Code of Ethics
As a provincial division of the CMA, members of the British
Columbia Medical Association are bound by the code of ethics
approved by the CMA Board of Directors, October 15, 1996.
Preface
General Responsibilities
Responsibilities to
the Patient
Initiating and Dissolving
a Patient-Physician Relationship
Communication,
Decision Making and Consent
Confidentiality
Clinical Research
Professional Fees
Responsibilities
to Society
Responsibilities to
the Profession
Responsibilities
to Oneself
Preface
The Canadian Medical Association accepts the responsibility
for delineating the standard of ethical behaviour expected
of Canadian physicians and has developed and approved this
Code of Ethics as a guide for physicians.
The Code is an ethical document. Its sources are the traditional
codes of medical ethics such as the Hippocratic Oath, as well
as developments in human rights and recent bioethical discussion.
Legislation and court decisions may also influence medical
ethics. Physicians should be aware of the legal and regulatory
requirements for medical practice in their jurisdiction. However,
the Code may set out different standards of behaviour than
does the law.
The Code has been prepared by physicians for physicians.
It is based on the fundamental ethical principles of medicine,
especially compassion, beneficence, non-maleficence, respect
for persons and justice. It interprets these principles with
respect to the responsibilities of physicians to individual
patients, family and significant others, colleagues, other
health professionals, and society.
The Code is not, and cannot be, exhaustive. Its statements
are general in nature, to be interpreted and applied in particular
situations. Specific ethical issues such as abortion, transplantation
and euthanasia are not mentioned; they are treated in appropriate
detail in CMA policy statements.
Physicians may experience conflict between different ethical
principles, between ethical and legal or regulatory requirements,
or between their own ethical convictions and the demands of
patients, proxy decision makers, other health professionals,
employers or other involved parties. Training in ethical analysis
and decision making during undergraduate, postgraduate and
continuing medical education is recommended for physicians
to develop the knowledge, skills and attitudes needed to deal
with these conflicts. Consultation with colleagues, licensing
authorities, ethicists, ethics committees or others who have
expertise in these matters is also recommended.
The Code applies to physicians, including residents, and
medical students.
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General Responsibilities
1. Consider first the well-being of the patient.
2. Treat all patients with respect; do not exploit them for
personal advantage.
3. Provide for appropriate care for your patient, including
physical comfort and spiritual and psychosocial support even
when cure is no longer possible.
4. Practise the art and science of medicine competently and
without impairment.
5. Engage in lifelong learning to maintain and improve your
professional knowledge, skills and attitudes.
6. Recognize your limitations and the competence of others
and when indicated, recommend that additional opinions and
services be sought.
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Responsibilities
to the Patient
Initiating and
Dissolving a Patient-Physician Relationship
7. In providing medical service, do not discriminate against
any patient on such grounds as age, gender, marital status,
medical condition, national or ethnic origin, physical or
mental disability, political affiliation, race, religion,
sexual orientation, or socioeconomic status. This does not
abrogate the physician's right to refuse to accept a patient
for legitimate reasons.
8. Inform your patient when your personal morality would
influence the recommendation or practice of any medical procedure
that the patient needs or wants.
9. Provide whatever appropriate assistance you can to any
person with an urgent need for medical care.
10. Having accepted professional responsibility for a patient,
continue to provide services until they are no longer required
or wanted; until another suitable physician has assumed responsibility
for the patient; or until the patient has been given adequate
notice that you intend to terminate the relationship.
11. Limit treatment of yourself or members of your immediate
family to minor or emergency services and only when another
physician is not readily available; there should be no fee
for such treatment.
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Communication,
Decision Making and Consent
12. Provide your patients with the information they need
to make informed decisions about their medical care, and answer
their questions to the best of your ability.
13. Make every reasonable effort to communicate with your
patients in such a way that information exchanged is understood.
14. Recommend only those diagnostic and therapeutic procedures
that you consider to be beneficial to your patient or to others.
If a procedure is recommended for the benefit of others, as
for example in matters of public health, inform your patient
of this fact and proceed only with explicit informed consent
or where required by law.
15. Respect the right of a competent patient to accept or
reject any medical care recommended.
16. Recognize the need to balance the developing competency
of children and the role of families in medical decision-making.
17. Respect your patient's reasonable request for a second
opinion from a physician of the patient's choice.
18. Ascertain wherever possible and recognize your patient's
wishes about the initiation, continuation or cessation of
life-sustaining treatment.
19. Respect the intentions of an incompetent patient as they
were expressed (e.g., through an advance directive or proxy
designation) before the patient became incompetent.
20. When the intentions of an incompetent patient are unknown
and when no appropriate proxy is available, render such treatment
as you believe to be in accordance with the patient's values
or, if these are unknown, the patient's best interests.
21. Be considerate of the patient's family and significant
others and cooperate with them in the patient's interest.
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Confidentiality
22. Respect the patient's right to confidentiality except
when this right conflicts with your responsibility to the
law, or when the maintenance of confidentiality would result
in a significant risk of substantial harm to others or to
the patient if the patient is incompetent; in such cases,
take all reasonable steps to inform the patient that confidentiality
will be breached.
23. When acting on behalf of a third party, take reasonable
steps to ensure that the patient understands the nature and
extent of your responsibility to the third party.
24. Upon a patient's request, provide the patient or a third
party with a copy of his or her medical record, unless there
is a compelling reason to believe that information contained
in the record will result in substantial harm to the patient
or others.
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Clinical Research
25. Ensure that any research in which you participate is
evaluated both scientifically and ethically, is approved by
a responsible committee and is sufficiently planned and supervised
that research subjects are unlikely to suffer disproportionate
harm.
26. Inform the potential research subject, or proxy, about
the purpose of the study, its source of funding, the nature
and relative probability of harms and benefits, and the nature
of your participation.
27. Before proceeding with the study, obtain the informed
consent of the subject, or proxy, and advise prospective subjects
that they have the right to decline or withdraw from the study
at any time, without prejudice to their ongoing care.
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Professional Fees
28. In determining professional fees to patients, consider
both the nature of the service provided and the ability of
the patient to pay, and be prepared to discuss the fee with
the patient.
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Responsibilities
to Society
29. Recognize that community, society and the environment
are important factors in the health of individual patients.
30. Accept a share of the profession's responsibility to
society in matters relating to public health, health education,
environmental protection, legislation affecting the health
or well-being of the community, and the need for testimony
at judicial proceedings.
31. Recognize the responsibility of physicians to promote
fair access to health care resources.
32. Use health care resources prudently.
33. Refuse to participate in or support practices that violate
basic human rights.
34. Recognize a responsibility to give the generally held
opinions of the profession when interpreting scientific knowledge
to the public; when presenting an opinion that is contrary
to the generally held opinion of the profession, so indicate.
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Responsibilities
to the Profession
35. Recognize that the self-regulation of the profession
is a privilege and that each physician has a continuing responsibility
to merit this privilege.
36. Teach and be taught.
37. Avoid impugning the reputation of colleagues for personal
motives; however, report to the appropriate authority any
unprofessional conduct by colleagues.
38. Be willing to participate in peer review of other physicians
and to undergo review by your peers.
39. Enter into associations only if you can maintain your
professional integrity.
40. Avoid promoting, as a member of the medical profession,
any service (except your own) or product for personal gain.
41. Do not keep secret from colleagues the diagnostic or
therapeutic agents and procedures that you employ.
42. Collaborate with other physicians and health professionals
in the care of patients and the functioning and improvement
of health services.
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Responsibilities
to Oneself
43. Seek help from colleagues and appropriately qualified
professionals for personal problems that adversely affect
your service to patients, society or the profession.
© 1996 Canadian Medical Association.
Correspondence and requests for additional copies should
be addressed to the Member Service Centre, Canadian Medical
Association, 1867 Alta Vista Dr., Ottawa ON K1G 3Y6;
cmamsc@cma.ca; tel 1-888-855-2555
or (613) 731-8610 x2307; fax (613) 236-8864.
In the case of photocopying or other reprographic copying,
please contact CANCOPY (Canadian Copyright Licensing Agency),
6 Adelaide St. E., Ste. 900, Toronto ON M5C 1H6;
tel 1-800-893-5777.
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