Optimising Maltese Obstetric Medico-Legal Dynamics, Vol. 1, 2
by George Gregory Buttigieg, Lambert Academic Publishers,
Mauritius, 2020
George Gregory Buttigieg’s Optimising Obstetric Medico-Legal Dynamics in the Maltese Islands is uniquely the first major Maltese medico-legal monograph that fills a massive void in this specialised field of human knowledge.
The author is, undoubtedly, a leading connoisseur of the field, enjoying abundant experience as a seasoned practitioner, a well-versed court expert and a prominent obstetrician in his own right.
Apart from its immense academic merit, this work advocates a well-conceived proposal for the enactment of a Lex Medica as well as the establishment of a Maltese Institute of Medico-Legal Studies that are amply lacking in Malta and are vociferously crying out for immediate adoption.
This publication is of particular interest both to lawyers and medical practitioners not only in relation to obstetrics but to the practice of medicine in general. For medical negligence is not a subject reserved only to the practice of obstetrics but to all the branches of medicine.
This work delves into the challenges encountered on a daily basis by the obstetric court expert, the perils that such an expert has to traverse and master in the proper execution of his arduous duties, more so that in Malta there is not much guidance to go by in relation to matters such as criteria and qualifications for appointment of obstetric experts.
It also delves into court evidence, immunity, liability and case evaluation; lack of a codification of medico-legal guidance in relation to a plurality of subject-matters encountered by the obstetrician in the exercise of his/her profession, ranging from establishing standards of obstetric care, disclosure, informed consent, privacy and confidentiality, documentation, and female genital mutilation, just to mention a few of the topics covered in this two-volume work.
The publication makes two very well beefed proposals
Apart from the medical aspect, there is also the controversial legal aspect related to medical negligence, that is, under which branch of the law should it be classified: torts, quasi-torts or contracts? Indeed, the courts have fluctuated in their interpretation: for centuries they classified medical negligence under torts and quasi-torts and, as of very recent vintage, they categorise it under contract law.
It appears that here the Maltese courts were following the footsteps of Italian case law that had moved on to reflect changes in Italian statutory law that considers medical negligence within the realm of contract law.
Yet in Malta, the judiciary have embraced the changes in Italian medical negligence law and subsequent case law implementing such statutory changes in Italy when Maltese law has not been changed to reflect the changes brought about in Italian law.
Hence, one cannot but not query how centuries-old Maltese case law basing medical negligence actions within the realm of tort and quasi-tort is written off by the Maltese courts without them even providing a cogent explanation supporting this change of interpretation. Is it here a case of the judiciary usurping the power of the legislature at making law? After having identified the various lacunae that exist in the realm of obstetric care from a medico-legal perspective, this oeuvre proposes how all the several medico-legal difficulties identified in this publication can be successfully addressed.
The last part of the study is therefore of great relevance to the policy maker. Found here are two very well beefed proposals: the establishment of a Maltese Institute of Medico-Legal Studies, and the formulation of a Lex Medica.
Both proposals go hand in hand, and the latter cannot materialise without the former. Detailed terms of reference for the suggested institute are elaborated, and the body of medical law is set out under 16 diverse articles.
There is also an accompanying second volume, consisting of three appendices and pertinent primary and secondary references, and lists of laws and judgments, both Maltese and foreign, cited in the first volume.
One augurs that this scholarly work that has also policy implications serves not only as a reference book but, more importantly, that its recommendations are taken on board by the government with a view to implementation.
In this way, the oeuvre would have served both an academic and practical purpose, and good use is made of the author’s labour and birth-pangs of successfully delivering a new institute and medical law into this world.