New ethics guide for doctors' conduct

[Posted: Tue 17/11/2009 by Niall Hunter, Editor]

Doctors have been reminded by their regulatory body to be honest and open with patients following an adverse event.

The Medical Council has stressed that when errors or adverse events occur, doctors should acknowledge that the event happened, explain how it happened, apologise if appropriate, and give an assurance as to how lessons have been learned in order to minimise the chance of this event happening again in the future.

The Council says if an adverse event occurs, doctors must ensure that the effects of the event on the patient must be minimised as far as possible.

Doctors have also specifically been advised not to accept gifts, including hospitality, from drug companies or other commercial enterprises.

The advice is contained in new ethics guidelines produced for doctors by the Council. Its last ethics guide was published five years ago. (View the guidelines in full here)

The new guide contains expanded and revised guidelines in areas such as adverse events/communications; abortion; consent to treatment, and reporting of suspected abuse.

However, the Council has stressed that its new ethics guide is limited in the level of advice it can offer in key areas such as assisted reproduction, postmortem practice and advanced care directives (living wills) as a result of the lack of relevant legislation at present.

Medical Council President Prof Kieran Murphy said the Council would develop further guidelines in these areas, as this was an evolving process.

Dr Deirdre Madden, chair of the Council's ethics working group, told a press briefing that the Council would welcome legislation that will clarify issues arising for doctors relating to postmortem practice, advanced care directives, and assisted reproduction.

The revised guidelines for doctors include:

Abortion: Doctors have been reminded it is lawful to provide information in Ireland about abortions abroad, subject to strict conditions., but it is nor lawful to encourage or advocate an abortion in individual cases. This information advice been inserted into the guide in accordance with the regulation of abortion information legislation, and was not in the last guide. The  new guide says abortion is illegal except where there is a real and substantial risk to the life, as distinct from the health, of the mother, and this exception includes the risk of suicide.

End of life care: Doctors have been told there is no obligation on them to start or continue a treatment, or artificial nutrition or hydration, that is "futile or disproportionately burdensome", even if such treatment may prolong life. Doctors should respect the right of patients to refuse or request the withdrawal of treatment. Doctors should also respect a patient's advanced healthcare plan (living will). The guide says such plans have the same ethical status as a decision by a patient at the actual time of an illness and should be respected, but only if the decision was an informed choice, covers the situation that has arisen and wherethe patient has not changed their mind. The Council, however, stresses that the legal situation in this area has yet to be clarified.

Assisted reproduction: Doctors should ensure that appropriate counselling has been offered to the patient and that the patient has given informed consent before receiving any treatment. Assisted reproduction should only be provided by suitably qualified professionals in accordance with international best practice. (Again, legislation is awaited on the regulation of centres offering assisted reproduction). The guidelines state that doctors should not participate in creating new forms of life solely for experimental purposes and should not engage in human reproductive cloning.

Consent: Children and young people should be involved as much as possible in discussions about their healthcare. Patients aged 16 and over are entitled by law to give their own consent to surgical, medical or dental treatment. A refusal of treatment by a patient between 16 and 18 years, which is against medical advice and parental wishes, is of uncertain legal validity, and doctors are advised to consider getting legal advice before acting on such a decision. In exceptional circumstances, the guidelines state a patient under 16 may seek to make a healthcare decision without the knowledge or consent of their parents. In such cases, doctors are advised to encourage the patient to involve their parents in the decision.

Prescribing: Doctors should not rely solely or excessively on promotional literature from pharmaceutical companies for information about particular drugs. They should seek independent evidence-based sources of information on the benefits and risks associated with medicines before prescribing. Choice of drug should always be in the patient's best interests. Doctors are also advised not to accept gifts, including hospitality, from pharmaceutical or other commercial enterprises. This does not preclude the payment of reasonable fees if a doctor provides professional services to companies. Doctors receiving support from companies for professional or educational activities should address any potential conflicts of interest that arise, according to the guidelines.

Reporting of abuse: Where adult patients disclose abuse that took place during their childhood, doctors must assess the current risk to the patient or any other person (child or adult) who may be in contact with the alleged abuser. If the doctor considers that anyone is at risk, they should report this to the authorities, preferably with the patient's consent. Giving information to others for the protection of vulnerable people may be a justifiable breach of confidentiality.

Information/advertising: Doctors may advertise their practice by publicising the name and address, hours and contact details. They may include areas of specialist interest if they are recognised by the Council and they are entered for that specialty on the specialist register. Any further information provided must be accurate, verifiable, must not make false claims or raise unrealistic expectations. The information should also include any risks with a service provided. Doctors should not use photos or other illustrations of the human body to promote cosmetic or plastic surgery procedures, as they may raise unrealistic expectations in patients.