The
Nepal Medical Council has in accordance
with the Nepal Medical Council
Act 1964, passed a medical Code
of Ethics, which all doctors registered
under it, are to abide by. The
code is as follows:
1.
DECLARATION
The following
declaration should be read and
agreed upon by the applicant at
the time of registration:
Solemnly
pledge myself to dedicate my
life to the service of
humanity.
Even under
threat and duress I will not
use my knowledge
contrary to the norms of humanity.
I will
maintain the utmost respect
for human life right from the
time of conception as per the
laws of the land.
I will
not allow consideration of age,
sex, religion, nationality,
ethnicity, politics, or social
standing to intervene between
my
duty and my patient.
I will
carry out my professional duties
with conscience and
dignity.
The health
of my patient will be my first
consideration.
I will
respect the secrets of my patients
confided in me.
I will
give to my teachers the respect
and gratitude that is their
due.
I will
maintain, by all means in my
power, the honour and noble
traditions of the medical profession.
I will
maintain utmost rapport with
my professional colleagues.
I make these promises solemnly,
freely and upon my honour.
Reg.
No. if the witness is a registered
medical practitioner
Signature
:...........................................
2.
GENERAL PRINCIPLES OF MEDICAL
ETHICS
2.1 Character
of the Physician
A physician should be an upright
Person, instructed in the art
of healing. S/he should possess
good character and be diligent
in caring for the sick. S/he should
also be modest, sober, patient,
alert, and prompt in action.
2.2 Responsibility
of the Physician to Medical Profession
The main aim of the medical profession
is to render service to the cause
of humanity. S/he should work
with full devotion and should
always try to improve medical
knowledge and skill so that patients
and colleagues are maximally benefited.
The physician should practice
medicine on scientific basis and
should not be associated professionally
with anyone who violates this
principle.
2.3 Advertising
in Medical Practice
2.3.1
General Consideration
Nepal Medical Council (NMC) does
not wish to hinder the ethical
dissemination of relevant factual
information about the services
available at an institution or
being provided by a physician.
This can help the patient to make
informed choice seeking treatment
and assist physicians in advising
their patients on the choice of
specialist. The council recognizes
the duty the medical profession
has in disseminating information
about advances in medical science
and therapeutics, provided that
it is done in an ethical manner.
Solicitation of patients directly
or indirectly, by a physician,
by groups of physicians or by
institutions or organizations
is unethical. Self-advertisement
is not only incompatible with
the principles, which should govern
relationships between members
of a profession but could be a
source of danger to the public.
A physician successful at achieving
publicity may not be the most
appropriate physician for a patient
to consult and also may raise
illusionary hopes of cure in extreme
cases.
A physician is allowed to make
a formal announcement of the following
in the press related to medical
practice.
On
starting practice.
On
change of type of practice.
On
change of address.
On
temporary absence from duty.
On
resumption of another practice.
On
succeeding to another practice.
2.3.2
Privacy, Security and Confidentiality
of Information of the Patients
It is not a breach of confidentiality
to release or transfer confidential
health care information required
for the purpose of conducting
scientific research, management
audits, financial audits, programme
evaluations, or similar studies
provided the information released
dose not identify directly or
indirectly any individual patient
in any report of such research
audit or evaluation or otherwise
disclose patient's identity in
any manner.
2.4 Terms
of Payment of Professional Services
Fee for professional services
provided to the patient should
be clarified at the time of the
service given. It is unethical
to enter into a contract of 'no
cure no payment*.
2.5 Running
or Opening a Medical Shop
A physician should not run a shop
for dispensing prescriptions prescribed
by physician other than himself
or sale of the medical or surgical
appliances.
2.6 Secret
Remedies
It is unethical to prescribe drugs
or formulations about which the
physician has no knowledge about
its composition and pharmacoepial
action.
2.7 Commission
It is unethical to receive or
offer any gift, gratuity, commission,
or bonus in consideration of or
in return for referring, recommending,
or procuring of patient for prescribing
medical and surgical treatment,
investigation and consultation.
2.8 Legal
Restrictions
A physician should always follow
the Nepal Medical Council rules
and regulation, which regulate
the practice of medicine. S/he
should also abide by other laws
enforced in the country.
3.
DUTIES OF PHYSICIANS TO THEIR
PATIENTS
3.1 Obligation
to the Patient
A physician is not bound to treat
each and every patient asking
for his services except in emergencies,
but s/he should be ready to respond
to the calls of the sick and injured
in conformity with the high character
of medical profession.
3.2 Patient's
Secrecy
Patient's confidence concerning
individual or domestic life entrusted
by the patient to a physician
and observed during medical attendance
should never be divulged unless
the laws of the country require
its revelation. Even in such circumstances
it should only be made after formal
protest.
3.3 Prognosis
of the Disease
A physician should explain the
nature of the illness to the patient.
S/he should neither exaggerate
nor minimize the gravity of a
patient's condition but should
always be sympathetic to the patient
and his/her family.
3.4 Service
to the Patients
A physician is free to choose
whom to serve except in emergency
cases. But once s/he undertakes
a patient for treatment s/he should
not reject the patient without
giving reasonable time or information
in advance to the patient and
his/her relatives.
3.5 Consent
A physician must seek an informed
written consent prior to performing
a diagnostic or treatment procedure.
Consent should be taken from the
patient if s/he is above sixteen
years, but in the case of minors
or unconscious patients, consent
from guardian can be taken. If
there is an emergency and nobody
is available to sign consent on
behalf of patient, it is the responsibility
of the physician to start the
treatment. It is obligatory for
the physician to explain the nature
of the procedure and the expected
result.
3.6 Attendant
A physician should keep in all
instances an attendant before
examining a patient of the opposite
sex.
3.7 Continuity
of Treatment
A physician should not discontinue
the treatment except in the following
conditions:
Refusal to pay the fee for
service.
Non-compliance with the recommended
treatment.
Exerting undue pressure to
prescribe unnecessary drugs.
Forcing to do an immoral
act in his/her favour.
When physician himself is
unwell.
4.
DUTIES OF THE PHYSICIAN TO THE
MEDICAL PROFESSION
4.1 Honour
of the Profession
A physician should uphold the
dignity and honour of medical
profession to the highest standard.
4.2 Membership
in Medical
For the advancement of profession,
a physician is encouraged to affiliate
with medical societies and contribute
his time, energy and other means
so that these societies may represent
the ideals of the profession.
4.3 Safeguard
to the Profession
The physician should not employ,
in connection with his professional
practice, any physician who is
neither registered nor enlisted
under the Nepal Medical Council
Act in force, and should not permit
such persons to attend, treat
or perform operations upon patients
so as to endanger their life.
4.4 Exposure
of Unethical Conduct
It is the duty of the physician
to report to the NMC without fear
of any incompetent, corrupt, and
dishonest member or unethical
conduct on the part of members
of the profession.
5. DUTIES
OF PHYSICIANS TO THE FAMILY
MEMBERS OF THE PROFESSIONAL
COLLEAGUES
It is not mandatory that a physician
should not charge fee from another
physician or his/her immediate family
members for rendering professional
services. But the physician should
consider it a pleasure and privilege
to render such services to their
professional colleagues and their
immediate family members, free of
charge as far as possible.
6. DUTIES OF
PHYSICIAN IN CONSULTATION
In case of any doubt or difficulty,
a physician should request consultation
with other colleagues giving priority
to the patient's benefit. No insincerity,
rivalry, or envy should be indulged
in during consultation.
During the temporary absence
of one physician, if s/he requests
another physician to attend his/her
patients, it is a professional
courtesy to accept such a request.
Upon such temporary appointment,
the physician acting under such
privilege should give utmost consideration
to the interest and representation
of the absent physician.
A physician should not usually
take charge of or visit another
physician's patient in the same
illness except in emergency. If
s/he does so in emergency, then
it is his/her duty to explain
the reason of visit and treatment
given to the patient to his/her
colleague.
7. DISCIPLINARY
ACTIONS
There are certain kinds of professional
misconduct and criminal offences,
which lead to disciplinary proceedings
or which in the opinion of the Nepal
Medical Council (NMC), could give
rise to a charge of serious professional
misconduct. Any abuse of the professional
privileges accorded to him/her or
restriction of professional duty
or serious breach of medical ethics
may lead to charge of serious professional
misconduct. In accordance with the
Nepal Medical Council Act and Regulations,
NMC will form professional conduct
and health committee, which will
then recommend the gravity of conviction
to Nepal Medical Council.
8. PROFESSIONAL
CONDUCT AND PERSONAL BEHAVIOUR
OF THE PHYSICIAN
8.1.1
Neglect or Disregard by physician
of Their Professional Responsibilities
to patients for Their Care and
Treatment
a.
Neglect or Disregard on Medical
Care
The Nepal Medical Council may
institute disciplinary proceedings
when a physician seriously disregards
or neglects professional duties
to his/her patient.
b.
Improper Delegation of Medical
Duties
It is the responsibility of a
physician to delegate his/her
responsibility of management of
the patient to his/her subordinates
e.g., nurses, paramedical, medical
personnel etc. Therefore, she
should be fully satisfied that
the person to whom these duties
are delegated is competent enough
to carry these out.
8.1.2 Abuse
of Professional Privileges and
Skills
a. Prescribing
Narcotic Drugs to Addicts
All physicians must provide standard
medical care as allowed by available
resources. A physician should
not prescribe or supply controlled
drugs to addicted persons other
than in the course of bonafide
treatment.
b. Medical
Certificates
Physicians are expected to exercise
care in issuing medical certificates
or similar documents.
c.
Termination of pregnancy
The law of the country prohibits
the termination of pregnancy unless
medically indicated.
d. Sex
Determination
Divulging the gender of a foetus
should not be done in USG or other
investigation report as this may
lead to subsequent termination.
e. Professional
Confidence
A physician should not disclose
information, which he obtained
in confidence from or about a
patient except in conditions required
by law. The infirmity of the patient
and prognosis should not be told
to others not directly concerned.
f. Improper
Pressure
A physician should not exert improper
pressure upon a patient to lend
him money or to alter the patient's
will in his favour.
g. Emotional
or Sexual Relationship
A physician should not enter into
any emotional or sexual relationship
with patient or a member of patient's
family, which may disrupt the
patient's life, damage, or distress
the patient or his or her family.
8.2 Personal
Behaviour
To keep up the reputation of the
medical profession in the public,
a physician should maintain proper
standard of personal behaviour
not only in professional duties
but at other times as well. The
following are the three main areas
of personal behaviour, which may
lead to disciplinary proceedings: a. Abuse
of Alcohol and Drugs
Treating the patient under the
influence of alcohol or drugs
is liable to disciplinary proceedings.
b. Dishonesty
Criminal deception, forgery, fraud,
theft, and any other offences
involving morality and honesty
are liable to disciplinary action.
c. Indecency
and Violence
Indecent behaviour or violent
assault on a patient would be
regarded as a serious professional
misconduct.
9. UNPROFESSIONAL
ACTIONS AND MISCONDUCTS
9.1
A physician should use
an 18x14 inch size signboard and
write his name, NMC number, qualification,
titles, and name of his specialty.
The letters should be in blue
on a white background. S/he should
not use the International Red
Cross symbol to make known the
fact of being a physician. It
is improper to affix a signboard
on a chemist's shop.
9.2
A physician should not encourage
any direct or indirect advertisement
in the media, with or without
photograph, of a congratulatory
nature that is linked with professional
services being offered.
9.3
A physician should not use touts
or agents for procuring patients.
9.4 A
physician should not insult or
misbehave with fellow physicians
by words or
behaviour.
10. POWER OF
PROFESSIONAL CONDUCT AND HEALTH
COMMITTEE
The committee will initially enquire
all the complaints and issues
related to professional misconduct.
At the conclusion of any inquiry
regarding professional misconduct,
the committee will decide one
of the following alternatives,
according to the severity of misconduct:
10.1
Warn and conclude the case
In case the physician is found
innocent, the committee will admonish
and conclude the case.
10.2
Put on probation by postponing
judgement
The committee can recommend Nepal
Medical Council to put a physician
on probation for a specified period,
and in this period, professional
referees are appointed to look
after the conduct of the convicted
physician. If referees furnish
the satisfactory report of conduct
after a specified period, then
the case will be normally concluded.
10.3
Recommendation of name to be struck
off the register
In case of unsatisfactory report
of conduct from referees or if
there is a serious professional
misconduct or conviction by court
in criminal cases involving moral
or ethical issues, the committee
may recommend erasure of physician's
registration to the Nepal Medical
Council. If a physician's registration
is erased, s/he ceases to practice
as a registered physician; the
erasure of registration, in accordance
with the NMC Act, will be for
two years.
10.4
Application for restoration of
registration
Application for restoration of
registration can be made to the
Professional Conduct and Health
Committee at any time after 2
years from the date of erasure.
The Professional Conduct and Health
Committee determine every application
on its merits any may recommend
unconditional or conditional restoration
or registration or extend the
period or erasure for another
one year. In case of unsuccessful
application, a further period
of at least 12 months must elapse
before a further application can
be made.
11. ERASURE
OF NAME FROM MEDICAL REGISTER
The
NMC can order the erasure of name
of physician from the medical
register for two years on recommendation
of the Professional Conduct and
Health Committee. The erasure
remains effective unless the physician's
application is accepted for restoration
of name to the medical register.
12. APPEAL AGAINST
ERASURE IN COURT
If
a physician's registration is
erased from the medical register
for whatever reason, s/he has
got the right to appeal to the
court against it.
"A
person may be a poor writer, a
bad painter, or a bad actor but
a man cannot and must not be a
bad doctor."
Prof. M.P. Konchalovsky.
