Medical ethics.

Mutual trust and relationship between doctors and patients is an important factor of treatment plan. Changing trends in medical field does affect this relationship. This article reviews the basic code of conduct for every medical practitioner.

The issues in medical ethics often involve life and death. Serious health issues are raised over rights of patient, informed consent, confidentiality, competence, advance directives, negligence, and many others.

Ethics deals with the right choices of conduct considering all the circumstances. It deals with the distinction between what is considered right or wrong at a given time in a given culture. Medical ethics is concerned with the obligations of the doctors and the hospital to the patient along with other health professionals and society.

The health profession has a set of ethics, applicable to different groups of health professionals and health-care institutions. Ethics is not static, applicable for all times. What was considered good ethics a hundred years ago may not be considered so today. The hospital administrator has an obligation to have a clear understanding of its legal and ethical responsibilities.[1]

Law and Ethics

Law is an obligation on the part of society imposed by the competent authority, and noncompliance may lead to punishment in the form of monetary (fine) or imprisonment or both. There are two kinds of laws mainly, statutory law and judgment law.[2]

“Ethics” is concerned with studying and/or building up a coherent set of “rules” or principles by which people ought to live. It is the social value which binds the society by uniform opinion/consideration and enables the society to decide what is wrong and what is right. It is the science of morale concerning principle of human duty in the society.[3]

Duties and Responsibilities of the Physician

A physician shall uphold the dignity and honor of his/her profession.

The prime object of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. A physician should be instructed in the art of healing.

No person other than doctor having qualification recognized by the Medical Council of India/State Medical Council is allowed to practice modern system of medicine or surgery.[1]

Maintaining Good Medical Practice

The principal objective of the medical profession is to render service to humanity with full respect for the dignity of profession and man. Physicians should improve knowledge and skills and should make these available to patients and colleagues.

Membership in medical society – physician should affiliate with associations and societies and involve in the active functioning of these bodies.

A physician should participate in professional as part of continuing medical education programs for at least 30 h every 5 years organized by reputed professional academic bodies.[4]

Maintenance of Medical Records

Every physician should maintain medical records of his/her patients for 3 years from the date of commencement of the treatment in a standard pro forma.

If any request is made for medical records either by patients/authorized attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued within 72 h.

A registered medical practitioner shall maintain a register of medical certificates giving full details of certificates issued.

Efforts shall be made to computerize medical records for quick retrieval.[1]

Display of Registration Numbers

Every physician shall display the registration number accorded to him/her by the State Medical Council/Medical Council of India in his/her clinic and all his/her prescriptions, certificates, money receipts given to his/her patients.

Every physician should prescribe drugs with generic names and should ensure that there are rational prescription and use of drugs.[1]

Exposure of Unethical Conduct

A physician should expose without fear or favor, incompetent or corrupt, dishonest or unethical conduct on the part of members of the profession.[5]

Payment of Professional Services

The personal financial interests of a physician should not conflict with the medical interests of the patients. A physician should announce his/her fees before rendering his/her service and not after the treatment is underway.[6]

Evasion of Legal Restrictions

The physician shall observe the laws of the country in regulating the practice of medicine. He should cooperate with observance and enforcement of sanitary laws and regulations in the interest of public health.[1]

Medicolegal Cases

Attending doctor can decide further investigations required by the law enforcing agencies in accordance with the prevailing law of the land, but the treating doctor decides the admissibility of the case.[1]

Duties and Responsibilities of the Doctor

Compulsory duties

Notification of births and deaths

Notification of notifiable diseases to the appropriate authorities

Reporting of cases of poisoning

Reporting of suspected causes of death

Reporting of cases covered under the privileged communication

Responding to call for emergency, military services.

Voluntary duties

To treat and to continue to treat and maintain the professional secrets of the patients

To obtain consent of the patients for medical examination

To obtain informed consent before any procedure

To issue medical certificate, fitness certificate, death certificate, vaccination certificate, or certificate of disabilities

To conduct postmortem examination as per the requirement and request from appropriate authority

To inspect prisons

To attend cases of accidents and medical emergencies

To conduct medicolegal examinations.[1]

Consent

It is an act of voluntary agreement between two parties; in medical care, it is the patient and the doctor. The consent is of two types.

Implied consent

The consent is not written, when a patient submits to health care agencies for medical examination or treatment. Patient attending the OPD of the hospital for consultation and treatment does not require written consent unless some complicated procedures are performed.

Informed consent

It may be oral or written, mostly written for future references. Informed means that the patient or his/her attendant understands the mode of treatment or procedure, and only after understanding it fully, the patient or attendant has signed. The legal age for giving consent in India is 12 years. In sterilization, all consents should be taken from the partner also.

In simple terms, informed consent can be defined as an instrument of mutual communication between doctor and patient, with an expression of authorization/permission/choice by the latter for the doctor to act in a particular way.[6]

Consent not Required

When the patient is unconscious, no attendant is there to give consent and delay can be dangerous for the patient.

Medicolegal cases brought by police.[1]

Refusal of Treatment

Medical Council of India is of the opinion that there is no provision in the law which prevents the doctor attending to seriously injured and accidental cases before the arrival of the police or registering the case and completing other formalities.

There are legal frameworks for treating someone who refuses treatment: The common law and the statutory law. Common law is more informatively known as the “doctrine of necessity” and statutory law is based on acts of parliament.[7]

Law of Torts

The Law of Tort can be is derived from the word tortus and torts can be defined as any wrong doing to a person, for which a civil case can be lodged. It is generally injury to persons, usually arising out of an accident.

Performing an operation without medical indication, leaving a forceps or gauze inside the abdomen during surgery come under this.[8]

Unethical Acts

Advertising: A physician alone or in conjunction with others cannot make advertisements. A medical practitioner can make a formal announcement in press regarding starting of practice, change of type of practice, changing address, temporary absence from duties, and resumption of practice

Printing of self-photograph in letterhead or sign board

Running an open medical shop

Rebates and commission

Practice of euthanasia.[1]

Misconduct

The following acts of commission or omission on the part of a physician constitute professional misconduct rendering them liable for disciplinary action

Not maintaining medical records for 3 years

Not displaying registration number in clinic and prescriptions

Sex determination tests

Contravening drugs and cosmetics act

Contribute to lay press articles which advertise themselves

Using unusually large sign board

Disclosing secrets of patients learned by profession unless medically or legally needed

Publishing photographs or reports without permission

Claiming as a specialist when you do not have a special qualification

Violation of existing ICMR guidelines

In vitro fertilization without consent from female patient, spouse, and donor

Teaching faculty or physician posted in medical college found absent on more than two occasions during duty hours.[1]

Conclusion

The doctor–patient relationship is one based on mutual trust and respect between the two parties. However, the rapid changes in the medical field and the corporatization of health-care system have strained the age-old good relations between the patient and the treating physician/surgeon. The legal, ethical, and moral liabilities of the doctors are enshrined in the Hippocratic Oath that we take when being ordained into the medical fraternity and we should try to uphold them.[9]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.