Fitness to practise legislation in the medical and dental profession : a comparative study

Abstract

In this dissertation a comparative study of fitness to practise legislation in the medical and dental professions is examined. The study is limited to fitness to practise issues originating from health impairments. Under Maltese Law the operative law is Section 38 of the Health Care Professions Act, Chapter 464 of the Laws of Malta, which is the legal provision which regulates unfitness to practise procedures due ‘physical’ and ‘mental’ infirmity. An overview of the present procedures of the Malta Medical Council, the regulatory authority charged with examining fitness to practise issues for the medical and dental professions is presented. In this study the application of the law is compared to the application of similar law in other jurisdictions with particular focus on the definition of fitness to practise and the evolution of the concept in the United Kingdom. Reference is made to local and foreign legislation, local and foreign case-law, guidelines and scholarly articles. Specific health impairments are identified and analysed in the context of fitness to practise issues. The health impairments studied are infectious diseases limitedly to blood-borne diseases with particular reference to Acquired Immune Deficiency Syndrome (AIDS) and HIV-Infection, physical disability, substance abuse, mental health impairments and ageing practitioners. An analysis of whether practitioners who are afflicted by any of these conditions are safe to practise their profession is made. Reference is also made to guidelines and standard procedures applied in other jurisdiction. Recommendations for the introduction of standardised procedures in Malta are presented. This study proposes recommendations and proposals for legislative reform both on the substantive aspect of the law and the procedural aspect of the law. An argument for the introduction of specific health procedures in the Health Care Professions Act and proposals of how it can be effected with a minimum disturbance to the existing procedures under Maltese Law is made. Finally, this dissertation also advocates for the introduction of the interim orders in fitness to practise proceedings under the Health Care Professions Act, Chapter 464 of the Laws of Malta where there are issues that may affect patient safety.