Introduction:

There has been growing public concern regarding the ethical conduct of Healthcare professionals which is often
reflected as Complaints about ethical conduct and an increasing use of litigation against health care practitioners. Although
ethics as applied to medical practice date back to the ancient civilization by the symbolic adherence to the Hippocratic oath,
codes of conduct and laws regulating the professions are devised and updated from time to time. These codes have been
included in the health professionals training curriculum in many countries and there has been a growth in the number of
ethicists and ethical committees.
Defintion of Ethical Committee:
An Ethical Committee is a group of persons comprising health care professionals and nonmembers who are
officially responsible for promoting ethical practices and code of ethics, protects the dignity, rights, safety and well-being of
trial subjects and particular care to protect vulnerable participant.
It is advisory and takes decisions regarding ethics and resolves ethical issues and dilemmas in practice,
administration, education and research.
Ethical Committees in India:
 Indian Council for Medical Research(ICMR) initiated formulation of the EC in India and prepared its first official
guidelines to form an ethics committee in February 1980 for conducting research that provided membership criteria and
standards for an ethical standard for review.
 ICMR issued guidelines for bioethics for research in medical, epidemiology and public health in the year 2002 and
revises in the year 2006.
 It is mandatory to get approval for any biomedical research on human participants by the Institutional Ethical
Committee(IEC)/Institutional review board (IRB) before its initiation.
 Therefore each institution should have its ethics committee under Amendment 2005 of the drugs and cosmetics Act,1940.
 ICMR developed guidelines for preparing standard operating procedures (SOPs) for Institutional Ethics Committee (IEC)
for Human Research in collaboration with the Forum for Ethics Review Committees of Asia Pacific (FERCAP).
 The Forum for Ethics Committee Review in India (FERC) has been set up under FERCAP.
 Ethics committees are concerned with derious adverse events reporting and compensation in cases of deaths occurs during
clinical trial and care of participants injured during research.
Some EC/IRB around the World
 Research Ethics Committee (REC) in the United Kingdom
 Medical Research Ethics Committee (MREC) in the Netherlands
 Comités de Protection des Personnes (CPP) in France
 Institutional Review Board in United States
 Research Ethics Board (REB) in Canada
 Human Research ethics committee (HREC) in Australia
Functions of Ethics Committee:
 Research:
 Validates research proposal from the technical, scientific, statistics and ethical point of view.
 Examines adherence of principles of research ethics.
 Reviews informed consent process
 Examines risk-benefit ratio, distribution of burden and benefits and provision of appropriate compensation.
 Examines compliance with all regulating requirements, applicable guidelines and laws.
 Decides to solve actual or anticipated ethical dilemmas in research.
 Quality of Care:
 Evaluates the quality of care with respect to ethical principles and rights of patients in various areas.
 Some of areas of care include the art of bedside care, relief of suffering, cure of disease, incidence, trend over time of
iatrogenic disease cost to patient in terms of tests, drugs, other costs, prompt attention to the needs of the patient and care of
the seriously ill, dying and dead patients.
 Education:
 Plans and conduct in-service training programs, seminars/workshops/mini-conferences on various topics related to
biomedical ethics, ethical principles, rights of patients, code of ethics and quality research.
 Other roles of the ethics committee:
 Policy development
 Providing consultation in cases of ethical dilemma and resolving ethical conflicts.
 Preparing guidelines, manual on bioethics, principles of ethics, code of ethics, a method of dealing with ethical dilemmas
etc. for staff.
 Preparing guidelines to patients, families regarding their rights, responsibilities, means of seeking redress for any harm.
 Disclosure of diagnosis
 Diagnosis of brain death
 Requesting permission to harvest organs for transplantation.
 Informed consent process.
Composition:
 The committee should be multidisciplinary.
 The hospital EC must ensure representatives from the administrators, clinicians, social worker, priest/philosopher,lawyer,
rehabilitation personnel, a layperson from the community and statistician.
 Each department should also constitute a departmental EC to deal with its respective ethical issues.The size of EC vary
according to the size of the institution and function of ECs.
 According to guidelines for preparing SOPs for IEC for Human research by ICMR, the committee should have 7 to 9
members and maximum 12-15.
 The minimum 5 members are required to compose a quorum.
 The IEC for research should comprise the following members:
 Chairperson ,preferably be from outside the institution.
 Basic medical Scientists - 1 or 2
 Clinicians from various institutes - 1 or 2
Duration:
The committee is constituted by the Head of Institution initially for 2 - 3 years.
Meeting Procedure:
 Committee meetings held on scheduled intervals as prescribed and also as and when required.
 The chairperson chairs the session and member secretary is the convener.
 Convener organizes meetings, maintains records, writes and prepares minutes of the meetings and get it approved by the
chairman and communicates to all concerned.
CODE OF ETHICS
Introduction:
The code is a collection of laws or a system of rules and regulations. A code adopted by profession is to regulate the
profession and to promote high standard of competence among its members.
Code of ethics is a formal statement of an organization’s values on certain ethical and social issues derived from the
dignity and rights of the patient as a person.Within any given profession, a code of ethics serves as a means of self regulation and
a source of guidelines for individual behaviour and responsibility.
Definition of Code of Ethics:
A code of ethics is a set of ethical principle that
A} is shared by members of a group
B} reflects their moral judgments over time
C} serves as a standard for their professional actions.
-Barbara Kozier
Purposes of Code of Ethics:
 It directs nurses to take ethical decisions in day-to-day situations.
 Means for self evaluation.
 Provides a framework for peer review initiatives.
 Educate nurses about their ethical responsibilities.
 Conveys the commitment of nurses to health care professionals and public towards service.
Code of ethics for Nurses by ICN
The ICN code of Ethics for Nurses most recently revised in the year 2012 is a guide for action based on social values and needs.
The code has served as the standard for nurses worldwide since it was first adopted in the year 1953.The code makes it clear that
inherent in nursing is respect for human rights including the right to life, to dignity and to be treated with respect.
ICN Code:
The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct. Elements of the code
are:
 Nurses and People
 The nurse’s primary professional responsibility is towards people requiring nursing care.
 In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the
individual, family and community are respected.
 The nurse ensures that the individual receives sufficient information on which to base consent for care and related treatment.
 The nurse holds in confidence personal information and uses judgement in sharing this information.
 The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of
public in particular those of vulnerable populations.
 Nurses and Practice
 The nurse carries personal responsibility and accountability for nursing practice and for maintaining competence by
continual learning.
 The nurse uses judgement regarding individual competence when accepting and delegating responsibility.
 The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance public
confidence.
 The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity
and rights of people.
 Nurse and the Profession
 The nurse assumes major role in determining and implementing acceptable standard of clinical nursing practice,
management, research and education.
 The nurse is active in developing a core of research-based professional knowledge.
 The nurse, acting through the professional organization, participates in creating and maintaining safe,equitable social and
economic working condition in nursing.
 Nurses and Co-Worker
 The nurse sustains a co-operative relationship with co-workers in nursing and other fields.
 The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a
coworker or any other person.
Code of Ethics for Nurses in India (INC)
1. The nurse respects the uniqueness of Individual in provision of care.
Nurse:
 Provides care for individual without consideration of caste, creed, religion, culture, ethnicity, gender, socio-economics and
political status, personal attributes or any other grounds.
 Individualizes the care considering the beliefs, values and cultural sensitivities.
 Appreciates the place of individual in the family and community and facilitates participation of significant others in the care.
 Develops and promotes trustful relationship with Individual.
 Recognizes uniqueness of response of individual to interventions and adapts accordingly.
2. The nurse respects the rights of individuals as partner in care and help in making informed choices.
Nurse:
 Appreciates individuals right to make decisions about their care and therefore gives adequate and accurate information for
enabling them to make informed choices
 Respects the decisions made by individual regarding their care.
 Protects public from misinformation and misinterpretations.
 Advocates special provisions to protect vulnerable individuals/groups.
3. The nurse respects individual’s right to privacy, maintains confidentiality and shares information judiciously.
Nurse:
 Respects the individual’s right to privacy of their personal information.
 Maintains confidentiality of privileged information except in life threatening situations and uses discretion in sharing
information.
 Takes informed consent and maintains anonymity when information is required for quality assurance/academic/legal
reasons.
 Limits the access to all personal records written and computerized to authorized persons only.
4. Nurse maintains competence in order to render quality nursing care.
Nurse:
 Nursing care must be provided only by registered nurse.
 Nurse strives to maintain quality nursing care and upholds the standard of care.
 Nurse values continuing education, initiates and utilizes all opportunities for self development.
 Nurse values research as a means of development of nursing profession and participates in nursing research adhering to
ethical principles.
5. The nurse is obliged to practice within the framework of ethical, professional and legal boundaries.
Nurse:
 Adheres to code of ethics and code of professional conduct for nurses in India developed by Indian Nursing Council.
 Familiarizes with relevant laws and practices in accordance with the law of the state.
6. Nurse is obliged to work harmoniously with members of the health team.
Nurse:
 Appreciates the team efforts in rendering care.
 Cooperates,coordinates and collaborates with members of the health team to meet the needs of people.
7. Nurse commits to reciprocate the trust invested in nursing profession by society.
Nurse:
 Demonstrates personal etiquettes in all dealings.
 Demonstrates professional attributes in all dealings.
CODE OF PROFESSIONAL CONDUCT IN VARIOUS ASPECTS IN NURSING
A. Professional responsibility and accountability
Nurse:
 Appreciates sense of self worth and nurtures it.
 Maintains standards of personal conduct reflecting credit upon the profession.
 Carries out responsibilities within the framework of the professional boundaries.
 Is accountable for maintaining practice standards set by INC.
 Is accountable for own decisions and actions.
 Is compassionate
 Is responsible for continuous improvement of current practices.
 Provides adequate information to individuals that allows them informed choices.
 Practices healthful behavior.
B. Nursing Practice
Nurse:
 Provides care in accordance with set standards of practice.
 Treats all individuals and families with human dignity in providing physical, psychological, emotional, social and spiritual
aspects of care.
 Ensures safe practice.
 Consults, co-ordinates, collaborate and follows up appropriately when individual care needs exceed the nurse’s competence.
C. Communication and Interpersonal relationships
Nurse:
 Establishes and maintains effective interpersonal relationships with individuals, families and communities.
 Upholds the dignity of team members and maintains effective interpersonal relationship with them.
 Appreciates and nurtures professional role of team members.
 Co-operates with other health professional to met the needs of individuals, families and communities.
D. Valuing Human being
Nurse:
 Takes appropriate action to protect individuals from harmful unethical practice.
 Considers relevant facts while taking conscience decisions in the best interest of individuals.
 Encourages and support individuals in their right to speak for themselves on issues affecting their health and welfare.
 Respects and supports choices made by individuals.
E. Management
 Ensures appropriate allocation and utilization of available resources.
 Participates in supervision and education of students and other formal care providers.
 Uses judgement in relation to individual competence while accepting and delegating responsibility.
 Facilities conducive work culture in order to achieve institutional objectives.
 Communicates effectively following appropriate channels of communication.
 Participates in performance appraisal.
 Participates in evaluation of nursing service.
 Participates in policy decisions, following the principle of equity and accessibility of services.
 Works with individuals to identify their needs and sensitizes policy makers and funding agencies for resource allocation.
F. Professional Advancement
Nurse:
 Ensures the protection of human rights while pursuing the advancement of knowledge.
 Contributes to development of nursing practice.
 Participates in determining and implementing quality care.
 Take responsibility for updating own knowledge by conducting and participating in research.
Conclusion:
Since nurses address complex ethical and human rights issues on a regular basis, the American Board of Directors
and the congress on Nursing practice first initiated the code of ethics for nurses in the year 1985 to delineate the code of
responsibilities and conduct expected from nurses in their practices. Advancement in the globalization, modernization and
technology has an impact in nursing. Increased complexity in the professional role and awareness among the clients for their
rights required nurses to pay attention to understand and follow strictly ethical responsibilities about their jobs and clients.