A practical guide for physicians worldwide to develop the principles of ethics
The International Code of Medical Ethics was written with the aim to establish and equipped physician worldwide with principles of ethics. The Code classified the expected ethical principles into three main areas – Duties of Physicians in General, Duties of Physicians to the Sick and Duties of Physicians to Each Other.
Based on the Declaration of Geneva, the first draft was adopted by the 3rd General Assembly of the World Medical Association at London in 1949. Since then, further amendments were made in 1968, 1983 and 2006 respectively.
Below is a summary adapted from the World Medical Association.
Based on the Declaration of Geneva, the first draft was adopted by the 3rd General Assembly of the World Medical Association at London in 1949. Since then, further amendments were made in 1968, 1983 and 2006 respectively.
Below is a summary adapted from the World Medical Association.
1. Duties of Physicians in General
Highest standards of professional conduct
Highest level of medical practice
Fitness to practice
Integrity
- Maintain competence and moral independence
- Respect the local and national codes of ethics
- Best use health care resources to benefit patients and the community
Highest level of medical practice
- Uphold scientific standards, practice evidence-based medicine
- Lifelong professional development
- Promote research to create new knowledge
- Caution in divulging discoveries, new techniques or treatment through non-professional channels
- Certify after personal verified
- Do NOT practice beyond own capacity, refer to people with necessary ability
Fitness to practice
- Seek appropriate care if you suffer from mental or physical illness
Integrity
- Do not permit motives of profit to influence professional judgment
- Do not self advertise in general
2. Duties of Physicians to the Sick
Obligation
Good medical practice
Honesty
Confidentiality
Appropriate relations with patients
- Preserve human life
- Provide emergency care as a humanitarian duty
Good medical practice
- Autonomy – Respect the right of patients
- Beneficence – Act in patient’s interest when providing medical care
- Empower patient to participate in medical decisions
Honesty
- Disclose all conflict of interest and medical errors
Confidentiality
- Preserve absolute confidentiality even after the death of the patient
- Confining to necessary patient information when communicating with colleagues
- Breach of confidentially can be considered ethical if
- Under patient consent
- Real and imminent threat of harm to patient or others
- Public interest
Appropriate relations with patients
- Do not exploit patient for sexual advantages, personal gain or other private purposes
3. Duties of Physicians to Each Other
Attitude to criticism
Relations with colleagues
- Expose physicians deficient in competence
- Accept external scrutiny of professional performance
Relations with colleagues
- Behave towards others as you would have people behaved towards yourself
- Respect the right of colleagues and other health professionals
- Do not undermine doctor-patient relationship of colleagues
Questions example
1) A 14 years-old girl came in to see you. Before the start of the consultation, she asked you not to inform her parents about the following discussion. What is your approach?
Routine discussion with the child privately
2) A male with confirmed HIV infection came in to see you. During the consultation, he refused your recommendation of using condom for future sexual intercourse with his wife. What is your approach?
Routine discussion with the child privately
- Explain confidentiality is no absolute and exception are made in specific situations
- Do not promise more than what you can do
- Suspected child abuse
- Neglect to child protective services agencies
- Medically indicated absence from school
- Keeping confidentiality with the children encourages them to seek medical care
- Issues concerning pregnancy, birth and sexually transmitted disease should not be routinely reported to parents unless consented by the child
- Sexual abuse must be reported to parents unless the parents committed assault or rape
2) A male with confirmed HIV infection came in to see you. During the consultation, he refused your recommendation of using condom for future sexual intercourse with his wife. What is your approach?
- Enquire for the underlying reasons
- Discuss the situation fully and completely
- Endeavour to obtain patient permission for disclosure to the patient
- Respect patients decision in case of refusal
- Determine how to proceed depending on clinical judgment and urgency
- Consider a duty to inform the spouse and other partners in case of refusal to disclosure