European Code of Medical Ethics

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EUROPEAN CODE OF MEDICAL ETHICS

Conférence Internationale des Ordres et des

Organismes d'Attributions Similaies

1987

•••

Drafted in January 1987 by the Conférence Internationale des Ordres et des Organismes d'Attributions Similaires, this European Code of Medical Ethics represents one effort to articulate medical ethics guidelines for the European Community. The code represents a guide for the countries involved, each of which must decide whether further action at a national level is warranted. The twelve participating countries and their representative bodies include: Belgium, Conseil National de l'Ordre des Médecins Belges; Denmark, Danish Medical Association and National Board of Health; Spain, Consejo General de Colegios Oficiales de Medicos; France, Conseil National de l'Ordre des Médecins Français; Luxembourg, Collège Médical; Ireland, Medical Council; Italy, Federazione Nazionale degli Ordini dei Medici; The Netherlands, Koninklijke Nederlandsche Maatschappij tot Bevordering der Geneeskunst; Portugal, Ordem dos Medicos; Germany, Bundesärztekammer; United Kingdom, General Medical Council; and observer for Sweden, Association Médicale Suédoise.

This guide is intended to influence the professional conduct of doctors, in whatever branch of practice, in their contacts with patients, with society and between themselves. The guide also refers to the privileged position of doctors, upon which good medical practice depends. The Conference has recommended to its constituent regulatory bodies in each member state of the European Communities that they take such measures as may be necessary to ensure that their national requirements relating to the duties and privileges of doctors vis-à-vis their patients and society and in their professional relationships conform with the principles set out in this guide, and that there is provision within their legal systems for the effective enforcement of these principles.

ARTICLE 1

The doctor's vocation is to safeguard man's physical and mental health and relieve his suffering, while respecting human life and dignity with no discrimination on the grounds of age, race, religion, nationality, social status, political opinions or any other, whether in peace time or in war time.

Undertakings by the Doctor

ARTICLE 2

A doctor engaging in medical practice undertakes to give priority to the medical interests of the patient. The doctor may use his professional knowledge only to improve or maintain the health of those who place their trust in him; in no circumstances may he act to their detriment.

ARTICLE 3

A doctor engaging in medical practice must refrain from imposing on a patient his personal philosophical, moral or political opinions.

Enlightened Consent

ARTICLE 4

Except in an emergency, a doctor will explain to the patient the effects and the expected consequences of treatment. He will obtain the patient's consent, particularly when his proposed medical interventions present a serious risk.

The doctor may not substitute his own definition of the quality of life for that of his patient.

Moral and Technical Independence

ARTICLE 5

Both when given advice and when giving treatment, a doctor must make best use of his complete professional freedom and the technical and moral circumstances which permit him to act in complete independence.

The patient should be informed if these conditions are not met.

ARTICLE 6

When a doctor is working for a private or public authority or when he is acting on behalf of a third party, be it an individual or institution, he must also inform the patient of this.

Professional Confidentiality

ARTICLE 7

The doctor is necessarily the patient's confidant. He must guarantee to him complete confidentiality of all the information which he may have acquired and of the investigations which he may have undertaken in the course of his contacts with him.

The death of a patient does not absolve a doctor from the rule of professional secrecy.

ARTICLE 8

A doctor must respect the privacy of his patients and take all necessary steps to prevent the disclosure of anything which he may have learned in the course of his professional practice.

Where national law provides for exceptions to the principles of confidentiality, the doctor should be able to consult the Medical Council or equivalent professional authority.

ARTICLE 9

Doctors may not collaborate in the establishment of electronic medical data banks which could imperil or diminish the right of the patient to the safely protected confidentiality of his privacy. A nominated doctor should be responsible for ethical supervision and control of each computerised medical data bank.

Medical data banks must have no links with other data banks.

Standards of Medical Care

ARTICLE 10

The doctor must have access to all the resources of medical knowledge in order to utilise them as necessary for the benefit of his patient.

ARTICLE 11

He should not lay claim to a competence which he does not possess.

ARTICLE 12

He must call upon a more experienced colleague in any case which requires an examination or method of treatment beyond his own competence.

Care of the Terminally Ill

ARTICLE 13

While the practice of medicine must in all circumstances constantly respect the life, the moral autonomy and the free choice of the patient, the doctor may, in the case of an incurable and terminal illness, alleviate the physical and mental suffering of the patient by restricting his intervention to such treatment as is appropriate to preserve, so far as possible, the quality of a life which is drawing to its close.

It is essential to assist the dying patient right to the end and to take such action as will permit the patient to retain his dignity.

Removal of Organs

ARTICLE 14

In a case where it is impossible to reverse the terminal processes leading to the cessation of a patient's vital functions, doctors will establish that death has occurred, taking account of the most recent scientific data.

At least two doctors, acting individually, should take meticulous steps to verify that this situation has occurred, and record their findings in writing.

They should be independent of the team which is to carry out the transplantation and must, in all respects, give priority to the care of the dying patient.

ARTICLE 15

Doctors removing an organ for transplantation may give particular treatment designed to maintain the condition of that organ.

ARTICLE 16

Doctors removing organs for transplantation and those carrying out transplantations should take all practicable steps to ensure that the donor had not expressed opposition or left instructions to this effect either in writing or with his family.

Reproduction

ARTICLE 17

The doctor will furnish the patient, on request, with all relevant information on the subjects of reproduction and contraception.

ARTICLE 18

It is ethical for a doctor, by reason of his own beliefs, to refuse to intervene in the processes of reproduction or termination of pregnancy, and to suggest to the patients concerned that they consult other doctors.

Experimentation on Humans

ARTICLE 19

Progress in the field of medicine is based on research which must finally lead to experiments which have a direct bearing on humans.

ARTICLE 20

Details of all proposed experimentation involving patients must first be submitted to an ethical committee which is independent of the research team for opinions and advice.

ARTICLE 21

The free and informed consent of any person who is to be involved in a research project must be obtained after he has first been sufficiently informed of the aims, methods and expected benefits as well as the risks and potential problems, and of his right not to take part in experiments (or other research) and to withdraw from participation at any time.

Torture and Inhuman Treatment

ARTICLE 22

A doctor must never attend, take part in or carry out acts of torture or other kinds of cruel, inhuman or degrading treatment whatever the crime, accusation against, beliefs or motives of the victim or of those who commit these deeds, whatever the situation, including cases of civil or armed conflict.

ARTICLE 23

A doctor must never use his knowledge, his competence or his skills for the purpose of facilitating the use of torture or any other cruel, inhuman or degrading procedure for the purpose of weakening the resistance of a victim of these methods.

The Doctor and Society

ARTICLE 24

In order to accomplish his humanitarian duties, every doctor has the right to legal protection of his professional independence and his standing in society, in times of peace as in times of war.

ARTICLE 25

It is the duty of a doctor, whether acting alone or in conjunction with other doctors, to draw the attention of society to any deficiencies in the quality of health care or in the professional independence of doctors.

ARTICLE 26

Doctors must be involved in the development and the implementation of all collective measures designed to improve the prevention, diagnosis and treatment of disease. In particular, they must provide a medical contribution to the organisation of rescue services, particularly in the event of public disaster.

ARTICLE 27

They must participate, so far as their competence and available facilities permit, in constant improvement of the quality of care through research and continual refinement of methods of treatment, in accordance with advances in medical knowledge.

Relationships with Professional Colleagues

ARTICLE 28

The rules of professional etiquette were introduced in the interest of patients. They were designed to prevent patients becoming the victims of dishonest manoeuvres between doctors. The latter may, on the other hand, legitimately rely on their colleagues to adhere to the standards of conduct to which the profession as a whole subscribes.

ARTICLE 29

A doctor has a duty to inform the competent professional regulatory authorities of any lapses of which he may be aware on the part of his colleagues from the rules of medical ethics and good professional practice.

Publication of Findings

ARTICLE 30

It is the duty of a doctor to publish, initially in professional journals, any discoveries that he may have made or conclusions that he may have drawn from his scientific studies relevant to diagnosis or treatment. He must submit his findings in the appropriate form for review by his colleagues before releasing them to the lay public.

ARTICLE 31

Any exploitation or advertisement of a medical success to the profit of an individual or of a group or of an institution is contrary to medical ethics.

Continuity of Care

ARTICLE 32

A doctor, whatever his specialty, is obliged by his humanitarian duty to give emergency treatment to any patient in immediate danger, unless he is satisfied that other doctors will provide this care and are capable of doing so.

ARTICLE 33

The doctor who agrees to give care to a patient undertakes to ensure continuity of care when necessary with the help of assistants, locums or colleagues.

Freedom of Choice

ARTICLE 34

Freedom of choice constitutes a fundamental principle of the patient–doctor relationship. The doctor must respect, and make sure that others respect, the patient's freedom of choice of doctors.

The doctor, for his part, may refuse to treat a particular patient, unless the patient is in immediate danger.

Withdrawal of Services

ARTICLE 35

When a doctor decides to participate in an organised, collective withdrawal of services, he is not absolved of his ethical responsibilities vis-à-vis his patients to whom he must guarantee emergency services and such care as is required by those currently being treated.

Fees

ARTICLE 36

In fixing his fees, the doctor will take account, in the absence of any contract or of individual or collective agreement, of the importance of the service which has been given, any special circumstances in a particular case, his own competence and the financial situation of the patient.