Tuesday, January 13, 2015



Dr. Abhishek Karn
Dept. of Forensic Medicine & Toxicology

·      Medical service is the most humane of all the services to humanity.

·      Ethics is the understanding of moral values.

·      Medical ethics is a system of moral principles that apply values and judgments to the practice of medicine. It deals with the moral principles which should guide members of the medical profession in their dealings with each other, their patients and the State.

·      A common framework used in the analysis of medical ethics is the "4 principles" approach postulated by Tom Beauchamp and James Childress which are to be judged and weighed against each other, with attention given to the scope of their application.

·      The 4 principles are:

1.  Respect for autonomy - the patient has the right to refuse or choose their treatment.
2.  Beneficence - a practitioner should act in the best interest of the patient.
3.  Non-maleficence - "first, do no harm"
4. Justice - concerns the distribution of scarce health resources, and the decision of who gets what treatment (fairness and equality).

Other values that are sometimes discussed include:

1.  Respect for persons - the patient (and the person treating the patient) have the right to be treated with dignity.
2.  Truthfulness and honesty - (Informed Consent--refers to the idea that 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. It does not specifically mean the process of obtaining consent, or the specific legal requirements, which vary from place to place, for capacity to consent. Patients can elect to make their own medical decisions, or can delegate decision-making authority to another party. The value of informed consent is closely related to the values of autonomy and truth telling.

NMC - Code of Ethics

CODE OF ETHICS--- • The code of ethics is the rules framed in this line and on the basis of this sense of moral values to guide the conduct of all concerned.
0    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.

0    The code is as follows:

(The following declaration should be read and agreed upon by the applicant at the time of registration)

0    I solemnly pledge myself to dedicate my life to the service of humanity.
0    Even under threat and duress I will not use my knowledge contrary to the norms of humanity.
0    I will maintain the utmost respect for human life right from the time of conception as per the laws of the land.
0    I will not allow consideration of age, sex, religion, nationality, ethnicity, politics, or social standing to intervene between my duty and my patient.
0    I will carry out my professional duties with conscience and dignity.
0    The health of my patient will be my first consideration.
0    I will respect the secrets of my patients confided in me.

0    I will give to my teachers the respect and gratitude that is their due.

0    I will maintain, by all means in my power, the honour and noble traditions of the medical profession.
0    I will maintain utmost rapport with my professional colleagues.
0    I make these promises solemnly, freely and upon my honour.


2.1 Character of the Physician
0    A physician should be an upright Person, instructed in the art of healing.
0    S/he should possess good character and be diligent in caring for the sick.
0    S/he should also be modest, sober, patient, alert, and prompt in action.

2.2 Responsibility of the Physician to Medical Profession
0    The main aim of the medical profession is to render service to the cause of humanity.
0    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.
0    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

0    2.3.1 General Consideration
0    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.
0    This can help the patient to make informed choice seeking treatment and assist physicians in advising their patients on the choice of specialist.
0    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.
0    Solicitation of patients directly or indirectly, by a physician, by groups of physicians or by institutions or organizations is unethical.
0    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.
0    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.

0    On starting practice.
0    On change of type of practice.
0    On change of address.
0    On temporary absence from duty.
0    On resumption of another practice.
0    On succeeding to another practice.

2.3.2 Privacy, Security and Confidentiality of Information of the Patients
0    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
0    Fee for professional services provided to the patient should be clarified at the time of the service given.
0    It is unethical to enter into a contract of – ‘no cure no payment’.

2.5 Running or Opening a Medical Shop
0    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
0    It is unethical to prescribe drugs or formulations about which the physician has no knowledge about its composition and pharmacological action.

2.7 Commission
0    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
0    A physician should always follow the Nepal Medical Council rules and regulation, which regulate the practice of medicine.
0    S/he should also abide by other laws enforced in the country.


3.1 Obligation to the Patient
0    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
0    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.
0    Even in such circumstances it should only be made after formal protest.

3.3 Prognosis of the Disease
0    A physician should explain the nature of the illness to the patient.
0    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
0    A physician is free to choose whom to serve except in emergency cases.
0    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
0    A physician must seek an informed written consent prior to performing a diagnostic or treatment procedure.
0    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.
0    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.
0    It is obligatory for the physician to explain the nature of the procedure and the expected result.

3.6 Attendant
0    A physician should keep in all instances an attendant before examining a patient of the opposite sex.

3.7 Continuity of Treatment
0    A physician should not discontinue the treatment except in the following conditions:
0    Refusal to pay the fee for service.
0    Non-compliance with the recommended treatment.
0    Exerting undue pressure to prescribe unnecessary drugs.
0    Forcing to do an immoral act in his/her favour.
0    When physician himself is unwell.


4.1 Honour of the Profession
0    A physician should uphold the dignity and honour of medical profession to the highest standard.

4.2 Membership in Medical Societies
0    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
0    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
0    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.


0    It is not mandatory that a physician should not charge fee from another physician or his/her immediate family members for rendering professional services.

0    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.


0    In case of any doubt or difficulty, a physician should request consultation with other colleagues giving priority to the patient's benefit.
0    No insincerity, rivalry, or envy should be indulged in during consultation.
0    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.
0    Upon such temporary appointment, the physician acting under such privilege should give utmost consideration to the interest and representation of the absent physician.
0    A physician should not usually take charge of or visit another physician's patient in the same illness except in emergency.
0    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.

0    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.
0    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.
0    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.


8.1.1 Neglect or Disregard by physician of Their Professional Responsibilities to patients for Their Care and Treatment
a. Neglect or Disregard on Medical Care:
0    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:
0    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.
0    Therefore, h/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:-
0    All physicians must provide standard medical care as allowed by available resources.
0    A physician should not prescribe or supply controlled drugs to addicted persons other than in the course of bonafide treatment.

b. Medical Certificates:-
0    Physicians are expected to exercise care in issuing medical certificates or similar documents.

0    c. Termination of pregnancy
The law of the country prohibits the termination of pregnancy unless medically indicated.

0    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.

0    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.
0    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.

0    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
0    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.
0    The following are the three main areas of personal behaviour, which may lead to disciplinary proceedings:

0    a. Abuse of Alcohol and Drugs
Treating the patient under the influence of alcohol or drugs is liable to disciplinary proceedings.
0    b. Dishonesty
Criminal deception, forgery, fraud, theft, and any other offences involving morality and honesty are liable to disciplinary action.
0    c. Indecency and Violence
Indecent behaviour or violent assault on a patient would be regarded as a serious professional misconduct.


0    9.1 A physician should use an 18x14 inch size signboard and write his name, NMC number, qualification, titles, and name of his specialty.
0    The letters should be in blue on a white background.
0    S/he should not use the International Red Cross symbol to make known the fact of being a physician.
0    It is improper to affix a signboard on a chemist's shop.

0    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.

0    9.3 A physician should not use touts or agents for procuring patients.

0    9.4 A physician should not insult or misbehave with fellow physicians by words or behaviour.


0    The committee will initially enquire all the complaints and issues related to professional misconduct.

0    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
0    In case the physician is found innocent, the committee will admonish and conclude the case.

10.2 Put on probation by postponing judgement
0    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.
0    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

0    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.

0    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
0    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.
0    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.
0    In case of unsuccessful application, a further period of at least 12 months must elapse before a further application can be made.


0    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.

0    The erasure remains effective unless the physician's application is accepted for restoration of name to the medical register.


0    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.

No comments:

Post a Comment