Medical ethics.
These are the rules that control the practice of medicine through
professional traditions. They are considered the minimum requirements
expected from any practitioner in his professional conduct.
No person is allowed to examine a patient, to perform an operation, to
attend delivery (except registered midwives), to prescribe a medicine or
treatment or to take a sample or specimen from the patient’s body for
diagnosis, unless his name is registered.
Registration is the inclusion of the practitioner’s name in both the
Medical Register of the Ministry of Public Health and the Syndicate of
Medical Practitioners.
Erasure of the name occurs in the following conditions:
I. Disgraceful indecent conduct.
2. Professional mal-practice.
3. Final conviction in a court of justice,
The rules include
1. Obligations towards the profession:
Every practitioner must show a reasonable degree of skill and avoid
any indecent conduct so:
1. He must not write false reports or certificates.
2. He must not adapt fraudulent methods in his practice.
3. He must not use agents to obtain patients.
4. He must not ask for commission in return for recommending certain
hospitals or pharmacies.
5. He must not use his name for commercial purposes.
6. He must not advertise any new method of treatment or pretending any
new scientific discovery.
7- He must not advertise himself or his profession in an indecent manner.
II. Obligations towards other practitioners:
1. He must not replace another colleague in the treatment of a patient or
in any job. .
2. He must not refuse to take over the place. of a colleague on his request
(for a short time).
3. He must not work in place of a suspended practitioner in his practice.
4. He must not attend a patient who is under the care of a fellow
practitioner.
5. In consultation, the practitioner must not share the fee with the
consultant. He can ask for a special fee for himself from the patients.
III. Obligations towards the patient:
1. A practitioner should do his best to treat patients without any respect to
his own personal feelings, or regard to the social, moral, or financial state
of the patient. .
2. He must not refuse to attend an emergency.
3. He should do his utmost to reach a correct diagnosis.. He should
consult other doctors and use scientific methods.
4. He must not discontinue his treatment if this causes any harm to the
patient.
5. He must not divulge his patient’s secrecy.
Professional secrecy
This obligation is a legal one. A medical practitioner who divulges any
such secrecy is held responsible and is liable to criminal conviction. The
secrecy includes diagnosis, causal factors and prognosis.
Disclosure of professional secrecy is permissible In the following
conditions:
1. On request of the patient himself.
2. For the benefit of the patient himself e.g. mental illness, in order
to receive a particular treatment.
3. For the benefit of the practitioner, when he is accused for
malpractice, lie must explain to the court only the amount of work he
has done.
4. Notification of infectious and transmissible diseases e.g.
Meningitis, Diphtheria.
5, Notification of births and deaths,
6. For notification of any case of death, where a crime or unnatural
cause is suspected.
7. Medical experts should divulge to the court, what they had learnt
about the medical condition of the patient.
8. When a practitioner is acting as expert for an insurance company,
if the person is one of his patients, he must refuse to examine him and
send him to another doctor.
9. A medical. practitioner is allowed to inform the legal authorities only
about an imminent crime to prevent it, but not about already committed
ones. The practitioner is a treating doctor and not a detective. .
If the patient has an illness which may endanger the community;
example: a bus driver suffering from serious visual trouble or
uncontrollable hypertension, the doctor must ask for change of his
patient’s job for safety without divulging his secrecy
Professional malpractice and, responsibility
Medical practitioners are considered responsible for any error whether it
is technical or non-technical, major or minor in the following conditions:
1. There was actual negligence or incompetence due to absence of a
reasonable degree of skill and attention of the doctor.
2. The patient actually suffered some form of danger or harm,
3. This damage to the patient was the result of .the negligence or
incompetence of the doctor.
The damage or harm may be produced by
1. Act of omission: i.e. failure of the practitioner to do what any ordinary
fellow would have done under the same circumstances or failure to
follow concrete (established) medical principles and scientific methods.
2. Act of commission: the damage done to the patient was the result of
the practitioner’s negligence or incompetence.
MEDICAL CERTIFICATES
Medical certificates should be true and correct. A certificate may be
issued to students, government, employees and others
Indications:
I. To prove sickness for sick leaves or excusing attendance in public
service or court of justice.
2. In vaccination against infectious diseases for example small pox,
diphtheria.
3. In the registration of births and deaths.
4. In the notification of infectious and transmissible diseases,
5. In lunacy and treatment of lunatics.
6. In social insurance.
7. As an evidence in front of courts for compensations after an assault or
injury.
Terms before issuing any medical report or certificate:
1. Medical certificate should only be given to the patient himself or to his
guardian.
2. It should include correct data. No exaggeration or omission of certain
facts,
3. Make sure of the personal identity of the patient before giving the
certificate. If this can not be proved, take the print of the left index finger
on the certificate.
CONSENT
Is the patient’s agreement to receive any type of medical care whether
diagnostic or therapeutic. This consent is obtained to protect the patient
from unauthorized procedures and also to protect the physician from
claims of malpractice.
Types of consent:
1. implied consent: is known by .the behavior of the patient for
usual, medical practice.
2. express consent: it may be oral or written
i. oral consent before any intimate examination (recta! or vaginal)
or sampling “
ii. written consent in major procedures e.g. anesthesia and operations .
3. Express consent may be preceded by full information about the
medical care i.e. informed consent it entails:
a. the nature of the patient’s condition! and the purpose of the medical
care ‘
b. ‘the risks consequences and the probability of success or failure
c. the alternatives
d. the prognosis if the procedure is not performed or .thc treatment is not
given
The consent must be:
1. Signed by the patient
2.. Witnessed by the responsible physician .
3. Placed in the medical record .
Conditions of valid consent:
. No force.
• No fear
• No fraud (preceded by full information)
• Not for illegal act as euthanasia
• The patient should be adult and sane
Circumstances in which a doctor may proceed to manage a patient
without his consent:
1. Insane person
2. If the patient is a minor
3. Patient in coma
4. In emergency: the doctor has to do the procedure that saves the
patient’s life only and not the definitive treatment
5. In certain occupations e.g. food dealers and pilots
6 Patients in prison
Consent in special cases:
— By husband and wife: in therapeutic abortion, sterilization or
hysterectomy. Consent is taken from the husband only if the wife is
unconscious.
— For minors or mentally iil patients: consent is taken from the parents
or guardians.
Refusal of consent:
If the patient did not give his consent, the doctor has to respect the
patient’s wish or desire with no obligations.