Old is Gold

ANONYMOUS

High on the hills low in the lakes
After the sunset and before it wakes
Running on the banks and dipping in the waters
In my hands your pretty palms

Sky is blue and horizon rosy
Happy birds and flowers hazy
Vanishing slowly a veil of cloud
And you, with me, are laughing loud.

Smooth and silky thy hairs shine
And lovely curves of eyebrow line
Nothing is hypnotic than your dreamy eyes
There on my shoulder your forehead lies

In this winter my mouth sips
Pinkish cheeks thy rosy lips
Roaming on the rocks and sleeping on the sand
Enjoyed we lot on the tableland

Moon is rising and stars are twinkling
Path is charming and memories lingering
Right on my lips your lips rest
In my arms thy beautiful waist

Two bodies but soul one
In this world we alone!

(This poem was composed by me more than 20 years back!)

Medical Profession and Law

Medical Profession is one of the noble professions in the present civilisation. A patient in distressed circumstances looks to the doctor as a ray of hope for his recovery. A doctor saves the life of a serious patient and assumes the position of God in lay-man’s mind. But this so called God now-a-days is frequently subjected to civil or criminal litigation for his lapses. This is because of legal literacy, legal awareness, supplemented with modern legislations like consumer protection laws. Notwithstanding this, the law always upholds the dignity of medical profession and medical personnel.

So far as criminal liability of doctors is concerned, Section 88 of Indian Penal Code comes to their ready help. According to this section, causing of any harm to any person, if it is for his benefit is no crime, provided the act which causes harm is done in ‘good faith’ and express or implied consent of that person, to suffer that harm is obtained. A surgeon would be protected, if a patient dies during or after an operation, if that patient has given free and intelligent consent to take the risk of the operation and the surgeon has acted in good faith. The term ‘good faith’ in this section is to be interpreted as meaning ‘with due care and attention’.

The Court, before holding a doctor guilty of carelessness, has to consider, whether in execution of the duty, which a doctor has undertaken to perform, the doctor is proved to have shown ‘gross’ want of care or gross culpable want of skill.

It is always desirable and prudent for a doctor to take express or written consent of the patient for the required treatment. But a patient who puts himself under the treatment of a doctor is supposed to give an implied consent to suffer the harm and to take the risk of treatment. But if the medical practitioner is not qualified and registered, the consent is not the consent obtained in ‘good faith’ so the quacks would not be protected under section 88, even if the consent of the patient is obtained. Due diligence, caution and care refer to the moment of treatment and also to learning and the experience of the doctor who has to have acquired earlier. If a person purports or pretends to act as a doctor without knowing anything of medicine or surgery and tries to do the best, he could under the circumstances still be acting in bad faith, because he has set himself up as a medical practitioner without the requisite education, training and experience. The two elements i.e. consent on the part of the patient and good faith on the part of the medical practitioner are interdependent and nobody can claim the benefit of the exception without ‘good faith’.

Greater the education of the doctor, the greater will be the amount of care, attention and skill required. A surgeon does not undertake that he will perform a cure. He also does not undertake to use the highest possible degree of skill. He undertakes a fair, reasonable and competent degree of skill.

If death of the patient is caused by ‘rash and negligent’ treatment of the doctor, then the doctor would be criminally liable under S. 304-A of the Indian Penal Code, the punishment for which is two years of imprisonment or fine or both. The rash or negligent act must be the direct or proximate cause of death. To hold a doctor responsible under this section, criminal negligence should be proved i.e. gross and culpable neglect or failure to exercise that reasonable or proper care and precaution to guard against injury to the patient which having regard to all the circumstances attending the charge, it was imperative duty of the doctor to have adopted. It is not every little trip or mistake or genuine error of judgment that will make a doctor so liable. Negligence that may give rise to civil liability will not be enough for the purpose of establishing the crime under Section 304-A of the Indian Penal Code.

A civil suit for damages may lie against a medical practitioner if his negligence has caused an injury to the patient. But the burden of proving negligence lies on the patient complaining the injury. This civil liability of doctors extends to negligence in diagnosis and negligence in respect of treatment. The doctor has a duty to warn his patient of risks inherent in treatment. After examining a patient, the doctor should be careful in deciding what line of treatment he should adopt. The doctor has discretion in choosing treatment which should be given to the patient. A doctor, who acts in accordance with a practice accepted as proper by a responsible body of medical practitioners, is not negligent merely because there is a body of opinion that takes a contrary view.[i] The test of adequacy of care to be exercised is the standard of the ordinary skilled man in exercising and professing to have that special skill. A man need not possess the highest degree of skill. It is sufficient that he exercises skill of an ordinary competent man exercising that particular art. In the case of a doctor, negligence means failure to act in accordance with the standards of reasonably competent medical men. There may be one or more perfectly proper standards and if the doctor conforms to one of these, then he is not negligent. A doctor undertakes to bring a fair, reasonable and competent degree of skill. A breach of this duty gives right of action for negligence to the patient. A doctor who professes to exercise a special skill must exercise the ordinary skill of his speciality. Difference of opinion and practice do exist in all professions and medical profession is no exception to that. There is seldom any one answer exclusive of all others to problems of professional judgement.

The hospital authorities are responsible for the whole of their staff; not only for the nurses and doctors but also for the anaesthetists and surgeons. This staff may be of any categories: permanent, temporary, resident, visiting, whole time, part time. The hospital authority is responsible for all of them because even though some of them may not be servants, they are in the position of agents of the hospital to give the treatment.

The Consumer Protection Act, 1986 is enacted for better protection of the interests of consumers. The object of this Act amongst other things is to provide speedy and simple redressal to consumer disputes through quasi-judicial machinery set up at the district, State and Central level. The quasi-judicial bodies have been empowered to award compensation to consumers. ‘Consumer’ means any person who buys any goods for a consideration or hires any services for a consideration. Any ‘service’ rendered ‘free of charge’ is expressly excluded from the scope of the definition of ‘service’, so the persons who avail themselves of the facility of the medical treatment in Government Hospitals are not Consumers and the said facility as offered in Government Hospital cannot be regarded as services ‘hired’ for ‘consideration’ for the purpose of the Consumer Protection Act.[ii] In order to satisfy the definition of ‘Consumer’ a person should have hired any services for a consideration. But where a hospital renders services of hospital on payment, then such a patient is ‘Consumer’ within the scope of the Act. It is not a contract of ‘personal service’.[iii] Legal representative of the deceased consumer has a locus standi to file complaint regarding deficiency of service.[iv]

It was held in a case[v] that the provisions of the Consumer Protection Act relating to adjudication of consumer disputes and award of relief under Section 14 of the Act fully apply to the disputes concerning deficiency in the service rendered by the hospital and the members of the medical profession.

The doctors frequently refuse to attend injured patients in accident cases or medico-legal cases. The reason is they fear that they would be unnecessarily harassed by police or prosecuted for doing their duty without first complying with the police formalities. The Supreme Court of India in this regard observed in a Public Interest Litigation:[vi] “Preservation of human life is of paramount importance. That is so on account of the fact that once life is lost, the status quo ante cannot be restored. Every doctor whether at Government Hospital or otherwise has the professional obligation to extend his services with due expertise for protecting life. The laws of procedure whether in statute or otherwise which would interfere with the discharge of this obligation cannot be sustained and must therefore give way. Every injured citizen brought for medical treatment should instantaneously be given medical aid to preserve life and thereafter procedural criminal law should be allowed to operate.”

It is prudent and beneficial for a doctor to get insured for Doctor’s Professional Indemnity Insurance. The policy of insurance indemnifies any act committed by the insured giving rise to any legal liability to patient. The indemnity applies to claims arising out of bodily injury, illness or death of any patient caused by error, omission or negligence in professional service rendered by the insured doctor. It should be remembered that only civil liability to pay damages to patients is covered by insurance. Criminal liability can never be insured. The insured doctor would still be liable personally for any criminal wrong or any act committed in violation of law. The policy never covers liability arising out of deliberate, wilful or intentional non-compliance of any statutory provision.

Medicine and law frequently go hand in hand. Every medical practitioner, as a matter of prudence, should know the basic principles and provisions of law pertaining to medical practice. He should be aware of his legal rights, duties, obligations and liabilities. Then he will be freed from misplaced anxieties about clutches of law!

[i] Bolam v. Friern Hospital Management Committee (1957) 2 All ER 118.
[ii] Consumer Unity and Trust Society, Jaipur v. Rajasthan 1991 (1) CPR 241.
[iii] Smt. Motibai Dalvi Hospital v. M. I. Govilkar, 1991 (1) CPR 334.
[iv] Gulam Abdul Hussain v. Dr. Katta Pullaiah Choudhary 1991 (1) CPR 499.
[v] Sachin Aggarwal alias Vicky v. Dr. Ashok Arora (1993) 1 CPJ 113.
[vi] Pt. Parmanand Katara v. Union of India, A.I.R. 1989 SC 2039.

(Complete Article available in Criminal Law Journal, July 2004, at pp. Journal 210-214.)

Joke

A woman during dining out summoned her waiter and requested that the air-conditioning be turned down. Minutes later, the same woman was fanning herself and she again summoned the waiter, asking that the air-conditioning be turned up. As her complaints continued, a man seated at the next table called the waiter.

“She must be driving you crazy?” he said, “making you turn the air-conditioning up and down like that”.

“Not at all”, the waiter replied, “I am driving her crazy. We don’t have air-conditioning”!

Don't ever give up

Thesis Writing – IX (General Guidelines)

Thesis should reveal originality of the researcher.

Thesis should be a contribution to the advancement of knowledge.

Thesis should be long enough to cover the area of research and short enough to maintain readers’ interest.

Adopt the past tense throughout.

Do not use contractions like can’t, shouldn’t etc.

Repetitions and exaggerations should be avoided.

There should be simplicity, clarity and objectivity in writing.

Research should meet academic standards.

Lay-out and presentation of the thesis should be attractive.

Pay attention to the consistency of the format throughout the thesis regarding type of font, font size, footnotes, pagination, margins, titles, headings, sub-headings.

Statistics, tables, charts, graphs, figures, illustrations, photographs, pictograms may be used wherever necessary.

Your original work and work of others should be clearly distinguishable. All ideas and work of others used in the thesis should be acknowledged and properly referenced. Be careful about plagiarism which is not only immoral but also a crime.

Research should not be mostly a ‘copy’ and ‘paste’ work.

Thesis must be carefully proof-read so as to eliminate all typographical mistakes, mistakes in the spelling and grammar before giving it to binding. Check whether the pages of the text are in correct order before it is handed over for the binding.

Prepare also a pdf formatted CD of the thesis.

Follow specific rules of respective University, if any.

Finally, it is very exhilarating, ecstatic and rewarding to see oneself eligible for prefixing ‘Dr.’ before our name. So, best luck for completion of your Ph.D.!

Thesis Writing – VIII (Format and Appearance)

Paper: Paper used for printing of thesis should be of good quality white bond paper of 75 g. at least, substance weight 20-26 pound weight and acid-free, pH being 6.8 or above. Size of the Paper should be 8½" x 11" (A 4).

Pagination: For the preliminary pages small Roman numerals (i, ii, iii) at the bottom in the centre of the page should be used. For the main body of the thesis Arabic numerals beginning with 1 from Chapter 1 throughout rest of the thesis including bibliography and appendix should be used. All the pages must be consecutively numbered on top right hand corner of the page. Do not print page number on the title page and the first page of every chapter but count it in the series.

Printing: Thesis should be printed in laser printing, on one side of each page only, with permanent black ink, without smudges or toner break.

Margin: Left margin (binding side) should be 1.75" and right, top and bottom margin should be 1".

Font: Size of the font should be 12. Typeface may be Times New Roman, Arial, Palatino, Bookman, Garamond, and Tahoma. Standard fonts should be used, not ornamental. Different fonts or point sizes (different than the text) may be used for chapter titles, headings, sub-headings, footnotes, quotations etc. Titles may be bold, but should not be underlined. Italics should only be used for foreign words or special emphasis. The font size and type should be consistent throughout the thesis.

Paragraph: Indent the first line of a paragraph by ½" (five spaces or press tab once) from the left margin. Spacing of 10 points may be kept after the paragraph. At least two lines of a paragraph must appear together at the top and bottom of every page. This can be achieved by ‘widow/orphan control’ function of the word processor through paragraph sub-menu by checking ‘widow/orphan control’ checkbox under ‘Line and Page Breaks’.

Spacing: For general text 1.5 spacing should be provided. Long quotations, footnotes, endnotes, bibliography and captions take single spacing.

Alignment: Justified alignment looks good for the main text.

Typing: Professional typist with great proficiency should be engaged for typing the thesis.

Corrections: There should not be any ink corrections, strikeover, correction fluid (whitener), correction tape, paste-ups, and insertion between lines in the final copy of the thesis. All corrections should be made before final copy of the thesis is printed. Page should be substituted for any page on which an error has been found.

Duplication: Copies of thesis should be made by using services of reputable Xeroxing firm. Care should be taken to see that the copies are clear and there are no smudges.

Multiple Volumes: If thesis exceeds 2" thickness it must be bound in two volumes. All volumes must be numbered consecutively, using capital Roman numerals. Title pages of both volumes should be identical except for the notation Volume I, Volume II. Each volume must contain a complete Table of Contents.

Binding: Thesis should be given to reputed binder for binding. It should be bound in black or red cloth as prescribed by the University. Binding must be firm and stitched by drilling 5 holes with a 2 mm. drill. A white blank page must be placed after the front and before the back covers. The spine should bear the candidate’s name, the degree and year of submission. The front cover should bear the title of the thesis.

Thesis Writing – VII (Format: Main Body)

Chapters are numbered consecutively in Arabic or Roman numerals.

Chapters need short but substantially descriptive titles.

Only new chapter should begin with a new page. Each chapter begins on a new page, even if the last page of the preceding chapter has only two or three lines.

The heading CHAPTER 1 in all capitals is centred between the text margins, 1½" from the top of the page; the title is typed two spaces below, centred and in all capital letters. The text begins at least two spaces below.

Headings and Sub-headings: The kinds of headings used include centre headings, side headings and paragraph headings. In addition, each chapter has a chapter heading. Usually centred headings are used for chapter divisions. Side and paragraph headings are used for sub-divisions. There may be three, four or five levels of sub-division within a chapter. All headings and sub-headings should be consistently presented in the same way in each chapter in terms of capitalisation, placement on page and type and size of font used.

Headers or footers are not to be inserted.

Figures, Tables, Graphs etc.: Chapters in the Main Body may include figures, tables, graphs, diagrams, photographs, drawings etc. These should appear as near as possible to the part of the text which refers to them.

Table numbers in Arabic numerals and captions are placed above the table. Figure numbers in Arabic numerals and captions are placed at the bottom of the figures. Tables and Figures are labelled with the word ‘Table’ and ‘Figure’ respectively and numbered consecutively. For numbering, straight sequence of 1, 2, 3 or decimal approach of 1.1, 1.2, 1.3, where the first digit is the chapter and the digit after the decimal point is the table or figure number within that chapter, may be followed.

Bar graph is used to compare the relative amounts of some attribute possessed by two or more groups.

Pie chart is useful when proportion of the total is to be shown in a circle.

Organisation chart is used to show various organisational functions like lines of authority, flow of work or relationship within an organisation.

Colour may be used in figures and photographs. But then duplicate copies should also be produced by colour photography.

Thesis Writing – VI (Format: Preliminary Pages)

Title Page :
Title page must be single-spaced, in all capital letters and should begin at 1½" from the top of the page. Long titles can be written in multiple lines placed in inverted pyramid style.

Title page should bear the title of the thesis, full name of the candidate and the guide, the words ‘Thesis submitted to … University for the degree of Doctor of Philosophy in …’ and the month and year of submission.

Most Universities prescribe their own form of title page and that should be complied with regarding matters of content and spacing.

Title should neither be underlined nor included in inverted commas.

Acknowledgement, Dedication and Preface :
Each of these items must appear on a separate page.

Dedication must be brief and centred on the page. e.g. To My Parents

Acknowledgements and preface must have headings and should use same spacing as the text (i.e. 1.5 spacing).

The heading ACKNOWLEDGEMENTS or PREFACE in capital should appear centred between text margins, 1½" from the top of the page; the text begins at least two spaces below the heading.

The page of Acknowledgements should mention the persons who have made a real effort to help the author in the preparation of the thesis. Routine help by members of the researcher’s family, faculty, librarians and clerical helpers is unnecessary to be mentioned.

Table of Contents :
The Table of Contents must list the preliminary pages, title of each chapter and its parts and sections, bibliography, appendices.

The wording used for all entries in the table of contents must match exactly with what is used in the text.

Each entry must have leader dots, which connects it to its corresponding page number.
The heading TABLE OF CONTENTS in capital is centred between the text margins 1½" from the top of the page. The listing of actual contents should begin at the left margin at least three spaces below the heading.

For thesis comprising more than one volume, the contents of the whole thesis should be shown in the first volume.

List of Tables :
The heading ‘List of Tables’ appears centred between the text margins 1½" from the top of the pages; the listing begins at the left margin at least two spaces below the heading.

Each entry should have the same number and the same caption or title used for a table in the text.

Each entry must have leader dots.

Thesis Writing – V (Quotations)

Quotations may be short quotations or long quotations. Quotations upto three lines should be placed in quotation marks forming an immediate part of the text. Quotations of more than three lines should start on a new line, single spaced and indented in its entirety half an inch (4 spaces) from the left margin with no quotation marks at the beginning or end. Include a complete reference of the quotation in the footnote.

If you add a word or words in a quotation, put bracket around the words which indicates that they are not part of the original text.

If you omit a word or words from a quotation, you should indicate the deleted words by using ellipsis marks which are three periods preceded and followed by a space. e.g. …

If grammatical mistakes are done by the author type sic in the bracket after the mistake. e.g. “The statue (sic) is offensive”.

If the beginning of the original sentence has been omitted, capitalise the first letter, if it is not already capitalised, and place it in brackets. e.g. “… (A)ny act of criminal”.

Thesis Writing – IV (Appendix and Index)

Appendix

Appendix is placed after Bibliography.

The questionnaire, interview schedule, sample information etc. is incorporated in Appendix.

If there are more than one Appendix, each should be given a letter like Appendix A, Appendix B, etc.

All appendices must have page numbers.

The heading APPENDIX should appear centred between the text margins 1½" from the top of the page. The font and point size should be same as those used for chapter titles.

Index

Index follows the Appendix. Index is given at the end of the thesis. It helps the reader to locate a topic or sub-topic in the thesis easily. The Index is to be arranged alphabetically. Index is of two types: i) Subject Index; ii) Author Index.

Thesis Writing – III (Bibliography)

Bibliography is a selected list of all books, magazines, journals, newspaper articles and other source material which the researcher has consulted. All the relevant material which has been consulted, whether or not it has been cited in the text of the thesis is incorporated in bibliography.

The bibliography should always be arranged in alphabetical order. The first part of the Bibliography should contain the names of the books and the second part will contain the names of journals, magazines, newspaper articles and unpublished work.

Entries: The entries in bibliography should be made in following order: i) Name of the author (Surname first, then comma, then initials or first name); ii) Title of the book in Italics, edition; iii) Publisher, Place of Publication, Year of Publication; iv) Volume Number.

For Periodicals, Magazines, Journal and Newspapers the order will be as under: i) Name of the author (Surname first); ii) Title of Article in double inverted commas; iii) Name of the periodical in Italics; iv) Volume Number/Issue Number; v) Date of Issue; vi) Pagination (First and last page number).

Upper case Roman Number is used to indicate the number of volume of a book.

Titles of unpublished works are enclosed with quotation marks.

The method of referencing should be consistent

Do not give the bibliography a chapter number; but it must have page numbers. Bibliography is preceded by a sheet containing the word BIBLIOGRAPHY capitalised and centred on the page.
The heading BIBLIOGRAPHY is centred between the text margins, 1½" from the top of the page. The list should begin two spaces below.

Each Bibliographic entry should be single spaced with double spacing between entries.

Internet Page: If an internet page is used as a reference source, title of the page and URL address is to be mentioned. The date accessed must be mentioned at the end ( … as visited on 1.1.2009).

Purpose of Bibliography is quite different from that of a footnote. The footnote gives specific location of the source of the statement made in the text, including page number. The purpose of bibliography is to identify the whole work rather than a specific part of it. The style of citation in bibliography is quite different from a footnote. e.g. In a footnote, the author’s name is given as initials or first name followed by the surname, but in bibliography the surname precedes the initials or first name.

Thesis Writing – II (Footnotes)

• Footnotes are used to give credit to sources of any material consulted, summarised or paraphrased. Footnotes are meant for citation of authorities, cross-references, acknowledgement of sources or explanation of point of view. They refer readers to the exact pages of the source material.




• Format: Footnotes are placed at the bottom of the very same page separated from the text by a line about 1½ " long. Footnotes should be numbered consecutively beginning with 1 in each chapter separately. The number is typed as superscript. Arabic numerals should be used for footnotes. Asterisks or other symbols should not be used for footnoting. In Microsoft word processor, from ‘Insert’ menu footnote can be inserted. Short-cut Alt + Ctrl + F also will insert footnote.
  
  Footnotes are typed in single space within and double space between each listing. Footnotes should be typed in a font size two points smaller than the text. Only one sentence is used in a footnote. Full stop is to be given at the end of the footnote.
  
  
• Book Reference: i) Name of the author (first name or initials first; surname last) followed by a comma; ii) Title of the Book in Italics, followed by comma, followed by edition, followed by comma; iii) Publisher, Place of Publication, Year of Publication in brackets; iv) Page number.




• Periodical Reference: i) Name of the author (surname last), followed by a comma; ii) Title of the Article in quotation marks; iii) Name of the periodical in Italics; iv) Volume number; v) Date of issuance; vi) Page numbers.




• Multiple authorship: If there are more than two authors, then the name of only the first is given and multiple authorship is indicated by et al (= and others).




• Multiple references of the same book: The first footnote reference should be complete in its documentation. Subsequent references to the same book without any other references intervening is indicated by Ibid. (Id. is commonly used in legal citations) followed by a comma and the page number. A single page is referred to as p. but multiple pages are referred to as pp. If there are more than one pages, it can be referred as pp. 333-335. Ibid. is used only if the previous reference is on the same page.
  
  Op. cit. (opera citato) (= in the work cited) which should be preceded by author’s name and followed by page number indicates that the reference is to a book by the author which has been cited in detail in an earlier footnote but intervened by some other references.
  Supra means cited with details of the source above.




• Citation of case law: i) The name of the case should be in Italics. ii) ‘v’ should be in small letter and it should not be in Italics. ‘v’ should be followed by a dot (v.). iii) In referencing the publication (i.e. A.I.R., SCC) year and page numbers should not be in Italics. iv) Prescribed citation method of respective Law Reports and Journal should be followed. e.g. (1993) 4 SCC 392.




• Referencing Quotations: If the wording of the sentence is exactly like that of your source, it is a direct quotation; it should be put in quotation marks and a footnote should be provided. If the wording of a sentence is similar to the source but not exactly the same, it is a paraphrase; it should not be put in quotation marks, but it must still be footnoted.




• Endnote: While footnotes are placed at the bottom of the page, endnotes are placed numerically at the end of the chapter on a separate page entitled Endnotes or Notes or References. Footnotes are preferred to endnotes. Short-cut in Microsoft Word for inserting endnote is Alt + Ctrl + D.

Thesis Writing – I (Lay-out)

• First chapter should have title ‘Introduction’ and last chapter should have title ‘Conclusion and Suggestions’.



• First chapter should contain: i) Statement of the Problem; ii) Significance of the Study; iii) Review of Related Literature; iv) Objectives of the Study; v) Formulation of the Hypothesis; vi) Definition of important concepts and terms; vii) Methodology adopted for research and data collection; viii) Scope and Limitations of the Study.



• Last chapter should contain whether hypothesis is ‘accepted’ or ‘rejected’ (not ‘proved’ or disproved’).



• Thesis should comprise three main parts: i) Preliminary pages; ii) Main Body; iii) Reference Section.



• Contents of ‘Preliminary pages’ should be in following order: i) Title Page; ii) Acknowledgements; iii) Declaration; iv) Table of Contents; v) Table of Cases (Alphabetically arranged); vi) List of Tables, if any; vii) List of Figures, if any: viii) List of Abbreviations, if any.



• The Main Body is divided into several chapters.



• Reference Section starts after the end of all chapters. It should contain in following order: i) Bibliography; ii) Appendix or Appendices; iii) Index.