Professional Documents
Culture Documents
Code of Medical Ethics - Tamil Nadu Medical Council
Code of Medical Ethics - Tamil Nadu Medical Council
http://www.tnmedicalcouncil.org/logo.aspx?code=33
TABLEOFCONTENTS
Logosymbology
TheCaduceusMedicalSymbol
TheGlobe
TheLamp
TheBalance
TheSheetAnchor
TheBook
TheRose
TheCornStem
Preamble
Chapter1codeofmedicalethics
1.01DisplayofMedicalDegreesandRegistrationNumber
1.02Declaration
1.03DutiesandresponsibilitiesofthePhysicianingeneral
1.04ThePhysician'sResponsibility
1.05Maintaininggoodmedicalpractice
1.06MembershipinMedicalSociety
1.07Maintenanceofmedicalrecords
1.08UseofGenericnamesofdrugs
1.09HighestQualityAssuranceinpatientcare
1.10ExposureofUnethicalConduct
1.11PaymentofProfessionalService
1.12EvasionofLegalRestriction
Chapter2Dutiesofphysicianstotheirpatients
2.01ObligationstotheSick
2.01.1
2.01.2
2.02Patience,DelicacyandSecrecy:
2.3Prognosis:
2.4ThePatientmustnotbeneglected:
2.5EngagementforanObstetriccase:
Chapter3:Dutiesofphysicianinconsultation
3.1Unnecessaryconsultationsshouldbeavoided
3.1.1
3.1.2
3.2ConsultationforPatientsBenefit
3.3PunctualityinConsultation
3.4StatementtopatientafterConsultation
3.4.1
3.4.2
3.5TreatmentafterConsultation
3.6PatientsReferredtoSpecialists
3.7Feesandothercharges
3.7.1
3.7.2
Note:
Chapter4:Responsibilitiesofphysicianstoeachother
4.1Conductinconsultation:
4.2Consultantnottotakechargeofthecase
4.3AppointmentofSubstitute
4.4VisitinganotherPhysician'sCase
4.5DependenceofPhysiciansoneachother
Chapter5:Dutiesofphysiciantothepublicandtotheparamedicalprofession
5.1PhysiciansasCitizens
5.2PublicandCommunityHealth
5.3Pharmacists/Nurses
Chapter6:Unethicalacts
6.1Advertising
6.1.1
6.1.2
6.2PatentandCopyrights
6.3Runninganopenshop(DispensingofDrugsandAppliancesbyPhysicians
6.4Rebates*andCommission**
6.4.1
6.4.2
6.5SecretRemedies
6.6HumanRights
6.7Euthanasia
Chapter7:Misconduct
7.01Violationoftheregulations
7.01.1
7.01.2
7.02AdulteryorImproperConduct
7.03ConvictionbyCourtofLaw
7.04SexDeterminationTests
7.05SigningProfessionalCertificates,ReportsandotherDocuments
7.06
7.07
7.08
Note:
7.09
7.10
7.11
7.12
7.13Shouldnotrefusetogiveprofessionalserviceonreligiousgrounds
7.14
7.15
7.16
7.17
7.18
7.19
7.20Research:
Chapter8:Punishmentanddisciplinaryaction
8.01
8.02
8.03
8.04
8.05
8.06
Hippocraticoath
BRIEFNOTEONHIPPOCRATICOATH
HIPPOCRATICOATH
Central/StatemedicalActs
TheIndianMedicalDegreesAct1916
TheIndianMedicalCouncilAct1956
TheDrugsandCosmeticsAct1940
TheDrugsandMagicRemedies(Objectionable)AdvertisementAct,1954.(DMRACT)
TheSchedule
PenalProvisionsagainstquacks
SupremeCourtJudgementonPracticeofotherSystemsofMedicine:
WhenaMedicalPractitioneriscalledtoappearasanexpertwitness:
AnimportantSupremeCourtjudgement
Nolegalimpedimentforamedicalprofessionaltoattendtoaninjuredpersonneedinghismedical
assistanceimmediatelysays:SupremeCourtofIndia:
Historyofallopathicmedicineinindia
Statemedicalcouncils&theirpowers
Logo symbology
TheCaduceusMedicalSymbol
ThisistheuniversalsymbolusedtodenotethefieldofMedicine.Themythicalsignificanceofthissymbolis
thatthecaduceusisbelievedtobethemagicrodofHermestheGreekmessengeroftheGods.Accordingto
legend,hermesissupposedtohavepacifiedtwofightingsnakesbythrowingthewandatthem,andthey
stoppedfightingandbecameentwinedinthewand.Snakesarealsoreveredinmanyculturesastheyare
believedtohavealonglifespanduetotheirabilitytorenewtheircellsandkeepthemeveryouthfulby
sheddingtheirskin.
TheGlobe
ThisrepresentsthefarreachingimpactoftheTNMedicalCouncilwithourdoctorsfrequentlytakingthe
bannerofourmedicalheritageallovertheworldandmakingtheirinvaluablecontributionstothefieldof
medicinewhereevertheygo.
TheLamp
ThisisaculturalsymbolthatportraystheglorioustraditionsofTamilNadu.Thelampisalsoanuniversal
symboltodenoteknowledge,throwinglight,enlightenment,etc.,
TheBalance
ThisisagainanuniversalsymbolthatdenotesJustice.ToupholdjusticeisacoreactivityoftheCouncil.
TheSheetAnchor
ThisdenotesthestabilityandunshakeablenatureoftheCouncileveninfacingadverseconditions.Likea
sheetanchorthatfirmlygrapplesandprotectsamightyship,theCouncilprotectseverybodyunderitshold
thedoctorsaswellasthegeneralpublicandensuresthatthehonourablepracticeofmedicineisalways
carriedoutforthemaximumbenefitofhumanity.
TheBook
Thedenotesthefieldofeducation,researchandprogressinthefieldofmedicineandtheCouncil'sactivepart
infurtheringthecauseofmedicine.Themicroscopedenotesthefieldofresearchthepetridishdenotesthe
subjectofbiologicalsciencethebeakersdenotethedrugresearchandthesyringe,tonic,capsulesand
tabletsdenotetheoutcomeoftheresearch.
TheRose
Theroseisauniversallyfavouriteobjecttodescribethehealthinessofaperson,especiallyinpoetrywherea
healthypersonisoftendescribedasbeinginthepinkofhishealth.Thethornsaroundtherosedenotethe
protectionfortherose,toensurethatitisnotdestroyedbyevilhands.ThisdenotestheactivityoftheCouncil
aswatchdogtoprotectthepublicfromquacksandcheats.
TheCornStem
ThisisacommonfeatureintheinsigniasofGovernmentsandeducationalinstitutionsworldwide.This
denotesthenatureoftheCouncilasabodysupportedbytheGovernment.
Preamble
TheTamilNaduMedicalCouncilCodeofMedicalEthicsprovidesasetoffundamentalprinciples,officialset
oflawsorregulationswhichshouldguidetheMedicalPractitionersintheirprofessionalconduct.Ethicsis
definedasthescienceofmoralprinciples.Ethicsisanappealtotheconscienceandmoreoftenthannot,it
helpsthepeopleintreading/walkingrightpaths.MedicalEthicsdealswiththemoralprincipleswhichshould
guidethemembersofthemedicalprofessionintheirdealingswitheachother,theirpatientsandtheState.
MedicalEtiquettedealswiththeconventionallawsofcourtesyobservedbetweenmembersofthemedical
profession.MedicalEtiquettedealswiththeconventionallawsofcourtesyobservedbetweenmembersofthe
medicalprofession.Becauseoftheirspecialknowledgeandexpertise,thedoctorshavearesponsibilityto
improveandmaintainthehealthoftheirpatientswho,areeitherinavulnerablestateofillnessorforthe
maintenanceoftheirhealth,entrustthemselvestomedicalcare.Overthecenturies,doctorshaveheldtoa
bodyofethicalprinciplesdevelopedtoguidetheirbehaviourtowardspatients,theirprofessionalcolleagues,
peersandsociety.TheHippocraticOath*wasanearlyexpressionofsuchaCode.Asamemberofmedical
profession,aphysicianmustrecognizeresponsibilitytopatientsfirstandforemost,aswellastosociety,to
otherhealthprofessionals,andtoself.TheloftyidealssetupbyCharakatheancientIndianPhilosopherand
Physicianinhisenunciation,"Evenifyourownlifebeindanger,youshouldnotneglectorbetraytheinterest
ofyourpatients",shouldbefondlycherishedbyalldoctors.Themedicalprofessionisgovernedbylegislation
andbyaCodeofEthicsandEtiquette.EnforcementoftheCodeisdonebytheMedicalCouncils.The
followingprinciplesadoptedbytheTamilNaduMedicalCouncilarestandardsofconductwhichdefinethe
essentialsofhonourablebehaviourforthephysician.Advancingmedicalknowledgeandtechnologycreate
newchallengingethicalproblems.TheEthicsCommitteeoftheTamilNaduMedicalCouncilwilladdressthese
issuesfromtimetotime.TheCodeappliestophysiciansincludinghousesurgeons/residentsandmedical
students.
EveryphysicianshalldisplaytheregistrationnumberaccordedtohimbytheStateMedicalCouncil/Medical
CouncilofIndiainhisclinicandinallhisprescriptions,certificates,moneyreceiptsgiventohispatients.
Physicianshalldisplayassuffixtotheirnamesonlyrecognizedmedicaldegreesorsuchcertificates/diplomas
andmemberships/honourswhichconferprofessionalknowledgeorrecognizesanyexemplary
qualification/achievements.
1.02Declaration
Eachapplicant,atthetimeofmakinganapplicationforregistrationundertheprovisionofAct,shallbe
providedacopyofthedeclarationandshallsubmitadulysignedDeclarationasprovidedinAppendix1.The
applicantshallalsocertifythathe/shehadreadandagreedtoabidebythesame.
1.03DutiesandresponsibilitiesofthePhysicianingeneral
CharacterofPhysician(DoctorwithqualificationofMBBSorMBBSwithpostgraduatedegree/diplomaorwith
equivalentqualificationonanymedicaldiscipline)Aphysicianshallupholdthedignityandhonourofhis
profession.
1.04ThePhysician'sResponsibility
Theprimeobjectofthemedicalprofessionistorenderservicetohumanityrewardorfinancialgainisa
subordinateconsideration.Whosoeverchooseshisprofession,assumestheobligationtoconducthimselfin
accordancewithitsideals.Aphysicianshouldbeanuprightman,instructedintheartofhealings.Heshall
keephimselfpureincharacterandbediligentincaringforthesickheshouldbemodest,sober,patient
promptindischarginghisdutywithoutanxietyconductinghimselfwithproprietyinhisprofessionandinallthe
actionofhislife.NopersonotherthanadoctorhavingqualificationrecognizedbyMedicalCouncilofIndiaand
registeredwithMedicalCouncilofIndia/StateMedicalCouncil(s)isallowedtopracticemodernsystemof
MedicineorSurgery.ApersonobtainingqualificationinanyothersystemofMedicineisnotallowedtopractice
ModernsystemofMedicineinanyform.
1.05Maintaininggoodmedicalpractice
ThePrincipalobjectiveofthemedicalprofessionistorenderservicetohumanitywithfullrespectforthe
dignityofprofessionandman.Physiciansshouldmerittheconfidenceofpatiententrustedtotheircare,
renderingtoeachafullmeasureofserviceanddevotion.Physicianshouldtrycontinuouslytoimprovemedical
knowledgeandskillsandshouldmakeavailabletotheirpatientsandcolleaguesthebenefitsoftheir
professionalattainments.Thephysicianshouldpracticemethodsofhealingfoundedonscientificbasisand
shouldnotassociateprofessionallywithanyonewhoviolatesthisprincipal.Thehonouredidealsofthemedical
professionimplythattheresponsibilitiesofthephysicianextendnotonlytoindividualsalsotosociety.
1.06MembershipinMedicalSociety
Fortheadvancementoftheprofession,aphysicianshouldaffiliatewithassociationandsocietiesofallopathic
medialprofessionsandinvolvesactivelyinthefunctioningsuchbodies.APhysicianshouldparticipatein
professionalmeetingsaspartofContinuingMedicalEducationprogrammes,foratleast30hourseveryfive
years,Organizedbyreputedprofessionalacademicbodiesoranyotherauthorizedorganizations.The
complianceofthisrequirementshallbeinformedregularlytoTamilNaduMedicalCouncil.
1.07Maintenanceofmedicalrecords
Everyphysicianshallmaintainthemedicalrecordspertainingtohis/herindoorpatientsforaperiodof3years
fromthedateofcommencementofthetreatmentinastandardproformalaiddownbytheMedicalCouncilof
IndiaandattachedasAppendix3.Ifanyrequestismadeformedicalrecordseitherbythepatients/authorized
attendantorlegalauthoritiesinvolved,thesamemaybedulyacknowledgedanddocumentsshallbeissued
withintheperiodof72hours.AregisteredmedicalpractitionershallmaintainaRegisterofMedicalCertificates
givingfulldetailsofcertificatesissued.Whenissuingamedicalcertificatehe/sheshallalwaysenterthe
identificationmarksofthepatientandkeepacopyofthecertificate.He/Sheshallnotomittorecordthe
signatureand/orthumbmark,addressandleastoneidentificationmarkofthepatientonthemedical
certificatesorreport.ThemedicalcertificateshallbepreparedasinAppendix2.Effortsshallbemadeto
computerizemedicalrecordsforquickretrieval.
1.08UseofGenericnamesofdrugs
Everyphysicianshould,asfaraspossible,prescribedrugswithgenericnamesandhe/sheshallensurethat
thereisarationalprescriptionanduseofdrugs.
1.09HighestQualityAssuranceinpatientcare
Everyphysicianshouldaidinsafeguardingtheprofessionagainstadmissiontoitofthosewhoaredeficientin
moralcharacteroreducation.Physicianshallnotemployinconnectionwithhisprofessionalpracticeany
attendanttowhoisneitherregisterednorenlistedundertheMedicalactsinforceandshallnorpermitsuch
personstoattend,treatorperformoperationsuponpatientswhereverprofessionaldiscretionorskillis
required.
1.10ExposureofUnethicalConduct
APhysicianshouldexpose,withoutfearorfavour,incompetentorcorrupt,dishonestorunethicalconducton
thepartofmembersoftheprofession.
1.11PaymentofProfessionalService
Thephysicianengagedinpracticeofmedicineshallgiveprioritytotheinterestofpatients.Thepersonal
financialinterestsofashouldnotconflictwiththemedicalinterestsofthepatients.Remunerationreceivedfor
suchservicesshouldbeintheformandamountspecificallyannouncedtothepatientatthetimetheserviceis
rendered.Itisunethicaltoenterintoacontractof"nocurenopayment".Physicianrenderingserviceson
behalfoftheStateshallrefrainfromanticipatingoracceptinganyconsideration.
1.12EvasionofLegalRestriction
Thephysicianwillobservethelawsofthecountryinregulatingthepracticeofmedicineandwillalsonotassist
otherstoevadesuchlaws.Heshouldbecooperativeinobservanceandenforcementofsanitarylawsand
regulationsintheinterestofpublichealth.Legislationandcourtdecisionsmayalsoinfluencemedicalethics.
HenceMedicalPractitionersmustbefamiliarwiththevariousActs,RulesandRegulationsthatareinforce
andwhichhavebeenenactedbytheCentralorStateGovernment,Statutorybodies,TamilNaduMedical
CouncilandtheIndianMedicalCouncil.Unlessheisfamiliarwithalltherelevantlawsandregulationshemay
findhimselfinadvertentlycontraveningtheseandcourtingtrouble.AMedicalPractitionermustaboveallbea
goodcitizenandmustupholdanddefendthelawsoftheStateandtheNation.Aphysicianshouldobservethe
provisionsoftheStateActslikeDrugsandCosmeticsAct,1940PharmacyAct,1948NarcoticDrugsand
PsychotropicSubstancesAct,1985MedicalTerminationofPregnancyAct,1971TransplantationofHuman
OrganAct,1994MentalHealthAct,1987EnvironmentalProtectionAct1986PrenatalSexDetermination
TestAct,1994DrugsandMagicRemedies(ObjectionableAdvertisement)Act,1954PersonswithDisabilities
(EqualOpportunitiesandFullParticipation)Act,1995andBioMedicalWaste(ManagementandHandling)
Rules,1998andsuchotherActs,Rules,RegulationsmadebytheCentral/StateGovernmentsorlocal
AdministrativeBodiesoranyotherrelevantActrelatingtotheprotectionandpromotionofpublichealth.
2.01.2
Medicalpractitionerhavinganyincapacitydetrimentaltothepatientorwhichcanaffecthis
performancevisvisthepatientisnotpermittedtopracticehisprofession
2.02Patience,DelicacyandSecrecy:
Patienceanddelicacyshouldcharacterizethephysician.Confidencesconcerningindividualordomesticlife
entrustedbypatientstoaphysiciananddefectsinthedispositionorcharacterofpatientsobservedduring
medicalattendanceshouldneverberevealedunlesstheirrevelationisrequiredbythelawsoftheState.
Sometimes,however,aphysicianmustdeterminewhetherhisdutytosocietyrequireshimtoemploy
knowledge,obtainedthroughconfidenceasaphysician,toprotectahealthypersonagainstacommunicable
diseasetowhichheisabouttobeexposed.Insuchinstance,thephysicianshouldactashewouldwish
anothertoacttowardoneofhisownfamilyinlikecircumstances.
2.3Prognosis:
Thephysicianshouldneitherexaggeratenorminimizethegravityofapatientscondition.Heshouldensure
himselfthatthepatient,hisrelativesorhisresponsiblefriendshavesuchknowledgeofthepatientscondition
aswillservethebestinterestsofthepatientandthefamily.
2.4ThePatientmustnotbeneglected:
Aphysicianisfreetochoosewhomhewillserve.Heshould,however,respondtoanyrequestforhis
assistanceinanemergency.Oncehavingundertakenacase,thephysicianshouldnotneglectthepatient,nor
shouldhewithdrawfromthecasewithoutgivingadequatenoticetothepatientandhisfamily.Provisionallyor
fullyregisteredmedicalpractitionershallnotwillfullycommitanactofnegligencethatmaydeprivehispatient
orpatientsfromnecessarymedicalcare.
2.5EngagementforanObstetriccase:
Whenaphysicianwhohasbeenengagedtoattendanobstetriccaseisabsentandanotherissentforand
deliveryaccomplished,theactingphysicianisentitledtohisprofessionalfees,butshouldsecurethepatients
consenttoresignonthearrivalofthephysicianengaged.
3.1.2
Consultingpathologists/radiologistsoraskingforanyotherdiagnosticLabinvestigationshouldbedone
judiciouslyandnotinaroutinemanner.
3.2ConsultationforPatientsBenefit
Ineveryconsultation,thebenefittothepatientisofforemostimportance.Allphysiciansengagedinthecase
shouldbefrankwiththepatientandhisattendants.
3.3PunctualityinConsultation
Utmostpunctualityshouldbeobservedbyphysiciansinmakingthemselvesavailableforconsultations.
3.4StatementtopatientafterConsultation
3.4.1
Allstatementstothepatientorhisrepresentativesshouldtakeplaceinthepresenceoftheconsulting
physicians,exceptasotherwiseagreed.Thedisclosureoftheopiniontothepatientorhisrelativesor
friendsshallrestwiththemedicalattendant.
3.4.2
Differencesofopinionshouldnotbedivulgedunnecessarilybutwhenthereisirreconcilabledifference
ofopinionthecircumstancesshouldbefranklyandimpartiallyexplainedtothepatientorhisrelatives
orfriends.Itwouldbeopentothemtoseekfurtheradviceastheyasdesire.
3.5TreatmentafterConsultation
Nodecisionshouldrestraintheattendingphysicianfrommakingsuchsubsequentvariationsinthetreatmentif
anyunexpectedchangeoccurs,butatthenextconsultation,reasonsforthevariationsshouldbe
discussed/explained.Thesameprivilege,withitsobligations,belongstotheconsultantwhensentforinan
emergencyduringtheabsenceofattendingphysician.Theattendingphysicianmayprescribemedicineatany
timeforthepatient,whereastheconsultantmayprescribeonlyincaseofemergencyorasanexpertwhen
calledfor.
3.6PatientsReferredtoSpecialists
Whenapatientisreferredtoaspecialistbytheattendingphysician,acasesummaryofthepatientshouldbe
giventothespecialist,whoshouldcommunicatehisopinioninwritingtotheattendingphysician.
3.7Feesandothercharges
3.7.1
APhysicianshallinformhisfeesandotherchargestoapatientbeforerenderingserviceandnotafter
theoperationortreatmentisunderway.Prescriptionshouldalsomakeclearthatthephysicianhimself
dispensedanymedicine.
3.7.2
Aphysicianshallwritehisnameanddesignationinfullalongwithregistrationparticularsinhis
prescriptionletterhead.
Note:
InGovernmenthospitalwherethepatientloadisheavy,thenameoftheprescribingdoctormustbe
writtenbelowhis/hersignature.
4.2Consultantnottotakechargeofthecase
Whenaphysicianhasbeencalledforconsultation,theConsultantshouldnormallynottakechargeofthe
case,especiallyonthesolicitationofthepatientorfriends.TheConsultantshallnotcriticizethereferring
physician.He/sheshalldiscussthediagnosistreatmentplanwiththereferringphysician.
4.3AppointmentofSubstitute
Wheneveraphysicianrequestsanotherphysiciantoattendhispatientsduringhistemporaryabsencefromhis
practice,professionalcourtesyrequirestheacceptanceofsuchappointmentonlywhenhehasthecapacityto
dischargetheadditionalresponsibilityalongwithhis/herotherduties.Thephysicianactingundersuchan
appointmentshouldgivetheutmostconsiderationtotheinterestsandreputationoftheabsentphysicianand
allsuchpatientsshouldberestoredtothecareofthelatteruponhis/herreturn.
4.4VisitinganotherPhysician'sCase
Whenitbecomesthedutyofaphysicianoccupyinganofficialpositiontoseeandreportuponanillnessor
injury,heshouldcommunicatetothephysicianinattendancesoastogivehimanoptionofbeingpresent.The
medicalofficer/physicianoccupyinganofficialpositionshouldavoidremarksuponthediagnosisorthe
treatmentthathasbeenadopted.
4.5DependenceofPhysiciansoneachother
Aphysicianshouldconsideritasapleasureandprivilegetorendergratuitousservicetoallphysiciansand
theirimmediatefamilydependants.
Physicians,asgoodcitizens,possessedofspecialtrainingshoulddisseminateadviceonpublichealthissues.
Theyshouldplaytheirpartinenforcingthelawsofthecommunityandinsustainingtheinstitutionsthat
advancetheinterestsofhumanity.Theyshouldparticularlycooperatewiththeauthoritiesintheadministration
ofsanitary/publichealthlawsandregulations.
5.2PublicandCommunityHealth
Physicians,especiallythoseengagedinpublichealthwork,shouldenlightenthepublicconcerningquarantine
regulationsandmeasuresforthepreventionofepidemicandcommunicablediseases.Atalltimesthe
physicianshouldnotifytheconstitutedpublichealthauthoritiesofeverycaseofcommunicablediseaseunder
hiscare,inaccordancewiththelaws,rulesandregulationsofthehealthauthorities.Whenanepidemicoccurs
aphysicianshouldnotabandonhisdutyforfearofcontractingthediseasehimself.
5.3Pharmacists/Nurses
Physiciansshouldrecognizeandpromotethepracticeofdifferentservicessuchas,pharmacyandnursingas
pharmacyandnursingasprofessionsandshouldseektheircooperationwhereverrequired.
1. Onstartingpractice.
2. Onchangeoftypeofpractice.
3. Onchangingaddress.
4. Ontemporaryabsencefromduty.
5. Onresumptionofanotherpractice.
6. Onsucceedingtoanotherpractice.
7. Publicdeclarationcharges.
6.1.2
Printingofselfphotograph,oranysuchmaterialofpublicityintheletterheadoronsignboardofthe
consultingroomoranysuchclinicalestablishmentshallberegardedasactsof,selfadvertisementand
unethicalconductonthepartofthephysician.However,printingofsketches,diagrams,pictureof
systemshallnotbetreatedasunethical
6.2PatentandCopyrights
Aphysicianmaypresentsurgicalinstruments,appliancesandmedicineorCopyrightapplications,methods
andprocedures.However,itshallbeunethicalifthebenefitsofsuchpatentsorcopyrightsarenotmade
availableinsituationswheretheinterestoflargepopulationisinvolved.
6.3Runninganopenshop(DispensingofDrugsandAppliancesby
Physicians
Aphysicianshouldnotrunanopenshopforsaleofmedicinefordispensingprescriptionsprescribedby
doctorsotherthanhimselforforsaleofmedicalorsurgicalappliancesItisnotunethicalforaphysicianto
prescribeorsupplydrugs,remediesorappliancesaslongasthereisnoexploitationofthepatient.Drugs
prescribedbyaphysicianorbroughtfromthemarketforapatientshouldexplicitlystatetheproprietary
formulaeaswellasgenericnameofthedrug.
6.4Rebates*andCommission**
6.4.1
Aphysicianshallnotgive,solicit,orreceivenorshallheoffertogivesolicitorreceiveanygift,gratuity,
commissionorbonusinconsiderationoforreturnforthereferring,recommendingorprocuringofany
patientformedical,surgicalorothertreatmentAphysicianshallnotdirectlyorindirectly,participatein
orbeapartytoactofdivision,transference,assignment,subordination,rebating,splittingorrefunding
ofanyfeeformedical,surgicalorothertreatment.
6.4.2
Provisionsofpara64.1shallapplywithequalforcetothereferring,recommendingorprocuringbya
physicianoranyotherperson,specimenormaterialfordiagnosticpurposesorotherstudy/work.
Nothinginthissection,however,shallprohibitpaymentofsalariesbyaqualifiedphysiciantootherduly
qualifiedpersonrenderingmedicalcareunderhissupervision.
6.5SecretRemedies
Theprescribingordispensingbyaphysicianofsecretremedialagentsofwhichhedoesnotknowthe
composition,orthemanufactureorpromotionoftheiruseisunethicalandassuchprohibited.Allthedrugs
prescribedbyaphysicianshouldalwayscarryaproprietaryformulaandclearname.
6.6HumanRights
Thephysicianshallnotaidorabettorturenorshallhebeapartytoeitherinflectionofmentalorphysical
traumaorconcealmentoftortureinflictedbysomeotherpersonoragencyinclearviolationofbasichuman
rights.
6.7Euthanasia
Practicingeuthanasiashallconstituteunethicalconduct.Howeveronspecificoccasion,thequestionof
withdrawingsupportingdevicestosustaincardiopulmonaryfunctionevenafterbraindeath,shallbedecided
onlybyateamofdoctorsandnotmerelybythetreatingphysicianalone.Ateamofdoctorsshalldeclare
withdrawalofsupportsystem.Suchteamshallconsistofthedoctorinchargeofthepatient,ChiefMedical
Officer/MedicalOfficerinchargeofthehospitalandadoctornominatedbytheinchargeofthehospitalstaff
fromthehospitalstafforinaccordancewiththeprovisionsoftheTransplantationofHumanOrganAct,1994.
Chapter - 7 : Misconduct
7.01Violationoftheregulations
7.01.1
Ifhe/shedoesnotmaintainthemedicalrecordsofhis/herindoorpatientsforaperiodofthreeyearsas
perregulation1.3andrefusestoprovidethesamewithin72hourswhenthepatientorhis/her
authorizedrepresentativemakesarequestforitasperregulation1.3.
7.01.2
Ifhe/shedoesnotdisplaytheregistrationnumberaccordedtohim/herbytheTamilNaduMedical
Councilinhis/herclinic,prescriptionsandcertificatesetc.issuedbyhimorviolatestheprovisionof
regulation1.4.2(displayofrecognizedmedicaldegrees)
7.02AdulteryorImproperConduct
Abusesofprofessionalpositionbycommittingadulteryorimproperconductwithapatientorbymaintainingan
improperassociationwithapatientwillrenderaphysicianliablefordisciplinaryactionasprovidedunderthe
TamilNaduMedicalRegistrationAct,1914ortheIndianMedicalCouncilAct.1956.
7.03ConvictionbyCourtofLaw
ConvictionbyacourtofLawforoffencesinvolvingmoralturpitude/Criminalacts.
7.04SexDeterminationTests
Onnoaccountsexdeterminationtestshallbeundertakenwiththeintenttoterminatethelifeofafemale
foetusdevelopinginhermother'swomb,unlessthereareotherabsoluteindicationsforterminationof
pregnancyasspecifiedintheMedicalTerminationofPregnancyAct,1971.Anyactofterminationof
pregnancyofnormalfemalefoetusamountingtofemalefoeticideshallberegardedasprofessional
misconductonthepartofthephysicianleadingtopenalerasure,besidesrenderinghimliabletocriminal
proceedingsaspertheprovisionsoftheaboveAct.
7.05SigningProfessionalCertificates,ReportsandotherDocuments
Registeredmedicalpractitionersareincertaincasesboundbylawtogive,ormayfromtimetotimebecalled
uponorrequestedtogivecertificates,notification,reportsandotherdocumentsofsimilarcharactersignedby
themintheirprofessionalcapacityforsubsequentuseinthecourtsorforadministrativepurposesetc.Such
documents,amongothers,includetheonesgivenatAppendix4.Anyregisteredpractitionerwhoisshownto
havesignedorgivenhisnameandauthorityanysuchcertificate,notification,reportordocumentofasimilar
characterwhichisuntrue,misleadingorimproper,isliabletohavehisnamedeletedfromtheStateMedical
Register.
7.06
AregisteredmedicalpractitionershallnotcontravenetheprovisionsoftheDrugsandCosmeticsAct*andthe
Regulationsmadethereunder.
Accordingly.
A. Prescribingsteroids/psychotropicdrugswhenthereisnoabsolutemedicalindication.
B. SellingScheduleG,H,L&Xdrugsandpoisonstothepublicexcepttohispatientin
contraventionoftheaboveprovisions
shallconstitutegrossprofessionalmisconductonthepartofthephysician.
7.07
Performingorenablingunqualifiedpersontoperformanabortionoranyillegaloperationforwhichthereisno
medical,surgicalorpsychologicalindication.
7.08
Aregisteredmedicalpractitionershallnotissuecertificatesofefficiencyinmodernmedicinetounqualifiedor
nonmedicalperson.
Note:
Theforegoingdoesnotrestrictthepropertrainingandinstructionofbonafidestudents,midwives,
dispensers,surgicalattendantsorskilledmechanicalandtechnicalassistantsandtherapyassistants
underthepersonalsupervisionofphysicians.
7.09
Aphysicianshouldnotcontributetothelaypressarticlesandgiveinterviewsregardingdiseasesand
treatmentswhichmayhavetheeffectofadvertisinghimselforsolicitingpracticebutisopentowritetothelay
pressunderhisownname(WithoutSelfPhotograph)onmattersofpublichealth,hygieniclivingortodeliver
publiclectures,givetalksontheratio/TV/internetchatforthesamepurposeandsendannouncementofthe
sametolaypress.
7.10
Aninstitutionrunbyaphysicianforaparticularpurposesuchasamaternityhome,nursinghome,private
hospital,rehabilitationcentreoranytypeoftraininginstitutionetc.,maybeadvertisedinthelaypress,but
suchadvertisementsshouldnotcontainanythingmorethanthenameoftheinstitution,typeofpatients
admitted,typeoftrainingandotherfacilitiesofferedandthefees.
7.11
Itisimproperforaphysiciantouseanunusuallylargesignboardandwriteonitanythingotherthanhisname,
qualificationobtainedfromaUniversityorastatutorybody,titlesandnameofhisspeciality,registration
numberincludingthenameoftheStateMedicalCouncilunderwhichregistered.Thesameshouldbethe
contentsofhisprescriptionpapersalso.Itisimpropertoaffixasignboardonachemistsshoporinplaces
wherehedoesnotresideorwork.
7.12
Theregisteredmedicalpractitionershallnotdisclosethesecretsofapatientthathavebeenlearntinthe
exercisesofhis/herprofessionexceptInacourtoflawunderordersofthepresidingJudgeIn
cirucumstanceswherethereisaseriousandidentifiedrisktoaspecificpersonand/orcommunityNotificable
diseases.Incaseofcommunicable/notificablediseases,concernedpublichealthauthoritiesshouldbe
informedimmediately.
7.13Shouldnotrefusetogiveprofessionalserviceonreligiousgrounds
Theregisteredmedicalpractitionershallnotrefuseonreligiousgroundsalonetogiveassistanceinorconduct
ofsterility,birthcontrol,circumcisionandmedicalterminationofpregnancywhenthereismedicalindication,
unlessthemedicalpractitionerfeelshimself/herselfincompetenttodoso.
7.14
Beforeperforminganoperationthephysicianshouldobtaininwritingtheconsentfromthehusbandorwife,
parentorguardianinthecaseofminor,orthepatienthimselfasthecasemaybe.Inanoperationwhichmay
resultinsterilitytheconsentofbothhusbandandwifeisneeded.
7.15
Aregisteredmedicalpractitionershallnotpublishphotographsorcasereportsofhis/herpatientswithouttheir
permission,inanymedicalorotherjournalinamannerbywhichtheiridentitycouldbemadeout.Iftheidentity
isnotbedisclosed,theconsentisnotneeded.
7.16
IntheCaseofrunningofanursinghomebyaphysicianandemployingassistantstohelphim/her,the
ultimateresponsibilityrestsonthephysician.
7.17
Aphysicianshallnotusetoutsoragentsforprocuringpatients.
7.18
Aphysicianshallnotclaimtobespecialistunlesshehasspecialqualificationinthatbranch.
7.19
Noactofinvitrofertilizationorartificialinseminationshallbeundertakenwithouttheinformedconsenttothe
femalepatientandherspouseaswellasthedonor.Suchconsentshallbeobtainedinwritingonlyafterthe
patientisprovided,atherownlevelofcomprehension,withsufficientinformationaboutthepurpose,methods,
risks,inconveniences,disappointmentsoftheprocedureandpossiblerisksandhazards.
7.20Research:
ClinicaldrugtrialsorotherresearchinvolvingpatientsorvolunteersaspertheguidelinesofIndianCouncilof
MedicalResearchcanbeundertaken,providedethicalconsiderationsareborneinmind.
ViolationofexistingICMRguidelinesindrugortherapywhichisnotinconsonancewiththeguidelinesshall
alsobeconstruedasmisconduct.
8.02
ItismadeclearthatanycompliantwithregardtoprofessionalmisconductcanbebroughtbeforetheTamil
NaduCouncilforDisciplinaryaction.Uponreceiptofanycomplaintofprofessionalmisconduct,theTamil
NaduMedicalCouncilwouldholdanenquiryandgiveopportunitytotheregisteredmedicalpractitionertobe
heardinpersonorbypleader.Ifthemedicalpractitionerisfoundtobeguiltyofcommittingprofessional
misconduct,theTamilNaduMedicalCouncilmayawardsuchpunishmentasdeemednecessaryormaydirect
theremovalaltogetherorforaspecifiedperiod,fromtheregisterofthenameofthedelinquentregistered
practitioner.DeletionfromtheRegistershallbewidelypublicizedinlocalpressaswellasinthepublicationsof
differentMedicalAssociations/Societies/Bodies.
8.03
Incasethepublishmentofremovalfromtheregisterisforalimitedperiod,theTamilNaduMedicalCouncil
mayalsodirectthatthenamewasorderedtoberemoved.
8.04
Decisiononcomplaintagainstdelinquentphysicianshallbetakenwithinatimelimitof6months.
8.05
DuringthependencyofthecomplainttheTamilNaduMedicalCouncilmayrestrainthephysicianfrom
performingtheprocedureorpracticewhichisunderscrutiny.
8.06
ProfessionalincompetenceshallbejudgedbypeergroupasperguidelinesprescribedbyTamilNaduMedical
Council/medicalCouncilofIndia.
Hippocratic oath
BRIEFNOTEONHIPPOCRATICOATH
ThisisattributedtotheGreekphysicianHippocrates(460BC377BC)whoisknownasthe"Fatherof
WesternMedicine".HippocrateswasbornandpracticedintheislandofKosinGreece.Hisnameis
synonymouswithethicsandhighproficiencyintheartofhealings.Hiswritingsweremainlyresponsiblefor
providingafirmscientificbasisformedicineandalsodistinguishingitfromphilosophyandreligion.Fromthe
writingsofHippocratesonelearnsthemedicinewasnotboundbysuperstitionbutbasedoncareful
observationandinference.Hippocratescametoberegardedastheidealphysicianinthe2ndcenturyA.D.
andeventodaypeopleallovertheworldspeakofthenoblequalitiesembodiedinthe"Hippocraticworld"
whichserveastheconscienceofthedoctorinhissacredhealingart.GreatpersonslikeHippocratesare
alwaysrememberedforthecontributionstheyhavemadetothebettermentofthehumanityInthiscontextthe
followingimmortalwordsofHippocratesringastruetodayastheydidwhichtheywereutteredcenturiesage.
"LifeisshortandtheArt(ofmedicine)longtheopportunityfleeting,experimentdangerousandjudgement
difficult".
HIPPOCRATICOATH
IsolemnlypledgemyselftoconsecratemylifetotheserviceofhumanityIwillgivetomyteacherstherespect
andgratitudewhichistheirdueIwillpracticemyprofessionwithconscienceanddignityThehealthofmy
patientwillbemyfirstconsiderationIwillrespectthesecretswhichareconfidedinmeIwillmaintainbyall
themeansinmypower,thehonourandthenobletraditionofthemedicalprofessionMycolleagueswillbemy
brothersIwillnotpermitconsiderationsofreligion,nationality,race,partypoliticsorsocialstandingto
intervenebetweenmydutyandmypatientIwillmaintaintheutmostrespectforhumanlife,fromthetimeof
conceptionevenunderthreat,IwillnotusemymedicalknowledgecontrarytothelawsofhumanityImake
thesepromisessolemnly,freelyanduponmyhonour.
ThisCentralActwasenactedtoregulatethegrantoftitlesimplyingqualificationinWesternMedicalScience
andtheassumptionandusebyunqualifiedpersonsofsuchtitles.TheaboveActwassubsequentlyamended
bytheTHeIndianMedicalDegrees(MAdrasAmendment)Act1940(MadrasActNo.XXof1940)inits
applicationtotheprovinceofMAdrasforcertainpurpose.
TheIndianMedicalCouncilAct1956
TheIndianMedicalCouncilAct1933extendstothewholeofIndia.ThisCentralActwaslaterrepealedbythe
IndianMedicalCouncilAct1956astoprovideforthereconstitutionofMedicalCouncilofIndia,the
maintenanceoftheIndianMedicalRegisterandformattersconnectedtherewith.TheaboveActwas
subsequentlyamendedin1958,1993and2001.
TheDrugsandCosmeticsAct1940
TheaimoftheActistoregulatetheimport,manufacture,distributionandsaleofdrugsandcosmetics.The
aboveCentralActwhichpartlyrelatestowomen'sHealthhadbeenamendedoneightoccasionsinkeeping
withthechangingcircumstances.Drugs:TheworldHealthOrganizationScientificGrouphasdefinedadrug
as"anysubstanceorproductthatisusedorintendedtobeusedtomodifyorexplorephysiologicalsystemsor
pathologicalsystemsorpathologicalstatesforthebenefitoftherecipient".Cosmetic:meansanyarticle
intendedtoberubbed,poured,sprinkledorsprayedon,orintroducedinto,orotherwiseappliedto,thehuman
bodyoranypartthereofforcleansing,beautifying,promotingattractiveness,oralteringtheappearance,and
includesanyarticlesintendedforuseasacomponentofcosmetic.
TheDrugsandMagicRemedies(Objectionable)AdvertisementAct,1954.
(DMRACT)
TheActprovidesforpreventionofadvertisementwhichmaybeexploitedbyunscrupulousandcommercially
orientedpersonnelforinducingpeopleforselfmedicationorfraudulentorexploitativeordangerousand
harmfulnature.Theundesirableaspectsofadvertisementsincludeattemptsatanyofthefollowing:
Procurementofmiscarriageinwomenorpreventionofconceptioninwomen.Correctionofmenstrualdisorder
inwomenMaintenanceorimprovementofthecapacityofhumanbeingsforsexualpleasure.Diagnosis,cure,
mitigation,treatmentorpreventionofanydisease,disorderorconditionspecifiedintheScheduleoftheDMR
Act.
The Schedule
PenalProvisionsagainstquacks
ThequackspracticingAllopathicmedicineareliabletobepunishedundertheprovisionsoftheIndianPenal
Code1860(IPC)andotherCentral/StateAct.I.P.C.Sections:419&420,(forcheatingthepatients).I.P.C.
Sections:338(InjectionsoflethalmedicineintoHumanBody)I.P.C.Sections:471(Possessingbogus(fake)
degrees).TheIndianMEdicalDegreesAct1956,(Sections15.2(b)and15(3).)TheIndianMedicalDegrees
Act,1916asamendedbytheIndianMedicalDegrees(MadrasAmendment)Act1940.(Section6A)The
DrugsandCosmeticsAct,1940[Section18(b)]TheDrugsandMagicRemedies(Objectionable)
AdvertisementAct.1954.
SupremeCourtJudgementonPracticeofotherSystemsofMedicine:
AnMBBSMedicalPractitionerregisteredwithTamilNaduMedicalCouncilisentitledtopracticeModern
AllopathicMedicineonlyieinthesysteminwhichhehasqualified,himselfaspertheApexCourtscaseLaw.
Dt.10thMay1996.SimilarlyaphysicianwhohasobtainedarecognizedqualificationinanyotherIndigenous
SystemofMedicineincludingHomeopathyisnotallowedtopracticeModernMedicineinanyform.
WhenaMedicalPractitioneriscalledtoappearasanexpertwitness:
AdoctormaybecalledtotestifyAsanordinarywitnesswhosawsomethinghappen.Asamedicalpractitioner
whotreatedthepatient&Asanexperttogivehisopiniononmatterofscience.Inthefirst2conditionsitishis
dutyandobligationtotestify.Inthelastconditionhemayrefusetherequest,ifhefeelsthatheisnot
sufficientlyqualifiedtotestify,withanyconvictioninthatparticularcaseorifhefeelsthathecannotsparetime
toprepareproperlyortotakelongappearanceinCourt.Amedicalwitnessshouldstrivetoachieverespect,
understandingandcredibilityinCourt.Hemustgivetheappearanceofbeinganindependentnonpartisan
scientist.Thedoctorshouldnotbecomepartisan.BrouardeltheFrenchmedicolegalauthoritywrote,"ifthe
lawhasmadeyou(thephysician)witness,remainamanofscienceyouhavenovictimtoavenge,noguilty
persontoconvictandnoinnocentpersontosave,youmustbeartestimonywithinthelimitsofscience.The
attitudeofascientificwitnessshouldbethesamewhetherheiscalledbytheprosecutionorbythedefence.
Thedoctorreallytestifiesneitherfor,noragainsttheprosecutionorbythedefence.Thedoctor'sexpertiseisin
theapplicationofsciencetoalegalcontroversyandtheproperinterpretationofscientificfindings.Hissole
obligationistopresentthetruthasheseesit,addingnothing,withholdingnothinganddistortingnothing.He
shouldnotconcernhimselfwiththepreviouscharacteroftheaccusedorwithotherevidenceinthecase.He
shouldnotbeinfluencedinanywaybyemotionalconsideration,suchassympathyorantipathy.Thedoctor
mustbehonest,forconfidenceisinspiredbyhonestyandsuccessdependsuponconfidence.
Nolegalimpedimentforamedicalprofessionaltoattendtoaninjured
personneedinghismedicalassistanceimmediatelysays:SupremeCourt
ofIndia:
Hon'bleSupremeCourtJudgesJusticeRanganathanMisraandJusticeG.L.Ozahavemadethefollowing
observationsintheirjudgementRef:AIR1989SC2039,inresponsetoaPILfiled.(TheSecretary,Ministry
ofHealthF&F.W.oftheUnionofIndia,theIMC,theIndianMedicalAssociationwereimpleadedas
respondents).
Thereisalsonodoubtthattheefforttosavethepersonshouldbethetopprioritynotonlyforthemedical
professionalbutevenofthepoliceoranyothercitizenwhohappenstobeconnectedwiththematterorwhat
happenstonoticesuchanincidentorasituation.
Butonbehalfofthemedicalprofessionthereisonemoreapprehensionwhichsometimespreventsamedical
professionalinspiteofhisdesiretohelptheperson,asheapprehendsthathewillbeawitnessandmayhave
tofacethepoliceinterrogationwhichsometimesmayneedgoingtothepolicestationrepeatedlyandwaiting
andalsotobeawitnessinacourtoflawwherealsoheapprehendsthathemayhavetogoonnumberof
daysandmayhavetowaitforalongtimeandmayhavetofacesometimeslongunnecessary
crossexaminationwhichsometimesmayevenbehumiliatingforamaninthemedicalprofessionandinour
opinionitisthisapprehensionwhichpreventsamedicalprofessionalwhoisnotentrustedwiththedutyof
handlingmedicolegalcasestodotheneedful,healwaystriestoavoidandevenifapproacheddirectsthe
personconcernedtogotoaStatehospitalandparticularlytothepersonwhoisinchargeofthemedicolegal
cases.
Wethereforehavenohesitationinassuringthepersonsinthemedicalprofessionthattheseapprehensions,
eveniftheyhavesomefoundation,shouldnotpreventthemfromdischargingtheirdutyasamedical
professionaltosaveahumanlifeandtodoallthatisnecessarybutatthesametimewehopeandtrustthat
withthisexpectationfromthemembersofthemedicalprofession,thepolice,themembersofthelegal
profession,ourlawcourtsandeveryoneconcernedwillalsokeepinmindthatamaninthemedicalprofession
shouldnotbeunnecessarilyharassedforpurposesofinterrogationorforanyotherformalitiesandshouldnot
bedraggedduringinvestigationsatthepolicestationanditshouldbeavoidedasfaraspossible.
Wealsohopeandtrustthatourlawcourtswillnotsummonamedicalprofessionaltogiveevidenceunlessthe
evidenceisnecessaryandevenifheissummoned,attemptshouldbemadetoseethatthemeninthis
professionarenotmadetowaitandwastetimeunnecessarilyanditisknownthatourlawcourtsalwayshave
respectforthemeninthemedicalprofessionandtheyarecalledtogiveevidencewhennecessaryand
attemptsaremadesothattheymayhavetowaitforlong.
Wehavenohesitationinsayingthatitisexpectedofthemembersofthelegalprofessionwhichistheother
honorableprofessiontohonourthepersonsinthemedicalprofessionandseethattheyarenotcalledtogive
evidencesolongasitisnotnecessary.
Itisalsoexpectedthatwherethefactsaresoclearitisexpectedthatunnecessaryharassmentofthe
membersofthemedicalprofessioneitherbywayofrequestforadjournmentsorbycrossexaminationshould
beavoidedsothattheapprehensionthatthemeninthemedicalprofessionhavewhichpreventsthemfrom
dischargingtheirdutytoasufferingpersonwhoneedstheirassistanceutmost,isremovedandacitizen
needingtheassistanceofamaninthemedicalprofessionreceivesit.wewouldalsoliketomentionthat
wheneveronsuchoccasionsamanofthemedicalprofessionisapproachedandifhefindsthatwhenever
assistancehecouldgiveisnotsufficientreallytosavethelifeofthepersonbutsomebetterassistanceis
necessaryitisalsothedutyofthemaninthemedicalprofessionsoapproachedtorenderallthehelpwhich
hecouldandalsoseethatthepersonreachestheproperexpertasearlyaspossible