INTERNATIONAL CODE OF
MEDICAL ETHICS, CEA& CPA
– By
V. MANASA
INTERNATIONAL CODE OF MEDICAL ETHICS
Medical Ethics: Medical ethics refers to the system of values common to medical profession and
application of these values to practice of medicine.
● It is the standard of behaviour by which physician evaluates their relationship with
their patients, colleagues and society.
⮚ The International Code of Medical Ethics was established by the World Medical
Association (WMA) in 1949. It serves as a guiding document for physicians worldwide,
outlining ethical principles for the medical profession.
The International Code of Medical Ethics provides guidelines for ethical conduct in the
medical field, emphasizing respect for patients, confidentiality, competence and
professional behaviour. It helps guide physicians globally in their practice while
prioritizing the well-being and rights of patients.
It was Adopted by the 3rd General Assembly of the World Medical Association,
London, England, October 1949 and amended by the 22nd World Medical Assembly,
Sydney, Australia, August 1968, the 35th World Medical Assembly, Venice, Italy, October
1983 and the WMA General Assembly, Pilanesberg, South Africa, October 2006.
The International Code of Medical Ethics serves as a foundational document that sets forth
the ethical principles and standards guiding medical professional in their practice
worldwide. This code outlines fundamental principles that physicians should uphold when
caring for patients, interacting with colleagues and contributing to the medical profession.
Ethical Principles in the International Code of Medical Ethics:
❖ Respect for Human Life:
● The code emphasizes the utmost respect for human life from conception to its
natural end. It highlights the duty of physicians to safeguard and promote the health
and well-being of patients.
❖ Patient Autonomy:
● Respecting a patient’s autonomy involves acknowledging their right to make
informed decisions about their medical care. Physicians must provide adequate
information, ensure comprehension and respect patients’ choices.
❖ Confidentiality:
● Protecting patients’ confidentiality is crucial. Physicians are expected to maintain
confidentiality concerning patient information, barring situations where the law
requires disclosure or when necessary for patient care.
❖ Professional Competence:
● Physicians are obligated to continually enhance their professional knowledge and
skills, maintaining a high level of competence. This involves staying updated with
advancements in medical science and technology.
❖ Honesty and Integrity:
● Physicians are expected to uphold honesty and integrity in all their professional
interactions. This encompasses truthful communication with patients, colleagues
and the public.
❖ Ethical relationships:
● The code emphasizes maintaining ethical relationships with patients, colleagues
and society. It discourages any behaviour that might exploit patients, undermine
trust or compromise professional integrity.
❖ Responsibility to society:
● Physicians have a responsibility not only to individual patients but also to the
broader society. They should contribute to public health, promote access to
healthcare and address societal health issues.
❖ Responsibility to Colleagues:
● The code underscores the importance of collegiality, mutual respect and support
among medical professionals. Collaboration and sharing knowledge benefit both
patients and the medical community.
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Significance and Application:
⮚ The International Code of Medical Ethics is not legally binding but serves as a
moral compass, guiding physicians globally. It aids in fostering trust between
patients and healthcare providers, ensuring the provision of high-quality care while
maintaining ethical standards.
⮚ In presentations or discussions, it is crucial to highlight the universality of these
principles and their role in shaping medical practice. Emphasize the evolving nature
of medical ethics in response to societal changes, technological advancements and
diverse cultural contexts.
⮚ Additionally, showcasing real-life case studies or examples where adherence to
these principles positively impacted patient care can illustrate their practical
significance.
⮚ Always remember, the code is a dynamic document, subject to review and updates
by the WMA to address emerging ethical dilemmas in medicine.
THE WMA INTERNATIONAL CODE OF MEDICAL ETHICS
Duties of physicians in general:
✔ A physician shall always exercise his/her independent professional judgement and
maintain the highest and maintain the highest standards of professional conduct.
✔ A physician shall respect a competent patient’s right to accept or refuse treatment.
✔ A physician shall not allow his/her judgement to be influenced by personal profit
or unfair discrimination.
✔ A physician shall be dedicated to providing competent medical service in full
professional and moral independence, with compassion and respect for human
dignity.
✔ A physician shall deal honestly with patients and colleagues and report to the
appropriate authorities those physicians who practice unethically or incompetently
or who engage in fraud or deception.
✔ A physician shall not receive any financial benefits or other incentives solely for
referring patients or prescribing specific products.
✔ A physician shall respect the rights and preferences of patients, colleagues and
other health professionals.
✔ A physician shall recognize his/her important role in educating the public but
should use due caution in divulging discoveries or new techniques or treatment
through non-professional channels.
✔ A PHYSICIAN SHALL certify only that which he/she has personally verified.
✔ A PHYSICIAN SHALL strive to use health care resources in the best way to
benefit patients and their community.
✔ A PHYSICIAN SHALL seek appropriate care and attention if he/she suffers from
mental or physical illness.
✔ A PHYSICIAN SHALL respect the local and national codes of ethics.
DUTIES OF PHYSICIANS TO PATIENTS
● A PHYSICIAN SHALL always bear in mind the obligation to respect human life.
● A PHYSICIAN SHALL act in the patient’s best interest when providing medical
care.
● A PHYSICIAN SHALL owe his/her patients complete loyalty and all the scientific
resources available to him/her. Whenever an examination or treatment is beyond
the physician’s capacity, he/she should consult with or refer to another physician
who has the necessary ability.
● A PHYSICIAN SHALL respect a patient’s right to confidentiality. It is ethical to
disclose confidential information when the patient consents to it or when there is a
real and imminent threat of harm to the patient or to others and this threat can be
only removed by a breach of confidentiality.
● A PHYSICIAN SHALL give emergency care as a humanitarian duty unless he/she
is assured that others are willing and able to give such care.
● A PHYSICIAN SHALL, in situations when he/she is acting for a third party, ensure
that the patient has full knowledge of that situation.
● A PHYSICIAN SHALL not enter into a sexual relationship with his/her current
patient or into any other abusive or exploitative relationship.
DUTIES OF PHYSICIANS TO COLLEAGUES
⮚ A PHYSICIAN SHALL behave towards colleagues as he/she would have them behave
towards him/her.
⮚ A PHYSICIAN SHALL NOT undermine the patient-physician relationship of colleagues
in order to attract patients.
⮚ A PHYSICIAN SHALL, when medically necessary, communicate with colleagues who
are involved in the care of the same patient. This communication should respect patient
confidentiality and be confined to necessary information.
CHARAKA SAMHITA
- recorded in 600 BC
- code of conduct for the would be physician
SUSRUTA SAMHITA
- guidelines for surgeon and surgical procedures.
HIPPOCRATIC OATH
- written in 400 BC by Hippocrates, father of medicine.
- based on Greek tradition
ROLE IN FORENSIC MEDICINE
The International Code of Medical Ethics plays a crucial role in forensic medicine by providing
ethical guidelines for physicians involved in legal and forensic contexts. In these situations, the
code helps ensure that medical professionals adhere to ethical standards while providing expert
opinions, examining evidence, and presenting findings in legal proceedings.
For instance, the code emphasizes the importance of professional competence and integrity, which
is particularly relevant when forensic physicians testify or provide expert opinions in legal cases.
It also underscores the duty to maintain patient confidentiality, even in forensic contexts, unless
legally required to disclose information.
Additionally, the principles of respecting human dignity and the responsibility to the patient help
guide forensic practitioners in conducting examinations and providing unbiased and accurate
medical assessments while upholding the rights of individuals involved in legal proceedings.
CEA (THE CLINICAL ESTABLISHMENTS ACT)
The Clinical Establishments Act is a legislative framework implemented in India to regulate the
functioning and standards of clinical establishments, aiming to ensure quality healthcare services
across the country. Enacted to improve healthcare infrastructure and services, the act primarily
focuses on standardizing medical facilities, ensuring patient safety, and enhancing accountability
within clinical establishments.
This act was initiated in 2010 with the aim of standardizing healthcare services across India.
The amendments to this act were proposed in 2012 but implementation varied across states. It
sought to regulate the quality of care, infrastructure, and services provided by clinical
establishments. However, its implementation varied across states due to healthcare being a state
subject. Some states adopted and enforced the Act sooner than others, leading to discrepancies in
its application nationwide
KEY ASPECTS OF THE CLINICAL ESTABLISHMENTS ACT :
1. Regulation and Registration:
The act mandates the registration and regulation of clinical establishments, including hospitals,
diagnostic centers, clinics, and laboratories. It sets standards for infrastructure, staffing, equipment,
and quality of care.
2. Standardization of Services:
It establishes minimum standards for medical services, facilities, and personnel qualifications,
ensuring a certain level of quality and safety for patients seeking healthcare services.
3. Patient Rights and Responsibilities:
Emphasizes patient rights, including information about treatment, informed consent,
confidentiality, and grievance redressal mechanisms. It also outlines patient responsibilities toward
compliance with prescribed treatments.
4. Documentation and Record-Keeping:
Mandates the maintenance of medical records and documentation, ensuring accuracy,
confidentiality, and accessibility of patient information for better continuity of care.
5. Fee Regulation:
The act may include provisions to regulate fees charged by clinical establishments, preventing
overcharging or unethical practices in billing patients for healthcare services.
6. Inspections and Compliance:
Authorities conduct periodic inspections to ensure compliance with the set standards and
regulations. Non-compliance can lead to penalties or even closure of the establishment.
Significance and Impact:
The Clinical Establishments Act seeks to standardize healthcare services, promoting uniformity in
quality across different regions and settings within India. By establishing guidelines and enforcing
compliance, it aims to improve patient outcomes, increase access to quality healthcare, and
enhance accountability within the healthcare sector.
However, implementation and enforcement of the act can vary among states, and challenges
related to resource allocation, infrastructure development, and monitoring persist.
ITS ROLE IN HEALTH CARE QUALITY
The Clinical Establishments Act plays a significant role in enhancing healthcare quality through
several key mechanisms:
Standardization and Regulation:
Setting Standards: The Act establishes minimum standards for infrastructure, facilities, equipment,
and staffing requirements for clinical establishments. This ensures that healthcare facilities
maintain a certain level of quality and safety in their services.
Quality Assurance: By regulating clinical establishments and ensuring compliance with set
standards, the Act aims to improve the overall quality of healthcare services provided to patients.
Patient-Centric Approach:
Patient Rights: The Act emphasizes patient rights, including informed consent, confidentiality, and
access to information about treatments. This empowers patients and ensures their active
participation in their healthcare decisions.
Grievance Redressal: It establishes mechanisms for addressing patient grievances, ensuring that
patients have a means to voice their concerns and seek resolution in case of any issues with the
quality of care.
Accountability and Transparency:
Documentation and Record-Keeping: Mandating proper documentation and maintenance of
medical records ensures accurate and accessible patient information, contributing to better
continuity of care and informed decision-making.
Regulation of Fees: In some cases, the Act regulates fees charged by clinical establishments,
preventing overcharging and promoting transparency in billing practices.
Improved Access and Equity:
Uniform Standards: By standardizing healthcare facilities and services, the Act aims to reduce
disparities in healthcare quality across different regions, making quality healthcare more accessible
and uniform.
Increased Trust: The Act's emphasis on compliance and adherence to standards fosters trust
between patients and healthcare providers, contributing to better doctor-patient relationships and
improved health-seeking behavior.
CHALLENGES AND IMPACT :
While the Act is designed to enhance healthcare quality, challenges such as varying
implementation across states, resource constraints, and ensuring continuous monitoring and
compliance persist. However, it serves as a crucial framework for driving improvements in
healthcare quality by providing guidelines and a regulatory structure for clinical establishments.
In presentations or discussions, highlighting how the Act addresses these facets and contributes to
raising the overall standard of healthcare can underscore its role in improving quality, patient
experiences, and outcomes within the healthcare system. Additionally, showcasing examples or
studies illustrating improvements in healthcare quality post-implementation could further illustrate
its impact.
Enactment of the Act faced challenges, including the diversity of healthcare systems in
different states, resource constraints, and resistance from some healthcare providers. Implementing
uniform standards across a country as vast and diverse as India proved challenging due to varying
infrastructural capabilities and resource availability in different regions.
CPA ( THE CONSUMER PROTECTION ACT )
The Consumer Protection Act, a significant legislation in India, was enacted in 1986 to safeguard
consumers' rights and ensure fair and efficient redressal of grievances. It aimed to protect
consumers against unfair trade practices, defective products, and deficient services while
promoting consumer awareness and empowerment.
This Act established consumer rights such as the right to information, right to choose, right to be
heard, right to seek redressal, and the right to consumer education. It created Consumer Dispute
Redressal Commissions at the district, state, and national levels to swiftly address consumer
complaints, offering accessible and affordable avenues for dispute resolution.
The Act covered various aspects, including misleading advertisements, unfair trade practices, sale
of defective goods, and deficiencies in services. It imposed liability on manufacturers, sellers, and
service providers to ensure the quality and safety of products and services offered to consumers.
The consumer protection act 1986, amended in 2002 provides the better protection of interests
of the consumer and for the establishment of consumer councils and other authorities for the
settlement of consumer disputes and for matters connected therewith.
CONSUMER DISPUTES REDRESSAL AGENCIES :
1. District forum
2. State commission
3. Central commission
DISTRICT FORUM :
Headed by retired district judge
It entertains claims upto 20 lakhs
STATE COMMISSION
Headed by high court judge
It entertains claims between 20lakhs to one crore
NATIONAL COMMISSION
Headed by retired supreme court judge
It entertains claims of one crore.
THE MANNER IN WHICH THE COMPLAINT SHALL BE MADE :
A complaint in relation to any goods or services maybe filed with a district forum by,
a) consumer
b) recognised consumer association
c) one or more consumer
d) Central or state government
PROCEDURE :
- if the complaint relates to any services, the district forum shall refer a copy of such complaint to
opposite party within 21 days of the admission date.
- if the complaint about any good or services are proved, district forum will issue an order to the
opposite party to replace goods or to provide adequate cost to the parties.
APPEAL :
The person can prefer an appeal to the state commission within 30 days from the date of the order.
Further appeal can be made to national commission and finally to supreme court, within a period
of 30 days from the date of order.
LIMITATION PERIOD :
The district forum, state commission will not admit a complaint unless it is filed within 2 years
from the date of occurance of the cause of the action.
PENALTIES :
For false complaints, the complaint has to pay as penalty to opposite party, not exceeding
rs.10,000.
The doctors and hospitals who render service as medical practitioners are liable for any act of
medical negligence and they can be sued for compensation under consumer protection act.
Over the years, amendments were made to the Act to adapt to changing market dynamics and
enhance consumer protection. In 2019, a revised Consumer Protection Act was passed to
strengthen consumer rights further, introduce stricter penalties for misleading advertisements and
unfair trade practices, establish a central consumer protection authority, and streamline the process
for filing complaints and seeking redressal.
The Consumer Protection Act remains a cornerstone of consumer rights in India, offering a legal
framework that empowers consumers and holds businesses accountable for delivering quality
products and services. Its ongoing evolution reflects the government's commitment to ensuring a
fair marketplace and protecting the interests of consumers in the ever-evolving landscape of
commerce and trade.
ITS ROLE IN FORENSIC MEDICINE :
The Consumer Protection Act plays a significant role in forensic medicine by providing a legal
framework to address cases involving medical negligence, malpractice, or deficiencies in
healthcare services. In forensic medicine, this Act serves as a crucial tool in investigating and
resolving disputes related to medical treatments, diagnostic errors, or deficiencies in healthcare
facilities.
Forensic medicine involves the application of medical knowledge to legal issues, and the
Consumer Protection Act assists in such scenarios by:
Redressal of Medical Negligence: The Act allows aggrieved consumers to file complaints against
healthcare providers for negligence or deficient services. Forensic experts may be involved in
examining medical records, conducting investigations, and providing expert opinions to
determine if negligence occurred.
Evidential Support: Forensic experts often aid in presenting evidence and providing expert
testimony in cases related to medical malpractice or deficiency in services. Their analysis and
opinions contribute significantly to the resolution of disputes.
Standardizing Medical Practices: The Act emphasizes the provision of quality healthcare
services and holds healthcare establishments accountable for maintaining prescribed standards.
Forensic medicine experts may be consulted to assess whether these standards were met and
whether deviations led to the alleged harm or negligence.
Determining Compensation: In cases where consumers suffer harm due to medical negligence or
deficiencies, forensic experts may assist in assessing the extent of damage caused. This
assessment aids in determining fair compensation for the affected individuals.
Overall, the Consumer Protection Act serves as a recourse for individuals seeking justice and
compensation in cases involving medical malpractice or deficient healthcare services. Forensic
medicine plays a crucial role within this legal framework by providing expert opinions,
analyzing evidence, and aiding in the resolution of disputes related to healthcare.
