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Russian
00:00:00
[Music]00:00:05
Hello, we are starting another00:00:07
broadcast from the00:00:13
C faculty While we make our final00:00:16
adjustments, check out some of the content we00:00:18
prepared for you, see you00:00:21
soon, let's go00:00:26
together, welcome to the legal faculty,00:00:30
find the00:00:32
future, here the classroom is wherever00:00:34
you are without frontiers for00:00:37
knowledge a practical experience00:00:39
where each click is a step in00:00:41
building your00:00:44
success connect with the best in00:00:46
law without leaving home and be part of the00:00:49
law of the future here the community is00:00:52
strengthened digitally by building ties00:00:55
that go beyond the campus with00:00:59
cutting-edge technology we put the future of law in the00:01:02
palm of your hand be part of the00:01:05
Educational revolution the law of the future is here at00:01:08
Faculty00:01:15
C since 2017 the faculty prepares00:01:20
thousands of students to transform their00:01:23
career in law yes more than 20,00000:01:26
students have already passed through our00:01:28
postgraduate courses, we have00:01:30
postgraduate courses in the most diverse areas,00:01:32
whether they are more traditional ones such as00:01:35
criminal sciences, law and00:01:38
labor proceedings, family civil proceedings, as00:01:41
well as some00:01:43
more closed technological areas, such as, for example,00:01:46
bidding, health law and also00:01:48
digital law you have several options00:01:51
to train yourself with postgraduate studies from00:01:54
college with courses lasting up to four to 1200:01:58
months, all done in your own time, in addition00:02:01
we have a very00:02:03
well prepared tutoring team that provides subsidies and support00:02:06
for our coordinators, the greatest00:02:08
Masters and Doctors in the country, classes also00:02:11
live and also recorded, everything so that00:02:14
you have the flexibility to study in the00:02:18
best time that your routine can00:02:21
provide you and so, after you00:02:23
go through our postgraduate cycle,00:02:25
I am sure that you will have a00:02:28
great advance in your career in law00:02:31
Hello everyone, how are you, if00:02:35
you don't already know I have something00:02:36
new to tell you now I have taken over00:02:39
the coordination of the college's postgraduate course, it is00:02:41
a 100%00:02:44
online postgraduate course with several00:02:48
amazing teachers This postgraduate course is in00:02:50
tax law and tax process,00:02:52
so in it you will learn all the00:02:56
material tax law, always00:02:58
linked to PR00:03:00
and procedural law, also with a lot of00:03:03
practice involved. The teachers are00:03:05
lawyers, auditors, judges,00:03:07
judges, people who really00:03:10
have practice tax, in addition to in-00:03:13
depth knowledge of the subject,00:03:15
this postgraduate degree is a great00:03:17
differentiator in the market that you can00:03:19
do to change your career and then you are00:03:22
waiting to come with us for00:03:25
this online postgraduate course here at cers college, it is00:03:28
an unmissable opportunity00:03:30
and Take advantage of the fact that the price is super00:03:33
affordable so you can make this00:03:35
investment in your professional life,00:03:37
don't miss this opportunity, come with00:03:39
us Hello everyone, I'm a professor Ron00:03:42
Charles, a lawyer for the Union, author of00:03:45
several books in the area of00:03:47
administrative law, contract bidding00:03:49
age administrative third sector I am00:03:52
also a doctoral student in law and00:03:54
state regulation from UFPE, a master in00:03:56
economic law from UFPB, in addition to some00:03:59
postgraduate titles in the00:04:01
broadest sense and I was awarded this subject, this subject, the00:04:06
constitutional legal regime for bidding, which00:04:10
I will address. some important00:04:12
relevant provisions of our00:04:14
Constitution that deal with the subject of00:04:16
tenders and contracts, this will allow00:04:19
an approach based on00:04:21
constitutional provisions and topics that are extremely00:04:24
relevant to the practice of00:04:26
public relations, which are fundamental for all those00:04:28
who work with contracts and public actions00:04:30
to have more knowledge qualified00:04:32
on the topic, then approach to issues00:04:35
such as, for example, Legislative competence00:04:38
to deal with the topic of tenders and00:04:39
contracts, regulatory competence,00:04:42
approach to topics, For example, the00:04:44
principle of the obligation to bid00:04:47
and the competence to legislate on the00:04:49
topic, approach to topics, such as00:04:52
maintenance of economic balance00:04:54
payment obligations by the00:04:56
administration, respect for equality and00:05:00
several other topics that I can00:05:03
extract from simple00:05:06
constitutional provisions and this allows you,00:05:09
student, a qualified view of our00:05:11
bidding legal regime through00:05:13
a constitutional perspective and this is00:05:16
the proposal of this Our brief class that will00:05:19
pique your curiosity and above all,00:05:24
qualify your knowledge00:05:28
about the legal contractual bidding regime00:05:30
from a00:05:32
constitutional perspective This is my wish and00:05:35
I hope you enjoy this class Happy00:05:38
studying strong00:05:44
[Music]00:05:56
hug Hello good class Evening00:06:00
I'm already seeing some names here Amanda00:06:04
Antônio00:06:05
João Lenovo I don't know who Lenovo is,00:06:08
put the name there who's at Lenovo Amanda00:06:12
agilson00:06:14
rielle00:06:17
welcome Antônio they say only the beautiful ones00:06:20
turn on the00:06:23
cameras that's what they say00:06:27
Good evening Bruna00:06:30
everything Well, you hear me00:06:33
well, you hear me well, I also wanted to say00:06:36
good night to my class who is on00:06:38
YouTube00:06:39
specifically Cátia de Campo Grande00:06:42
Mato Grosso do Sul Mônica Dora and00:06:45
everyone who is arriving here for our00:06:47
open class of our00:06:49
postgraduate course -graduation in Medical and00:06:50
Health Law from the SS faculty here on Zoom,00:06:54
our privileged students who are already00:06:57
enrolled in the course and who I hope00:07:00
are taking a good course00:07:02
today, including here in the presence of the00:07:04
Coordinator, as well as the teacher, who can00:07:07
possibly make a complaint Face00:07:10
to Face or a compliment is also welcome00:07:14
at onem Just yesterday Antônio00:07:17
and I participated in a00:07:19
trial session at the00:07:21
Pernambuco Regional Medical Council and I was very00:07:24
happy because after00:07:26
my client's unanimous acquittal I received a00:07:28
compliment from the Counselor who took the00:07:30
floor of the President Counselor to00:07:33
thank that the illustrious lawyer had00:07:35
made important00:07:37
legal clarifications to the judging council So00:07:41
compliments are also welcome, class, I00:07:44
'm going to share the screen with you, someone00:07:46
put something here, wait, let00:07:49
me see in the chat It's out audio, I don't have00:07:51
audio, right? You can hear me well, you can't00:07:54
hear me well, so maybe the rit is a00:07:56
problem with your machine, I can't00:07:59
hear the YouTube broadcast here,00:08:01
but I believe it's fine too,00:08:03
because when it's not fine, they usually00:08:05
let me know or Someone is complaining but I wanted to00:08:08
share the screen with you because today for00:08:10
those who are arriving here now or who are00:08:12
watching later, this class will be00:08:14
recorded here on YouTube and several00:08:17
clients, colleagues said, Professor, the00:08:20
class will be recorded on YouTube00:08:22
will also be recorded So who perhaps If you00:08:24
weren't able to watch it live today, you can00:08:26
watch our recording later on00:08:28
YouTube So today we chose a00:08:31
very important topic to address, which is00:08:34
the duty of information, it's there on the screen,00:08:37
I hope you can see it, right? The00:08:40
duty of information for00:08:42
Health Professionals specifically I will focus on00:08:44
doctors but I want to say that this00:08:48
extends to other health professionals00:08:50
who perform procedures,00:08:52
interventions or something on the00:08:55
patient's body and a specific document that is00:08:58
the realization of00:09:00
this right to self-determination of the00:09:02
body which is the so-called00:09:04
consent form free informed o tcle00:09:08
many people confuse the term with00:09:10
consent and we will see that it00:09:12
is not the same thing consent is a00:09:14
larger institute that goes through notes00:09:16
in the medical record goes through the conversation that the00:09:20
patient has with the doctor the anamnesis the00:09:23
interview with the throughout the treatment, the00:09:26
consent formed is procedural and00:09:28
also has a term that, despite being a00:09:32
detail in court, is what most facilitates the00:09:36
medical defense in relation to this, the breach00:09:39
of the duty to provide information, who is my00:09:43
student and I will pass and the class is made00:09:45
for our students who are here on00:09:47
Zoom and also for those who are here on00:09:48
YouTube following me But whoever is my00:09:51
student has already seen this evolution of00:09:53
medical law with me, I don't know if I don't remember if in the00:09:55
first or second class that00:09:56
we there was, but it is from00:09:59
informed consent and00:10:01
patient autonomy that00:10:03
medical law arises and bioethics emerges,00:10:05
so it is like Practically everything does not arise00:10:09
from laws but from culture itself, which00:10:12
materializes in00:10:14
jurisprudential understanding for the first time in the00:10:16
Western world. that we heard about00:10:18
formed consent was in the00:10:21
Slater versus Baker trial in which Baker, the00:10:24
orthopedic doctor, performed a reduction on a00:10:27
bone fracture without Mr Slater's consent00:10:30
there in England, see I'm00:10:33
talking about the 17th century in00:10:36
1767 The English Court decided the Next,00:10:40
look Baker, you couldn't have made00:10:42
a new bone fracture on the patient without00:10:45
him having been consulted because00:10:48
that takes a lot of00:10:49
recovery time, it takes a whole new00:10:52
surgery, a post-operative one and this is the00:10:54
First Record that we have of this00:10:56
need to give to the patient00:10:59
his age to choose whether or not to carry out the00:11:01
procedure, spanning practically a century00:11:04
in the United States in the case of00:11:06
pret versus Davis Then there is a00:11:09
new appearance in world jurisprudence00:11:11
about the need for00:11:13
informed consent when it is not a case of00:11:16
therapeutic privilege, which It is a00:11:18
therapeutic privilege, class are those00:11:20
cases of emergency and medical urgency00:11:22
that in these cases and medical ethics itself00:11:25
predicts this, we will see this00:11:26
here, consent is mitigated00:11:29
because the doctor has to act quickly, there is00:11:31
no time to collect consent,00:11:33
but except in these cases In these00:11:36
urgent cases, it is necessary to00:11:39
obtain the patient's consent, as it00:11:41
is the patient who has to choose, after00:11:43
all, it is not heading towards the00:11:45
1930s. I usually say that00:11:48
this ruling from the French court of cassation00:11:52
is the seed of medical law.00:11:54
which says that the relationship between the00:11:56
patient and the doctor is of a00:11:58
contractual nature, this is where this00:12:00
perspective of the treatment contract arises.00:12:03
I already had the opportunity to00:12:04
write a book about this,00:12:06
similar to what happened in00:12:08
German law, it would be ideal for00:12:10
medical patient relationship that we had at the00:12:12
level of ordinary Federal law the00:12:13
typification of the treatment contract that00:12:16
basically determines the00:12:18
contractual relationship with obligation of means this is00:12:21
very important group because if it is an00:12:22
obligation of means if the doctor does not have00:12:25
an obligation of result or it00:12:27
shouldn't have unless he takes00:12:29
the advertising on Instagram completely00:12:32
wrong, promising a result without00:12:36
saying that that result is not00:12:38
guaranteed or without saying observing the new00:12:42
resolution 2336 of the Federal Council of00:12:44
Medicine from last year that says if you00:12:46
put a result and the doctor00:12:48
can now show the result if you put00:12:50
a satisfactory result you have to00:12:53
also put the00:12:56
unsatisfactory result I have already recorded a class00:12:58
for this for post I don't know if you00:13:00
have watched my students who are here00:13:02
in the room and at this moment I I only see Bruna00:13:05
and Antônio If you have00:13:08
already attended this class about medical advertisements,00:13:10
you certainly remember that I spoke about00:13:13
this possibility in00:13:16
1947, the first typification in law appears00:13:19
in the Nuremberg code on this00:13:22
Perspective of self-determination, until00:13:24
then it was just jurisprudence, so with the At the00:13:26
end of the Second World War comes the00:13:29
Nuremberg trial, the00:13:30
Nuremberg code and brings this perspective of the00:13:32
right to self-determination founded00:13:35
on the dignity of the00:13:37
human person. 10 years later, back in the00:13:40
United States, the expression00:13:42
informed consent appears, which later00:13:45
evolved into free informed consent00:13:47
and clarified in00:13:50
Germany in00:13:52
1979, the German federal constitutional court00:13:55
deciding a case of medical error00:13:58
says the following look in relation to the00:14:00
duty of information Look at the duty of00:14:03
information consent, in addition to being00:14:05
an ethical requirement, is also a00:14:07
legal requirement Civil making a00:14:11
distinction in relation to what the Civil sphere is, the00:14:13
criminal sphere and the00:14:15
administrative sphere, in the Dutch civil code it00:14:18
is the first typification of the00:14:20
treatment contract there they call it a00:14:22
service provision contract which has00:14:24
a provision specifically about00:14:26
this need for the duty of information00:14:29
and in the code German civil law that has the00:14:32
behandlung vertrag as we have already seen00:14:34
here in the post which are the00:14:36
treatment contracts that also have00:14:39
specific provisions on the duty of00:14:42
information The big question is the following00:14:44
The Rise of the duty of information which00:14:47
implements the patient's right to00:14:50
self-determining respect for00:14:52
patient autonomy is exactly at par with the00:14:55
evolution of medical law, exactly at00:14:57
par with the evolution and emergence00:14:59
of bioethics itself back in the 1960s,00:15:02
especially in 1971 when00:15:05
Potter's book was published. by Van00:15:08
his Potter, bioethics is a bridge to the00:15:11
future and from this initial milestone00:15:15
there was a German In 1927, Fritz, who00:15:19
wrote about bioethics as an00:15:20
imperative, he is a bioethical imperative, inspired by00:15:24
Kant in the categorical imperative, he wrote in the00:15:26
bioethical imperative, but the dissemination00:15:28
of bioethics and the dissemination of respect00:15:30
for patient autonomy starts00:15:33
from North American bioethics and00:15:35
then comes with the foundations the00:15:37
principles of biomedical ethics by B00:15:38
Champs and Chr, which is perhaps the00:15:40
most robust bibliography in this00:15:43
sense and then moving on to00:15:46
jurisprudence of the duty to provide information00:15:49
here in the Brazilian legal system,00:15:51
we have a case in which the doctor was00:15:54
exonerated precisely because he00:15:56
proved that those involved in the00:15:59
treatment, a peeling treatment,00:16:02
were duly informed to the patient00:16:04
and the patient signed the term and therefore00:16:07
he was not obliged to pay the00:16:09
compensation because look at medicine, it is00:16:12
iatrogenic, you are going to undergo treatment,00:16:15
Antônio, you enter the hospital, you already00:16:17
receive a puncture from a needle,00:16:18
radiation from an00:16:21
MRI, it is iatrogenic, it is harmful if00:16:23
I go to do a procedure, especially00:16:25
one The procedure00:16:27
is more invasive or aesthetic, as is the00:16:30
case with hair damage to the skin, it will have00:16:33
consequences and the00:16:35
consumer, after completing the first00:16:38
phase of the procedure,00:16:39
asked for a refund of the amount because00:16:43
she had adverse reactions. And then the00:16:46
judge states the following Look,00:16:48
it appears that the author had contracted an00:16:51
aesthetic treatment called peeling and00:16:52
that after completing the first00:16:54
phase of the procedure, she ended up giving up00:16:56
on continuing with the other treatment sessions.00:17:04
their payments00:17:06
in the treatment contract, it is clear that the00:17:09
doctor's obligation is much00:17:11
greater, but the patient also has to00:17:13
take the medications, he has to return for the00:17:15
return appointment, he has to continue with the00:17:17
treatment, if he does not continue with00:17:20
the treatment, he assumes this00:17:22
responsibility And then the judge00:17:24
complements the allegations of intense burning pain00:17:26
and appearance of spots in the00:17:27
area for were considered to have certainly00:17:30
had an inherent expertise in the procedure00:17:33
and therefore normal reactions to the treatment, in00:17:35
addition, the author had signed a00:17:38
consent form which contained these00:17:41
warnings, so in this case the00:17:43
doctor was cleared exactly for00:17:46
carrying out the duty to provide information in00:17:49
another case, however, the00:17:51
opposite happened. This is a judgment from Rio de00:17:54
Janeiro, Rio de Janeiro, from the Court of00:17:57
Justice of Rio de Janeiro, there is00:17:59
the consumer's right, compensation action,00:18:01
carrying out tubal ligation surgery00:18:03
that What happened, I'll summarize it00:18:06
so I don't have to read the whole thing, the00:18:09
patient had tubal ligation surgery,00:18:11
it's a00:18:15
sterilization method, but the doctor didn't00:18:18
inform her that the method was flawed,00:18:21
like any method, there is no method of00:18:23
contraception 100 % safe and what00:18:26
happened was not It was proven in the records00:18:28
that the doctor who accompanied The author and00:18:30
who performed the procedure advised the00:18:32
patient to undergo00:18:35
periodic medical examinations in order to00:18:37
check whether the tubal ligation worked00:18:40
If there was no00:18:42
recanalization Then as he did not do00:18:44
this there was a breach of the duty of00:18:46
information and not of the duty of care00:18:48
because from a technical point of view the00:18:50
doctor acted correctly he performed the00:18:52
surgery with expertise there was no00:18:54
recklessness there was no negligence but he did00:18:57
not inform the patient that the00:18:59
patient could get pregnant, she should00:19:02
have had a salpingography exam to00:19:05
find out if the tube was permeable and for00:19:08
nature, nature always has its00:19:10
ways, isn't it, she got pregnant, she demanded00:19:14
compensation from the doctor, including asking for a00:19:17
lifetime pension for the child, the court00:19:20
denied it because it understood that the child it00:19:24
is not a damage and it is not a damage in fact but00:19:27
there was a breach of the duty of00:19:28
information so the medical provision00:19:32
related to the duty of information regarding00:19:34
informed consent was not00:19:37
done well and compensation of00:19:39
R$ 1,000 was paid and this is One point,00:19:41
compensation for breach of the duty to provide00:19:43
information tends to be lower than the amount of00:19:46
compensation, but we must remember00:19:48
that these processes often take 10,00:19:51
15, 20 years to complete and this value00:19:54
has to be taken back to the date of the00:19:57
event for correction, following the00:20:00
summary understanding including from the00:20:02
STJ itself talking about the STJ just to00:20:05
close these preliminary judgments00:20:07
here it is, failure in the duty of00:20:10
information is a recent judgment and is from00:20:12
2022 Despite the action started in 2002 it00:20:16
takes 20 years to finish the action failure in the00:20:18
duty of information about of the risks of00:20:20
surgery, finding only00:20:23
Generic consent and this group is a00:20:26
problem that I want to talk to you about00:20:28
today, here I also have many00:20:30
clients who are satisfied with those00:20:33
terms of consent that they have in the00:20:35
hospital C the subject is a surgeon, a00:20:37
urologist, a gynecologist,00:20:40
head and neck surgeon, the hospital has00:20:42
that standard term that the judiciary00:20:45
understands as the so-called blanket concent, right?00:20:59
talk that I'm just00:21:00
seeing the two of you, you saw the other screens, I00:21:01
can't see why I'm showing it,00:21:04
but Rúbia, who watches us here and is in the00:21:06
chat on YouTube, Cátia Raquel, each one has00:21:10
a different body composition and in this00:21:13
case it was about an obese patient and00:21:17
this obese patient because he is obese and because he00:21:19
has a specific anatomy on the tongue,00:21:23
mouth anatomy, uh, particular,00:21:27
intubation in the event of a need for00:21:29
cardiorespiratory arrest was more00:21:30
difficult in his case and what00:21:33
happened and this is only when the risk00:21:36
implements -if he had an00:21:38
arrest during anesthetic induction, he was unable to be00:21:41
intubated, he died, the patient was a risk00:21:44
inherent to the surgery, there was this00:21:47
in the consent form, which included the00:21:50
risk of death, but it was not00:21:54
a consent form made00:21:56
specific to the case of the patient and the00:21:59
surgeon was sentenced to R 10$ 10,00000:22:01
in court it went to 50,000 the STJ00:22:03
reformed it back to R 10$00:22:05
10,000 that's it, resp 1.00:22:12
88486 862 Orion do Rio Grande do Norte00:22:16
judged in 2022 By the third00:22:19
eh eh class Cira session of the STJ that00:22:24
understood the following,00:22:26
look, this00:22:28
generic consent is not allowed, so00:22:31
the compensation of R 10,000 must be there,00:22:33
the third class must be there, the STJ is sure,00:22:36
the STJ understands that this needs to be00:22:39
done according to the case00:22:42
specific to the patient, ok And at the end00:22:46
of our presentation I'm going00:22:49
to show you a00:22:50
simple consent form from me and my Lavra00:22:52
for a relatively00:22:54
simple procedure, of course the terms vary and00:22:56
we have to give this action in the form00:22:59
so that it has legal validity and is00:23:01
not as simple as a00:23:03
contract of adhesion Okay, so let's00:23:07
talk now about the normative concept of00:23:09
guilt, this class on00:23:12
civil liability, I no longer teach in the00:23:14
postgraduate course, I used to teach this class, but00:23:17
we did some reformulations and I00:23:20
left it to the more intelligent and more00:23:21
prepared course teachers00:23:24
to provide this class, but in this class I00:23:27
use myself, which is what I do in my00:23:29
practice, a matrix of the possibilities00:23:33
of the points that I have to attack00:23:35
when I analyze the responsibility00:23:37
of the health professional. health and basically00:23:39
I have three pillars of attack I have00:23:42
to observe the duty of safety the00:23:43
duty of care and then I have to see00:23:45
if evidence-based medicine was met the00:23:48
conduct of that doctor00:23:50
was in accordance with what demands00:23:52
medical knowledge at the time of the event Or00:23:55
he could or should have acted00:23:57
differently he fulfilled his duty of00:23:59
secrecy the professional's behavior00:24:02
followed the standards of deontology of what00:24:04
medical ethics determines if it was not00:24:08
fulfilled this contributed to the00:24:10
patient's harm this is the duty of Be careful with the00:24:12
specific circumstances, which is the00:24:15
third pillar, there are those issues00:24:18
relating to the medical activity itself.00:24:20
What were the working conditions of00:24:22
that medical professional? Was there00:24:24
any other area inherent to the treatment00:24:27
that could have contributed to Dan, for00:24:28
example, a complication, an00:24:31
adverse effect, an event itself?00:24:33
inaccuracy in Medicine I have a case of a00:24:36
surgeon who operated on two twin brothers00:24:40
for the same disease in the same way, he operated on one00:24:42
first, everything went well, he operated on another, he00:24:45
had to redo the surgery because the00:24:46
surgery using the same technique didn't00:24:49
work, so medicine doesn't have00:24:53
a guarantee result and it also has00:24:55
to be analyzed What was the00:24:57
patient's own conduct throughout the treatment00:24:59
which is very important but I want to00:25:01
focus there Aé because the class is not00:25:03
about civil liability and what about the00:25:05
duty of information in the middle column00:25:08
which is this the most00:25:11
contemporary duty that emerged mainly in the00:25:14
20th century, now it won the courts00:25:16
in the 20th century as an autonomous duty,00:25:19
independent of the duty of care, the00:25:21
duty of information is insitu00:25:23
medical activity and how do we study in the00:25:27
specific case, investigate whether there was or not00:25:31
the duty to provide information, we have to00:25:33
know whether there was informed consent and00:25:35
how we identify this, there is a00:25:37
note in the medical record that the patient00:25:40
was duly informed about the00:25:42
surgical procedure he was going to undergo,00:25:44
there was oral information, there is a00:25:47
witness who verifies that or even00:25:50
recording For example, Antônio, when00:25:53
I took my children when they were little00:25:54
to the pediatrician, when it arrived at the time of00:25:57
the pediatrician's conduct, right?00:26:05
The00:26:07
boys' diet, vaccines, I said, Doctor,00:26:11
I can record the consultation from00:26:13
now on, I'll just record the audio, I won't00:26:14
record the image of you, no, I can00:26:16
record, Yes, you can, and Dr Irene would let me. So00:26:19
this is also a form of00:26:21
free informed consent. what is00:26:23
going to be done, but above all if there is a00:26:26
term in the medical record, this00:26:29
consent form is unequivocal proof that00:26:35
consent was given, the patient was given the00:26:37
possibility of choosing, of course00:26:40
the term cannot be a standard term, a00:26:42
blanket Concept when we said there it00:26:44
has to be a customized term00:26:46
specific to the procedure that is going to be00:26:48
performed it has to be given to the00:26:51
patient in advance of the00:26:54
procedure if it is a major surgery you00:26:56
cannot come up with the term the day before00:26:57
the surgery the ideal is that be given at00:26:59
least a week before the surgery00:27:02
Even because if it's a major surgery00:27:04
you have to make the request with the operator00:27:06
if it's on the private network and this is the00:27:10
moment, even many doctors think,00:27:13
see Bruna, that the consent form is00:27:17
bureaucracy it will remove oops, not quite00:27:20
on the contrary, it has to be seen00:27:22
as a moment of proximity in which the00:27:24
health professional will read the term00:27:27
together with the patient or offer the00:27:29
term and then in a consultation you. Did you00:27:31
have any doubts about the term? Is there00:27:33
any point? Did you understand well these00:27:36
risks and benefits of procedure A of00:27:39
procedure B or even of not doing the00:27:42
procedure for this purpose, which is what00:27:43
free informed consent is for00:27:45
because the patient can get00:27:49
prostate cancer through consent knowing00:27:52
that he will be impotent because the method00:27:55
of removal, radical prostatectomy00:27:58
can leave him impotent and I know00:28:00
a case like this of the guy who chose it, I won't have00:28:01
surgery, I'll date happily until I00:28:05
die, then I'll00:28:06
die soon. Sign here, put it in the medical record,00:28:09
right, sign the form saying that00:28:12
you chose not to have the surgery, ready.00:28:16
Recourse to treatment is the00:28:17
patient's right, the patient cannot be00:28:19
forced to undergo medical treatment, except00:28:23
as stated in Article 15 of the Civil Code and00:28:25
medical ethics itself, if there is an00:28:27
imminent risk of death if he is00:28:30
stopped, then the doctor, even because he is stopped,00:28:34
or or a nearby stop, there is no way for00:28:36
the treatment team to collect00:28:37
consent from the patient, okay, so00:28:42
informed consent, I'll be here00:28:44
for 20 minutes of speaking, stop me and00:28:47
ask me if you have any questions00:28:48
Because if you let me, I'll talk until tomorrow but00:28:51
I won't I will be very patient with00:28:52
you, no, the medical team has to obtain the00:28:57
patient's free informed consent or be the00:28:58
legal representative in the case of a minor,00:29:01
for example, and immediately after clarifying the00:29:05
patient about the procedure that will be00:29:07
performed, he tries to guarantee the patient,00:29:11
this exercise of freely deciding00:29:14
on the execution of00:29:16
therapeutic and diagnostic and00:29:19
diagnostic practices, we have to remember that00:29:20
the medical act is therapeutic and00:29:22
diagnostic.00:29:32
consent is very interesting, right,00:29:34
because sometimes the person has one00:29:39
because many times the person is going to do00:29:40
a certain procedure, the doctor00:29:43
asks if they have any example, any00:29:48
allergies, any medication, something,00:29:50
they say no and something else,00:29:54
sometimes the doctor is afraid to say00:29:57
what the patient is really lying about and00:30:00
the risks she runs and this is very00:30:04
interesting, right, because it would prevent many00:30:07
deaths due to00:30:10
medical negligence, not just from the doctor,00:30:13
even from the patient himself, right, because00:30:15
nowadays the Sir, you know that when it00:30:17
comes to aesthetics, many people don't00:30:21
say that they really have to be allergic00:30:24
to some medication, the problem that00:30:27
the doctor has to carry out the00:30:29
procedure on this person, right?00:30:38
this question your intervention00:30:39
because medical consent or00:30:42
informed consent is actually00:30:44
multidisciplinary, right? Nursing does00:30:46
this screening, the surgeon does this00:30:50
screening or the doctor will perform the00:30:51
procedure, the anesthetist also does this00:30:53
screening with the00:30:55
pre-anesthetic consultation, so there are several00:30:58
Barriers for the patient to have the00:31:02
exact notion of what can be done,00:31:06
what can be done as an00:31:07
alternative therapy, risks and benefits of both00:31:10
and what will happen if he00:31:12
does nothing because doing nothing00:31:14
is also an option, right? see here00:31:16
that this is exactly what he has to have00:31:18
access to he has to have access to the00:31:21
diagnosis which is what he has and00:31:25
he cannot be treated as incapable00:31:28
unless the00:31:30
diagnosis report could cause a risk to the00:31:32
patient for example a00:31:35
young patient in his early 20s who has00:31:37
heart disease, cardiomegaly, and if00:31:41
he has an emotion or something00:31:43
serious at that moment, he may have00:31:45
decompensation and have an arrest,00:31:47
in this case, which is an exception to the exception,00:31:50
even if it is an adult and capable patient,00:31:52
the doctor must inform the00:31:55
legal representative, right, the father, the mother, the wife, and the00:31:59
brother, someone who looks, I'm not going to tell00:32:02
him at this moment, we're going to compensate00:32:04
him, we're going to treat him, but as soon as it's00:32:08
necessary, it's safe, he has the right00:32:10
to knowing what he will want to do, he will00:32:12
want to have a transplant, he will00:32:14
want to undergo drug therapy, he will00:32:16
want to have surgery,00:32:18
right, so informing the00:32:21
diagnosis, informing the00:32:24
therapeutic alternatives and the00:32:26
prognosis, which is also due, is the00:32:29
doctor's duty and what the prognosis is are the00:32:31
chances of a cure with00:32:33
certain treatments, this also has00:32:36
to be included, right? Of course, we're00:32:38
talking about an estimate, he can't00:32:41
give an estimate, but he can give an00:32:43
estimate. Look, you have an 80%00:32:45
chance, approximately00:32:47
medical literature a patient of your00:32:50
age to be successful in this00:32:52
specific procedure, but we know that in00:32:56
medicine there is no way for us to be00:32:59
certain about a given00:33:01
procedure if the doctor were00:33:03
commenting on how it is sometimes he would00:33:05
n't even perform surgery That's what Bruna said,00:33:07
it was from her comment Good evening00:33:08
Teacher, this class will be available in the00:33:10
student tab, I believe so, see00:33:12
Antônia, it will stay on YouTube I don't know00:33:14
how long on YouTube because it00:33:17
will stay on YouTube for our00:33:20
colleagues who don't They are college students,00:33:22
if the class will be in the student's area, will there be00:33:24
any way to be present,00:33:27
I believe it won't happen, I will take advantage of the00:33:29
duty of information and appeal and view and00:33:33
in the SUS these protocols are not00:33:35
respected without generalizing exactly00:33:37
Luciane is in the SUS and in the private network, you00:33:40
also saw in the private network, it's not00:33:44
uncommon for us to have difficulty00:33:46
finding this respect for00:33:50
patient autonomy, this has to happen in00:33:52
any environment, University Hospital,00:33:54
and I have cases of lack of respect for00:33:57
patient autonomy, which I studied00:33:59
Medicine In the 90s, right, Bruna, she00:34:01
wasn't even born, she was a different scenario, she was a00:34:05
patient, Bruna, at that00:34:08
time, maybe Antônio was kind of00:34:10
contemporary, there wasn't much of a decision,00:34:12
no, the doctor decided for the patient,00:34:15
Public University Hospital, a00:34:17
low-sufficiency patient, right, who needed that00:34:20
service there with those doctors trained00:34:23
in the 20s or 30s of the00:34:26
last century didn't exist, that's because they did00:34:28
n't see that respect for00:34:30
patient autonomy is a thing of the end00:34:31
of the last century and here in Brazil it's00:34:33
beginning to enter the legal system in the00:34:37
courts in the beginning of the century how00:34:39
we started here seeing that00:34:41
jurisprudence So what are the steps the00:34:43
first step is to inform the00:34:45
diagnosis the therapeutic alternatives00:34:47
and the prognosis the second step of00:34:49
consent is to00:34:51
confirm that what was said the00:34:54
patient understood because something is the00:34:55
what you say is something else that the00:34:57
patient understands, it00:34:58
is often a technical language that00:35:00
the patient does not understand, just as it is00:35:02
in law, right, we have to avoid00:35:04
juridics so that the client understands00:35:07
what we say and ultimately00:35:09
reaps it if consent is obtained,00:35:12
consent is obtained then first00:35:14
confirms that the person understood that the00:35:17
patient understood and obtains00:35:19
consent by writing out the00:35:22
form and noting in the medical record that it was00:35:28
authorized and consented by the patient00:35:31
that procedure, recanalization00:35:34
example of of all of these The examples00:35:37
I will cite here are examples of00:35:39
jurisprudence that occurred and00:35:41
doctors were held responsible for00:35:43
breaching the duty to provide information00:35:45
Tubá recanalization after ligation I have already00:35:48
shown necrosis of the testicle in00:35:51
innal hernia surgery and not Sep like00:35:54
jurisprudence but there are cases like this that00:35:57
the ernal is the one that hernes that is there in the00:36:00
tongue, it is not that we have there in the00:36:02
na na pbbs there between the root of the thigh00:36:07
and the scrotum or the vagina in the case00:36:10
of women that herginal that comes out00:36:12
there one of surgeries on men Of course, it00:36:16
can cause necrosis of the testicle because00:36:19
it can damage the vascular supply00:36:21
of the testicle and the patient has to know00:36:25
about this risk Because this can lead to00:36:28
sterilization, it's something about the procedure and00:36:31
it can resolve it, look, Doctor, I'm going to00:36:33
keep mine herne here is hurting but00:36:35
wait a minute let me separate some semen let00:36:38
me have a baby then I'll come back here00:36:40
because if I don't have the baby I don't00:36:42
want to I want to have a baby of my own with my00:36:45
face with my face and I'll00:36:47
be prevented from doing so Let's go00:36:49
me and my wife to do an insemination and then00:36:51
I come to have the surgery. So00:36:53
the patient has to be given the possibility00:36:57
of00:36:58
even though this is a consequence00:37:00
predicted in the literature to happen if00:37:02
the patient was not given the opportunity to00:37:04
choose and this occurrence comes to00:37:08
emerge is characterized by a breach of the duty to provide00:37:10
information, oh, oh, this case00:37:14
was actually the performance of an00:37:16
orchiectomy removed from the testicle00:37:19
because the doctor suspected that it was00:37:21
a00:37:22
tumor and he even had it during the surgery, he00:37:26
looks there, there is the testicle, he suspected,00:37:29
he could even do this00:37:32
therapeutically, remove the testicle and send it00:37:33
to pathological anatomy, but what would00:37:35
he have to do during surgery? He00:37:38
would have to stop the surgery at that00:37:41
moment quickly and go to the00:37:43
waiting room to find the patient's guardian,00:37:46
the mother. or the father and obtain consent00:37:48
father mother the patient has an injury to the00:37:52
child's testicle P which everything indicates is00:37:55
a tumor can I remove the00:37:58
child's testicle this was not done00:38:02
the child's testicle was removed And00:38:04
to make matters worse the anatomy pathology00:38:08
revealed that it was not a tumor, so00:38:11
that could happen, right?00:38:29
whether00:38:30
or not the surgery should actually be performed00:38:33
because when the doctor goes to the00:38:35
waiting room and interviews the mother00:38:39
and asks the mother or father and00:38:42
eventually submits, in this case, it is a term.00:38:45
It would be something that is even difficult to do,00:38:48
it would be more for the sake of proof is from00:38:50
Witnesses from the medical team, in this case00:38:53
the family itself will be a Doctor who doesn't00:38:54
have an alternative for this Does00:38:56
this need to be done now, is there no way00:38:58
we can do another exam and then00:39:00
just to enjoy the surgical procedure00:39:03
or We can't do00:39:04
a puncture or something more conservative afterwards,00:39:08
right? But the doctor took advantage of the fact that he was already undergoing00:39:10
open-air surgery and did it and00:39:13
was condemned by the Court of Justice00:39:15
of Paraná, which even used as a00:39:17
basis the code of medical ethics that00:39:20
That's what we're going to show in a00:39:21
little while, which is in fact the legal basis00:39:24
for this, professor, you're saying, I do00:39:27
n't know if you saw there was a00:39:30
recent case involving a doctor Guys, I00:39:33
thought it was absurd, he's a 6-00:39:37
year-old child. there in Campina Grande Instead of him00:39:40
putting the pin that was in the Instead of00:39:44
him putting the pin in the correct leg he00:39:47
put it in the other leg which there was no00:39:48
problem I saw I saw this case I00:39:53
Wow, it's absurd, I don't have the case but I saw the00:39:55
news This is the so-called Bruno damage in00:39:58
defendant ipsa in defendant ipsa, right, the thing speaks for00:40:01
itself, it's something absurd, in this case there is00:40:06
even an automatic reversal of the00:40:08
year of proof, in this case the00:40:11
liability is difficult for00:40:14
you to eliminate it and for you to remove it And00:40:18
I have a case like this,00:40:21
but my case, my00:40:25
client's case, and I can't comment here00:40:28
because it's still in progress, and00:40:31
he had some complications, which, the00:40:37
fact that the surgery was performed, wasn't even00:40:39
on the side. wrong was on the wrong patient on the00:40:41
wrong patient and it points to the sense00:40:45
that it was much more an error on the part of the hospital00:40:47
in screening the patient's medical record in the00:40:51
na and and and of the madness of the00:40:53
public system of a highly complex public maternity hospital00:40:57
here in Salvador in00:41:00
which they were to have four doctors on00:41:02
duty only Four doctors on duty There were only00:41:04
two doctors on duty on duty, something00:41:06
extremely overloaded and two00:41:08
patients arrived with very00:41:09
similar illnesses, except one in a tube in one00:41:11
ovary and the other in the other00:41:12
contralateral ovary and there was an exchange of00:41:16
medical records in our assessment of the00:41:19
Medical Defense by the00:41:23
receiving Nursing Triage system and the00:41:26
patient herself is this is a thesis including that00:41:29
all the witnesses confirmed that she00:41:31
was called by the name of the other patient00:41:33
and did not say no I am not that patient00:41:35
no I am the other and that of course00:41:37
hasn't had the result yet but it's something that it's it's it's it's it's00:41:42
a difficult defense it00:41:46
's not a simple defense I must tell00:41:48
you that it's in fact something and in this00:41:51
case, operating on the leg against lateral00:41:54
in 2022 because this happened in the00:41:58
last century, right? Nowadays, with the00:42:01
security controls with the barriers, it is something00:42:04
really inadmissible, something inadmissible,00:42:07
so no information on the necessary00:42:12
recovery time, you have to say, the00:42:15
doctor has to say, look, sir, you will00:42:16
be 15 days away 30 days away00:42:19
from work no information regarding00:42:21
natural scars from the procedure, you have00:42:25
to inform it, especially if it is a00:42:27
female patient, especially if it is a young patient,00:42:30
depending on the area, including the scar,00:42:34
this has to be informed. So in this00:42:36
case, the causal link links the damage is00:42:40
not the breach of the duty of care but rather00:42:43
the breach of the duty of information. So if00:42:47
that event is linked to the absence of00:42:49
information, we have the00:42:51
responsibility of the professional, then00:42:54
we have one more judgment in this case,00:42:57
leave it until we get here because the bar00:42:59
with you were ahead here, right?00:43:02
Civil and medical liability00:43:06
arising from the failure to provide00:43:08
information, although00:43:11
technical expertise has proven that the00:43:13
appropriate technique was reused to carry out the00:43:16
liposuction procedure, it was also established00:43:19
that for the specific bodily condition00:43:21
of the author, it would be It is necessary to perform an00:43:23
abdominoplasty, which is another thing, you know,00:43:26
one thing there is perspiration, another thing is00:43:29
abdominoplasty together or in a00:43:32
second phase and who has to decide00:43:35
this is the patient, do you want to do the00:43:37
two surgeries together because the00:43:39
recovery from two surgeries or even00:43:42
more surgeries she performs in the same act is00:43:44
greater the bodily injury the00:43:46
bodily inflammation is greater or in different Acts the00:43:50
doctor went and did it without consulting the00:43:53
patient everything at once was called in and00:43:56
had to pay compensation because nothing00:43:59
went wrong everything went wrong right, but00:44:01
he didn't give it to the patient, she woke up and00:44:03
discovered that she had had another surgery,00:44:05
right, to which she had not consented.00:44:09
So in this case there was a breach of the00:44:13
duty to provide information and00:44:17
the conviction for the lack00:44:21
of consent formed, so class And00:44:23
then I already have 40 minutes I want to stop00:44:25
talking to listen to you, coming to the00:44:27
very end, consent is an00:44:29
indispensable condition for the formation of the00:44:31
treatment contract, avoiding the00:44:33
so-called generic consent that00:44:35
we just saw in the00:44:37
STJ's special resource, which is what TJ oando00:44:41
resulting from the lack or disability00:44:44
because sometimes consent exists, the00:44:46
term but it is poorly done, it is bad, there00:44:49
is no information about what happened, the amount of00:44:52
compensation is generally less,00:44:56
for example, in that case of00:44:59
innal hernia, if it had been00:45:02
testicular necrosis with sterility of the patient00:45:05
due to a malpractice error, the00:45:07
compensation would be greater and not R 10,00000:45:10
as it was and in that specific case, it's00:45:13
like the theory of loss of a00:45:15
chance, right, you go in a proportion there,00:45:18
what would be the proportion of that00:45:20
happening and stipulate it is generally there 800:45:23
10,000 15,000 20,000 I have never seen00:45:26
compensation greater than 20,000 for00:45:28
breach of the duty to provide information but the00:45:30
tendency is for this to increase the tendency to00:45:32
increase the proof of the presence or00:45:35
lack of information it can be00:45:37
carried out as in law by all00:45:39
means of proof, but the main one is the00:45:44
consent form document, if it exists and if there is a00:45:46
witness, if there is a recording, it is necessary to00:45:49
ask the following question: the risk that00:45:51
was not informed that it was implemented was00:45:54
common or extremely rare because if00:45:57
is extremely rare, it is00:45:59
also unreasonable for the doctor to put in a00:46:01
consent form everything that could00:46:03
happen to the patient during surgery, it is00:46:05
materially impossible, so this has to00:46:07
be taken into consideration, it00:46:09
also has to be taken into consideration in a00:46:11
possible defense or defense argument.00:46:14
medical accusation, the uninformed risk00:46:17
that was implemented brought a00:46:19
serious consequence because it changes the00:46:22
situation because if it is a00:46:24
serious consequence, even if rare, even if remote, the00:46:27
possibility has to be informed00:46:29
to the patient Because if it is something00:46:31
significant and there is also a margin00:46:34
of reasonableness in the specific case, the00:46:37
professional has to know, according00:46:41
to the common experience of what type of00:46:43
surgery, what type of00:46:45
procedure, serious aquacia can00:46:49
happen, even though it can rarely happen.00:46:53
alterity, right00:46:56
? And then it's much more for the judge, right? What00:46:59
a patient in the same00:47:01
information conditions would have chosen? This also00:47:03
has to be taken into consideration,00:47:05
especially you who are doing medical defense, right?00:47:07
Say, look, there wasn't that information in the00:47:10
book there, but a patient Normally,00:47:13
Antônio would probably have chosen00:47:15
to do this additional procedure or not,00:47:19
that's what has to be clear and it has to00:47:22
be proven in the eventual00:47:25
instruction where the normative source comes from,00:47:28
first of article 15 of the Civil Code,00:47:31
right, no one can be forced to00:47:33
submit life-threatening00:47:35
medical treatment or00:47:37
surgical intervention is a poorly written article for00:47:40
bioethics for people who deal with00:47:43
medical law, but it sheds light on the fact that one00:47:45
must respect the patient's autonomy, one00:47:48
cannot embarrass the patient, he00:47:51
said less than what I should say but00:47:53
we take this Telos that you cannot00:47:57
force the patient to undergo00:47:59
surgical treatment or a00:48:02
medical intervention that has risk or00:48:05
that does not have risk either, right, not only in00:48:07
those that have risk, not in fact in those00:48:10
that imminent risk to life,00:48:12
medical deontology itself mitigates the00:48:14
need for consent at that00:48:16
moment and it is in medical deontology that00:48:19
the code of medical ethics is where00:48:20
our main normative sources are that00:48:23
even the courts use to00:48:25
justify the breach of the00:48:26
training duty, right? The first rule is that00:48:29
we have fundamental principle00:48:31
number 21. I don't know if you are already00:48:35
familiar with the code of medical ethics,00:48:37
but it opens the code to the00:48:38
principles that govern the practice of00:48:41
Medicine and fundamental principle00:48:43
number 21 says There, in the process of making00:48:45
professional decisions in accordance with00:48:47
the dictates of conscience and00:48:49
legal provisions, the doctor will accept the00:48:52
choices of his patients regarding the00:48:54
diagnostic and00:48:56
therapeutic procedures expressed by them as long00:48:59
as they are appropriate to the case and scientifically00:49:03
recognized, very important huh, very00:49:05
important this comma there because the00:49:07
patient may not want to force the I don't00:49:09
know if you remember that case of the00:49:11
patient from Santos who came to the doctor00:49:13
and said I want to take chloroquine I00:49:16
want to take the president's kit, do you00:49:18
remember this during the pandemic and the doctor00:49:21
demanded the patient won exactly00:49:25
on this basis Look, there is no00:49:27
scientific proof of this, I am not00:49:29
obliged to carry out this treatment because00:49:31
the patient left angry,00:49:34
insulted, slandered, defamed the doctor and was00:49:38
duly and00:49:41
quickly sanctioned by the São00:49:43
Paulo Judiciary correctly Article 13 failing00:49:47
to clarify the patient is It is forbidden for the00:49:49
doctor to fail to inform the patient00:49:51
about the social, environmental00:49:54
or professional determinants of his illness.00:50:06
of00:50:08
death article 24 fails to guarantee the00:50:11
patient the exercise of the right to00:50:13
decide freely about his person00:50:15
and his well-being as well as exercising00:50:18
his authority to00:50:20
limit it is also true to fail to00:50:22
respect the will of any person00:50:24
considered physical and mentally00:50:27
on a hunger strike or compulsorily feeding her,00:50:29
you should be aware of the00:50:32
likely complications of00:50:34
prolonged fasting and in the event of an00:50:37
imminent risk of death, treat her. I don't know if00:50:39
you've ever seen a documentary00:50:43
called Anonymous Solitary, look for it00:50:46
on YouTube, take note, watch it Anonymous loner00:50:49
I don't, I know it's00:50:52
written by a bioethicist I don't00:50:53
remember her name but I'll remember it00:50:56
on Netflix, no00:50:57
Netflix, but it's on YouTube I don't00:50:59
think it's on Netflix, but it's00:51:01
open on YouTube, Anonymous loner, which00:51:05
is o Exactly this is the case of a00:51:07
patient who decided not to live anymore00:51:11
he didn't have the courage to kill himself he00:51:14
decided to stop eating and he enters the00:51:17
hospital with this condition and the00:51:20
whole time he says I don't want to be00:51:22
treated I just came to stop here because I00:51:25
fainted in the street because I don't00:51:28
want to eat I want to die and the00:51:31
ambulance brought me here but I did00:51:32
n't authorize anyone to bring me here00:51:35
I don't want to and the medical team, in a00:51:39
nursing way,00:51:41
treats him in a very paternalistic way he compulsorily00:51:44
passes the feeding tube and00:51:47
all the time he says I don't want to00:51:50
be treated I don't want to be treated it's00:51:52
very interesting the documentary is00:51:54
short 20 minutes it's just for you to see00:51:57
the clash between autonomy, respect for00:51:59
patient autonomy and00:52:01
medical beneficence and a clear case of non-respect for the00:52:05
patient's autonomy, which applies well00:52:07
to Article 26 of the Code of00:52:09
Medical Ethics, Article 31 of the Code of00:52:11
Medical Ethics states that it is true to disrespect00:52:13
the right of the patient or their00:52:14
legal representative to decide00:52:16
freely about the execution of00:52:19
diagnostic or therapeutic practices, here is the00:52:21
article that subsumes that hypothesis of00:52:24
orchiectomy of the minor patient,00:52:27
the child's testicle was removed without00:52:29
telling those legally responsible, except00:52:33
in cases of imminent risk of death, it00:52:35
was not the patient's case that the testicle was removed.00:52:38
testicle was not fundamental to the00:52:40
preservation of the child's life article 3400:52:43
it is true to fail to inform the patient about00:52:46
the diagnosis, prognosis and risks00:52:49
the objectives of the treatment except when00:52:52
direct communication could cause00:52:53
harm, in which case his00:52:57
legal representative should do so. that example00:52:58
I gave of the patient who, for a given00:53:01
moment during the medical evaluation, cannot00:53:03
receive information about his diagnosis,00:53:05
but this diagnosis must be00:53:07
immediately offered to his00:53:09
legal representative and the Federal Council00:53:12
of Medicine must have the00:53:14
informed consent manual, which is the00:53:15
recommendation number 1 of00:53:18
2016 anyone who wants to write an00:53:21
informed consent form must read this00:53:22
document because it is this document that00:53:25
provides the00:53:26
margins on how the00:53:30
informed consent form should be written, in addition to it00:53:33
for those looking for a00:53:36
doctrinal source, the best book I have00:53:38
I know about formed consent It's the00:53:40
doctoral thesis by professor André00:53:42
André Gonçalo Dias Pereira Portuguese it's00:53:45
a thesis from 2004 it's 20 years old but it's very00:53:48
current it's a very complete and very00:53:51
good book we can't find it00:53:53
easily here in Brazil but00:53:55
nowadays with international purchases, but00:53:56
as long as the government doesn't start00:53:58
taxing us, we can buy because00:53:59
soon we won't be able to buy00:54:01
anything else without being taxed abroad,00:54:04
eh, it's already taxing, it's already taxing, right00:54:09
This thesis from 2015, 2012, pardon00:54:13
Bergstein, Very interesting USP, it00:54:16
brings Exactly This perspective of Look,00:54:20
the duty of information is an00:54:23
autonomous duty already in the Brazilian legal system00:54:25
in the Brazilian juris ence00:54:27
So if the doctor, even though he has00:54:29
preserved the duty of care, which is the00:54:32
classic duty of Medicine, the duty of00:54:35
Hippocrates, right, my patient's health00:54:37
will be my first concern This is00:54:40
the duty of care but the duty of00:54:42
information, respect for the00:54:43
patient's autonomy must also be respected and a00:54:46
more recent book that I haven't read all of00:54:49
but I did find it very interesting that It00:54:51
has a preface by André00:54:53
Gonçalo Dias Pereira, this book by00:54:56
Lopes Júnior about the consent00:54:58
formed in the doctor-patient relationship,00:55:00
I'm not receiving any00:55:02
merchandising for this promotion, but00:55:04
I believe they are good works for the00:55:07
library of00:55:10
medical law and health professionals. and talking about the term00:55:13
because I already have 50 minutes 44 talking00:55:16
here is the example I will send it to00:55:18
you this is of course just a00:55:21
small example of the consent form the00:55:23
term has to be suitable for each type00:55:25
of procedure Proc me right now00:55:27
I was writing a term for some00:55:30
clients in our office about a00:55:32
TMJ orthognathic surgery, I don't00:55:35
know if you are familiar with00:55:36
orthognathic surgery, which is the one that places the00:55:38
chin further back or00:55:40
forward, the guy's chin is too far00:55:41
forward, Cácio, the goalkeeper of the00:55:44
Corinthians has that forward chin,00:55:45
so you know, he's a candidate for00:55:48
orthognathic surgery to place his00:55:49
chin further back because00:55:51
he certainly doesn't have a lip seal there,00:55:54
probably and there are a series of00:55:56
consequences due to the poor00:56:00
anatomy of his masticatory system. it's00:56:03
functional but it's also aesthetic,00:56:05
surgery a lot of people do it and it leaves00:56:08
someone else, I know people who really have00:56:10
completely changed their appearance00:56:13
and this term, for example, is a term that00:56:15
the term has to be as succinct as00:56:18
possible and it's a big challenge to be00:56:20
complete and succinct at the same time, so00:56:22
the one I'm doing already has four00:56:25
pages front and back, right, two pages00:56:27
Four pages but and and and it's one and it's00:56:32
a document that you create00:56:34
together with the professional, your client He's the one00:56:37
Doctor will tell you about this00:56:39
procedure here doctor What are the00:56:41
consequences of it, okay, this surgery00:56:44
is different TMJ surgery, what00:56:46
are these, this dental implant, what00:56:49
are the risks and benefits, what00:56:51
happens, of course there is a part of the00:56:54
term that it can be used for everyone00:56:56
but the specific thing about00:57:01
the procedure to be carried out00:57:04
is something that has to be customized00:57:09
And then how do I make the term one of the00:57:12
things I try to do in the term is00:57:14
that I put the00:57:17
paragraphs and I give space so that the00:57:21
patient Reads the important paragraph and00:57:23
agrees or not with the paragraph and00:57:24
what is written because this way I00:57:27
remove the characteristic of the00:57:29
adhesion contract which is that contract that the00:57:31
patient only signs at the end as if he00:57:33
had agreed to all the clauses00:57:36
he may say that he does not agree with one00:57:38
of the clauses or one of the things that00:57:40
are noted there, so I put it here00:57:44
where my little mark is, there is the00:57:47
mark of the clinic or the doctor's00:57:51
o o o the title of the document which is the00:57:55
term of the document clarified book and the00:57:57
type of term is a term that00:57:59
refers to a hormonal implant that00:58:02
is performed on an outpatient basis in00:58:05
gynecology clinics, Obstetrics, eh,00:58:09
and00:58:11
endocrinologist, who even There are many00:58:13
people who do it for aesthetic purposes and00:58:14
for aesthetic purposes, it is prohibited by the The00:58:18
Federal Council of Medicine00:58:20
recently banned the use of00:58:23
anabolic steroids and hormones for00:58:25
purely aesthetic purposes. Yes, but it has00:58:29
therapeutic purposes, for example,00:58:30
endometriosis and it is a disease that,00:58:34
depending on the condition, if you undergo00:58:37
hormonal therapy. And then I go back to00:58:40
studies by D cotinho with a good memory00:58:43
Noble doctor from Bahia who didn't win the00:58:47
Nobel Prize in medicine only because he was00:58:48
Brazilian and because he was from Bahia to00:58:50
make matters worse, but if he hadn't been he would00:58:53
certainly have won, he was the guy who00:58:56
invented contraception, right, imagine the00:58:59
impact of this invention on world was supposed to00:59:02
have won the Nobel Prize for Medicine, right00:59:04
? Or at least for pharmacy, he was a00:59:06
pharmacist too, but the pharmacist The00:59:09
doctor cannot practice Pharmacy and00:59:10
Medicine at the same time, he abandoned his00:59:12
training, it was his first training and00:59:14
he went on to medicine afterwards a guy00:59:17
is extraordinary and I had the00:59:20
pleasure of spending some time with him. I00:59:23
participated in some events with him, but here00:59:24
we go, here it is, I'll start.00:59:32
all00:59:34
legal purposes I was duly informed in a00:59:36
free manner clarified by Dr Alessandre00:59:39
Timbó, right there is my CRM here in Bahia00:59:42
complying with these commands determined00:59:44
by the medical deontology code and see I00:59:47
put it here in a footnote let me00:59:49
pass here the articles that I I just00:59:52
mentioned it to you because I want00:59:55
the patient to have access, I'm not going to00:59:58
describe it in the term but I put the01:00:00
reference so that he can look at what01:00:02
his rights are in the code of01:00:04
medical ethics because in the event of a lawsuit in01:00:07
court I will argue this, Your Excellency01:00:10
it's all there, all the medical deontology that01:00:14
allows this Noble accused here01:00:18
is in the dock at this moment for01:00:20
breach of the duty to provide information,01:00:23
the patient was given the possibility of01:00:24
choosing he he understood what01:00:27
could happen01:00:29
and so that the exercise is guaranteed01:00:32
of my free right to decide freely01:00:34
about my person, my biopsychosocial well-being,01:00:35
which is health, right,01:00:38
health is biopsychosocial well-being,01:00:41
according to the World01:00:42
Health Organization, as well as articles 15 of the01:00:44
Civil Code that I just mentioned and the 42201:00:47
which brings good faith about the risks and01:00:51
benefits in bold involving the01:00:53
hormonal implant procedure must01:00:56
be highlighted and about the procedure01:00:58
to be performed as well as about the01:01:00
possible risks and benefits of these and01:01:02
other alternative therapies for my01:01:04
specific case,01:01:06
I declare that I received from Dr01:01:10
Alessandro Timbot all the01:01:11
most important and common information that01:01:13
includes the chosen therapy and01:01:15
that during the placement of my01:01:17
hormonal implant, there is space because the01:01:19
hormonal implant can be01:01:20
testosterone, gestrinone, estradiol,01:01:24
depending on the substance that is placed01:01:26
it will be carried out with local sedation and01:01:28
the following symptoms may occur edema01:01:30
swelling local redness hematoma etc01:01:34
etc etc this may grow depending01:01:37
on what is done depending on the size01:01:40
of the implant site that's it he she or01:01:43
he ticks do you understand that01:01:45
yes or no yes, because then I confirm that01:01:48
he read it all so he doesn't turn around and then01:01:50
say, oh, I didn't read the01:01:52
consent form, no, I didn't read that part, I read it,01:01:54
it's written there, I also declare that01:01:57
I understood all the physiological effects01:01:58
of the treatment of the substance and the hormone01:02:01
can give possible oily skin01:02:03
acne hair loss01:02:06
irregular bleeding among others and then I'm01:02:08
talking specifically01:02:10
about a female implant, right01:02:13
because if there is irregular bleeding then01:02:15
I'm talking about the menstrual cycle,01:02:18
understand that this can happen, yes,01:02:20
no, I'll follow it, leave it I come here to01:02:24
lower the bar because your bar01:02:26
is in front of the01:02:28
authorizes the doctor as well as his01:02:30
assistants and other professionals01:02:32
selected by him to intervene in the01:02:34
procedure contained in this term,01:02:36
understanding that If there is a need01:02:37
for other interventions arising from01:02:39
unforeseen situations that may occur01:02:42
and require01:02:44
different care initially proposed an01:02:46
additional authorization must be obtained from01:02:49
me or my legal representative yes or01:02:51
no finally I confirm that I received01:02:54
explanations of the procedure I understand this01:02:56
is very important to have in the01:02:58
consent form there is no guarantee of01:03:00
results No it is an obligation to result01:03:03
medicine it is an obligation to means because if01:03:07
in the process there is a reversal, the owners of the01:03:09
evidence, as always happens, right, consumer court,01:03:11
if it is in the Civil Court, in the01:03:13
public treasury, also if it is a01:03:15
public hospital, they reverse the evidence.01:03:18
Then you look, there is the term and the patient01:03:20
knew that the result of the procedure01:03:22
was not guaranteed. I declare that I read this01:03:26
term completely and understand,01:03:28
agreeing with everything that was stated.01:03:40
the declaration that remains in one copy with the01:03:43
doctor in the patient's medical record and one01:03:46
copy given to the patient, Dr aland01:03:49
timb declare that I explained the01:03:50
procedure and signed it in my CRM and01:03:53
the footnotes are there at the bottom.01:03:56
I even put a footnote in01:03:59
in relation to copyright, you know, the term,01:04:01
which is one to avoid possible01:04:05
copying, and on the back I put a message01:04:10
to the patient, which are actually the01:04:12
main points of that01:04:15
number one recommendation from 2016 that I said, which is the01:04:18
consent form manual, right? what01:04:21
is there saying like this, look what01:04:23
informed consent is, sometimes the01:04:24
patient doesn't even know what01:04:25
formed consent is and I'll explain it, look at01:04:27
the formed conscious, formed consent, an01:04:29
informed book is the act of01:04:32
decision, agreement and approval of the01:04:34
patient or your representative after the01:04:36
necessary explanation about the01:04:38
responsibility of the attending physician regarding01:04:41
therapeutic or diagnostic conduct and procedures that are01:04:44
specifically indicated to you, the information01:04:47
and clarifications given by me must01:04:49
be substantially adequate, i.e.01:04:52
in sufficient quantity and quality01:04:54
for you to see that what I don't do in the01:04:56
language for the patient because the01:04:58
common terms are for I put it in the01:05:00
language for you who are reading this01:05:02
term the protagonist of your treatment01:05:05
who can make your decision aware of01:05:07
what happens and the consequences You can01:05:10
take it for yourself this is important too It is not necessary for the01:05:13
patient to know that he can withdraw01:05:14
consent at any time without01:05:17
resulting in any disadvantage or01:05:19
harm, except if withdrawing01:05:22
consent when the01:05:24
medical procedure has already begun implies the01:05:26
possibility of harm to the01:05:28
patient, in which case if he is unable to01:05:31
return ago, due to a technical issue,01:05:33
there is no way to go back. Of course, in the case of the01:05:37
patient who is conscious, right,01:05:41
because the patient who is under01:05:43
general anesthesia, he will not change, but let's go, let's go, in01:05:45
an anesthesia, which is01:05:48
a cesarean section, for example, right? The mother She's there01:05:51
conscious, she's understanding everything, the01:05:54
obstetrician opened it, I'm going to have the cesarean section, don't01:05:56
wait, I don't want the cesarean anymore, don't wait,01:05:57
ma'am, I've already opened it, no,01:05:59
there's no way, now the wall of the uterus is already cut,01:06:00
I'm not, I'm at a point where I01:06:02
have no way of doing this, it will cause01:06:04
additional damage to you if I go and01:06:06
to the baby if I stop for suturing01:06:08
and then try to induce meso01:06:11
because it won't even help, I'm going to give01:06:12
medication now and the wall of your uterus01:06:14
is cut It's going to bleed, so it's going to have to be01:06:15
accessed. So in this01:06:19
hypothetical case, I've never seen this before, but01:06:21
hypothetically speaking,01:06:23
it would be contraindicated, right, on01:06:27
medical advice. So, always count on me,01:06:29
Dr. FL, so, of course, I put01:06:31
my name there, but I don't practice01:06:32
medicine anymore. right, I replace it01:06:35
with the name of the clients, right, and, and,01:06:38
and, of course, depending on01:06:42
the client or patient, I can make01:06:45
some changes to this document that I01:06:48
will send to you. Including01:06:50
everything that is here, the decisions and the01:06:52
document for College students01:06:54
obviously don't know, whoever is01:06:56
watching on YouTube has access to the01:06:58
content but doesn't have access to the01:07:01
specific documentation,01:07:05
depending on the procedure and I want01:07:07
this to be very clear in01:07:08
your heads, class. This is a good time to If01:07:13
I provide the service to a health professional,01:07:14
I have clients for whom I01:07:18
set terms, then I charge for each01:07:21
term, let's go, two, three salaries,01:07:23
depending on what it is, make a package, right, and01:07:26
that's one, and depending on the01:07:29
professional's, you can make an agreement01:07:31
with him so that you make all the01:07:34
terms that, depending on all the terms01:07:37
of each surgery, because depending on the01:07:39
patient, it is interesting to have this01:07:41
customization of the term, as we saw01:07:44
there, the obese patient, right, in that case, it is the01:07:47
patient, so Depending on the level and01:07:50
complexity of the surgery, it is01:07:53
interesting that you also provide this service01:07:55
to your client, right,01:07:57
medical client, Doctor. Don't worry, this01:08:00
surgery has a period of time for the01:08:03
health plan to authorize.01:08:08
Sir, you're going to pay a01:08:10
monthly end, I don't know, let's go, two three01:08:12
salaries, we're going to make all the01:08:13
terms of your surgery01:08:15
legally adequate. Don't worry01:08:17
about this, of course, he's the one who's going to01:08:19
offer the term to the patient, but01:08:21
you provide information in Regarding the01:08:26
specific terms of each procedure,01:08:29
class, that was it for an hour or 5901:08:33
minutes, I'm going to end my01:08:35
presentation here, where do I01:08:36
end this, interrupt01:08:39
sharing, I promised myself I01:08:41
wouldn't speak for an hour, but unfortunately01:08:44
I can't control this logor.01:08:47
rage that I have, right? This need01:08:50
to talk a lot I wanted to thank01:08:52
Janaína here, oh Janaa, you're there with01:08:56
our esteemed general coordinator of the01:09:00
college SS top class Thank you C01:09:03
Thank you Cosmo Ferreira good evening let01:09:05
me talk to the YouTube guys here01:09:07
Marcelo Moreira Moa Cátia, I'm a01:09:11
public defender working in the public treasury and I01:09:13
just became aware of a ruling01:09:15
that condemned the municipality to pay 100,00001:09:17
to a widow for neglecting her01:09:19
husband's care. It's interesting and01:09:22
that's what most of all let me see.01:09:27
I'll see if there are any questions in the chat here01:09:29
Janaína also posted here01:09:31
excellent class, kindness of you, Jana,01:09:34
any01:09:37
questions, no, not while, no, teacher01:09:43
didactic, it was very didactic, sir, it's01:09:46
excellent, oh, cool people, Professor, it was01:09:50
a class for me, for me, I would give all01:09:54
the classes, but I can't, it was a01:09:57
pleasant class, Professor, you're kind, I01:10:01
really appreciate it, but you01:10:04
allow me a question, of course, at 8 pm01:10:07
on the eve of a holiday, no, but01:10:10
the class, I didn't pay attention to that, today it's01:10:14
almost a basket, right? The class01:10:19
was brilliant, Professor, I'm grateful01:10:21
for the01:10:22
teachings, but if you allow me,01:10:25
I would like to, of course, address the following01:10:28
situation,01:10:31
medical expertise, we know01:10:34
that there is an esprit de corps among01:10:38
medical professionals, how01:10:41
have you seen the performance of the01:10:45
medical expert, okay?01:10:48
eh In this context, esprit de corps01:10:52
has prevailed or professionals01:10:55
are moving away from that a little01:11:00
Look at my opinion,01:11:03
Antônio, I think that in the01:11:07
administrative sphere, in regional councils,01:11:09
esprit de corps is practically01:11:13
mitigated, so the01:11:16
technical opinion that the counselors issue is01:11:19
technique and if there was a technical error they01:11:21
tend to condemn it is a mistake to think01:11:24
that in the administrative sphere there is01:11:28
this leniency or there is this favoritism01:11:32
because it may be a colleague01:11:36
and even because the favoritism, as a01:11:40
general rule, can exist before01:11:42
becoming a PEP while it is in the01:11:44
inquiry phase and people file it after it01:11:46
has become a PEP there is no way it will01:11:47
have to be judged and the Spirit of01:11:49
Body will not prevail because there are 1101:11:52
counselors there judging, right and not the01:11:55
Federal Council of Medicine itself At the01:11:56
appellate level, I have observed that the01:11:59
cfm has placed01:12:02
experts in the trial session01:12:04
to be the rapporteur of the case, for example, it is01:12:07
a case that deals with sickle cell disease and a01:12:10
hematological disease, it is a hematologist01:12:13
who will do the report and01:12:16
ends up being eh um um a01:12:20
very fair trial from a technical point of view01:12:22
now in common justice in the courts01:12:25
This depends a lot on what the court has01:12:27
to offer because the court does not always01:12:30
have that specialist from that01:12:32
profession, not to carry out that01:12:34
expertise specifically or sometimes they have01:12:37
the expert but not has that01:12:39
commitment So what is my01:12:42
advice assistant to the prosecution01:12:45
assistant to the prosecution so I know that01:12:47
when the patient is going to propose an action01:12:49
he is disadvantaged because we who01:12:52
provide medical defense already have the doctor He01:12:55
is being accused as a01:12:57
technical defense assistant but if the patient01:13:00
can get a doctor to carry out this01:13:02
assessment, it is unlikely that he will sign it, it will01:13:05
be difficult for him to produce a report01:13:08
proving guilt or not, but01:13:12
he can point out Where is the error, point01:13:16
out Where is the causal link01:13:18
point out Where is the professional's culpable conduct?01:13:21
This is an01:13:23
alternative to now and what I01:13:26
also see in many cases Antônio is that01:13:29
the absence of the technical error is confused01:13:32
with the Spirit of Body, it appears01:13:34
that he didn't alleviate it because he is a doctor,01:13:36
he also didn't alleviate it Because in fact01:13:38
medicine is this I'm going, I'm going to give01:13:41
a kick here, see, it's a kick, it's just my01:13:43
guess, my understanding is that more01:13:46
or less 80% of the causes that involve a01:13:48
medical error, there was no01:13:51
medical error, there was an error in the healthcare system,01:13:54
there was an error There was an error01:13:56
in the process of changing the port, there was01:13:59
a hospital infection There was01:14:02
something that the patient had, or nothing,01:14:05
it was a consequence of the disease itself01:14:07
but there was no information, many actions01:14:10
happen because there is no dialogue01:14:11
patient doctor doctor patient no01:14:13
This duty of information is well fulfilled01:14:15
in the United States, there is a study that says01:14:17
this, the highest rate the greatest doctors01:14:20
who are sued in court are not01:14:22
those less qualified who have just01:14:24
left college but are those who01:14:26
spend less time with the patient and it is a01:14:30
problem with these quick appointments, you know, these01:14:33
quick procedures, several01:14:35
procedures in the same, in the same01:14:38
shift on the same day, so I01:14:41
believe that although we01:14:45
always have to be aware of the possible presence01:14:48
of esprit de corps, but I think it01:14:51
is a smaller ghost than it appears to be01:14:55
because doctors judge and at least01:14:58
my experience is that they judge in a01:15:00
way. Of course, there are some pieces of advice that are01:15:02
harsher than others and this also changes01:15:04
according to the management of the Council, right,01:15:07
sometimes the management changes of the Council he becomes01:15:09
more punitive than E guarantor01:15:12
so Eh it's a I think it's much more of01:15:16
an impression than a01:15:21
specific observation Thank you Antônio for the01:15:23
question thank you Luciane good absence01:15:26
I wanted to wish you all a great01:15:29
night a good holiday and you know that if If01:15:31
you want to find me on Instagram or01:15:34
if you made a print and put it01:15:36
there, tag me01:15:37
@alessandro timbol, an excellent course,01:15:40
class, and if everything goes well, we'll01:15:41
still be in a class. From now on, at the01:15:43
end of the perfect teaching course, I already01:15:46
want more live classes. So, because01:15:48
this topic is very interesting, very01:15:51
interesting and your teaching01:15:54
is very good, I want to thank you,01:15:57
it's exciting, I want to thank01:15:59
you for being here, see, because01:16:01
lately the Qurum is good here, but I've01:16:04
already done a live class for postgraduate studies.01:16:06
having few people because the students, the01:16:08
class will be recorded, it will be on the01:16:10
student's tab so I watch it later but it's01:16:12
not the dynamics of the live class, right the01:16:14
live class demands that having faces01:16:17
have participation have exchanges clearing01:16:19
doubts that which is interesting but I01:16:21
'm very flattered by01:16:24
your presence here and by your participation,01:16:27
okay, big hug to the whole group who's01:16:30
watching us on YouTube A01:16:32
big hug too, if you're not doing it01:16:34
yet, come and do our01:16:36
post- degree in Medical and Health Law01:16:37
here at our college S01:16:42
support class here thank you all very much, see01:16:44
everyone who helped me with the broadcast,01:16:46
thank you Janaína Thank you everyone01:16:51
bye bye01:16:58
[Music]01:17:23
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