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FMT Chapter 2 - Legal Procedure: Exam-Oriented Summary

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1. THE THREE MAJOR LAWS (New Codes 2023)

Exam Tip: All three new codes were enacted together in 2023. BNS = substantive law, BNSS = procedure, BSA = evidence.

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2. TYPES OF CASES

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3. INQUEST

When is Inquest Done?

• Suicide, murder
• Killing by animal or machinery
• Accidents
• Deaths due to torture or ill-treatment
• Occupational diseases
• Suspected medical negligence
• Suspicious/unnatural deaths
• Deaths due to anesthesia or operation
• Unidentified or skeletonized bodies

Two Types in India:

A) Police Inquest (Section 194, BNSS; old S. 174 Cr.P.C.)

• Conducted by officer-in-charge of a police station (usually Sub-Inspector, not below Head Constable rank)
• The officer is called the Investigating Officer (I.O.)
• Done in presence of two or more respectable persons (Panchas)
• Report = Panchanama (signed by I.O. and Panchas)
• Body sent for postmortem (PM) to nearest authorized govt. doctor
• Sent with: Dead Body Challan + copy of inquest
• Note: Private institutions can do medicolegal examination of the living, but autopsies require State government permission
• Report forwarded to Magistrate; if no foul play suspected, body handed to relatives

B) Magistrate's Inquest (Section 196, BNSS)

1. Dowry death
2. Death of a woman within 7 years of marriage if:
   • She commits suicide
   • Dies under suspicious circumstances
   • Any relative requests it
   • Any doubt about cause of death
3. Exhumation (digging up a buried body)
4. Any person dies/disappears or rape is alleged while in police custody or court-authorized custody

Exam Tip (Key Difference): Police inquest is for general suspicious deaths. Magistrate's inquest is specifically for dowry deaths, women within 7 years of marriage, custody deaths/rape, and exhumation.

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4. COURTS OF LAW

Criminal Courts (4 Types - Hierarchy):

Note (2023 Update): In metropolitan cities with >1 million population, Chief Judicial Magistrate and First Class have been removed under BNSS.

• Sessions Judges and Magistrates are appointed by the High Court
• The President of India can grant pardons, remissions, and commutation of death sentences

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5. COGNIZABLE vs. NON-COGNIZABLE OFFENCES

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Quick Memory Points for Exam:

• BNS = IPC replacement (substantive)
• BNSS = Cr.P.C. replacement (procedure)
• BSA = IEA replacement (evidence)
• Police inquest = Section 194 BNSS (old 174 Cr.P.C.)
• Magistrate inquest = Section 196 BNSS
• Panchanama = signed by I.O. + 2 or more Panchas
• Autopsy = only authorized government doctor
• Exhumation = always Magistrate's inquest
• Dowry death + 7-year marriage death = Magistrate's inquest
• Death/rape in custody = Magistrate's inquest

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FMT Chapter 3 - Medical Law and Ethics: Complete Exam Notes

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1. PRINCIPLES OF MEDICAL ETHICS (FM10.17)

Exam Tip: BANJ = Beneficence, Autonomy, Non-maleficence, Justice. Non-maleficence = primary consideration ("primum").

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2. HISTORICAL EMERGENCE OF MEDICAL ETHICS (FM10.1)

Exam Tip: Thomas Percival coined "medical ethics." Declaration of Geneva = modern Hippocratic Oath.

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3. NATIONAL MEDICAL COMMISSION (NMC)

• Replaced the old Medical Council of India (MCI) under the NMC Act 2020
• Key functions:
  • Observes and promotes professional ethics
  • Conducts NEET (undergraduate/postgraduate admissions)
  • Conducts NEXT (National Exit Test) = common final year MBBS exam for license to practice
  • Grants limited license to Community Health Provider (CHP) for mid-level practice
  • Regulates fee for 50% seats in private medical institutions

1. Under-Graduate Medical Education Board (UGMEB)
2. Post-Graduate Medical Education Board (PGMEB)
3. Medical Assessment and Rating Board (MARB)
4. Ethics and Medical Registration Board (EMRB)

Exam Tip (MCI vs NMC): MCI = old body; NMC = new body from 2020. NEXT = new licensing exam replacing old final MBBS.

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4. DUTIES OF MEDICAL PRACTITIONERS (FM10.6)

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5. PROFESSIONAL SECRECY / CONFIDENTIALITY

• An implied term of contract between doctor and patient
• Doctor must keep secret everything known about the patient in professional capacity
• Patient can sue for damages if disclosure is: (a) voluntary, (b) causes harm, (c) not in public interest

1. Notifiable diseases (must report to public health authorities)
2. Court order (subpoena)
3. Patient's own consent
4. For the safety of third parties (e.g., risk of violence to others)
5. In the public interest

• If patient is major - never disclose to parents/relatives without patient's consent
• If patient is minor or insane - inform guardians/parents
• Even husband and wife - must not disclose to each other without that person's consent
• Government servants examined on behalf of employer - doctor cannot disclose without patient's consent

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6. PRIVILEGED COMMUNICATION

• Communication between doctor and patient that is protected from disclosure in court
• A doctor cannot be compelled to reveal in court what a patient told him in professional confidence
• Exceptions: doctor may disclose if patient waives privilege, or if court so orders

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7. PROFESSIONAL (MEDICAL) NEGLIGENCE / MALPRACTICE (FM10.18)

• Medical negligence = part of law of torts (civil wrong for which compensation can be sought)

4 Types of Medical Negligence:

Civil vs Criminal Negligence (High-Yield Comparison):

Key Doctrines:

• Res Ipsa Loquitur = "The thing speaks for itself" - negligence is obvious from facts alone (e.g., leaving a surgical instrument inside patient)
• Vicarious Liability = Employer responsible for employee's negligence (hospital liable for nurse's error)
• Contributory Negligence = Patient's own fault reduces or negates doctor's liability

Defenses Against Negligence:

1. No duty of care existed
2. Duty of care was not breached
3. No causal link between breach and injury
4. Error of judgment (not negligence)
5. Accepted practice followed (Bolam principle)
6. Contributory negligence by patient

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8. CONSENT IN MEDICAL PRACTICE (FM10.19)

• Given freely (no coercion)
• Given with understanding of what it is for + risks involved

Exam Tip: Treatment without consent = assault (battery). Even in absence of harm, patient can sue.

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9. EUTHANASIA - MERCY KILLING (FM10.11)

Types:

Legal Position in India:

• Supreme Court held that "right to die with dignity" is a fundamental right under Article 21 of the Constitution
• "Living Will" is permitted - a conscious adult may refuse medical treatment and embrace natural death
• Active euthanasia = illegal in India
• Passive euthanasia = permitted under strict guidelines

1. Executor must be an adult with sound mind
2. Voluntarily executed; based on informed consent
3. Clear and unambiguous terms
4. Signed before a First-Class Judicial Magistrate
5. Must mention circumstances for withdrawal and name of guardian/close relative

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10. MALINGERING

• Definition: Conscious, deliberate, and willful feigning or exaggeration of disease or disability to gain some benefit (compensation, avoiding military duty, etc.)
• Distinguished from hysteria (unconscious, no willful intent)
• Doctor's duty: detect and report malingering

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QUICK MEMORY SUMMARY FOR EXAM

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FMT Chapter 6 - Death and Its Causes: Complete Exam Notes

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1. DEFINITIONS AND TERMINOLOGY

Exam Tip: "Death is not an event; it is a process."

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2. TYPES OF DEATH (FM2.3)

A) SOMATIC DEATH (Clinical / Systemic Death)

• Definition: Complete and irreversible stoppage of Circulation + Respiration + Brain function
• Also called: Clinical death / Systemic death
• Bishop's Triad of Life (Nicolas Bishop, 1638-1686): Circulation + Respiration + Brain function
• Current concept: Somatic death = death of the brainstem
• As long as oxygenated blood reaches the brainstem = life exists
• A person who cannot survive withdrawal of artificial maintenance = dead

Exam Tip: Bishop's triad = 3 components of life. Bichat's 3 modes = 3 ways life stops. Both describe the same triad from different angles.

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B) MOLECULAR DEATH (Cellular Death)

• Definition: Death of cells and tissues individually, after somatic death
• Occurs 1-2 hours after stoppage of vital functions
• Occurs piecemeal (not all at once)
• Individual cells survive on residual oxygen - duration depends on metabolic activity

Exam Tip: Molecular death = cellular death = death of individual tissues. Brain dies first, muscles last.

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C) BRAIN DEATH

1. Cortical Death - Only cortex is damaged; brainstem intact → "Persistent Vegetative State" (PVS). Patient breathes spontaneously, stable circulation, sleep-wake cycles present but no awareness.
2. Brainstem Death - Complete irreversible loss of brainstem function → legally and medically = death

1. Unreceptivity and unresponsivity (deep coma)
2. No spontaneous movements or breathing
3. No reflexes
4. Flat EEG (isoelectric) - confirmatory

• Patient must be deeply comatose
• Patient must be on a ventilator
• Cause of coma must be known
• Core temperature must be >35°C
• Rule out: drugs/overdose, hypothermia (<35°C), metabolic/endocrine disturbance

• Must be performed by two medical practitioners
• Both must be experts; transplant surgeons cannot perform tests
• At least one must be of consultant status (junior doctors not permitted)
• Each doctor must perform the tests twice

1. Pupillary response to light
2. Corneal reflex
3. Vestibulo-ocular reflex
4. Gag or cough reflex
5. Grimacing to pain

• French and English schools (similar to Harvard)
• Austro-German school = Harvard criteria + bilateral serial angiography of internal carotid and vertebral artery; negative angiogram for >15 min = proves death

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D) SUSPENDED ANIMATION

• Definition: Vital functions are at such a low pitch that they cannot be detected by routine clinical examination - mimics death but is reversible
• Death has NOT occurred; resuscitation is possible

• Hypothermia (most common - MCQ answer)
• Drowning
• Electrocution
• Strangulation/Hanging
• Cholera (severe dehydration)
• Drug overdose

Exam Tip (MCQ): Suspended animation = temporary cessation of vital functions. Most common cause = Hypothermia. It can mimic death. Recovery is possible. NOT always reversible (false).

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3. CAUSE OF DEATH (FM2.6)

3 Components of Cause of Death:

Manner of Death:

• Natural - death caused entirely by disease (no trauma/poison)
• Unnatural/Violent - death by injury, or natural disease hastened by injury
  • Sub-types: Suicidal, Homicidal, Accidental, Undetermined

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4. MEDICAL CERTIFICATE OF CAUSE OF DEATH (MCCD) - ICD-11 Format

• Line (a) = Immediate cause (e.g., Septicemia)
• Line (b) = Intermediate cause (e.g., Extensive burns)
• Line (c) = Underlying cause (e.g., Assault by burning - dowry related) → this gets the ICD-11 code

• Dowry assault death: ICD-11 code = PK80.1 (Assault by burning)

Exam Tip: The underlying cause in Part I is what gets coded in ICD-11 - it is the root event that started everything.

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5. MODES OF DEATH - BICHAT'S TRIAD IN DETAIL

A) SYNCOPE (Stoppage of Circulation)

• Sudden failure of cardiac action with stoppage of circulation
• Heart stops first → respiration stops within 20 minutes

B) COMA (Stoppage of Brain Function)

• Unarousable unconsciousness; no psychologically understandable response to external stimuli or inner need
• Involves central portion of brainstem
• Coma is a clinical symptom, NOT a cause of death

1. Brain compression (blood/pus/tumor)
2. Drugs: opium, hypnotics, cocaine, alcohol, cyanide, CO
3. Metabolic disorders: uremia, hepatic failure, hypoglycemia, electrolyte imbalance
4. Infections: meningitis, encephalitis

C) ASPHYXIA (Stoppage of Respiration)

• Interference with respiration or lack of O₂ causing organs/tissues to be deprived of oxygen (+ failure to eliminate CO₂)
• "Asphyxia indicates a mode of dying, not a cause of death"

• Breathing stops within 20 seconds of cardiac arrest
• Heart stops within 20 minutes of breathing stoppage

• Cerebral cortex function stops: 8-15 seconds
• Brainstem ganglia: 25-30 seconds
• Irreparable cortex damage: ~3 minutes

• Tardieu spots = petechial hemorrhages on visceral surface of pleura (classic)
• Petechial hemorrhages on brain (white matter)
• Cyanosis
• Congestion of internal organs
• Frothy mucus in airways
• Pulmonary edema

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6. SUDDEN DEATH (FM2.5)

• Some authors define it as death within 1 hour of symptom onset
• Incidence: approximately 10% of all deaths
• Emphasis on unexpected character rather than suddenness

System-wise Causes of Sudden Death (Table 6.1):

Exam Tip (MCQ): Most common cause of sudden death = Cardiovascular (45-50%). Most common specific cause = Coronary atherosclerosis.

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7. OBSCURE AUTOPSY

• Autopsy where no definite anatomical cause of death is found
• "The doctor should admit inability to give a positive opinion"
• Common obscure deaths: hypoglycemia, hyperkalemia, cardiac arrhythmias, epilepsy, vagal inhibition, snake bites
• When no cause found + natural circumstances: certify as "undetermined natural circumstances"
• When circumstances equivocal: certify cause and manner as "undetermined"
• Old age with generalized senile atrophy: certify as "myocardial degeneration due to senility"

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QUICK MEMORY CHART FOR EXAM

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