as a compulsory subject in medical studies.

29) The doctor should seriously care about the patient, his disease, and the treatment consequences while ensuring the patient’s wellbeing based on social circumstances, and the nature of the prevalent culture.

30) The doctor should take care of the patient seriously like a caretaker.

31) Preventing doctors from disclosing the medical secrets of their patients. The doctor becomes responsible for whatever may result from the disclosure of secrets, whether moral or physical damage. See the Academy resolution no. 79 (10/8), and the recommendation of the conference of the Islamic Organization for Medical Sciences held in Kuwait in April 1987.

Second:
A. Medical Consent

The basic principle is to require medical consent, and no exceptions are made except for a few cases, which are the following:

1. A) Urgent cases that include a threat to the patient’s life or his essential body parts when it is not possible to receive consent from the patient or his guardian.
2. B) Cases in which the general interest requires curing it, or preventing it, such as infectious diseases which represent a threat to public health.
3. C) If the patient has a mental or psychological illness threatening his life or the lives of others, he must be forced for treatment after taking necessary actions.
4. Medical Consent Cancellation
5. A) If the guardian of the patient refuses to grant consent, the patient’s guardianship will shift to the next guardian in line, or to the general guardianship (i.e. governor or authorities).
6. B) In critical cases, when the adult and the sane patient refuses to grant consent for treatment, he should be clarified about the possible risks of his disapproval. The doctor should record this clarification in an official form, and the consent cannot be cancelled since the patient’s mind is still conscious.
7. C) It is necessary to conduct more research and studies on cases requiring a caesarian birth to save the mother’s life, or the fetus’s life, or both, such as the nuchal cord wrapping over the fetus’ neck, if the mother refuses to grant consent for caesarian birth.

Third: General Recommendations

The Academy recommends the following :

1) Calling the Islamic Organization for Medical Sciences to undertake comparative studies between the principles of Shariah in the field of medical practice, the responsibility on medical practice errors; and legislative provisions in force, the related laws in both the Arab and Muslim worlds. Moreover, suggesting necessary measures to realize full relevance between Shariah law and modern laws.

2) Coordination between the Organization of Islamic Cooperation and the Arab League, and peer organizations in the Muslim world, to study the establishment of a unified legal guiding project on the rulings of medical practice, and the responsibility emanating from its errors, which will be utilized by Arab and Muslim states in enacting laws on medical practice, and medical errors.

3) Establishing an exclusive and independent authority in every Arab and Muslim state, which will be distinguished, distinctively from other authorities, to prepare experience reports in civil and private judicial lawsuits and disputes for arbitration committees and tribunals on medical practice errors.

4) Introducing the reconciliation system in criminal lawsuits related to medical practice errors at any stage of the lawsuit, in which point reconciliation may result at the end of the lawsuit to cancel the execution of penalties if the judgments have become valid.

5) Broaden the means of solving disputes, and recourse to arbitration regarding civil responsibilities emanating from medical practice error.

6) Establishing special committees to look after the non-criminal and civil lawsuits against doctors and collaborators errors provided that its jurisdiction has specialization in this regard.

7) Raising awareness and spreading knowledge on all thematical and operational issues related to the principal teamwork components, and reinforcing them through programs and training in an early stage at medical universities and institutes.

8) Doctors should receive training in practice and reactions (crisis management) related to developing teamwork knowledge and skills in order to refine the acquired competencies at universities, academies, and institutes.

9) Training doctors during residency (postgraduate training), in reinforcing the importance of the teamwork in health care, so as to facilitate transformation towards a safety culture.

10) Health care sector should develop and intensify the lessons acquired from advanced qualifications programs.

11) Doctors’ teamwork competencies should be honoured through procedures of granting licenses for professional practice.

12) License examination by competent boards should include an evaluation of new doctors’ knowledge of the teamwork components and their common career expectations.

13) Study the establishment of assurance regulations on risks emanating from medical practices, to encourage doctors to make more efforts in patients treatment.

14) Media and other means of awareness-raising should draw attention to the information delivered on psychological disorders, to treat it earlier and efficiently and to raise awareness on the rights of psychiatric patients.

15) Cooperation between Arab and Muslim countries, to issue unified guiding regulations on psychological health, inspired by Shariah principles, as well as relevant international agreements and principles.

16) In coordination with Arab and Muslim states, the OIC shall adopt a unified guiding law for mental health, inspired by Shariah principles, and relevant international agreements.

17) Hold a specialized seminar on psychological and mental health to discuss its ethical and legal issues, and to conclude with specific recommendations in that regard.

18) Medical institutions should hold periodic meetings between doctors and collaborators, to investigate and study new issues in the field of medical practices, and to exchange views about the problems and obstacles of the medical profession, to investigate and study medical errors, to suggest preventive and minimizing methods.

19) Developing doctors skills in communication with patients and their relatives, in order to achieve the patients’ welfare by following their health timeline and the problems that can occur during medical procedures practice.

Allah Knows Best.