The Whole-Ukrainian Congress of Medical Organizations Yepvatoria, September 24-27, 2009
CODE OF ETHICS OF UKRAINIAN DOCTOR
Following the principles of humanism and charity, WHO declarations, Ukrainian civil rights laws ensuring equal access to quality medical care, and the oath of Ukrainian physician declaring the leading role of medics in the healthcare system, considering the specific character of doctor-patient relations, the necessity of additional mechanisms of their ethical and deontological legal regulations, as well as the moral civil and medical responsibility of a doctor for his professional activity, the whole-Ukrainian congress of medical organizations approves this Code of Ethics of Ukrainian Doctor .
INTRODUCTION
Human life and health are the principle, fundamental values. The aim of doctor’s actions lays in their preservation taking care of them from the moment of conception, requiring human attitude, sympathy, kindness, mercy, patience, mutual trust, decency and equity while treating patients. Doctor should remember that first of all it is his conscience that is the chief justice for him.
These moral principles are anchored in the Code of Ethics of Ukrainian Doctor (hereinafter referred as Code) considering the guidelines of the International Code of Medical Ethics, the Helsinki declarations, the Universal Declaration on the Human Genome and Human Rights and Convention for the Protection of Human Rights and Dignity of the Human Being, taking into consideration the results achieved in the fields of Biology and Medicine.
This Code refers to the professional activity of medics and scientists, whose interests include prenatal and postnatal life of human being, his health, birth and death.
PART 1. ACTION OF CODE
1.1 The provisions of the Code are to be executed by medics, administrative staff and investigators who are professionally occupied with treatment, preventive care, and research in the filed of healthcare.
1.2 The Code’s support and control functions belong to the ethics commissions and committees of healthcare institutions and research organizations, medical and scientific federations, associations, societies, and other public organizations in the field of healthcare that acknowledge this Code.
1.3 The acknowledgement of the Code by the medical staff of some healthcare institution, scientific organization, higher medical school or institution of post-diploma education, medical or scientific federation, association, society or any other public organization in the healthcare sphere is approved by the official statement to the Bioethics Commission at the Ministry of Public Healthcare of Ukraine ( hereinafter referred as – Bioethics Commission).
In case of violation of the Code by physicians of hospitals, scientific and educative medical institutions, members of federations, associations, societies or other public organizations in the healthcare sphere that acknowledge this Code, Ethics Commissions or Committees of these establishments are to impose the proper sanctions on them.
The severest public criticism for the violation of professional and universal moral and ethical values is the exclusion of physician or investigator out of the his professional association.
1.4 In each case the non-recognition and violation of the Code by public organizations, separate legal entities and physical persons occupied in the healthcare field the Bioethics Commission is to investigate the possible negative consequences for certain persons and society, take the measures for their prevention and liquidation through the petitions before the corresponding organizations and state bodies for disciplinary, administrative and legal sanctions.
1.5 In situations unforeseen by the Code, indefinite issues and disputes as to the interpretation, execution or violation of the Code the Bioethics Commission decides on their regulation.
1.6. If necessary, the Bioethics Commission, ethical commissions or committees of healthcare establishments, higher schools, scientific organizations, medical unions and associations are capable to assert and defend the honour and dignity of physician with his consent in mass media provided that his professional actions meet the requirements of the Ethics Code of Ukrainian Doctor.
PART 2. DOCTOR AND SOCIETY
2.1 The main purpose of a doctor as a practical physician and scientist is to preserve and protect human life and health in it their prenatal and postnatal period, prevent the diseases and restore the health, as well as to relieve the pains and suffering of those with fatal illnesses, during birth and death.
The attitude to the patient’s personality is to be ethical even after his death.
2.2 The doctor executes his duties with respect for the life, dignity and personality of his every patient following the public moral and ethical values, the Oath of Ukrainian Doctor and this Code.
2.3 The doctor assumes full liability for his decisions and actions as to the lives and health of his patients. He is to systematically upgrade his professional level using the most effective known earlier and the latest achievements of medical science in the sequence set out by the legislation.
2.4 Human purposes of doctor’s activity enable him to have legal defense of his moral and ethical principles, personal dignity, financial security, necessary conditions to discharge his professional duties.
2.5 The doctor’s professional impartiality is of utmost importance. Making professional decisions the issues of financial or self-profit, career, gratification of his ambitions must be excluded.
2.6 In the state and autonomous medical facilities the doctor renders free medical aid within the limits of financial resources allocated to this facility. The extortion of any unintended gratification from patient or his relatives is criminal and immoral.
The doctor’s right to establish his private practice is regulated by the Law.
2.7 The doctor has the right to be paid for his labour according to the Law, defend the right to be paid by the State as much as he has reserved, avoid humiliation and financial discrimination working in private facilities and private practice.
In addition the doctor must not:
engage in unfair advertising and allow others use his name and statements for advertising unreliable medical information;
spread medicines and medical products for financial purpose, except certain cases defined by the Law;
join in any conspiracy with medics, pharmaceutists, representatives of medical and pharmaceutical industries, other physical persons and legal entities for the purpose of illegal profit;
accept monetary rewards from manufacturers and distributors for the prescription of their medicines, diagnostic and hygienic medical products, dietary products, except the circumstances defined by the Law;
engage in any other activity incompatible with his professional dignity and authority;
use his elective, administrative or other official status to unreasonably increase the number of his patients in his private practice or state medical facility;
create the conditions to gain illegal profit and evade taxes.
2.8 The doctor is capable to engage in any other activity provided it doesn’t interfere with his professional impartiality, doesn’t humiliate his dignity, doesn’t do any harm to his patients and his medical practice.
2.9 The doctor is to render medical aid according to his speciality regardless of the age, sex, race, nationality, religion, social status, political opinion, inhabitation, citizenship, and other non-medical factors concerning his patients, including financial situation.
2.10 The doctor with his professionalism, moral and ethical values, behavior in different life situations, attitude to patient and execution of his professional duties is to be a worthy example for his colleagues and other society members.
2.11 The doctor with his behavior and other available means (lectures, discussions, mass media, Internet, etc.) is to propagate the healthy way of life and to be an example in following its norms and rules.
2.12 The doctor can actively participate in the work of professional unions and associations receiving their support and protection. Medical unions and associations are to promote and help each of their members in the following and assertion of principles of high professionalism, professional impartiality, morality, ethics and deontology.
2.13 The doctor is to be honest with his patients and colleagues, man of principle as to the professional flaws of other medics, acknowledge his own errors, as well as do not tolerate fraud and dishonesty.
2.14 The doctor is not to engage in political or religious propaganda during working hours, to induce to actions incompatible with the status of a doctor.
2.15 The doctor has the right to participate in the protest actions in the forms foreseen by the Ukrainian legislation, but he is not relieved of his responsibility to render the necessary medical aid to patients under his supervision.
PART 3. DOCTOR AND PATIENT
3.1 From the moment of taking the decision concerning the personal rendering medical aid to any person or the proposal to participate in the scientific research as a volunteer the doctor is to plan his actions regarding this person and their relationships following the principles of universal human ethics and morality anchored in the Oath of Ukrainian Doctor, medical deontology, as well as the Ethics Code of Ukrainian Doctor and International Code of Medical Ethics
3.2 The doctor is responsible for the quality and humanity of medical aid rendered to his patients and any other professional actions involving the interference with the patient’s life and health. In his work the doctor has to comply with the requirements of the Constitution of Ukraine, the medical practice guidelines considering the peculiarities of diseases, use the methods for prophylaxis, diagnosis and treatment that are the most effective in a certain case and considering the interests of a patient. If necessary, the doctor has to consult his colleagues.
3.3 In situations requiring help to a patient, under circumstances unforeseen by the legislation, legal texts and duty regulations the doctor has first of all to consider the patient’s interests, the principles of ethics and morality.
3.4 The doctor’s actions are to be aimed at the achievement of maximum benefit for patient’s life and health, his social protection.
Over the whole course of treatment while reporting to a patient on his condition and the recommended treatment the doctor has to consider the personal traits of his patient and his evaluation of the situation.
The doctor must not:
interfere with the private matters of his patient and patient’s family members without sufficient professional justification;
expose his patient to unjustified risk, all the more to apply his knowledge with non-human purposes. While choosing a method of treatment the doctor has to follow not only the principle “First, do no harm!”, but also ”Bring as much benefit as possible!”
The doctor has to allow time and pay attention to his patients as much as necessary to establish a correct diagnosis, administer treatment and explain everything comprehensively and carefully to his patients.
The doctor has no right consciously to exaggerate or underestimate the severity of patient’s disease seeking gratification.
3.5 Except emergency cases, the doctor has the right to refuse to treat the patient if he is sure that there is a lack of necessary trust between him and the patient, if he feels to be insufficiently competent or doesn’t have the necessary possibilities available or in other cases provided that it doesn’t contradict the Oath of Ukrainian Doctor. The doctor has to take all the necessary measures as to informing the patient about it and give him corresponding recommendations. The doctor must not interfere with the patient’s right to receive the consultation of another doctor.
The doctor has to respect the patient’s right to choose a doctor and participate in decision-making concerning the treatment and preventive measures being administered, apart from the cases of forced treatment according to the Law order. Voluntary consent of a patient to be examined, treated or participate in some medical research is to be obtained during the private conversation with him. This consent is to be conscious, the patient is to be fully aware of treatment methods, their consequences, in particular possible complications, as well as other alternative methods of treatment. If the patient is not able to express his consent consciously, it is expressed by the patient’s legal representative or trustee.
Taking measures for treatment and prevention without the patient’s consent is allowed only in life-threatening cases when the patient is unable to evaluate the situation adequately. In such cases the decision is made collectively and with participation of patient’s significant others.
During the management of a child or adult patient the doctor is to report about all the changes in the patient’s condition to the relatives or tutors, get their consent for the administration of a certain method of treatment or remedy.
The doctor has to defend the interests of a child or patients unable to take decisions themselves in cases when nobody else cares for their lives and health or these problems are underestimated by the others.
3.6. The doctor has to respect the honour and dignity of his patient, his right for the private life, be kind with him, understand the anxiety of patient’s relatives and significant others about patient’s condition.
3.7 Each patient has the right to keep the information concerning his health condition secret. The doctor and other persons participating in the patient’s management are to keep the personal medical information, including the facts of seeking medical help, confidentially, even after the patient’s death, unless there are other arrangements of a patient or a threat for the lives of patient’s relatives and society.
The secrecy concerns all the information received during the patient’s management, including diagnosis, treatment methods, prognosis etc.
The medial secrecy about the patient can be disclosed in the following cases:
there is a written consent of a patient;
there is a motivated request made by investigation agencies, public prosecutor's office, court, sanitary epidemiological agency;
if keeping a secrecy exposes patient’s health and life and/or those of other persons to significant risk (dangerous infectious diseases);
if the doctor consults the other specialists, who need this information.
Other persons, except doctor, using the patient’s medical data are to keep a medical secret and to be informed by a doctor about the responsibility associated with the disclosure of patient information.
During the research, education of students and refresher courses for doctors the medical secret is to be kept. It is released only with the consent of patient, his parents or tutors.
The patient has the right to get the detailed information on his condition, but can also refuse it or determine a person to be reported on patient’s condition.
The information can be concealed from patient in cases when it presents significant harm to him. However, if the patient insists, the doctor is obliged to provide exhaustive information. If the prognosis for patient is unfavorable, it is to be communicated delicately and carefully leaving a hope for a continuation of life and possible successful outcome.
3.8 In case of medical error or occurrence of unforeseen complications due to his actions the doctor has to report about it to his senior colleague or the head of the unite, and if they are absent, to the administration of the given medical establishment and immediately has to begin managing the negative consequences without waiting for someone’s commands. If necessary, other specialists are consulted while the doctor has to inform them honestly about the essence of his error or appeared complications.
The doctor has to analyze carefully his errors and discuss them with his colleagues and administration to prevent such cases in the clinical practice of other doctors.
3.9 The doctor has to carry out his practical activity only using his own surname without indication of titles, academic degrees and ranks given him unofficially.
3.10 The doctor has to promote the realization of patient’s right to receive spiritual assistance from the representative of the corresponding religious confession.
3.11 The doctor has to stay with his dying patient until the final moment of the patient’s life, take the adequate treatment measures, supervise, support the possible level of patient’s life, relieve physical and mental suffering of patient and those of his relatives using all the possible means.
The issue concerning ceasing intensive care is to be discussed collectively and in cases when the patient’s condition is terminal according to the criteria of the Ministry of Public Health of Ukraine.
The doctor has no right to accelerate the patient’s death consciously, resort to euthanasia or incite others to it.
3.12 The doctor has no right to leave his patients in cases of general danger.
3.13 The doctor cannot disregard any acts of cruelty or humiliation.
3.14 The doctor cannot suggest his patients the treatment methods, drugs and medical products unallowed for general use by the Ministry of Public Health of Ukraine in the order established by the legislation. The doctor can inform the patient about the treatment methods and medicines used abroad for the management of patient’s condition.
3.15 The doctor’s appearance has to correspond to his profession and have positive effect on his patients.
PART 4. MEDICAL COLLEGIALITY
4.1 Over the whole life the doctor has to respect and be thankful to those teaching him medicine.
4.2 The doctor has to defend the dignity and noble traditions of medical community, treat his colleagues with respect and kindness.
4.3. The doctor has no right to doubt or discredit the professional qualification of another doctor in public. Functional remarks addressed to his colleague are to be well-reasoned, non-abusive, expressed during the personal conversation before this issue is discussed with medical community or ethics committee or commission.
4.4 In severe clinical cases the doctors has to consult and assist their colleagues in correct form. There is only one responsible physician for the process of treatment who can consider or not the recommendations of other doctors in this case following only the patient’s interests. The doctor is not allowed to create the conditions in order to attract the patients of his colleagues.
4.5 The physicians-managers of heath care, scientific and educational medical establishments are obliged to follow the moral and ethical principles, respect human dignity, ensure sufficient financial provision and social security, create the appropriate conditions for the carrying out professional activity and upgrading professional skills of their subordinates.
4.6 The doctors have to respect each other and the nursing staff looking for constant upgrading of their skills.
PART 5. SCIENTIFIC INVESTIGATIONS WITH PATIENT’S PARTICIPATION
5.1 The doctor can combine the research with rendering medical aid only in cases when the investigation serves for prophylactic, diagnostic or therapeutic purposes.
5.2 Before the beginning of investigations, approbations of new drugs, treatment and diagnostic methods and equipment the doctor has to receive the written consent for their performance from an ethics commission or committee with approval of the plan (protocol) of the given investigations where the aims of the investigations, ethical aspects, the course and possible complications are to be described in detail.
5.3 After the patient (the participant of investigation) is acquainted with the aims, methods, potential benefit and possible risk the doctor has to get the patient’s written consent to participate in the investigations and to refuse it freely at its any stage.
5.4 The consent of incapacitated patients to participate in the investigations is to be obtained in the written form from their parents of other legal representative. Such investigations can be carried out only for the purpose of saving life, restoration or support of patient’s health , without doing him any harm or causing the deterioration of his condition.
5.5 Scientific investigations with the participation of patients are allowed to be carried out only if all the conditions listed below are fulfilled:
the investigations are aimed at the improvement of health of patients participating in them;
they make significant contribution to the medical science and practice;
the results of previous investigations and existing data are not evidence of possible complications;
all the measures ensuring the patient’s safety are taken.
5.6 Medical investigations connected with participation of patients in them are to be carried out in the conditions ensuring the rights and safety of research participants, defend their dignity; carried out by highly qualified doctors and researchers under the supervision of ethics commissions or committees. The investigations are stopped in occurrence of unclear and unforeseen situations, as well as in situations associated with the risk for the research participant’s life and health.
5.7 The research doctor is fully responsible for his actions (negligence, incorrectly carried out experiment, etc.) resulting in the decline of patient’s health. The doctor has to do all the possible to restore the patient’s normal condition.
5.8 All the research participants are to have health insurance for the cases of unintended damage to their health.
5.9 In experiments with animals the researcher has to follow the human principles, seek to reduce the number of experimental animals, promote working out methods giving the possibility to exclude animal use for the experiments. способствовать разработке методов, которые позволяют не использовать их во время опытов.
PART 6. THE LATEST MEDICAL TECHNOLOGIES
6.1 Doctor’s actions while using the latest medical technologies (transplantation of human organs and tissues, interventions in the human genom, human reproductive function, etc.) are regulated by the ethical and legal enactments of Ukraine, recommendations and requirements of WHO, UNESCO Bioethics Committee and Bioethics Commission.
6.2 While choosing patients requiring complex prophylactic, diagnostic and particularly treatment measures (for example, transplantation of organs), doctors having the list of patients needing medical help are to follow only medical indications taking decision themselves or collectively with the participation of the Ethics Committee (Commission) members.
PART 7. INFORMATION
7.1 The doctor is obliged to upgrade his qualification, be aware of the latest achievements in the medical sphere. He has to take active measure towards any unreliable information in the scientific literature and mass media.
7.2 Medical editions, reports of doctors at the scientific forums, educative programs in mass media are to correspond to ethical principles, be concentrated on the objective scientific and practical information and do not contain the elements of unfair competition, advertisement and self-promotion.
7.3. The doctor has to repost immediately according to the established order about all the unknown, undesirable and side effects of drugs and medical products, which he has observed during the scientific investigations and practice.
7.4. For the interests of patient’s life and health the doctor has to actively resist the popularization of use of diagnostic and treatment methods and means unforeseen by the functioning legislation.
7.5 Medical certificates are to be given according to the functioning legislation and methodical guidelines.
7.6 After the release of copyright for his inventions and discoveries the doctor has to inform his colleagues about the results of his investigations in the periodicals.
7.7 In the scientific publications the doctors have to follow the requirements as to the copyright. Mentioning oneself or other person without sufficient reasons in the list of composite authors or concealing surnames of researchers participating in the investigations, as well as plagiarism is a gross violation of principles of professional ethics.
Unscrupulous attitude and negligence towards the misinterpretation of scientific truth, concealing principal flaws of scientific research by a member of scientific community is prohibited.
PART 8. RESPECT OF MEDICAL PROFESSION
8.1. The principle to respect the medical profession is to be followed in all the spheres of doctor’s activity professional, public, общественной, journalistic, etc. Each doctor has to refrain from any actions or expressions undermining the respect of medical speciality. He has to promote the preservation and improvement of professional medical image and the effectiveness of this Code.
Approved and signed at the whole-Ukrainian congress of organizations and 10th congress of the Whole-Ukrainian Medical Society
in Yevpatoria, on 27 September, 2009
