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  1. 1. Forms of professional relationship:• 1. Between student and teacher. 2. Between doctors (including specialists) in the same discipline. 3. Between general practitioner (GP) and consultant. 4. Between two doctors in differing specialities. 5. Between the doctor and his doctor-patient.
  2. 2. Principles governing the relationship between doctors: the International Code of Ethics (3) states the following: .1 .2
  3. 3. Student and teacher:  
  4. 4. The doctor- doctorrelationship:professional criticism
  5. 5. Professional criticism  
  6. 6. Professionalcriticism 
  7. 7. When your patient sees another doctor duringan emergency, or because you are otherwisenot available, do not criticise the otherprofessional’s decisions. Be thankful to thedoctor for having taken care of your case inyour absence.
  8. 8. When you see negligence ?
  9. 9.
  10. 10. The Declaration of Geneva(World Medical Association, 1948
  11. 11. 1. I solemnly pledge to consecrate my life to the service of humanity. •2. I will give to my teachers the respect and gratitude which is their due. •3. I will practice my profession with conscience and dignity. •
  12. 12. 5. I will respect the secrets which are confided in me, even after the patient has died. •6. I will maintain by all means in my power, the honor and the noble traditions of the medical profession. •7. My colleagues will be my brothers •
  13. 13. 8. I will not permit considerations of religion, nationality, race, party politics, or social standing to intervene between my duty and my patient.9. I will maintain the utmost respect for human life from its beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity . •10. I make these promises solemnly, freely, and upon my honour.
  14. 14. International Code of MedicalEthics(World Medical Association, 1949, 1968, 1983)
  15. 15. :General Duties of Physicians in 1.A physician shall always maintain the highest standards of professional conduct. 2.A physician shall not permit motives of profit to influence the free and independent exercise of professional judgement on behalf of all patients. 
  16. 16. :General Duties of Physicians in 3. A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception. 
  17. 17. 5.The following practices are deemed to beunethical conduct: a) Self advertising by physicians, unless permitted by the laws of the country and the Code of Ethics of the National Medical Association.
  18. 18. b) Paying or receiving any fee or any other consideration solely to procure the referral of a patient or for prescribing or referring a patient to any source. 
  19. 19. 6. A physician shall respect the rights of patients, of colleagues, and of other health professionals, and shall safeguard patient confidences. 7. A physician shall act only in the patients interest when providing medical care which might have the effect of weakening the physical and medical condition of the patient.
  20. 20. 8. A physician shall use great caution in divulging discoveries or new techniques or treatment through non-professional channels. 9. A physician shall certify only that which he has personally verified. 
  21. 21. Regulations in Time of Armed Conflict Medical ethics in time of armed conflict are identical to medical ethics in time of peace . The primary task of the medical profession is to preserve health and save life. Hence it deemed unethical for physicians to: o Give advice or perform prophylactic, diagnostic, or therapeutic procedures that are not justifiable in the patients interest. o Weaken the physical or mental strength of a human being without therapeutic justification. o Employ scientific knowledge to imperil health or destroy life.
  22. 22. Rights of those in need of care A patient/prisoner has the right to refuse to eator to refuse treatments. The nurse may need toverify that the patient/prisoner understands theimplications of such action but she should notparticipate in the administration of food ormedications to such patients.
  23. 23. Rights and duties of nursesIt is a duty to have informed consent of patientsrelative to having research done on them andin receiving treatments such as bloodtransfusions, anesthesia, grafts, etc. Suchinformed consent is a patients right and mustbe ensured.
  24. 24. AMA Principles of Medical Ethics 2001
  25. 25. I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. 
  26. 26. II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities. 
  27. 27. III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient. 
  28. 28. IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law. V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education,
  29. 29. VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.IX. A physician shall support access to medical care for all people.
  31. 31. I. The Physician-Patient RelationshipA. Both the patient and the orthopaedic surgeon are free to enter or discontinue the relationship within any existing constraints of a contract with a third party. • An orthopaedic surgeon has an obligation to render care only for those conditions that he or she is competent to treat. • The orthopaedist shall not decline to accept patients solely on the basis of race, color, gender, sexual orientation, religion, or national origin or on any basis that would constitute illegal discrimination.
  32. 32. B. The orthopaedic surgeon may choose whom he or she will serve. • An orthopaedic surgeon should render services to the best of his or her ability. • Unless discharged by the patient, the orthopaedic surgeon may discontinue service only after giving adequate notice to the patient so that the patient can secure alternative care.
  33. 33. C. When obtaining informed consent for treatment, the orthopaedic surgeon is obligated to present to the patient or to the person responsible for the patient, in understandable terms, pertinent medical facts and recommendations consistent with good medical practice. Such information should include alternative modes of treatment, the objectives, risk and possible complications of such treatment, and the complications and consequences of no treatment.
  34. 34. II. Conflicts of Interest :a) When a conflict of interest arises, it must be resolved in the best interest of the patient , If the conflict of interest cannot be resolved, the orthopaedic surgeon should notify the patient of his or her intention to withdraw from the relationship.b) If the orthopaedic surgeon has a financial or ownership interest in a durable medical goods provider, imaging center, surgery center or other health care facility where the orthopaedic surgeons financial interest is not immediately obvious, the orthopaedic surgeon must disclose this interest to the patient.
  35. 35. C. It is unethical for an orthopaedic surgeon to receive compensation of any kind from industry for using a particular device or medication. 
  36. 36. VII. General Principles of Care A. An orthopaedic surgeon should practice only within the scope of his or her personal education, training, and experience. B. The orthopaedic surgeon should not perform a surgical operation under circumstances in which the responsibility for diagnosis or care of the patient is delegated to another who is not qualified to undertake it.
  37. 37. Doctors, drugs and ethics
  38. 38. GIFTS The gift is only of nominal value. The gift is not in cash. The gift, even one of nominal value, is not connected to any stipulation that the physician prescribes a certain medication, uses certain instruments or materials or refers patients to a certain facility. Gifts should be accepted only if decision- making is left manifestly unimpaired.
  39. 39.  Support for travel to conferences organised by professional societies should be restricted to people making formal contributions. Entertainment expenses should not be lavish.
  40. 40.  Access of representatives to students and health services should be limited. Sources of commercial funding should not influence the scientific, educational or public policy decisions of professional bodies, which should not associate themselves directly or indirectly with promotion of products of commercial sponsors.
  41. 41. In conference, The name of acommercial entity providing financialsupport is publicly disclosed in order toallow the medical community and thepublic to assess the information presentedin light of the source of funding.
  42. 42. A conference can be recognised for purposes ofcontinuing medical education/ continuingprofessional development (CME/CPD) only if itconforms to the following principles:1.The commercial entities acting as sponsors, such as pharmaceutical companies, have no influence on the content, presentation, choice of lecturers, or publication of results.2. Funding for the conference is accepted only as a contribution to the general costs of the meeting.