MEDICAL ETHICS

By : Dr. Fekadu Y. Gelmo

MD/ALP Alumni/MPH Candidate/lecturer at
NEUROSURGERY Department.
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• ‘a medical student begins with the patient,
continues with the patient, and ends his
studies with the patient, using books and
lectures as tools...’
 Objectives
• Introduction to Ethics and Morality
• Ethical Theories
• Principles of Medical Ethics
• History of Medical Ethics world and
Ethiopia
• Code of Medical conduct in Ethiopia
• Criminal laws related to Medical practice
 Brain Storming
1) Should a parent have a right to refuse
immunizations for his or her child?
2) public safety or individual’s right?
3) Should children with serious birth defects
be kept alive? who can decide?
4) Should a woman be allowed an abortion
for any reason?
5. Is it ethical if a person is donating a
kidney trading for an I-phone?
6. Should we reveal HIV test result for a
partner?
7. Should we treat both parteners for STD at
the same time?
8. have you ever heard of euthanasia?
should it be allowed or not?
 what is Ethics

• Ethos (Greek) : customs, culture, or

generally constant mode of behavior.
• Systematic or scientific study of morality
 Comparing Law and Ethics
• Law and ethics, are different but
related concepts.
• Laws are mandatory to which all
citizens must adhere or risk civil or
criminal liability.
• Ethics relate to morals and help us
organize complex information and
competing values and interests to
formulate consistent and coherent
decisions.
 What is “Medical
Ethics”
• Evaluating the rightness and
wrongness of human actions in
medicine

• It focuses on the doctor-patient

relationship and takes account of the
ethical and legal issues that patients,
doctors, and hospitals must address
to reach good decisions for individual
 Medical ethics
• It is a form of applied ethics
concerned with the application of
general principles to the moral
problems of medical profession
• Study of moral values and judgments
applied to medical practice
 What is Biomedical Ethics?
• The study of ethical issues and decision-
making associated with the use of living
organisms
• Bioethics includes both medical ethics and
environmental ethics.
• Bioethics is learning how to balance
different benefits, risks and duties.
 Why study Ethics
• Health care decisions are based not only
on clinical and technical grounds, but also
on ethical grounds.
 Why study Ethics

Because Doctors are

powerful
We get to look at you naked
we get to touch private parts of patients
doctors do Per Vaginal Exa
We can cut you open
We can decide what is in your best
interests
We might tell you that you are going to
die
 Why study Ethics
Doctors are trusted
• Trust to tell the truth %
– Doctor 92
– Teacher 88
– Professor 80
– Judge 80

– Journalist 22
– Politician 13
MORI poll 2009
Importance of Ethical Issues (contd.)

-Increase in technology

-Better informed society

-Doctors in Management

-Public activists
 Why study Ethics

• The ethical dilemmas of high technology

medicine like brain death, organ
transplantation, and concerns about
quality of life-have become increasingly
prominent.
 Why study Ethics

• ‘...the student begins with the patient,

continues with the patient, and ends his
studies with the patient, using books and
lectures as tools...’

• Sir William Osler, Canadian Physician(1906)

• As quoted in Singer, P, Viens, AM, Cambridge Textbook of Bioethics (2008)

Med Yr 1
 Why study Ethics

a physician must recognize

responsibility to patients first and
foremost, as well as to society, to
other health professionals, and to
self. These are not laws, but
standards of conduct which define the
essentials of honorable behavior for
the physician
 History of Medical Ethics

reading duty...
History of Medical Ethics
• Hammurabi's code of law (1790 BC):
Hammurabi's was the ruler of Babylon in
his codes of law he regulated the fees of
physician, for successful treatment the
physician was paid in proportion to the
patient wealth, but if an operation was
fatal, the physician hands were cut off.
• Jewish medical ethics obligates clinicians
to provide treatment to heal and improve
the life of the patient. Patients are
obligated to seek beneficial treatment. In
Jewish teachings, patients are to consider
their life as being not theirs to give away,
and we are not the proprietor of all human
life.
• The first of these professional codes was
the Oath of Hippocrates 4th century, B.C
• Have been publicly and solemnly pledged
by physicians as they are admitted to the
medical profession.
 The School of Hippocrates
5th century BC
• Hippocrates – ‘The Father of Medicine’
• Medical School (Greek Island of Cos)

460 – 377 BC
 The Hippocratic Oath

c.1595

Med Yr 1
 Hippocratic Oath I
• I swear by Apollo, the healer, Asclepius,
Hygieia, and Panacea, and I take to witness all
the gods, all the goddesses, to keep according
to my ability and my judgment, the following
Oath and agreement:

• To consider dear to me, as my parents, him who

taught me this art; to live in common with him
and, if necessary, to share my goods with him;
• To look upon his children as my own brothers,
to teach them this art.
Med Yr 1
 Hippocratic Oath II
• I will prescribe regimens for the good of my patients
according to my ability and my judgment and never do harm
to anyone.

• I will not give a lethal drug to anyone if I am asked, nor will I

advise such a plan; and similarly I will not give a woman a
pessary to cause an abortion

• But I will preserve the purity of my life and my arts.

• Euthanasia is the practice of ending the life of a patient to limit the

patient's suffering. The patient in question would typically be
terminally ill or experiencing great pain and suffering.
Med Yr 1
 Hippocratic Oath III
• I will not cut for stone, even for patients in whom
the disease is manifest; I will leave this
operation to be performed by practitioners,
specialists in this art.

• In every house where I come I will enter only for

the good of my patients, keeping myself far from
all intentional ill-doing and all seduction and
especially from the pleasures of love with
women or with men, be they free or slaves.
 Hippocratic Oath IV
• All that may come to my knowledge in the
exercise of my profession or in daily commerce
with men, which ought not to be spread abroad, I
will keep secret and will never reveal.

• If I keep this oath faithfully, may I enjoy my life

and practice my art, respected by all men and in
all times; but if I swerve from it or violate it, may
the reverse be my lot.
 Hippocratic Oath:
1. Established the principles of Beneficence
and Non-maleficence
2. Prohibited poisons and potions for
abortion or euthanasia
3. Maintain confidentiality
4. Avoid exploitation
5. Pursue ‘best interests’ of patient
 The Hippocratic Oath
• However no acknowledgement of the
patient’s rights (e.g. truth telling or
consent)

• Does not deal with welfare of society or of

others
 Western medical ethics
• The most significant contribution was
made by Thomas Percival,
• English physician, philosopher, and writer.
• Close association with infirmary, hospitals
and charities
• He was able to draft Code of Medical
Ethics that bears his name in 1803
 Western medical ethics
• In 1847 the American Medical
Association’s first adopted Code of Ethics
was based on Percival’s code.
• Major revisions took place and since 1957
the format known as the AMA Principles of
Medical Ethics was accepted.
• Further revision was made based on
changing legal standards and societal
 Advances in Medical Ethics
• Ethics to emerge as an area of great
concern beginning the late 1960s and the
early 1970s until today
 Advances in Medical Ethics
• Explosion of new medical technologies
and procedures
• Growing social concern and human rights,
• Major interest on moral obligation of the
physician to the patient and to the society,
• Complex medical decisions
 Modern Version

• Written in 1964 by Louis Lasagna,

Academic Dean of the School of Medicine
at Tufts University,
• I swear to fulfill, to the best of my ability
and judgment, this covenant:
• I will respect the hard-won scientific gains
of those physicians in whose steps I walk,
and gladly share such knowledge as is
mine with those who are to follow.
• I will apply, for the benefit of the sick, all
measures [that] are required, avoiding
those twin traps of over treatment and
therapeutic nihilism.
• I will remember that there is art to
medicine as well as science, and that
warmth, sympathy, and understanding
may outweigh the surgeon's knife or the
chemist's drug.
• I will not be ashamed to say "I know not,"
nor will I fail to call in my colleagues when
the skills of another are needed for a
patient's recovery.
• I will respect the privacy of my patients, for
their problems are not disclosed to me that
the world may know. Most especially must
I tread with care in matters of life and
death
• If it is given me to save a life, all thanks. But
it may also be within my power to take a life;
this awesome responsibility must be faced
with great humbleness and awareness of my
own frailty. Above all, I must not play at God.
• I will remember that I do not treat a fever
chart, a cancerous growth, but a sick human
being, whose illness may affect the person's
family and economic stability.
• My responsibility includes these related
problems, if I am to care adequately for
the sick. I will prevent disease whenever I
can, for prevention is preferable to cure.
• I will remember that I remain a member of
society, with special obligations to all my
fellow human beings, those sounds of
mind and body as well as the infirm.
• If I do not violate this oath, may I enjoy life
and art, respected while I live and
remembered with affection thereafter. May
I always act so as to preserve the finest
traditions of my calling and may I long
experience the joy of healing those who
seek my help.
Ethical Theories
 Theories
The Goal of Ethical Theory
• We set aside the question: ‘uhhhh....how people
should behave in medical situations, according
to whom?’
• to provide a systematic answer to the
question of how we should behave
 Where does ethics come from?
• Philosophers have several answers to
this question:
– God and religion
– Human conscience and intuition
– A rational moral cost-benefit analysis of
actions and their effects
– The example of good human beings
– A desire for the best for people in each
unique situation
– Political power
 Where does ethics come from?
Theory
• God-based ethics - supernaturalism
– Supernaturalism makes ethics
inseparable from religion.
– It teaches that the only source of moral
rules is God
– So, something is good because God
says it is, and the way to lead a good life
is to do what God wants
 Where does ethics come from?
• Intuitionism
– Intuitionists think that good and bad are
real objective properties that can't be
broken down into component parts
– Something is good because it's good; its
goodness doesn't need justifying or proving
– They believe human beings have an
intuitive moral sense that enables them to
detect real moral truths
– So good things are the things that a
sensible person realises are good if they
spend some time pondering the subject
 Where does ethics come from?
• Consequentialism
– It bases morality on the consequences of
human actions and not on the actions
themselves
– Consequentialism teaches that people
should do whatever produces the
greatest amount of good consequences
– One famous way of putting this is 'the
greatest good for the greatest number
of people‘
– Consequentialist theories are sometimes
called teleological theories.(end)
 Subdivision
• Ethical egoism : the consequence of the
action is more favorable to the agent
performing the action
• Ethical altruism: the consequence more
favorable to every one except the agent
performing it.
• Utilitarianism : The consequence more
favourable to every one
 Consequentialism

– Two problems with consequentialism are:

• it can lead to the conclusion that some

quite dreadful acts are good

• predicting and evaluating the

consequences of actions is often very
difficult.... eg new vaccine
 Where does ethics come from?
• Deontological ethics
– Non-consequentialism is concerned with
the actions themselves and not with the
consequences. It's the theory that people
are using when they refer to "the
principle of the thing“
– It teaches that some acts are right or
wrong in themselves, whatever the
consequences, and people should act
accordingly
• 'Duty Based' Ethics
• Deontologists deny that what ultimately
matters is an action's consequences.
• They claim that what matters is the kind of
action it is. What matters is doing our duty.
• There are many kinds of deontological
theory
– e.g., The 'Golden Rule' - "Do unto others as
you'd have them do unto you."
• Immanuel Kant (1724-1804) is the most
influential deontologist.
• Rejecting Consequentialism: "A good
will is good not because of what it effects
or accomplishes." Even if by bad luck a
good person never accomplishes anything
much, the good will would "like a jewel,
still shine by its own light as something
which has its full value in itself."
 Problems
• Deontology: What if doing your duty has
repugnant consequences?
– Kant on telling lies
• Consequentialism: What if you have to
do something that seems wrong in order to
produce the best consequences?
– Convicting the innocent
 Where does ethics come from?
• Virtue ethics
– Virtue ethics looks at virtue or moral
character
– Virtue ethics is particularly concerned with
the way individuals live their lives, and less
concerned in assessing particular actions
– Developing good habits and character
(benevolence)
– Avoid developing bad character
– Emphasizes moral education
• Virtue ethics teaches that an action is right if and
only if it is an action that a virtuous person would
do in the same circumstances,
• Virtuous person is someone who has a
particularly good character
• Virtue falls at mean between more extreme
character traits
 Where does ethics come from?
• Situation ethics
– Situation ethics rejects prescriptive rules
and argues that individual ethical
decisions should be made according to
the unique situation
– Rather than following rules the decision
maker should follow a desire to seek the
best for the people involved
– There are no moral rules or rights - each
case is unique and deserves a unique
solution
 Where does ethics come from?
• Ethics and ideology
– Some philosophers teach that ethics is
the codification of political ideology, and
that the function of ethics is to state,
enforce and preserve particular political
beliefs
– They usually go on to say that ethics is
used by the dominant political elite as a
tool to control everyone else
 Are there universal moral rules?
• Moral Absolutism
– The belief that there are such universal
rules that apply to everyone
– There are some moral rules that are
always true, that these rules can be
discovered and that these rules apply to
everyone
– Immoral acts - acts that break these
moral rules - are wrong in themselves,
regardless of the circumstances or the
consequences of those acts
 Moral Absolutism

– Absolutism takes a universal view of humanity - there

is one set of rules for everyone - which enables the
drafting of universal rules - such as the Declaration of
Human Rights
– Religious views of ethics tend to be absolutist

– Why people disagree:

• Many of us feel that the consequences of an act or

the circumstances surrounding it are relevant to
whether that act is good or bad
• Absolutism doesn't fit with respect for diversity and
tradition of unique societies and countries, or
religions and ethnic groups
 Are there universal moral rules?
• Moral Relativism
– Moral relativists say that if you look at
different cultures or different periods in
history you'll find that they have different
moral rules
– Therefore it makes sense to say that "good"
refers to the things that a particular group of
people approve of
– They believe that relativism respects the
diversity of human societies and responds to
the different circumstances surrounding
human acts
 Are there universal moral rules?
• Moral Relativism
– Why people disagree:
• Many of us feel that moral rules have
more to them than the general
agreement of a group of people - that
morality is more than a super-charged
form of etiquette (E.g. the Universal
Declaration of Human Rights make
sense not just because many people
agree to it. It is an intrinsic respect for
the sanctity of life)
 Are there universal moral rules?
• Moral Somewhere-in-between-ism
– Most non-philosophers think that both of
the above theories have some good
points and think that
• there are a few absolute ethical rules
• but a lot of ethical rules depend on the
culture
 The Point
• We won’t try to settle the question of what
the best theory is
• Think of them as tools to draw upon
 Principalism

4 basic principls medical ethics

• Autonomy
• Beneficence
• Non maleficience
• Justice
 Autonomy…
• Patiants has the right to decide on what
they want
• Rights in relation to health care are usually
taken to include:
The right to information
 The right to privacy and confidentiality
 The right to appropriate care and
treatment
• The patient must be informed clearly
the consequences of his action that
may affect him adversely.

• Desiring to "benefit" the patient, the

physician may strongly want to
intervene believing it to be a clear
"medical benefit." The physician has a
duty to respect the autonomous choice
of the patient, as well as a duty to avoid
harm and to provide a medical benefit.
 Beneficence

• Actions intended to benefit the patient or

others

• The practitioner should act in “the

best interest” of the patient - the
procedure be provided with the intent
of doing good to the patient
 Non maleficence
• “Above all, do no harm,“ – Make
sure that the procedure does not
harm the patient or others in
society
 Non-maleficence

• Actions are intended not to harm or bring

harm to the patient and others
• The concept of non-maleficence is
embodied by the phrase “first, do no
harm”
• In practice, many treatments carry some
risk of harm. In some circumstances,
risky treatments that stand a high chance
of harming the patient will be justified, as
the risk of not treating is also very likely
to do harm
• The principle of non-maleficence is not
absolute, and must be balanced against the
principle of beneficence (doing good)
 Justice / Fairness
• Human being should treat other human
being fairly and justly in distribution
goodness and badness among them. In
other words justice should include:
• Fair distribution of scarce resources
• Respect for individual and group rights
• •Following morally acceptable laws
 Justice / Fairness

• The burdens and benefits of new

or experimental treatments must
be distributed equally among all
groups in society
• no discrimnation based on race, age, sex,
religion
 think
• you are a doctor at one of a hospital when
you found your sister who come to seek a
medical help. Are you going to treat here?
VALUES IN MEDICAL ETHICS
 Compassion
Within the healthcare community,
compassion is defined as “the recognition,
understanding, and emotional resonance
with another's concerns, distress, pain or
suffering, coupled with relational action to
relieve these states”
Compassion consists of six 'attributes':
• Sensitivity,
• Sympathy,
• Empathy,
• Motivation/Caring,
• Distress Tolerance
• Non-Judgement.
 Characteristic and qualities of compassion

Motivation
• The initial stage requires the motivation
to be caring, supportive and helpful to
others.
• This is the “ commitment to try to do
something about it” aspects of
compassion.
 Characteristic and qualities of
compassion
Being sensitive
• This is the capacity to be sensitive and
to maintain open attention, enabling us to
notice when others need help.
 Characteristic and qualities of
compassion
Sympathetic
• Compassion requires us to be
emotionally open to ours and others’
suffering.
• This means that we are emotionally
touched, moved and sympathetic to
suffering
 Characteristic and qualities of
compassion
Distress tolerance
• This is our ability to bear difficult
emotions both with in ourselves and in
others.
• People who feel overwhelmed by
another’s distress may feel psychologically
unable to face it and so have to run away
 Characteristic and qualities of
compassion
Empathy
• It requires not simply an ability to
recognize another human being’s feelings,
motivations and intensions, but also to
make sense of their feelings and our own
emotional responses.
• It is the process of “being in another
persons shoes”
 Characteristic and qualities of
compassion
Non-condemning and non-judging
• Means not judging a person’s pain or distress,
but simply accepting and validating their
experience.
Caring
• Means “action and activities directed towards
assisting, supporting or enabling another
individual or group with evident or anticipated
needs to improve a human condition or life way
or to face death”.
RESPECT AND EQUAL TREATMENT

• All human beings deserve respect and equal

treatment
• It is relatively recent
• “All human beings are born free and equal in
dignity and rights.”
• “Don't permit considerations of age, disease or
disability, creed, ethnic origin, gender, nationality,
political affiliation, race, sexual orientation, or
social standing to intervene between my duty and
my patient” (Declaration of Geneva
RESPECT AND EQUAL TREATMENT

• Care of infectious patients. (HBV, HIV, Ebola

• physician-patient relationship can give rise
to sexual attraction.
• such attraction must be resisted
• “Whatever houses I may visit, I will come for
the benefit of the sick, remaining free of all
intentional injustice, of all mischief and in
particular of sexual with both female and male
persons…
RESPECT AND EQUAL TREATMENT

• Treating family members

• Physicians should exercise sound
professional judgement and avoid treating
anyone with whom they have another
relationship, which may affect the objectivity
of the medical care they provide.
• Wherever possible, avoid providing
medical care to anyone with whom you
have a close personal relationship.
COMMUNICATION AND CONSENT
• consent is one of the central concepts of present-day
medical ethics

• “The patient has the right to self-determination, to make free

decisions regarding himself/herself. The physician will inform
the patient of the consequences of his/her decisions. A
mentally competent adult patient has the right to give or
withhold consent to any diagnostic procedure or therapy. The
patient has the right to the information necessary to make
his/her decisions.The patient should understand clearly what is
the purpose of any test or treatment, what the results would
imply, and what would be the implications of withholding
consent.”
COMMUNICATION AND CONSENT
• Truthfulness and honesty
– Obligation to full and honest disclosure
– Informed consent:
• A person must be fully-informed about and understand
the potential benefits and risks of their choice of
treatment
• An uninformed person is at risk of mistakenly making a
choice not reflective of his or her values or wishes
• If the patient is incapacitated (bedridden, crippled etc) ,
laws around the world designate different processes for
obtaining informed consent, typically by having a person
appointed by the patient or their next of kin make
decisions for them
• The value of informed consent is closely related to the
values of autonomy and truth telling
COMMUNICATION AND CONSENT
• formal consent vs informal consent
 CONSENT...unconscious
• If the patient is unconscious or unable to
express his/her will consent must be
obtained, from a legally entitled
representative
• What if not available ?
• What if against the good of the patient ?
• Communication skill is very important
 What if not available ?
• If a legally entitled representative is not
available, but a medical intervention is
urgently needed, consent of the patient
may be presumed, unless it is obvious and
beyond any doubt on the basis of the
patient’s previous firm expression or
conviction that he/she would refuse
consent to the intervention in that
situation.
 suicide
• However, physicians should always try to
save the life of a patient unconscious due
to a suicide attempt
What if against the good of the patient ?

• If the patient’s legally entitled

representative, or a person authorized by
the patient, forbids treatment which is, in
the opinion of the physician, in the
patient’s best interest, the physician
should challenge this decision in the
relevant legal or other institution. In case
of emergency, the physician will act in the
patient’s best interest
Procedures against the patient’s will
• Diagnostic procedures or treatment
against the patient’s will can be carried out
only in exceptional cases, if specifically
permitted by law and conforming to the
principles of medical ethics.
 CONFIDENTIALITY
• The physician’s duty to keep patient
information confidential
“A physician shall preserve absolute confidentiality
on all he knows about his patient even after the
patient has died.”
 Breaches of confidentiality
• Routine breaches of confidentiality
o should be kept as minimum
• Comply with legal requirements.
o Laws for mandatory reporting
o Desirable to discuss with the patients
• Information to others who could be at risk of
harm from the patient.
o Expert advice
o Only the necessary information and to concerned person
o The patient’s co-operation should be enlisted if possible
Respect for Societal Institutions

• Life, culture, family, religion

Medical Ethics in Ethiopia
• Early not in the curriculum of medical schools
• AAU 1 credit hr in 2004
• 1988 committee to draft ethics established
• Although medical ethics principles are
universally accepted by all different countries,
• Every country adopt certain modifications
and devise specific interpretations based on
• Prevailing culture,
• Religious beliefs,
• social and anthropological norms,
• laws of the land, and
• Standards of medical practice in the
existing health system
 Ethics
• Fast or slow changes and transformations,
• Bound to dynamism and frequent
changes
• Guide lines and code may need revision
 Code of Medical Ethics
• This code does give an appropriate guideline
• Illustrates the acceptable behavior of a
doctor with a sound mind and self-control
• Focuses on the duties and obligations of the
doctor towards his patients

• Guides his or her association with

professional colleagues
 I Doctor-patient and Doctor-
community Relationships (14)
• Render service to the individual and the
community with full respect for life and the
dignity of man.
• The doctor shall attend her/his patient with
maximum possible care ,devotion and
conscientiousness. She/he shall respect
the dignity of her/his patient and her/his
attitudes shall be sympathetic, friendly and
helpful.
• In case of a female patient (client) presenting in
a clinic, the doctor shall perform her/his
examinations in the presence a female nurse or
a chaperone.
• The doctor shall practice her/his profession
without discrimination.
• The doctor shall provide her/his patient, the
family and the whole Community with the
prevention of disease or injury, maintenance of
good health and rehabilitative services
• The doctor shall cooperate with the public
authorities in the prevention of disease or
injury and in the maintenance of good
health
• The doctor shall cooperate with the public
authorities in the prevention of disease or
injury and in the maintenance of good
health
• The doctor shall make use of every
opportunity to teach the patient and her/his
family regarding the prevention of disease
and the promotion of health
• In case of emergency the doctor shall
extend all possible assistance to the
patient without fail.
• In the event of public danger, the doctor
shall not abandon patients in her/his
immediate care until all appropriate
measures have been taken to secure the
safety of the patients
• The doctor shall do nothing wasteful or
shall not do anything without justification
for the health of· the Individual or the
community
• The doctor shall be the defender of the
child when she/he judges the health of the
child is not well protected
• The doctor is obliged to consult colleagues
when it is necessary to do so, and shall
inform the patient and/or the patient’s
relatives about the consultations
• The doctor is free to choose whom she/he will serve.
The doctor should,however, respond to the best of
her/his ability in case of emergency where first aid
treatment is essential. While the doctor has the option of
with drawing from a case, she/he shall ascertain that:
A. The patient or the relatives or responsible person are
notified ahead of time.
B. The patient will have adequate care
C. A colleague will replace her/him
D. All necessary information will be conveyed to the
replacement
• The doctor-patient relationship shall not be
used as a means of developing intimacy
 II. The Doctor as a Professional
15-20)
• The doctor shall at all times conduct
herself/himself in such a way that she/he
may gain the respect and the confidence
of her/his fellow man and maintain the
dignity of her/his profession, and those
conditions are essential for the best
practice of her/his profession.
• The responsibility of the doctor shall be
strictly personal.
• The doctor shall at no time divest
herself/himself of her/his professional
freedom
• The doctor shall endeavor to improve
continuously her/his knowledge and skill
and should make them available to her/his
patients and colleagues.
• The doctor shall use recognized scientific
methods during her/his practice
• The doctor shall not administer unjustified
treatment
 III. Medical Secrecy
• The doctor shall maintain her/his
professional secrecy in respect for all
matters which have come to her/his
knowledge in the course of her/his duties
to the patients except in those situations
clearly stipulated by the law or when the
patient gives written consent for the
release of information.
• The use of any medium such as: film,
videotapes, or otherwise record patient
interactions with their health care
providers requires the utmost respect for
the privacy and confidentiality of the
patient.
• In case of minors and unconscious
patients or patients of unsound mind, the
doctor may reveal his professional secret
to the patient's relatives when such a
revelation would serve any useful purpose
for the cure of the patient or when her/his
condition otherwise so requires.
• The doctor shall see to it that persons
working with him respect medical secrecy.
• The doctor shall not disclose the
identification of her/his patient in her/his
scientific publications or lectures unless
there is a written consent of the patient
 Patients' Consent
• It is the duty of the physician to inform the
patient about the treatment (including
surgical procedures) obliged to obtain a
written consent of the patient before
carrying out procedures in the case of
minors or persons who are unconscious,
the necessary consent should be
surrogates
• Article 25. legitimate grounds, left to the
discretion of the physician information
about serious diagnoses and/or prognosis
may be withheld unless the patient
demands it. However, it is desirable to
inform the nearest relative when the
outcome is likely to be unfavorable
• The doctor has an ethical obligation to
help the patient make choices from among
the therapeutic alternatives consistent with
good medical practice
 Torture and Punishment
• Not participate in the practice of torture or
other cruel, inhuman or degrading
procedures. The physician shall not
provide premises instruments substances
or knowledge to facilitate the practice of
torture.
• Doctors may treat prisoners or detainees if
doing so is in their bestinterest. But doctors
should not treat individuals to verify their
health so that torture can begin or continue.
Doctors who treat torture victims should not be
persecuted. Doctors should help provide
support for victims of torture and, whenever
possible, strive to change situations in which
torture is practiced or the potential for torture is
great.
 Certificates, Prescriptions and
Signatures
• Any document or certificate issued by the
physician bear legible name and
signature. .
• The issuance of a tendentious report or a
false certificate is unethical.
• Upon request of the patient or legal
authorities the physician shall issue
certificate
• Formulate his prescriptions with the
necessary clarity. The patient or family
have well understood prescription