Situation Analysis of Medico-Legal Issues in Asmara, Eritrea, in 2008

Background: The Transitional Civil Code of Eritrea (TCCE) enshrines general principles of professional ethics and responsibilities and general principles of ethics have been rendered by training institutions to medical personnel. However, there is serious gap of principles of ethical rules and legislations that serves as binding source governing medico-legal issues in the context of Eritrea. Objective: The general objective of the Study is to examine the situation of medico-legal issues in Eritrea and to have baseline data about the knowledge, attitude and awareness of the society, health professionals and legal practitioners on medico-legal issues. Methods: The Study adheres to a structured questionnaire and personal interview with semi-structured checklists developed and administered to respondents to address the socio-demographic data, awareness, attitude, knowledge and practices among randomly selected representatives of health workers, clients and legal practitioners. The Study was done in 3 National Referral Hospitals in Asmara namely, Orotta National Referral Medical Surgical Hospital, Orotta National Referral Maternity Hospital, Berhan Aini Referral Hospital and the High Court and Attorney General’s Office. Results: : A total of 144 respondents were interviewed; 75 clients, 54 health workers and 15 legal practitioners. The most common medico-legal issues identified in the Study are road traffic accidents, rape, homicidal injury and suicide, question of paternity, age determination, abortion, medical record asked by court, insurance, work accident and unknown cause of homicide. The identified medico-legal issues are consistent with the reports from the health personnel and legal practitioners. The health workers know well about their duties and the rights of their patients in rendering medical care. However, they lack the knowledge on the legal basis of their relationship with their clients. Nevertheless, the three hospitals use informed consent in the form of both written and oral forms; 94.1% in the form of written document and the remaining 5.9% orally. So far, there are no comprehensively legislated laws or approved detailed rules that govern the relationship of health personnel and the public. Consequently, there have been few medico-legal cases adjudicated before the courts. The few adjudicated cases were raised by the clients against certain members of health personnel. Conclusion and recommendations: The Study concludes that the knowledge and awareness of the health workers, the public and legal practitioners on medico-legal issues have been gradually increasing. The Study has identified inadequate medical expertise, such as pathologists (post-mortem expertise), psychiatrists and Geneticians (DNA analysis). Furthermore, the Study discovered lack of medical instruments and technical know how to address medicolegal issues, such as paternity and unknown cause of death of human being. The Study, therefore, recommends legislation of public health law that specifically deals with ethical principles, medical professional rights, duties and powers and training of medical expertise specifically on pathology, DNA analysis and psychiatry. Furthermore, the Study recommends inclusion of comprehensive medico-legal curricula in training medical personnel