CODE OF CONDUCT & OTHER SUNDARY ISSUES. BY DR. B. A. ADIGUN Ag .P. S. OYO STATE HOSPITALS MANAGEMENT BOARD. & CHAIRMAN MDCN MONITORING COMMI TEE (OYO STATE CHAPTER). PREAMBLE CODE OF CONDUCT i.e. (MEDICAL ETHICS) OBJECTIVES OF CODE OF CONDUCT HYPOCRATIC OATH ALLEGIANCE TO PROFESSIONS
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DR. B. A. ADIGUN
Ag .P. S. OYO STATE HOSPITALS MANAGEMENT BOARD.
CHAIRMAN MDCN MONITORING COMMI TEE (OYO STATE CHAPTER)
b) The lawyer.
c) The priest.
The code of conduct serves asguiding standardsfor the relationship of medical and dental practitioners on one hand,
a) with the profession,
b) their colleagues,
c) their patients,
d) members of allied professions
e) and the public on the other.
b) to meet the standard set by Medical & Dental Council of Nigeria with regards to Ethics and Quality of professional practice.
c) to ensure that Medical & Dental practitioners perform their duties in a manner that earns the trust of Patients and the respect of the society for the profession.
d) to let the Public know what to expect from Medical practitioners.
e) to serve as standard to be used by disciplinary organs of MDCN to determine professional conduct.
I SOLEMNLY PLEDGE,
a) To consecrate my life to service of humanity:
b) I will give to my teachers the respect and gratitude which is their due:
c) I will practice my profession with conscience and dignity:
d) The health of my patient will be my first consideration:
e) I will respect the secrets that are confided in me, even after the death of the patient:
f) I will MAINTAIN by all means in my power, the honor and the noble traditions of the medical profession.
g) My colleagues shall be my sisters and brothers:
h) I will not permit considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to influence between my DUTY and my patient:
i) I will maintain the utmost respect for human life:
j) I will not use my medical knowledge to violate human rights and civil liberties, even under threat:
k) I make these solemn declarations freely and upon my honor.
Mandatory allegiance exist between a doctor or dentist and the corporate body of the profession i.e.
Medical and Dental Practitioners Act, Cap 221 Laws of the Federation of Nigeria 2004. gives the much needed legal backing to the Authority of the council (i.e.MDCN.) over all medical practitioners and dental surgeons in Nigeria.
a)Determining (and reviewing from time to time) the level of knowledge and skill that must be attained to become members of medical or dental profession.
b) Maintain a register of persons entitled to practice as members of medical or dental profession.
c) Reviewing the code of conduct from time to time as considered desirable.
d) Make rules for professional conduct.
f) EMPOWERED to establish
i) Medical and Dental Practitioners Investigating Panel.
ii) Medical and Dental Practitioner Disciplinary Tribunal.
iii) Committee on Practitioner’s Health.
Persons who have
i)under gone the course of training based on curriculum for Medical and Dental education which is approved by Medical and Dental Council of Nigeria and have OBTAINED certificates approved OR recognized by the Council.
ii) have been registered with the Council.
iii) licensed by M.&D.C.N.
Medical & Dental Practitioners Act CAP 221 1990, .
A person shall not hold an appointment or practise as a medical practitioner or dental surgeon UNLESS he\she is registered with the M&DCN.
“ It is the act of REGISTRATION and not the medical qualification that confers on the practitioner the LEGAL RIGHT to practice medicine or dentistry in Nigeria”.
This emphasizes the importance of registration with Nigerian Medical Council before engaging in any form of medical practice.
a) Provisional Registration:
- for internship.
- registration lapses when signed off.
- internship must be completed within TWO years of graduation.
- is obtainable after satisfactory completion of internship
-confers legal right to practice on his own, but he\she must recognise limitations.
c) Registration as a Specialist:
- have acquire specialist training from National Postgraduate Medical College .
- validly sign off interns.
d) Limited or Temporary Registration: specific period of validity.
Medical & Dental Practitioners Act CAP 221 1990.
NO registered medical practitioner or dental surgeon shall practise in any year UNLESS he\she has paid to the Council in respect of that that year the appropriate practising fee.
The regulation of the Council expect ALL practitioners to pay their practising fee for the ensuing year before the 31st December of the preceding year in other to remain currently licensed on the first day of the New Year.
b) >10 years N10,000:00
Medical practitioner or Dental surgeon who practises without paying the prescribed fee shall be Guilty of an offence and shall be liable on conviction:
- first offender shall be fined twice the prescribed fee
-second offender , to a fine not less than TEN times the prescribed practising fee.
Keeping such medical\dental practitioner in employment of any person or institution makes such employer guilty of a punishable offence.
LATE payment of the practising fee attract a surcharge determined by Council from time to time.
This means the failure on the part of a medical and dental practitioners to exercise reasonable degree of skill and care in the treatment of a patient resulting in arm or damage to the patient.
Characteristics of NEGLIGENCE; for a medical practitioner or dental surgeon to be negligent he\she must
a) Owe a duty of care to another person i.e. patient.
c) The patient must have suffered damage(s) as a result of the breach of duty of care.
Breaches of duty committed by doctors include:
v) Failure to obtain inform consent before proceeding on any surgical procedure.
vi)Failure to refer or transfer a patient in good time when such referral was necessary.
vii)Failure to advise, or proffering wrong advice, to a patient on the risk involved in a particular operation or course of treatment especially if the treatment involves loss of an organ, function or deformity.
viii) In instances where the legal axiom RES IPSA LOQUITOR (the fact speaks for itself) is applied.
a) operating on wrong patient.
b) amputating wrong limb.
c) leaving swabs and surgical instruments in the abdomen of patient.
WHO MAY SUE
Every person of full age of 18 years can sue provided he\she is
i) someone to whom duty of care is owed.
ii) someone who by statutes is conferred such right e.g. where death occur as a result the negligence.
iii) minor (not yet 18years) having a cause of action can sue through his parent or guardian.
Proof of Negligence.
Except in cases of res ipsa loquitur (the thing speaks for itself), the patient (plaintiff) must be able to proof that
- the injury or harm was actually caused by the breach of care and it is not traceable to any remote cause(s).
-the facts proved must point to the defendant as being the negligent party.
Recurrent Professional Negligence: refer to practitioner appearing before Disciplinary Tribunal for the second time and is found guilty.
Gross Professional Negligence; extent of negligence resulted in permanent disability or death of the patient, and the practitioner found guilty is liable to:
There must be evidence of Reckless Disregard for the Life and Safety of the patient.
“Section 303 of the criminal code of Nigeria”: imposes the duty on any person who performs surgical or medical treatment on any other person, to have reasonable Skill and to use reasonable Care in doing so.
The “state “ prosecutes the doctor and doctor is charged for Manslaughter depending on the circumstances of the case.
Unlike in civil negligence
The LAW demands that it should be “proved beyond reasonable doubt, that the Doctor’s action constitute a deliberate or reckless disregard for the patient’s life and safety.”
The practice of medicine and dentistry shall be conducted according to standards ( set by Medical and Dental Council of Nigeria), by methods adjudged acceptable, by registered medical and dental practitioners.
Any medical or dental practitioner who is found by statutory procedure, to have failed to meet the professionally accepted standards, methods or decorum, shall be guilty of MALPRACTICE.
Practitioners should learn not to take cases he\she cannot effectively handle in terms of;
Other forms of malpractices include:
A medical practitioner or dental surgeon shall preserve absolute secrecy on all he\she knows about his patient even after the death of the patient. Adherence to this ethical issues of confidentiality embraces:
Physician should refrain from self-advertisement because it could become a source of danger to the public. It may precipitate unwholesome rivalry among practitioners.
Conviction for alcohol or drug related offences is a discreditable action to the profession and a clear danger to patients. Practitioners may be adjudged guilty of infamous conduct on the following grounds:
Runs contrary to one of the cardinal principle of the Physician’s Oath. A doctor should not terminate life whether the patient is in a sound health or terminally ill. A practitioner shall be adjudged to be in breach of the ethical code of practice if found to have encouraged or participated in any of the following acts:
Termination of a patient’s life through the administration of drugs with or without the patient’s explicit request thinking same to be in the interest of the patient.
FITNESS TO PRACTICE.
Like any member of the society, medical practitioners and dental surgeons are prone to various ailments and undesirable habits. This ailments and habits may impair the productivity, judgment and alertness of the practitioners and render them unreliable. The council regard the following as conditions which could render a practitioner UNSAFE and constitute obstacles to fitness to practice medicine or dentistry:
Most times problems are encountered with the methodology of determining fitness to practice. Misgivings of any is eliminated by setting up Ad-hoc Committee on Practitioner’s Health comprising of the following members whom shall not be less than Fifteen (15) years post registration.