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Mission statement
The following key principles apply to all sections The doctor/patient relationship shall be
of the Code of Ethics. The latter sections characterised by confidentiality; that is, within
illustrate the application of the principles in a the limits of the law and the relevant protocols
range of contexts and situations that doctors may of the College, the patient may have complete
encounter in the course of their professional confidence that the doctor will safeguard patient
lives. information and confidences.
The doctor/patient relationship shall be The doctor shall conscientiously maintain the
characterised by the doctor’s concern for the contemporary professional knowledge and skills
benefit of the patient. necessary to the medical services he or she
renders.
The relationship shall be characterised by non-
maleficence; where the doctor acts in a manner
that minimises harm to the patient. The Collegiality
relationship must be characterised by mutual
respect for the autonomy of the patient and the The doctor shall maintain membership of the
doctor; nothing in relationship should violate or College, relate professionally to other College
compromise natural justice. members and uphold the dignity of the
profession and respect for the profession.
Equality
Trusteeship
The doctor shall strive wherever possible to
ensure equality of healthcare for all patients, and The College, through its members, shall maintain,
advocate for such equality. advance and convey its specialist body of
knowledge to future generations.
Advancement
Economy
Doctors, both individually and through their
professional associations, must take responsibility The College, through its members, shall
for the creation and implementation of encourage and participate in practices and
mechanisms designed to encourage continuous research which optimise benefit for resource use.
improvement in the quality of health care.
Advocacy
Veracity
The doctor shall be an advocate for safe, cost
The doctor/patient relationship shall be effective, high quality health care, accessible to
characterised by veracity; that is, the doctor all, and for appropriate allocation of health care
shall deal honestly with the patient, and seek to resources.
nurture a doctor/patient relationship in which the
patient may fully disclose all relevant
information. The doctor should also acknowledge Conscience
that, in health care, medical errors that injure
patients do sometimes occur. Whenever patients No doctor or patient shall be compelled to act
are injured as a consequence of medical care, contrary to moral conviction or religious belief,
patients should be informed promptly, because except as required by law.
failure to do so seriously compromises patient and
societal trust.
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1. Doctor conduct and practice It is incumbent upon all medical professionals to
persuade an impaired colleague whose
professional performance is of concern to seek
The doctor should: appropriate professional help. If this is not acted
upon voluntarily by the impaired professional, it
recognise the boundaries of her or his is the duty of her/his colleague to report the
particular competencies and expertise; impairment to the appropriate authority (for
provide only those services and use only example, the relevant medical board).
those techniques for which he/she has
been accredited by an organisation 1.1 Relationships with medical
professionally and publicly recognised professionals
as being competent to provide such
accreditation; Doctors should work closely with their
participate in continuing professional colleagues in order to monitor and maintain their
development relevant to the maintenance awareness of the quality of care provided.
of knowledge or skills necessary to
medical services he/she renders; and Such a relationship should exhibit:
use new/emergent techniques only after
fairness,
appropriate training and accreditation in
their use. In unproven areas of medical honesty,
treatment, the doctor should adhere to integrity and
guidelines established by the relevant consultation and cooperation with other
national or institutional body and other professionals to the extent necessary to
relevant professional organisations. In the serve the best interests of patients.
absence of such guidelines the doctor
should take appropriate precautions to 1.2 Relationships with other Health
protect patient welfare. Care Professionals
Any promotional activities or material should In order to maintain the highest level of clinical
foster trust and mutual respect among health care, the doctor should maintain an open and
professionals and enhance the dignity of the professional relationship with all workers in the
profession. The doctor should not misrepresent health care environment. There should be:
herself or himself in any publicity or
advertisement. He/she should not criticise any clear communication with respect for
other professional colleague in any untruthful, privacy and confidentiality;
misleading or deceptive manner to patients, cooperation, collaboration and
colleagues, other health care professionals or the teamwork;
general public as stated in the ‘Advertising of understanding; and
Medical Services’ section of the
RANZCOG/NASOG Practice Handbook.
due regard to the effectiveness of care
and the use of resources.
The doctor who suspects that he or she may be
infected with a serious infectious agent that
might be transferred to patients should
voluntarily be tested for such agents and should
avoid clinical situations that may lead to the
transfer of infection. Where infection is
confirmed the practitioner should adhere to the
fundamental professional obligation to avoid
harm to patients.
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2 The patient-doctor relationship about likely costs of consultation and treatment
prior to embarking on a therapeutic relationship.
The welfare of the patient is the focus of the Where examination is indicated, doctors should
relationship. The special responsibilities of the ensure that:
doctor arise from the patient’s need for
information and care. Intrinsic to the relationship an adequate explanation is provided
is the doctor’s respect for the humanity and about the nature of an examination and
dignity of patients. the information that it will provide;
the patient has the opportunity to decline
The patient may be vulnerable, or feel examination;
vulnerable, in the relationship. This should be consent is obtained, especially for breast
recognised, respected and not exploited and/or pelvic examination;
physically, emotionally, financially, or in any privacy is provided for disrobing;
other way. suitable cover is provided during
examination, for example, gown and
Good and ongoing communication is the key to cover sheet; and
effective medical practice.
a chaperone is available to attend any
patient undergoing physical examination
when requested, irrespective of the
2.2 General approach gender of the doctor.
3
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Where complementary and alternative medicines
are used by the patient, the doctor should be 2.8 Records and confidentiality
respectful of the patient’s decision to use these
treatments and the cultural context in which such Doctors should maintain records that allow for
treatments may be used. continuity of care and evaluation of therapeutic
outcomes.
Doctors should offer advice, where appropriate,
without coercion. Doctors have a responsibility to protect the
confidentiality of all information relevant to their
Doctors should provide for continuity of care patient. This responsibility, however, operates in
during any periods of leave and ensure that a broader context and will, at times, be
patients are aware of how to access such care. overridden by other responsibilities. The
circumstances in which such responsibilities may
arise include when the health and safety of
2.6 Further opinion / referral others is at risk, when required by law, or when
necessary for the best care of the patient.
Doctors should offer or arrange a further opinion
and/or ongoing care with another suitable Where doctors are legally required to release in-
practitioner if: formation about a patient, the patient should, if
reasonably practicable, be advised beforehand of
the patient requests this; the reasons and the information to be released.
the therapy required is beyond the
individual doctor’s expertise or For audit and research purposes aimed at
experience; improving the health care system, only securely
de-identified information should be used.
the therapy required is in conflict with the
doctor’s personal belief/value system.
2.9 Personal relationships with
If a doctor wishes to discontinue care of a
patients
particular patient, he/she must make appropriate
referral and with the patient’s consent
Doctors should not engage in sexual contact of
communicate relevant information to the new
any kind with patients. Such behaviour is an
practitioner.
abuse of professional power, a violation of trust
and, in many cases, a violation of civil or
Doctors should not unreasonably refuse to accept
criminal law.
referral or provide care; this applies particularly
in an emergency or if no other appropriate
Doctors should take care to avoid behaviour
practitioner is available.
which might reasonably be interpreted by patients
as demeaning or as a sexual advance, including
comments or innuendo of a sexual nature, or
2.7 Financial and Commercial Dealings
questioning on sexual matters which is
unnecessary for clinical purposes.
Doctors are entitled to charge a reasonable fee for
their professional services. The patient should be
fully informed of the estimated cost of a service.
2.10 Care of relatives and friends
This should form part of the informed financial
consent procedure. The patient should be given the
Doctors should avoid treating family members
opportunity to decline the service in a timely
because both care and relationships can be
manner and, if necessary, assisted in obtaining
compromised. If required to take on this role in
alternative medical care.
an emergency or when other medical care is not
accessible, consultation, record-keeping and
Professional fees should be reasonable, taking into
follow-up should be formalized.
account the professional service and the prevailing
standard of fees.
Similar caution and professionalism when
treating close friends should be exercised.
The practitioner should declare any pecuniary
interest. Doctors shall not take undue financial
advantage of a patient.
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3 Conflict of interest with, other organisations that could lead
to conflict of interest and they should be
recorded in the minutes;
upon discussion of any issue in which the
3.1 Introduction individual has an interest, this interest
should be declared and recorded in the
A conflict of interest exists when a person minutes; and
entrusted with the interests of a patient, other if the resolution of the issue might lead
individuals or the public violates that trust by to direct benefit to the individual, the
promoting her/his own self-interests or the individual must advise the convenor of
interests of third parties. Conflicts of interest the meeting that he/she cannot
may be financial, professional, personal or participate in the discussion and seek
religious. Multiple interests may pull people in advice from the convenor as to whether
different directions but a conflict of interest he/she should withdraw and have this
exists when such interests compromise known recorded in the minutes.
obligations and interfere with objective
professional judgement.
3.2 Whistle blowing
The nature of modern medical practice lends
itself to potential conflicts of interest. Listed Occasionally doctors will find themselves
below are examples of areas where conflict may concerned about the professional conduct of an
occur. individual or organization. In such a case, attempt
should be made to redress the situation. If the
Pecuniary and other interests which may matter is not resolved, or if satisfactory progress
lead to a conflict of interest should be has not been made, it should be taken to the
declared in all situations. appropriate authority.
Options offered and recommendations
made should not be influenced by
differences in fees for the various 3.3 Care and management
procedures.
Marketing or advertising for personal Doctors should ensure that care and management
gain should not overturn recommending is:
an appropriate procedure.
based solely on the medical needs of the
Doctors must resolve such conflicts in accordance patient;
with the best interests of the patient. While the not influenced by incentives from
interests of colleagues, employers and the pharmaceutical companies or other
community are important, they are secondary to medical entities; and
those of the patient. not determined on the basis of personal
profit.
The potential for conflict of interest exists in
many aspects of obstetric and gynaecological Doctors should advise patients of any research
practice. There will be some similarity in the interest in treatment and consultations should
nature of the potential conflict in these areas. include discussion about conflicts that may arise
Pecuniary interests can lead to conflicts in each as a result of belief differences, for example,
area. Declaration of interests can ameliorate the religious and cultural differences.
conflict, but it will sometimes be necessary for
Fellows to distance themselves from the event When a woman is pregnant there is a duty to
leading to the conflict if there is the capacity to consider the health of the woman and the fetus.
cause harm. The woman’s informed decisions about the
relative value of her own health and well being
In relation to conflict of interest occurring and that of her fetus must be respected.
outside the immediate doctor/patient
relationship, e.g, in the context of a meeting:
If doctors intend researching or publishing on a Although a doctor must make the interest of the
field of their specialty, then they should: patient his or her first concern, conflicts may
arise when the needs of the individual and the
disclose any financial or other benefit needs of a population of patients cannot both be
from recruitment of patients to clinical met. Where the best possible treatment cannot be
trials; provided, the reasons should be discussed with
advise colleagues of any pecuniary the patient and documented. The rationalisation
interests before commencing research; of health care resources should be transparent
and and, where possible, dictated by established
disclose details of commercial funding of guidelines, research and audit.
research when publication results.
be aware that he/she is responsible for the decline any gift, sponsorship or
competent performance of the trainee in hospitality that may affect, or be seen
delivering care; to affect, his or her judgement; and
disclose the role of the trainee to the in the conduct of medical research,
patient; declare any financial sponsorship to re-
not allow trainees to carry out procedures search ethics committees, to research
that will conflict with the best interests of participants and in any publication or
the patient or for which the trainee has meeting presentation resulting from the
not been adequately prepared; and research.
make every effort to provide maximal
operative and clinical experience for, and
suitable supervision of, the trainee.
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4 Responsibility to the College observe professional ethical obligations;
accept the profession’s self-imposed
discipline;
4.1 Competence permit assessment of professional
competence by a professional
In order to maintain their competency and association, hospital or peer review
performance standards, doctors should: committee;
encourage colleagues who are impaired
participate in educational activities or behave illegally or unethically to seek
relevant to the area of practice to help and, if necessary, inform the
maintain competence and performance; relevant authorities; and
maintain awareness of the quality of care cooperate with appropriate disciplinary
that is endorsed by the College as current authorities.
best practice;
participate in a regular and systematic
medical and clinical audit and, where 4.4 Research
indicated, act on the results of the audit;
comply with such standards produced or Where patients are to be approached to consider
endorsed by the College; participation in research, doctors should:
respond constructively to assessments
and appraisals of one’s professional ensure that the research has been
properly approved by a human research
competence and performance; and
ethics committee;
Give medico legal opinion only in
accordance with the principles of the
satisfy themselves that the research is of
value;
RANZCOG Expert Witness Register.
ensure that informed consent is obtained;
and
4.2 Education
ensure that patients understand their right
to refuse or to withdraw at any time
without prejudice or penalty.
The doctor in his/her professional reading should
critically evaluate authorship, reliability of in-
formation and be alert to conflicts of If research is undertaken involving patients or
interest. volunteers, the doctor should:
4.3 Discipline
4.5 Acting as an advocate for the
Doctors should: profession in public
be aware of and observe contemporary The College, through its members, should
laws, regulations and statutory codes of stimulate and foster the trust and confidence of
practice affecting their standard of care; patients and of the community. Members should
be prepared to support the profession in public
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and to demonstrate the profession’s integrity. In 5 Advocacy
this respect, doctors should:
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legislation affecting the health or well-being of 6 Special Cultural Considerations
the community. Specifically, they should:
practice within the boundaries of their In New Zealand there is a special relationship
training and experience and in keeping with between the “Tangata Whenua” (Maori People)
local resources, cultural imperatives and legal and the Crown. The Treaty of Waitangi was
frameworks; and signed in 1840 to provide governance and
promote the development of medical protection for Maori. It forms the basis of
expertise in developing countries. present New Zealand society, hence its articles
must underpin Maori health strategies and
research. Principles are derived from the Treaty
to reflect the spirit of the Treaty and its original
aims and enable contemporary application. There
are three such principles which are partnership,
participation and protection:
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Involving Maori at all levels of the sector
in planning, development and delivery of Bibliography
health services and research policies
To ensure that Maori “Tikanga” (values FIGO Committee for the Ethical Aspects of
and practices) are safeguarded and that Human Reproduction and Women’s Health
Maori enjoy the same level of health as Recommendations on Ethical Issues in
other New Zealanders. Obstetrics & Gynaecology (2000)
Maori concepts of health are important in FIGO Professional and Ethical Responsibilities
dealing with Maori patients. As with all Concerning Sexual and Reproductive Rights
Indigenous People faced with western
influence, there are different patterns of ill NHMRC ethical guidelines
health. In general, the Maori approach to
illness is holistic and not just physical. The Medical Council of New Zealand Statements
spiritual side is strong and the role of the
family (whanau) in support and decision General Medical Council Guidance on good
making is important. Cultural customs and practice
mannerisms may influence the medical
consultation, and the doctor needs to be RCOG Guidelines
sensitive to these.
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