The Contractual relationship between the doctor/hospital-patient relationship

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THE CONCEPT EXCLUSIONARY CLAUSE OR WAIVER IN THE LAW OF CONTRACT

The concept « exclusionary clauses » has over time been referred to in many ways. In this regard, reference has been made to « exemption clauses »; « indemnity clauses »; « exculpatory clauses » and « waivers ». It is not a modern day concept but has its roots firmly embedded in the Roman law period. Exclusionary clauses during this period took the form of informal pacta. The purpose these types of clauses seem to serve included, they served as a bar to litigation and provided a defence to a debtor if sued by a creditor. In all, exclusionary clauses limited or excluded certain rights and duties of contractants during this period. 25 Exclusionary clauses in contract found their way into Roman Dutch law; 26 thereafter into Europe as early as the fifteenth century and eventually into England in the seventeenth century. 27 The rationale for the recognition of exclusionary clauses is founded in the principle of freedom of contract which in turn, is based on social, economical and political philosophies in respect of which Grotius remarked « man’s right to contract ». 28 With the advent of standard form contracts, exclusionary clauses found their way into these types of contracts so much so that in modern days these types of clauses are still firmly embedded in standard form contracts. 29 It was especially, during the nineteenth century and influenced by the so-called philosophy of laissez-faire, that mass produced standardized contracts with mass produced exclusionary clauses incorporated therein, spread to all forms of business enterprises,including, transport, insurance and banking as well as trade. This remains very much the position today. 30 Their usage also subsequently extended to medical agreements, especially, hospitals. 31 The effect of exclusionary clauses on the law of contract when interpreted by the courts was that judges were very reluctant during the nineteenth and early part of the twentieth century to interfere with contractual arrangements and to limit the contractual powers of the contracting parties. 32 The judges at the time were very much influenced by the philosophy of laissez-faire, which meant, that the law should interfere with people as little as possible and not play such a paternalistic role. 33 The position was at the time summed up by Sir George Jessel, an eminent English judge at the time in the case of Printing and Numerical Registering Co v Sampson: « If there is one thing which more than another public policy requires it is that men of full age and competent understanding shall have the utmost liberty of contracting, and that their contracts when entered into freely and voluntarily shall be held sacred and shall be enforced by courts of justice. » 34 In time, although the initial introduction of standardized contracts, may have been done with a noble intent, fierce competition amongst businessmen led to some businesses using exclusionary clauses in business contracts as a means of exploiting their economic power. 35 Although these type of contracts found universal favour including the jurisdictions of South Africa, the United Kingdom and the United States of America, it was the rising of consumer organizations, who countered the exploitation of especially, the weaker contracting parties, through the usage of exclusionary clauses. 36 One of the many objections to the utilization of standardized contracts was the fact that the legal transaction entered into between the contracting parties when entering into the contract, was that the transaction was concluded without a give-and-take of bargaining between the parties, but, the weaker party often just had to adhere to the terms prescribed by the business enterprises. For that reason standardized contracts have also come to be known as « contracts of adhesion ». A significant feature of these types of contracts was, and continues to be the position today, that the customer has no bargaining power, alternatively, unequal bargaining power. 37 The era of consumerism brought about new thinking and legal jurisprudence. The legal jurisprudence was founded on morality in that man must respect man and not take advantage of his weakness. For that reason the ethos that contracts were there to honour and enforce was being challenged by the moral principle that one should not take advantage of an unfair contract. 38 Another troublesome feature of exemption clauses in standardized contracts is the fact that business enterprises use the clause to exonerate themselves from liability in virtually « any circumstances whatsoever ». Strong resistance to such attempts also followed as consumer organisations pushed for these types of clauses to be regulated. 39

CONTENTS :

• Abstract
• Preface
• Acknowledgements
• Chapter 1 Introduction
  • 1.1 General Introduction
  • 1.2 The concept of exclusionary clauses in contract
  • 1.3 Explanatory note on the title of this thesis
  • 1.4 Constitutional « underpinning » of the text
  • 1.4.1 Synthesis: Some legal questions
  • 1.4.2 Synthesis: Some practical questions
  • 1.5 Approach and methodology
    • 1.5.1 Division of research material
    • 1.5.2 Explanatory note on source referencing and bibliography
    • 1.5.3 Acknowledgement of the contribution of past and present South African writers on the title Exclusionary clauses in medical contract
  • 1.6 Concluding remarks
• Chapter 2 Historical overview and development of the doctor-patient relationship
  • 2.1 Introduction
  • 2.2 Historical Overview
    • 2.2.1 General
    • 2.2.2 The Ancient Period
    • 2.2.3 The Roman Era
    • 2.2.3.1 The Roman System of Legal Medicine
    • 2.2.3.2 The Duties of the Doctor
    • 2.2.3.2.1 The Standard of Care
    • 2.2.3.2.2 Legal Remedies
    • 2.2.3.2.3 Breach of Contract
    • 2.2.3.2.4 Malpractice
    • 2.2.3.2.5.1 Remedy for Wilful Malpractice
    • 2.2.3.2.5.2 Lex Cornelia de Sicariis et venefici
    • 2.2.3.2.5.2 Lex Pompeia de parricidiis
    • 2.2.3.2.5.3 Other Regulations
    • 2.2.3.2.6 Lex Aquilian Action
    • 2.2.3.2.7 Institutiones of Iustinianus
    • 2.2.4 The Post Roman Era
    • 2.2.4.1 The Medieval Era and the Middle Ages
    • 2.2.4.1.1 Legal Remedies
    • 2.2.4.1.1.1 Leges Barbarorum
    • 2.2.4.1.1.2 Lex Visi-Gothorum
    • 2.2.5 The Renaissance Period
    • 2.2.6 The Post Renaissance Period
    • 2.2.7 The Roman Dutch Era
    • 2.2.8 The Pre-Modern and Modern Era
    • 2.2.9 The Doctor-Patient relationship in the sociological construction in a Contemporary South Africa
    • 2.2.10 Legal Opinion
  • 2.3 Summary and Conclusions
• Chapter 3 The Contractual relationship between the doctor/hospital-patient relationships
  • 3.1 Introduction
  • 3.2 The Contractual Relationship between doctor and patient
  • 3.2.1 Commencement of the Relationship
    • 3.2.1.1 South Africa
    • 3.2.1.1.1 Legal Writings
    • 3.2.1.1.2 Case Law
    • 3.2.1.1.3 Legal Opinion
    • 3.2.1.2 England
    • 3.2.1.2.1 Legal Writings
    • 3.2.1.2.2 Case Law
    • 3.2.1.2.3 Legal Opinion
    • 3.2.1.3 United States of America
    • 3.2.1.3.1 Legal Writings
    • 3.2.1.3.2 Case Law
    • 3.2.1.3.3 Legal Opinion
    • 3.2.2 Nature of the contract between the doctor/hospital/other healthcare Providers and the patient
    • 3.2.2.1 South Africa
    • 3.2.2.1.1 Legal Writings
    • 3.2.2.1.2 Case Law
    • 3.2.2.1.3 Legal Opinion
    • 3.2.2.2 England
    • 3.2.2.2.1 Legal Writings
    • 3.2.2.2.2 Case Law
    • 3.2.2.2.3 Legal Opinion
    • 3.2.2.3 United States of America
    • 3.2.2.3.1 Legal Writings
    • 3.2.2.3.2 Case Law
  • 2.2.3.2.5.2 Lex Cornelia de Sicariis et venefici
  • 2.2.3.2.5.2 Lex Pompeia de parricidiis
  • 2.2.3.2.5.3 Other Regulations
  • 2.2.3.2.6 Lex Aquilian Action
  • 2.2.3.2.7 Institutiones of Iustinianus
  • 2.2.4 The Post Roman Era
  • 2.2.4.1 The Medieval Era and the Middle Ages
  • 2.2.4.1.1 Legal Remedies
  • 2.2.4.1.1.1 Leges Barbarorum
  • 2.2.4.1.1.2 Lex Visi-Gothorum
  • 2.2.5 The Renaissance Period
  • 2.2.6 The Post Renaissance Period
  • 2.2.7 The Roman Dutch Era
  • 2.2.8 The Pre-Modern and Modern Era
  • 2.2.9 The Doctor-Patient relationship in the sociological construction in a Contemporary South Africa
  • 2.2.10 Legal Opinion
  • 2.3 Summary and Conclusions
• Chapter 3 The Contractual relationship between the doctor/hospital-patient relationships
  • 3.1 Introduction
  • 3.2 The Contractual Relationship between doctor and patient
    • 3.2.1 Commencement of the Relationship
    • 3.2.1.1 South Africa
    • 3.2.1.1.1 Legal Writings
    • 3.2.1.1.2 Case Law
    • 3.2.1.1.3 Legal Opinion
    • 3.2.1.2 England
    • 3.2.1.2.1 Legal Writings
    • 3.2.1.2.2 Case Law
    • 3.2.1.2.3 Legal Opinion
    • 3.2.1.3 United States of America
    • 3.2.1.3.1 Legal Writings
    • 3.2.1.3.2 Case Law
    • 3.2.1.3.3 Legal Opinion
    • 3.2.2 Nature of the contract between the doctor/hospital/other healthcare Providers and the patient
    • 3.2.2.1 South Africa
  • 3.2.2.1.1 Legal Writings
  • 3.2.2.1.2 Case Law
  • 3.2.2.1.3 Legal Opinion
  • 3.2.2.2 England
  • 3.2.2.2.1 Legal Writings
  • 3.2.2.2.2 Case Law
  • 3.2.2.2.3 Legal Opinion
  • 3.2.2.3 United States of America
  • 3.2.2.3.1 Legal Writings
  • 3.2.2.3.2 Case Law
  • 5.2.3 The duty to obtain the patient’s consent
  • 5.2.4 The duty to inform the patient
  • 5.2.5 The duty to exercise due care and skill
  • 5.2.6 The duty to execute the patient’s instructions honestly, faithfully and with care
  • 5.2.7 The hospital’s general duty towards the patient
  • 5.3 The patient’s duty towards the doctor/hospital
  • 5.3.1 The patient’s general duty towards the doctor/hospital
  • 5.3.1.1 Legal writings
  • 5.3.1.2 Case Law
  • 5.4 The patient’s right to information
  • 5.5 The patient’s right to confidentiality
  • 5.5.1 Defences to the breach of confidentiality
  • 5.6 Summary and Conclusions
• Chapter 6 The Doctor/hospital’s general duty of care towards the patient
  • 6.1 Introduction
  • 6.2 The nature of the doctor’s duty of care
  • 6.2.1 South Africa
  • 6.2.1.1 Legal writings
    • 6.2.1.2 Case law
    • 6.2.1.3 Legal opinion
    • 6.2.2 England
    • 6.2.2.1 Introduction
    • 6.2.2.2 Legal writings
    • 6.2.2.3 Case law
    • 6.2.2.4 Legal opinion
    • 6.2.3 United States of America
    • 6.2.3.1 Introduction
    • 6.2.3.2 Legal writings
    • 6.2.3.3 Case law
    • 6.2.3.3 Legal opinion
  • 6.3 The doctor’s standard of care
  • 6.3.1 South Africa
    • 6.3.1.1 Legal writings
    • 6.3.1.2 Case law
    • 6.3.1.3 Legal opinion
    • 6.3.2 England
    • 6.3.2.1 Legal Writings
    • 6.3.2.2 Case Law
    • 6.3.2.3 Legal Opinion
    • 6.3.3 United States of America
    • 6.3.3.1 Legal Writings
    • 6.3.3.2 Case Law
    • 6.3.3.3 Legal opinion
  • 6.4 The elevated standard of care of the medical specialists
    • 6.4.1 South Africa
    • 6.4.1.1 Legal Writings
    • 6.4.1.2 Case Law
    • 6.4.1.3 Legal Opinion
    • 6.4.2 England
    • 6.4.2.1 Legal Writings
    • 6.4.2.2 Case Law
    • 6.4.2.3 Legal Opinion
    • 6.4.3 United States of America
    • 6.4.3.1 Legal Writings
    • 6.4.3.2 Case Law
    • 6.4.3.3 Legal Opinion
  • 6.5 Locality where treatment takes place
  • 6.5.1 South Africa
    • 6.5.1.1 Legal writings
    • 6.5.1.2 Case law
    • 6.5.1.3 Legal opinion
    • 6.5.2 England
    • 6.5.2.1 Legal Writings
    • 6.5.2.2 Case Law
    • 6.5.2.3 Legal Opinion
    • 6.5.3 United States of America
    • 6.5.3.1 Legal writings
    • 6.5.3.2 Case law
    • 6.5.3.3 Legal opinion
  • 6.6 Summary and Conclusions
• Chapter 7 Limiting or excluding the doctor/hospital’s general duty of care
  • 7.1 Introduction
  • 7.2 Limiting or Excluding Liability as a ground of justification in general
    • 7.2.1 The doctrine of volenti non fit iniuria in general context
    • 7.2.1.1 South Africa
    • 7.2.1.1.1 Legal Writings
    • 7.2.1.1.2 Case Law
    • 7.2.1.1.3 Legal Opinion
    • 7.2.1.2 England
    • 7.2.1.2.1 Legal Writings
    • 7.2.1.2.2 Case Law
    • 7.2.1.2.3 Legal Opinion
    • 7.2.1.3 United States of America
    • 7.2.1.3.1 Legal Writings
    • 7.2.1.3.2 Case Law
    • 7.2.1.3.3 Legal Opinion
    • 7.2.2 Assumption of Risk in general context
    • 7.2.2.1 South Africa
    • 7.2.2.1.1 Legal Writings
    • 7.2.2.1.2 Case Law
    • 7.2.2.1.3 Legal Opinion
    • 7.2.3.2 England
    • 7.2.3.2.1 Legal Writings
    • 7.2.3.2.2 Case Law
    • 7.2.3.2.3 Legal Opinion
    • 7.2.3.3 United States of America
    • 7.2.3.3.1 Legal Writings
    • 7.2.3.3.2 Case Law
    • 7.2.3.3.3 Legal Opinion
  • 7.3 Limiting or excluding liability in a medical context
    • 7.3.1 Volenti non fit iniuria/Assumption of risk in a medical context
    • 7.3.1.1 South Africa
    • 7.3.1.1.1 Legal Writings
    • 7.3.1.1.2 Case Law
    • 7.3.1.1.3 Legal Opinion
    • 7.3.2 England
    • 7.3.2.1 Legal Writings
    • 7.3.2.2 Case Law
    • 7.3.2.3 Legal Opinion
    • 7.3.3 United States of America
    • 7.3.3.1 Legal Writings
    • 7.3.3.2 Case Law
    • 7.3.3.3 Legal Opinion
  • 7.4 Summary and Conclusions
• Chapter 8 General Law of Contract: Selective Principles influencing the Law of Contract and impacting on Medical Contracts
  • 8.1 Introduction
  • 8.2 Freedom of Contract
    • 8.2.1 Historical Background
    • 8.2.2 The Influence of Freedom of Contract in South Africa
    • 8.2.2.1 Legal Writings
    • 8.2.2.2 Case Law
    • 8.2.2.3 Legal Opinion
    • 8.2.3 The Influence of Freedom of Contract in England
    • 8.2.3.1 Legal Writings
    • 8.2.3.2 Case Law
    • 8.2.3.3 Legal Opinion
    • 8.2.4 The Influence of Freedom of Contract in the United States of America
    • 8.2.4.1 Legal Writings
    • 8.2.4.2 Case Law
    • 8.2.4.3 Legal Opinion
    • 8.2.5 Summary and Conclusions
• Chapter 9 General Law of Contract: Selective principles influencing the law of contract and medical contracts. The influence of the caveat subscriptor rule
  • 9.1 Introduction
  • 9.2 The effect of the doctrine of freedom of contract with specific reference Inter alia to the caveat subscriptor rule and the general defences to the Caveat subscriptor rule
    • 9.2.1 South Africa
    • 9.2.1.1 Legal Writings
    • 9.2.1.2 Case Law
    • 9.2.1.3 Legal Opinion
    • 9.2.2 England
    • 9.2.2.1 Legal Writings
    • 9.2.2.2 Case Law
    • 9.2.2.3 Legal Opinion
    • 9.2.3 United States of America
    • 9.2.3.1 Legal Writings
    • 9.2.3.2 Case Law
    • 9.2.3.3 Legal Opinion
  • 9.3 Summary and conclusions
• Chapter 10 Factors influencing the Law of Contract in general and impacting on medical contracts
  • 10.1 Introduction
  • 10.2 Factors impacting on contractual freedom
    • 10.2.1 The Principle of Fairness
    • 10.2.1.1 South Africa
    • 10.2.1.1.1 Legal Writings
    • 10.2.1.1.2 Case Law
    • 10.2.1.1.3 Legal Opinion
    • 10.2.1.2 England
    • 10.2.1.2.1 Legal Writings
    • 10.2.1.2.2 Case Law
    • 10.2.1.2.3 Legal Opinion
    • 10.2.1.3 United States of America
    • 10.2.1.3.1 Legal Writings
    • 10.2.1.3.2 Case Law
    • 10.2.1.3.3 Legal Opinion
    • 10.2.2 The doctrine of unconscionability
    • 10.2.2.1 South Africa
    • 10.2.2.2.1 Legal Writings
    • 10.2.2.2.2 Case Law
    • 10.2.2.2.3 Legal Opinion
    • 10.2.2.2 England
    • 10.2.2.2.1 Legal Writings
    • 10.2.2.2.2 Case Law
    • 10.2.2.2.3 Legal Opinion
    • 10.2.2.3 United States of America
    • 10.2.2.3.1 Legal Writings
    • 10.2.2.3.2 Case Law
    • 10.2.2.3.3 Legal Opinion
    • 10.2.3 Agreements contrary to public policy
    • 10.2.3.1 South Africa
    • 10.2.3.1.1 Legal Writings
    • 10.2.3.1.2 Case Law
    • 10.2.3.1.3 Legal Opinion
    • 10.2.3.2 England
    • 10.2.3.2.1 Legal Writings
    • 10.2.3.2.2 Case Law
    • 10.2.3.2.3 Legal Opinion
    • 10.2.3.3 United States of America
    • 10.2.3.3.1 Legal Writings
    • 10.2.3.3.2 Case Law
    • 10.2.3.3.3 Legal Opinion
    • 10.2.4 Summary and Conclusions
• Chapter 11 The influence of exclusionary clauses on the Law of Contract in general
  • 11.1 Introduction
  • 11.2 Historical overview of the developments of exclusionary clauses
  • 11.3 Recognition of exclusionary clauses in different jurisdictions
    • 11.3.1 South Africa
    • 11.3.1.1 Legal Writings
    • 11.3.1.2 Case Law
    • 11.3.1.3 Legal Opinion
  • 11.3.2 England
  • 11.3.2.1 Legal Writings
  • 11.3.2.2 Case Law
  • 11.3.2.3 Legal Opinion
  • 11.3.3 United States of America
  • 11.3.3.1 Legal Writings
  • 11.3.3.2 Case Law
  • 11.3.3.3 Legal Opinion
  • 11.4 Summary and Conclusions
• Chapter 12 Law of Contract: Selective Principles influencing the Law of Contract and impacting on medical contracts
  • 12.1 Introduction
  • 12.2 Factors impacting on the validity of exclusionary clauses
    • 12.2.1 Exclusion of liability on the grounds of fraud or dolus
    • 12.2.1.1 South Africa
    • 10.2.2.2.3 Legal Opinion
    • 10.2.2.3 United States of America
    • 10.2.2.3.1 Legal Writings
    • 10.2.2.3.2 Case Law
    • 10.2.2.3.3 Legal Opinion
    • 10.2.3 Agreements contrary to public policy
    • 10.2.3.1 South Africa
    • 10.2.3.1.1 Legal Writings
    • 10.2.3.1.2 Case Law
    • 10.2.3.1.3 Legal Opinion
    • 10.2.3.2 England
    • 10.2.3.2.1 Legal Writings
    • 10.2.3.2.2 Case Law
    • 10.2.3.2.3 Legal Opinion
    • 10.2.3.3 United States of America
    • 10.2.3.3.1 Legal Writings
    • 10.2.3.3.2 Case Law
    • 10.2.3.3.3 Legal Opinion
    • 10.2.4 Summary and Conclusions
• Chapter 11 The influence of exclusionary clauses on the Law of Contract in general
  • 11.1 Introduction
  • 11.2 Historical overview of the developments of exclusionary clauses
  • 11.3 Recognition of exclusionary clauses in different jurisdictions
    • 11.3.1 South Africa
    • 11.3.1.1 Legal Writings
    • 11.3.1.2 Case Law
    • 11.3.1.3 Legal Opinion
    • 11.3.2 England
    • 11.3.2.1 Legal Writings
    • 11.3.2.2 Case Law
    • 11.3.2.3 Legal Opinion
    • 11.3.3 United States of America
    • 11.3.3.1 Legal Writings
    • 11.3.3.2 Case Law
    • 11.3.3.3 Legal Opinion
  • 11.4 Summary and Conclusions
• Chapter 12 Law of Contract: Selective Principles influencing the Law of Contract and impacting on medical contracts
  • 12.1 Introduction
  • 12.2 Factors impacting on the validity of exclusionary clauses
  • 12.2.1 Exclusion of liability on the grounds of fraud or dolus
  • 12.2.1.1 South Africa
  • 10.2.2.2.3 Legal Opinion
  • 10.2.2.3 United States of America
  • 10.2.2.3.1 Legal Writings
  • 10.2.2.3.2 Case Law
  • 10.2.2.3.3 Legal Opinion
  • 10.2.3 Agreements contrary to public policy
  • 10.2.3.1 South Africa
  • 10.2.3.1.1 Legal Writings
  • 10.2.3.1.2 Case Law
  • 10.2.3.1.3 Legal Opinion
  • 10.2.3.2 England
  • 10.2.3.2.1 Legal Writings
  • 10.2.3.2.2 Case Law
  • 10.2.3.2.3 Legal Opinion
  • 10.2.3.3 United States of America
  • 10.2.3.3.1 Legal Writings
  • 10.2.3.3.2 Case Law
    • 10.2.3.3.3 Legal Opinion
  • 10.2.4 Summary and Conclusions
• Chapter 13 The influence of exclusionary clauses on the Law of Contract in general
  • 11.1 Introduction
  • 11.2 Historical overview of the developments of exclusionary clauses
  • 11.3 Recognition of exclusionary clauses in different jurisdictions
  • 11.3.1 South Africa
  • 11.3.1.1 Legal Writings
  • 11.3.1.2 Case Law
  • 11.3.1.3 Legal Opinion
  • 11.3.2 England
  • 11.3.2.1 Legal Writings
  • 11.3.2.2 Case Law
  • 11.3.2.3 Legal Opinion
  • 11.3.3 United States of America
  • 11.3.3.1 Legal Writings
  • 11.3.3.2 Case Law
  • 11.3.3.3 Legal Opinion
  • 11.4 Summary and Conclusions
• Chapter 12 Law of Contract: Selective Principles influencing the Law of Contract and impacting on medical contracts
  • 12.1 Introduction
  • 12.2 Factors impacting on the validity of exclusionary clauses
  • 12.2.1 Exclusion of liability on the grounds of fraud or dolus
  • 12.2.1.1 South Africa
  • 14.3.1 ENGLAND
  • 14.3.1.1 Legal Writings
  • 14.3.1.2 Case Law
  • 14.3.1.3 Legal Opinion
  • 14.4.1 UNITED STATES OF AMERICA
  • 14.4.1.1 Legal Writings
  • 14.4.1.2 Case Law
  • 14.4.1.3 Legal Opinion
  • 14.5 Adjudication of exclusionary clauses in medical contractsin present context
  • 14.6 Proposed adjudication of exclusionary clauses in medical contracts
  • 14.7 Summary and Conclusions
  • 14.8 Conclusions and Recommendations concerning exclusionary clauses in medical contracts
  • 14.8.1 Recommendations to the key issues surrounding exclusionary clauses
  • in medical contracts
  • 14.9 In conclusion

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