ETHICAL ISSUES IN MEDICAL PRACTI
ISSUES IN MEDICAL PRACTICE
Advocate Allahabad High court
Medical practitioner are good citizens, possessed of special
training should disseminate advice on public health issues. They should play
their part in enforcing the laws of the community and in sustaining the
institutions that advance the interests of humanity. They should particularly
co-operate with the authorities in the administration of sanitary/public health
laws and regulations.
Medical ethics has developed into a well based discipline which
acts as a bridge between theoretical bioethics and bedside. The aim is “to
improve the quality of patient care by identifying, analyzing and attempting to
resolve the ethical problems that arise in practice”. Medical practitioners are
also bound by laws and official regulations. Violation of acts, rules or laws
may lead to criminal, civil liabilities and disciplinary actions.
Aim of the law and medical ethics are safeguarding
a good standard of medical practice within the community and ensure the health
and welfare of the general public. Medical practitioner may face civil or
criminal consequences due to breach of prescribed standards.
Legal work of medical council is regarding the
practice of medicine, violation of which may lead to criminal or civil
liabilities or disciplinary actions. Medical ethics is an applied which involves
examining specific controversial issues such as abortion, breach of
confidentiality, end-of-life care, rationing of scarce medical resources.
The fundamental principles that apply generally to
medicine or health care at large are
Respect of patient’s
The principle of non
maleficence or duty of avoids harm or injury to patients.
The principle of beneficence
or the duty of to do good to your patients, relieve their pain and suffering
and to save life if you can,
The principle of justice and
CODE OF MEDICAL ETHICS (Some important
(Published on 6, April, 2002 in Part III, Section 4
of the Gazette of India) (1)
the time of registration, each applicant shall be given a copy of the
following declaration by the Registrar concerned and the applicant
shall read and agree to abide
by the same:
I solemnly pledge myself
to consecrate my life to
service of humanity.
Even under threat, I
will not use my medical knowledge contrary to the laws of Humanity.
I will maintain
the utmost respect for human life from
the time of conception.
I will not permit
considerations of religion, nationality, race, party politics or social
standing to intervene between my duty and my patient.
I will practice my
profession with conscience and dignity.
of my patient will be my first consideration.
I will respect the
secrets which are confined in me.
I will give to my
teachers the respect and gratitude which is their due.
I will maintain by all
means in my power, the honour and noble traditions of medical
I will treat my
colleagues with all respect and dignity.
I shall abide by the
code of medical ethics as enunciated in the Indian Medical Council
(Professional Conduct, Etiquette and Ethics) Regulations 2001.(1)
I make these promises solemnly, freely and upon my
responsibilities of the Physician in general:
The prime object of the medical profession is to render service to
humanity; reward or financial gain is a subordinate consideration. Who-
so-ever chooses his profession, assumes the obligation to conduct
himself in accordance with its ideals. A physician should be an upright
man, instructed in the art of healings. He shall keep himself pure in
character and be diligent in caring for the sick; he should be modest,
sober, patient, prompt in discharging his duty without anxiety;
conducting himself with propriety in his profession and in all the
actions of his life.
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.
of medical records - Every
physician shall maintain the medical records pertaining to his / her
indoor patients for a period of 3 years from the date of commencement of
the treatment in a standard proforma. (by the Medical Council of India)
If any request is made
for medical records either by the patients / authorized attendant or
legal authorities involved, the same may be duly acknowledged and
documents shall be issued within the period of 72 hours.
A Registered medical
practitioner shall maintain a Register of Medical Certificates
giving full details of certificates issued. When issuing a medical
certificate he / she shall always enter the identification marks of
the patient and keep a copy of the certificate. He / She shall not
omit to record the signature and/or thumb mark, address and at least
one identification mark of the patient on the medical certificates
or report. The medical certificate shall be prepared as in Appendix
- 2 of Code of Medical Ethics.
Efforts shall be
made to computerize medical records for quick retrieval.
shall display the registration number accorded to him by the State
Medical Council / Medical Council of India in his clinic and in all
his prescriptions, certificates, money receipts given to his
Generic names of drugs -
Every physician should, as far as possible, prescribe drugs with generic
names and he / she shall ensure that there is a rational prescription
and use of drugs.
Professional Services: The
physician, engaged in the practice of medicine shall give priority to
the interests of patients. The personal financial interests of a
physician should not conflict with the medical interests of patients. A
physician should announce his fees before rendering service and not
after the operation or treatment is under way. Remuneration received for
such services should be in the form and amount specifically announced to
the patient at the time the service is rendered. It is unethical to
enter into a contract of "no cure no payment". Physician rendering
service on behalf of the state shall refrain from anticipating or
accepting any consideration.
PHYSICIANS TO THEIR PATIENTS
to the Sick - Though
a physician is not bound to treat each and every person asking his
services, he should not only be ever ready to respond to the calls of
the sick and the injured, but should be mindful of the high character of
his mission and the responsibility he discharges in the course of his
professional duties. A physician advising a patient to seek service of
another physician is acceptable; however, in case of emergency a
physician must treat the patient. No physician shall arbitrarily refuse
treatment to a patient.
Prognosis - The
physician should neither exaggerate nor minimize the gravity of a
patient's condition. He should ensure himself that the patient, his
relatives or his responsible friends have such knowledge of the
patient's condition as will serve the best interests of the patient and
must not be neglected: A
physician is free to choose whom he will serve. He should, however,
respond to any request for his assistance in an emergency. Once having
undertaken a case, the physician should not neglect the patient, nor
should he withdraw from the case without giving adequate notice to the
patient and his family.
PHYSICIAN IN CONSULTATION
consultations should be avoided - However
in case of serious illness and in doubtful or difficult conditions, the
physician should request consultation, but under any circumstances such
consultation should be justifiable and in the interest of the patient
only and not for any other consideration.
/radiologists or asking for any other diagnostic Lab investigation
should be done judiciously and not in a routine manner.
in Consultation: Utmost
punctuality should be observed by a physician in making themselves
available for consultations.
other charges - A
physician shall clearly display his fees and other charges on the board
of his chamber and/or the hospitals he is visiting.
shall write his name and designation in full along with registration
particulars in his prescription letter head.
Note: In Government
hospital where the patient-load is heavy, the name of the prescribing
doctor must be written below his/her signature.
UNETHICAL ACTS :
A physician shall not aid or abet or commit any of the following acts which
shall be construed as unethical –
Advertising - Soliciting
of patients directly or indirectly, by a physician, by a group of
physicians or by institutions or organizations is unethical. A physician
shall not make use of him / her (or his / her name) as subject of any
form or manner of advertising or publicity through any mode either alone
or in conjunction with others which is of such a character as to invite
attention to him or to his professional position, skill, qualification,
achievements, attainments, specialties, appointments, associations,
affiliations or honours and/or of such character as would ordinarily
result in his self aggrandisement. A medical practitioner is however
permitted to make a formal announcement in press regarding the
On change of
type of practice.
absence from duty.
On resumption of
On succeeding to
declaration of charges.
open shop (Dispensing of Drugs and Appliances by Physicians): - A
physician should not run
an open shop for sale of medicine for dispensing
prescriptions prescribed by doctors other than himself or for sale of
medical or surgical appliances. It is not unethical for a physician to
prescribe or supply drugs, remedies or appliances as long as there is no
exploitation of the patient. Drugs prescribed by a physician or brought
from the market for a patient should explicitly state the proprietary
formulae as well as generic name of the drug.
Commission - A
physician shall not give, solicit, or receive nor shall he offer to give
solicit or receive, any gift, gratuity, commission or bonus in
consideration of or return for the referring, recommending or procuring
of any patient for medical, surgical or other treatment. A physician
shall not directly or indirectly, participate in or be a party to act of
division, transference, assignment, subordination, rebating, splitting
or refunding of any fee for medical, surgical or other treatment.
prescribing or dispensing by a physician of secret remedial agents of
which he does not know the composition, or the manufacture or promotion
of their use is unethical and as such prohibited. All the drugs
prescribed by a physician should always carry a proprietary formula and
Human Rights: The
physician shall not aid or abet torture nor shall he be a party to
either infliction of mental or physical trauma or concealment of torture
inflicted by some other person or agency in clear violation of human
RED CROSS is
“Geneva Cross” - Every Medical Practitioners is not entitled to use Red
Cross. It is the right only the members of medical service of any army. The
Government of India had issued press notices in 1938 that such user was
illegal. Section 12 of Geneva Conventions Act, 1860 (as prevailing in India)
prohibits use of “Red Cross”.
7.Not for medico legal- This
line does not support and save any medical professional, you are save by your
act, rules, circulars and your honestly service only.
8. Medico Legal Case –
Doctors are looked upon by a common man as the only hope when a person is
hanging between life and death but they avoid their duty when they know that it
is medico legal case.
A medico-legal report prepared by a specialist has
a much stricter criteria for proof of identification of the subject examined
(one can use photographs, thumb impression, marks of identification etc) to
This does not mean that the doctor is not liable
for any medico-legal case arising from wrong report or diagnosis.
Render services to humanity with full respect for
the dignity of man. Dr. Lakshmanan Prakash Vs State 1999(4) Crimes 404(2)
Court of Law - Conviction
by a Court of Law for offences involving moral turpitude / Criminal acts
Determination Tests: On
no account sex determination test shall be undertaken with the intent to
terminate the life of a female foetus developing in her mother's womb,
unless there are other absolute indications for termination of pregnancy
as specified in the Medical Termination of Pregnancy Act, 1971. Any act
of termination of pregnancy of normal female foetus amounting to female
foeticide shall be regarded as professional misconduct on the part of
the physician leading to penal erasure besides rendering him liable to
criminal proceedings as per the provisions of this Act.
If you are running a
nursing home and if you employ assistants to help you, the ultimate
responsibility rests on you.
No physician shall use
touts or agents for procuring patients.
Medical Practitioner -
Witness of medical practitioner is an expert only; infact is really of
an advisory character and not as witness. Therefore, a doctor cannot
prove the occurrence. Rama Vs State, AIR
1969 Goa, 116(3)
Medical Report -
Medical Report can be used by doctor for refreshing his memory, it is
not a document. Suresh Kumar Vs State of U.P. 1992(2) Crimes 872 (All)(4)
medical advice -
If conflict between the medical evidence and eye-witness, it is well
settled that if the direct evidence is satisfactory and reliable, it
should not be over ridden by medical evidence. Punjab Singh Vs State of
Haryana, AIR 1984 SC 1233(5)
Positive evidence cannot
be over ridden by the medical evidence. – Piara Singh and others
Vs State of Punjab, AIR 1977 SC 2274(6)
Doctors - A person
who using such skills and knowledge, treats another person in emergency,
could not be convicted even though his diagnosis and treatment were
entirely incorrect and a mere mistake or error of judgment, will not be
Lexicon’ 14th Edition,
at page 685 says - In law
there are three degrees of negligence (1) Lata
culpa, Gross Neglect
connotes careless state of mind which may amount to recklessness or
indifference, (2) Leis
culpa, ordinary neglect
refers to a breach of a legal duty to take care, and (3) Levissima
culpa, slight neglect is
a careless conduct without reference to any duty to take care. (7)
It can be termed
“criminal” only when the medical person exhibits a gross lack of
competence or inaction and wanton indifference to his patient’s safety
and which is found to have arisen from gross ignorance or gross
Where operation of
cataract was performed by a qualified doctor in the recognized Indian
method of treatment with the consent of the patient who lost his
eye-sight after operation, held the doctor was not criminally liable.
R.P.Dhanda Vs Bhurela, 1987 MP LJ 27(8)
Failure of anesthetist
to check-up during pre-operative anesthesia as to whether the patient
would withstand 3 ml local anesthesia administered through spinal cord.
Held, it may amount to criminal negligence. Dr. Lakshmanan Prakash Vs
State, 1999(4) Crimes 404(9)
Thus a doctor cannot be
held criminally responsible for patient’s death unless his negligence or
incompetence showed such disregard for life and safety of his patient as
to amount to a crime against the state. R.V.Adomalo (Supra)
Doctor follows a
practice acceptable to the medical profession of that day, he cann’t be
held liable for negligence merely because a better alternative course or
method of treatment was also available. Medical professional cann’t also
be held liable simply because a more skilled doctor would not have
chosen to follow a resort to that practice or procedure which accused
followed. -Jacob Mathew Vs State of Punjab & Another,2005 (2) SCC 334(10)
Medical ethics are safeguarding a good standard of
medical practice within the community and ensure the health and welfare of the
Indian Medical Council (Professional conduct, Etiquette
and Ethics) Regulations, 2002.
Published on 6, pril,2002 in Part III, Section 4 of the Gazette of India
1999(4) Crimes 404
India Reporter 1969 Goa, 116
1992(2) Crimes 872 (All)
India Reporter 1984 Sc 1233
India Reporter 1977 Sc 2274
‘Wharton’s Law Lexicon’ 14th Edition
Mp LJ 27
1999(4) Crimes 404
(2) Supreme Court Cases 334