With commentaries as adopted by the Council of the College of Physicians and Surgeons of New Brunswick
- Consider first the well-being of the patient.
The physician should consider the well-being of other patients, of society and of colleagues, as well as his/her own well-being, but that of the patient being treated at the time must be the physician's primary concern.
- Practise the profession of medicine in a manner that treats the patient with dignity and as a person worthy of respect.
Respect for persons is a fundamental principle of medical ethics; it excludes not only exploitation and discrimination but also discourteous and insensitive behaviour.
- Provide for appropriate care for your patient, even when cure is no longer possible, including physical comfort and spiritual and psychosocial support.
The physician should try to ensure that all the patient's needs will be met.
- Consider the well-being of society in matters affecting health.
- Practise the art and science of medicine competently, with integrity and without impairment.
- Engage in life-long learning to maintain and improve your professional knowledge, skills and attitudes.
Continuous learning is necessary to maintain one's competence. Attitudes are central to the patient-physician relationship, as stated in article 2.
- Resist any influence or interference that could undermine your professional integrity.
- Contribute to the development of the medical profession, whether through clinical practice, research, teaching, administration or advocating on behalf of the profession or the public.
- Refuse to participate in or support practices that violate basic human rights.
Others may include non-physicians as well as physician colleagues.
- Promote and maintain your own health and well-being.
Responsibilities to the patient
- Recognize and disclose conflicts of interest that arise in the course of your professional duties and activities, and resolve them in the best interest of patients.
- Inform your patient when your personal values would influence the recommendation or practice of any medical procedure that the patient needs or wants.
If the denial or delay of treatment has the potential to cause harm, the physician is obligated to expedite access to another physician if possible. In any case, the physician cannot obstruct such access.
- Do not exploit patients for personal advantage.
- Take all reasonable steps to prevent harm to patients; should harm occur, disclose it to the patient.
- Recognize your limitations and, when indicated, recommend or seek additional opinions and services.
Others may include non-physicians as well as physician colleagues.
- In determining professional fees to patients for non-insured services, consider both the nature of the service provided and the ability of the patient to pay, and be prepared to discuss the fee with the patient.
Initiating and Dissolving a Patient-Physician Relationship
- Accept the patient without discrimination (such as on the basis of age, disability, gender identity or expression, genetic characteristics, language, marital and family status, medical condition, national or ethnic origin, political affiliation, race, religion, sex, sexual orientation or socioeconomic status).
The categories of discrimination are not closed. It is also improper to deny access to the other "classes" of patients. Examples might include current and former patients of a particular physician or physicians, or a class based on some other factor such as place of residence. Similarly, the right to deny access may be limited according to availability of alternate care.
- Provide whatever appropriate assistance you can to any person with an urgent need for medical care.
- Having accepted professional responsibility for a patient, continue to provide services until they are no longer required or wanted; until another suitable physician has assumed responsibility for the patient; or until the patient has been given reasonable notice that you intend to terminate the relationship.
Termination of care cannot occur for an improper purpose such as noted elsewhere in the Code.
"Adequate notice" will depend on the circumstances, particularly where necessary alternative care is not readily available.
- Limit treatment of yourself, or anyone with whom you have a personal close relationship, to minor or emergency interventions and only when another physician is not readily available; there should be no fee for such treatment.
There is a potential conflict between the roles of physician and family member when the patient is another family member. The definition of 'immediate family' will depend on the circumstances. Besides spouses, it generally includes parents, siblings, and children, but may include others depending on the potential for conflict.
Communication, Decision Making and Consent
- Provide your patients with the information they need to make informed decisions about their medical care, and answer their questions to the best of your ability.
The physician is obligated, as part of the process of informed consent, to provide the patient with whatever information will, from the patient's perspective, have a bearing on his/her medical care decision-making.
- Make every reasonable effort to communicate with your patients in such a way that information exchanged is understood.
Informed consent requires good communication.
- Recommend only those diagnostic and therapeutic services that you consider to be beneficial to your patient or to others. If a service is recommended for the benefit of others, as for example in matters of public health, inform your patient of this fact and proceed only with explicit informed consent or where required by law.
Physicians have a duty to promote public health and to protect society, even when the procedures in question may not be intended for the direct benefit of the individual patient (e.g. certain vaccinations or diagnostic procedures such as serologic typing of some viral infections for the purpose of public health surveillance). Such procedures still require informed consent, unless required by law.
- Respect the right of a competent patient to accept or reject any medical care recommended.
- Recognize the need to balance the developing competency of minors and the role of families in medical decision-making. Respect the autonomy of those minors who are authorized to consent to treatment.
Physicians should be mindful of the Medical Consent of Minors Act. Patients aged sixteen and older have the full rights of adults for all aspects of their medical care, including consent and refusal of treatment and confidentiality. Those under sixteen have similar rights if they are considered competent to consent by a physician and the treatment is in their best interest.
- Respect your patient's reasonable request for a second opinion from a physician of the patient's choice.
"Reasonable" will be determined on the basis of whether the requested opinion has the likelihood of contributing to the patient's well-being.
- Ascertain wherever possible and recognize your patient s wishes about the initiation, continuation or cessation of life-sustaining treatment.
Good patient-physician communication is especially important with regard to life-sustaining treatment such as CPR, which some patients may want to forego under certain circumstances.
- Respect the intentions of an incompetent patient as they were expressed (e.g., through a valid advance directive or proxy designation) before the patient became incompetent.
'Respect' does not necessarily mean 'fulfill to the letter', but physicians should be mindful of the effect of a prestated refusal of any particular form of treatment. Where possible, physicians should also confirm the legal status of any consent provided by an individual other than the patient.
- When the intentions of an incompetent patient are unknown and when no formal mechanism for making treatment decisions is in place, render such treatment as you believe to be in accordance with the patient's values or, if these are unknown, the patient's best interests.
The patient's own values take priority over the physician's opinion of what is the patient's best interests.
- Be considerate of the patient's family and significant others and cooperate with them in the patient's interest.
Privacy and Confidentiality
- Protect the Personal Health Information of your patients.
- Inform your patients about the reasons for the collection, use and disclosure of their Personal Health Information.
- Be aware of your patient's rights with respect to the collection, use, disclosure and access to their Personal Health Information; ensure that such information is recorded accurately.
- Avoid public discussions or comments about patients that could reasonably be seen as revealing confidential or identifying information.
- Disclose your patients' Personal Health Information to third parties only with their consent, or as provided for by law, such as when the maintenance of confidentiality would result in a significant risk of substantial harm to others or, in the case of incompetent patients, to the patients themselves. In such cases take all reasonable steps to inform the patients that the usual requirements for confidentiality will be breached.
- When acting on behalf of a third party, take reasonable steps to ensure that the patient understands the nature and extent of your responsibility to the third party.
This responsibility will include the right of a third party to a report of the assessment. The patient also has a right to such information.
- Upon a patient's request, provide the patient or a third party with a copy of his or her medical record, unless there is a compelling reason to believe that information contained in the record will result in substantial harm to the patient or others.
Patients have an ethical, as well as a legal, right to this information, and physicians have both an ethical and legal responsibility to provide it. "Medical record" also includes reports prepared at the request of third parties, notwithstanding any objections by the third party to the release of information to the patient. Physicians are also obligated to provide information, whether in the form of a report or completed form, if the patient requires same in order to obtain a benefit. These obligations may continue after the physician-patient relationship has ended.
- Ensure that any research in which you participate is evaluated both scientifically and ethically and is approved by a research ethics board that meets current standards of practice.
This applies to community-based physicians considering participation in drug marketing studies no less than primary investigators in basic clinical research projects.
- Inform the potential research subject, or proxy, about the purpose of the study, its source of funding, the nature and relative probability of harms and benefits, and the nature of your participation including any compensation.
- Before proceeding with the study, obtain the informed consent of the subject, or proxy, and advise prospective subjects that they have the right to decline or withdraw from the study at any time, without prejudice to their ongoing care.
Responsibilities to Society
- Recognize that community, society and the environment are important factors in the health of individual patients.
Because the health of patients is influenced by their life setting, physicians have a general responsibility to work towards the improvement of social and environmental factors in health.
- Recognize the profession's responsibility to society in matters relating to public health, health education, environmental protection, legislation affecting the health or well-being of the community and the need for testimony at judicial proceedings.
- Recognize the responsibility of physicians to promote equitable access to health care resources.
- Use health care resources prudently.
Physicians have a responsibility to use resources efficiently and effectively subject to other legal and ethical obligations.
- Recognize a responsibility to give generally held opinions of the profession when interpreting scientific knowledge to the public; when presenting an opinion that is contrary to the generally held opinion of the profession, so indicate.
The public needs to be protected against medically irresponsible opinions.
Responsibilities to the Profession
- Recognize that the self-regulation of the profession is a privilege and that each physician has a continuing responsibility to merit this privilege and to support its institutions.
Physicians support self-regulation when they acknowledge its role in public protection and fully assist in that process. "Support" also includes respecting the authority and guidance of the College.
- Be willing to teach and learn from medical students, residents, other colleagues and other health professionals.
This is a general responsibility of the profession. The extent of such teaching by any individual will depend on the physician's judgement of his/her availability and suitability for the task. All physicians should be prepared to teach informally, by example, other health care workers involved in the care of their patients, but not all physicians are expected to be involved with formal teaching programs.
- Avoid impugning the reputation of colleagues for personal motives; however, report to the appropriate authority any unprofessional conduct by colleagues.
- Be willing to participate in peer review of other physicians and to undergo review by your peers. Enter into associations, contracts and agreements only if you can maintain your professional integrity and safeguard the interests of your patients.
Peer review is an essential element of self-regulation as well as a learning opportunity for both reviewers and those being reviewed.
- Avoid promoting, as a member of the medical profession, any service (except your own) or product for personal gain.
- Do not keep secret from colleagues the diagnostic or therapeutic agents and procedures that you employ.
- Collaborate with other physicians and health professionals in the care of patients and the functioning and improvement of health services. Treat your colleagues with dignity and as persons worthy of respect.
Responsibilities to Oneself
- Seek help from colleagues and appropriately qualified professionals for personal problems that might adversely affect your service to patients, society or the profession.
Physicians are reminded that they may need help with their own personal problems if they are to serve their patients adequately.
- Protect and enhance your own health and well-being by identifying those stress factors in your professional and personal lives that can be managed by developing and practising appropriate coping strategies.
Adopted 11/96; amended 9/01, 10/04, 11/21