GUIDE TO PROFESSIONAL CONDUCT AND ETHICSFOR REGISTERED MEDICAL PRACTITIONERS
professional conduct
responsibilities to patients
medical records and confidentiality
consent to medical treatment
professional practice
7th Edition 2009
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 3
ContentsIntroduction 7
Section AProfessional Conduct 9
1 Generalprinciples 10
2 Professionalmisconductandpoorprofessionalperformance 11
3 Courtconvictions 12
Section BResponsibilities to Patients 13
4 Paramountresponsibilitytopatients 14
5 Dignityofthepatient 14
6 Protectionandwelfareofchildren 14
7 Reportingofallegedabuse 15
8 Continuityofcare 15
9 Refusaltotreat 16
10 Conscientiousobjection 16
11 Emergencies 16
12 Appropriateskillsandfacilities 17
13 Treatmentofprisoners 17
14 Patientswhopresentariskofviolence 17
15 Physicalandintimateexaminations 18
16 Personalrelationshipswithpatients 18
17 Medicalstudents’involvementinpatientcare 18
18 Adverseevents 19
19 Nutritionandhydration 20
20 Assistedhumanreproduction 20
21 Abortion 21
22 Endoflifecare 22
4 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
Section CMedical Records and Confidentiality 25
23 Medicalrecords 26
24 Generalprinciplesofconfidentiality 26
25 Patientinformationreceivedfromthirdparties 27
26 Disclosurewithpatient’sconsentto
relativesandcarers 28
27 Disclosurerequiredbylaw 28
28 Disclosureintheinterestofthepatientorotherpeople 29
29 Disclosureinthepublicinterest 29
30 Disclosuretootherhealthcareprofessionals 30
31 Registersofillness 31
32 Recording 31
Section DConsent to Medical Treatment 33
33 Generalprinciples 34
34 Capacitytoconsent 34
35 Informedconsenttomedicaltreatment 36
36 Informationforpatients 36
37 Timingofconsentprocess 37
38 Responsibilityforseekingconsent 38
39 Emergencysituations 38
40 Refusaloftreatment 38
41 Advancehealthcareplanning 39
42 Consenttogenetictesting 40
43 Childrenandminors 40
Section EProfessional Practice 43
44 Maintainingcompetence 44
45 Concernsaboutcolleagues 44
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 5
46 Relationshipsbetweencolleagues 44
47 Providingreferences 45
48 Acceptingposts 46
49 Healthcareresources 46
50 Professionalindemnity 46
51 Healthproblems 46
52 Treatmentofrelatives 47
53 Clinicaltrialsandresearch 47
54 Provisionofinformationtothepublicandadvertising 49
55 Registerednames 50
56 Premisesandpracticeinformation 50
57 Medicalreports 51
58 Certification 52
59 Prescribing 52
60 Referralofpatients 54
61 Medicalionisingradiation 55
62 Telemedicine 56
63 Locumandrotaarrangements 57
65 Retirementandtransferofpatientcare 58
Appendix AInformationforpatientspriortogivingconsent 60
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 7
IntroductionThepatient-doctor relationship is aprivilegedone thatdependson the
patient’s trust in the doctor’s professionalism. The role of the Medical
Council is to safeguard the public by ensuring that the quality of the
doctor’s competence, behaviours and relationships that underlie this
professionalismismaintainedinthepatient-doctorrelationship.
Doctorsmustalwaysbeguidedbytheirprimaryresponsibilitytoactinthe
bestinterestsoftheirpatients,withoutbeinginfluencedbyanypersonal
consideration. They should act independently in the service of their
patientsandhavearesponsibilitytoadvocatewiththerelevantauthorities
forappropriatehealthcareresourcesandfacilities.
InthiseditionoftheGuide, theMedicalCouncilhassoughttoclarifya
number of specific areas, including consent, confidentiality, end of life
care, provision of information to the public, prescribing practices and
referralofpatients. Increasedemphasis inrecentyearsonpatientsafety
hasalsoinfluencedtheexpansionofguidanceonadverseeventsandopen
communicationwithpatients.
TheMedicalCouncilalsointendstodevelop,inconsultationwithrelevant
stakeholders,furthercomprehensiveguidelinesrelatingtoassistedhuman
reproductionandtherelationshipbetweendoctorsandcommercialenter-
prises.DoctorsareadvisedtoconsulttheMedicalCouncil’swebsitewww.
medicalcouncil.ieforupdatesontheseandother issuesastheybecome
available.
Inadditiontoofferingguidancetodoctors,membersofthepublicarealso
encouragedtoreadtheGuidetoallowthemtounderstandthestandards
expectedofdoctors.Thiswillthenenablethemtoparticipatemoreequally
intherelationshipbetweendoctorsandpatients,arelationshipbasedon
partnershipandunderpinnedbysharedresponsibilities.
8 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS IN MEDICAL PRACTISE
IwouldparticularlyliketothankDrDeirdreMadden,whochairedtheEthics
WorkingGroup,membersoftheEthicsWorkingGroupandmembersof
Councilstafffortheirenergy,dedicationandenthusiasminassistingthe
Medical Council with the development of this edition of the Guide. In
addition, the Medical Council is grateful for the numerous submissions
receivedwhichprovedan invaluable resource in revising theGuideand
securingitspositionatthecentreofthepatient-doctorrelationship.
ProfessorKieranCMurphy
President
10 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
1 General principles1.1 Medicalprofessionalismisacoreelementofbeingagooddoctor.
Goodmedicalpracticeisbasedonarelationshipoftrustbetween
theprofessionandsociety,inwhichdoctorsareexpectedtomeet
the highest standards of professional practice and behaviour. It
involvesapartnershipbetweenpatientanddoctorthatisbased
on mutual respect, confidentiality, honesty, responsibility and
accountability.
1.2 Inaddition tomaintainingyour clinical competenceasadoctor
youshouldalso:
➤ showintegrity,compassionandconcernfor
othersinyourday-to-daypractice,
➤ developandmaintainasensitiveand
understandingattitudewithpatients,
➤ exercisegoodjudgementandcommunicate
soundclinicaladvicetopatients,
➤ searchforthebestevidencetoguide
yourprofessionalpractice,and
➤ becommittedtocontinuousimprovementand
excellenceintheprovisionofhealthcare,whether
youworkaloneoraspartofateam.
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 11
2 Professional misconduct and poor professional performance
2.1 Professionalmisconductis:
(a) Conduct which doctors of experience, competence and
goodreputeconsiderdisgracefulordishonourable;and/or
(b) Conductconnectedwithhisorherprofessioninwhichthe
doctor concernedhas seriously fallen shortbyomissionor
commission of the standards of conduct expected among
doctors.
2.2 Poor professional performance, in relation to a medical practi-
tioner,meansafailurebythepractitionertomeetthestandards
ofcompetence(whetherinknowledgeandskillortheapplication
ofknowledgeandskillorboth)thatcanreasonablybeexpected
ofmedicalpractitionerspractisingmedicineofthekindpractised
bythepractitioner.
2.3 Asadoctor,youshouldbeawarethatcomplaintsmaybemade
against you to the Medical Council on grounds of professional
misconduct or other grounds, including poor professional
performance, under the Medical Practitioners Act 2007.1 This
would include complaints based on unacceptable behaviour or
poorcommunication.
1 MedicalPractitionersAct,2007
www.irishstatutebook.ie/2007/en/act/pub/0025/index.html
12 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
3 Court convictions3.1 Ifadoctorisconvictedofacriminaloffence,thiswillbenotified
totheMedicalCouncil,whichwill investigatethecircumstances
involved.Youmaynotbeabletoavoidaninquirybyclaimingthat
youwerenotondutyatthetimeoftheoffence.
14 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
4 Paramount responsibility to patients4.1 Your paramount professional responsibility is to act in the best
interestsofyourpatients.Thistakespriorityoverresponsibilitiesto
yourcolleaguesandemployers.
5 Dignity of the patient5.1 Allpatientsmustalwaysbetreatedwithrespectfortheirdignity.
5.2 Patientswithdisabilitiesareentitledtothesametreatmentoptions
and respect for their autonomy as any other patient. Disability
doesnotnecessarilymeanlackofcapacity.Anydecisionyoumake
oninterventionornon-interventioninthecaseofapersonwitha
disabilityrequirestheirconsent.Ifapersonwithadisabilitylacks
the capacity to give consent, you should consult their parents,
guardiansorcarers.Wherenecessaryyoushouldconsidergetting
a second opinion before making decisions on complex issues.
Furtherguidanceisprovidedatparagraph34.
6 Protection and welfare of children6.1 Asadoctor,youshouldbeawareofthenationalguidelinesforthe
protectionofchildren,whichstatethatthewelfareofthechildis
ofparamountimportance.2
6.2 Ifyouhaveanyconcernsregardingallegedorsuspectedsexual,
physical,emotionalabuseorneglectofchildren,youmustreport
this to the appropriate authorities and/or the relevant statutory
agency without delay. You should inform the child’s parents
or guardians of your intention to report your concerns unless
2 ChildrenFirst:NationalGuidelinesfortheProtectionandWelfareofChildren
www.dohc.ie/publications/pdf/children_first.pdf?direct=1
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 15
informing the parents or guardians might endanger the child.
Givinginformationtoothersfortheprotectionofachildmaybea
justifiablebreachofconfidentiality.
7 Reporting of alleged abuse7.1 Whereadultpatientsdiscloseabusethattookplaceduringtheir
childhood, you must assess the current risk to your patient or
anyotherperson(childoradult)whomaybeincontactwiththe
allegedabuser.Ifyouconsiderthatanyoneisatrisk,youshould
report this to the appropriate authorities, preferably with your
patient’sconsent.
7.2 Youhaveadutytobealerttothepossibilityofabuseofvulnerable
adultsorelderlypatientsandtonotifytheappropriateauthorities
ifyouhaveconcerns.Givinginformationtoothersfortheprotec-
tionofthevulnerablemaybeajustifiablebreachofconfidentiality.
8 Continuity of care8.1 Once you undertake the care of patients you should usually
provide continuityof care for thedurationof the illness. If you
decide towithdrawyour services, eitherasan individualpracti-
tioneroraspartofateamorgroupthathasdecidedtowithdraw
care, itdoesnotreleaseyoufromyourethicalresponsibilitiesto
patients. Thismeans that youmustprovide emergency services
andanycarethatmayberequiredbythoseforwhomyouhold
clinical responsibility. When alternative medical care is in place,
youshouldtransferthepatient’smedicalrecordswithoutdelay.
8.2 You should provide medical information, normally with the
patient’sknowledgeandagreement,toanothermemberofthe
professionwhenrequested.
16 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
9 Refusal to treat9.1 Inexceptionalcircumstancesyoumayneed toconsider refusing
specific treatments to individual patients. This must never be
doneonthebasisofpersonaldiscrimination.Youmightconsider
refusing specific treatmentsbecause, for example, you consider
thatthetreatmentwouldnotworkorthat itmightcausemore
harm than good. You might also consider refusing treatment
whereyoubelieve thatyourpatient isunlikely toco-operateor
makethelifestylechangesrequiredtomakethetreatmenteffec-
tive. If you decide to refuse treatment, you must explain your
reasonstothepatientandoffer themanopportunitytoreview
thedecisionand/orseekanotheropinion.
10 Conscientious objection10.1 Asadoctor,youmustnotallowyourpersonalmoralstandardsto
influenceyourtreatmentofpatients.
10.2 Ifyouhaveaconscientiousobjectiontoacourseofaction,you
shouldexplainthistothepatientandmakethenamesofother
doctorsavailabletothem.
10.3 Conscientiousobjectiondoesnotabsolveyoufromresponsibility
toapatientinemergencycircumstances.
11 Emergencies11.1 Youshouldprovidecare inemergenciesunlessyouaresatisfied
thatalternativearrangementshavebeenmade.Youshouldalso
consider what assistance you can safely give in the event of a
major incident, a road traffic accident, fire, drowning or other
similaroccurrences.
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 17
12 Appropriate skills and facilities12.1 Ifyoudonothavetheprofessionalorlanguageskills,ortheneces-
sary facilities to provide appropriate medical care to a patient,
youmust refer thepatient to a colleaguewho canmeet those
requirements.
13 Treatment of prisoners13.1 Youmust treat prisonerswith thenormal courtesy and respect
extendedtoallpatients.Youmustrespecttheconfidentialityof
theirinformationbutwithdueregardforsafetyandsecurity.You
havearighttotakeappropriateprecautionsifyouthinkthereisa
risktoyourpersonalsafety.
13.2 Youmustnotparticipateintortureorotherformsofcruel,inhuman
ordegradingprocedures.3Youmustnotassistwithexecutions.
14 Patients who present a risk of violence14.1 If you are asked to examine or treat a patient who presents a
risk of violence, you should make reasonable efforts to assess
any possible underlying clinical causes of the violent behaviour.
However,youarenotobligedtoputyourselforotherhealthcare
staffatriskofundueharminthecourseofsuchassessmentor
treatment.
3 WorldMedicalAssociation,DeclarationofTokyo,revised2006.
www.wma.net/e/policy/c18.htm
18 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
15 Physical and intimate examinations15.1 Clinicalassessmentofapatientofteninvolvesaphysicalexamina-
tionaswell as relevanthistory-taking.You shouldexplainwhat
thisexaminationwillentailandseekpermissionfromthepatient
beforemakingaphysicalexamination.
15.2 Wherean intimateexamination isnecessary,youshouldexplain
tothepatientwhyitisneededandwhatitwillentail.Youshould
alsoletthepatientknowthattheycanhaveachaperonepresent
iftheywish.
16 Personal relationships with patients16.1 Yourprofessionalpositionmustneverbeusedtoformarelation-
shipofanemotional,sexualorexploitativenaturewithapatient
ortheirspouseorwithacloserelativeofapatient.
17 Medical students’ involvement in patient care
17.1 Mostpatientsunderstandandsupporttheimportanceofmedical
education and training. If you intend to involve students in a
patient’scare,thepatientshouldbeinformed.Iftheyhaveobjec-
tions,youshouldrespecttheirpointofviewasfaraspossible.
17.2 Medical studentsmust be identifiedbynameandmustnotbe
represented as doctors. Students must get permission from
patientsbeforetheyintervieworexaminethem.Patientsshould
notbeburdenedbyexcessivecontactwithmedicalstudents.
17.3 Youshouldensurethatyourstudentsfullyunderstandtheirrolein
relationtopatientcare.
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 19
17.4 Medicalstudentsshouldbefamiliarwithandshouldadheretothe
principlesofthisGuide.
17.5 Youshouldnotallowschoolchildrenorotherinappropriatepeople
to observe or become involved in the clinical care of patients
withouttheexplicitconsentoftheindividualpatientsandsubject
totheprinciplesofconfidentialitysetoutinparagraph24.
18 Adverse events18.1 Providingmedicaltreatmentnecessarily involvessomedegreeof
risk.However,youmustensureasfaraspossiblethattheservices
andtreatmentsyouprovidearesafeandcomplywiththestand-
ardsoftheprofession.
18.2 Ifanadverseeventoccurs,youmustensurethattheeffectsofthe
eventonthepatientareminimisedasfaraspossible.Ifthepatient
needsfurthercarebecauseoftheadverseevent,youmustmake
surethattheyarehelpedandsupportedthroughthisprocess.
18.3 Patientsandtheirfamiliesareentitledtohonest,openandprompt
communicationwith themabout adverse events thatmayhave
causedthemharm.Thereforeyoushould:
➤ acknowledgethattheeventhappened,
➤ explainhowithappened,
➤ apologise,ifappropriate,and
➤ giveanassuranceastohowlessonshave
beenlearnedtominimisethechanceofthis
eventhappeningagaininthefuture.
20 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
19 Nutrition and hydration19.1 Nutrition and hydration are basic needs of human beings. All
patientsareentitledtobeprovidedwithnutritionandhydration
in a way that meets their needs. If a patient is unable to take
sufficientnutritionandhydrationorally,youshouldassesswhat
alternativeformsarepossibleandappropriateinthecircumstances.
Youshouldbear inmindtheburdenorriskstothepatient,the
patient’swishesifknown,andtheoverallbenefittobeachieved.
Wherepossible,youshouldmakethepatientand/ortheirprimary
carerawareoftheseconclusions.
20 Assisted human reproduction20.1 Assistedhumanreproductiontreatments,suchasInVitroFertilisa-
tion (IVF), shouldonlybeusedafter thorough investigationhas
shownthatnoothertreatmentislikelytobeeffective.Youshould
ensure that appropriate counselling has been offered to the
patientand that thepatienthasgiven informedconsentbefore
receivinganytreatment.
20.2 Assistedreproductionservicesshouldonlybeprovidedbysuitably
qualifiedprofessionals, inappropriatefacilities,andaccordingto
internationalbestpractice.Regularclinicalauditandfollow-upof
outcomesshouldbethenorm.
20.3 Ifyouofferdonorprogrammestopatients,youmustconsiderthe
biologicaldifficultiesinvolvedandpayparticularattentiontothe
sourceofthedonatedmaterial.Suchdonationsshouldbealtru-
isticandnon-commercial.Youshouldkeepaccurate records for
futurereference.
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 21
20.4 Youshouldnotparticipateincreatingnewformsoflifesolelyfor
experimentalpurposes.Youshouldnotengageinhumanrepro-
ductivecloning.
21 Abortion21.1 Abortion is illegal in Ireland except where there is a real and
substantial risk to the life (as distinct from the health) of the
mother. Under current legal precedent, this exception includes
wherethereisaclearandsubstantialrisktothelifeofthemother
arisingfromathreatofsuicide.Youshouldundertakeafullassess-
mentofanysuchriskinlightoftheclinicalresearchonthisissue.
21.2 It is lawful to provide information in Ireland about abortions
abroad,subjecttostrictconditions.4Itisnotlawfultoencourage
oradvocateanabortioninindividualcases.
21.3 Youhaveadutytoprovidecare,supportandfollow-upservices
forwomenwhohaveanabortionabroad.
21.4 Incurrentobstetricalpractice,rarecomplicationscanarisewhere
therapeutic intervention (including termination of a pregnancy)
is required at a stage when, due to extreme immaturity of the
baby,theremaybelittleornohopeofthebabysurviving.Inthese
exceptional circumstances, it may be necessary to intervene to
terminatethepregnancytoprotectthelifeofthemother,while
makingeveryefforttopreservethelifeofthebaby.
4 RegulationofInformation(ServicesOutsidetheStateForTerminationof
Pregnancies)Act,1995
www.irishstatutebook.ie/1995/en/act/pub/0005/index.html
22 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
22 End of life care22.1 Asadoctor,youplayanimportantroleinassistingpatients,fami-
lies and the community in dealing with the reality of death. In
caring forpatientsat theendof life, yousharewithothers the
responsibility to take care that the patient dies with dignity, in
comfortandwithaslittlesufferingaspossible.
22.2 Thereisnoobligationonyoutostartorcontinueatreatment,or
artificialnutritionandhydration,thatisfutileordisproportionately
burdensome,evenifsuchtreatmentmayprolonglife.Youshould
carefully consider when to start and when to stop attempts to
prolonglife,whileensuringthatpatientsreceiveappropriatepain
managementandrelieffromdistress.
22.3 Youshouldrespecttherightofpatientstorefusemedicaltreat-
ment or to request the withdrawal of medical treatment. You
should also respect a patient’s Advance Healthcare Plan (also
knownasalivingwill).Furtherguidanceisprovidedinparagraphs
40and41.
22.4 Youshouldtakecare tocommunicateeffectivelyandsensitively
withpatientsandtheirfamiliessothattheyhaveaclearunder-
standingofwhatcanandcannotbeachieved.Youshouldoffer
adviceonothertreatmentorpalliativecareoptionsthatmaybe
availabletothem.Youshouldensurethatsupportisprovidedto
patientsandtheirfamilies,particularlywhentheoutcomeislikely
tobedistressingforthem.
22.5 Afterthedeathofapatient,youshouldbeavailabletospeakwith
thebereavedfamilyifthatiswhattheywish.Youshould,asfaras
possible,explainthecircumstancesofthepatient’sdeathtothe
familyinanopenandsensitivemannerunlessthepatientprevi-
ouslyrecordedanobjectiontosuchinformationbeinggiven.
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 23
22.6 Youmustnotparticipateinthedeliberatekillingofapatientby
activemeans.
26 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
23 Medical records23.1 You have a duty to maintain accurate and up-to-date patient
recordseitherinmanualorelectronicform.Youareexpectedto
beawareofyourobligationsundertheDataProtectionActs5 in
relationtosecurestorageandeventualdisposalofsuchrecordsas
wellasrelevantpublishedCodesofPractice.6
23.2 Patientsareentitledtoreceiveacopyoftheirownmedicalrecords,
provided thisdoesnotput theirhealth (or thehealth, safetyor
privacyofothers) at risk. This rightofaccess isprovided forby
law.7
24 General principles of confidentiality24.1 Confidentiality is a fundamental principle of medical ethics and
iscentraltothetrustbetweenpatientsanddoctors.Patientsare
entitled to expect that information about them will be held in
confidence.Youshouldnotdiscloseconfidentialpatientinforma-
tiontoothersexceptincertainlimitedcircumstancesoutlinedin
paragraphs26to30.
5 DataProtectionActs1988and2003www.dataprotection.ie
6 NationalHospitalsOfficeCodeofPracticeforHealthcareRecordsManagement
www.hse.ie/eng/Publications/Hospitals/National_Hospitals_Office_Code_
ofPractice_for_Healthcare_Records_Management.html)
GuidelinesoftheIrishCollegeofGeneralPractitionersNationalGeneralPractice
InformationTechnologyGroup(www.gpit.ie)
7 DataProtectionActs1988and2003www.dataprotection.ie;
FreedomofInformationAct1997,section6.
www.foi.gov.ie/legislation/freedom-of-information-act-1997-2/
part-ii-access-to-records
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 27
24.2 Patient information remains confidential even after death.
If it is unclear whether the patient consented to disclosure
of information after their death, you should consider how
disclosureof the informationmightbenefitorcausedistress
to thedeceased’s familyor carers.You should also consider
theeffectofdisclosureonthereputationofthedeceasedand
thepurposeofthedisclosure.Individualdiscretioninthisarea
mightbelimitedbylaw.8Seealsoparagraph18.3inrelationto
dealingwithadverseevents.
24.3 Youshouldensureasfaraspossiblethatthepatient’sprivacyis
maintainedatalltimesandthataccidentaldisclosureofconfi-
dentialinformationdoesnotoccur.
24.4 You should ensure as far as possible that confidential infor-
mation in relation to patients is maintained securely and in
compliancewithdataprotectionlegislation.9
25 Patient information received from third parties
25.1 Sometimes itmaybenecessary toobtain informationabout
apatientfromathirdparty,suchasarelative.This informa-
tionisgovernedbythesamerulesofconfidentialitysetoutin
paragraph24.
8 FreedomofInformationAct1997section28(6)Regulations1999
www.foi.gov.ie/regulations/regulation.2006-12-06.4301750217
9 DataProtectionActs1988and2003www.dataprotection.ie
28 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
26 Disclosure with patient’s consent to relatives and carers
26.1 While the concernof thepatient’s relatives and close friends is
understandable, you must not disclose information to anyone
withoutthepatient’sconsent.Ifthepatientdoesnotconsentto
disclosure,youshouldrespectthisexceptwherefailuretodisclose
wouldputothersatriskofseriousharm.
26.2 Ifthepatientisconsideredtobeincapableofgivingorwithholding
consenttodisclosure,youshouldconsiderwhetherdisclosingthe
information to family and carers is in the best interests of the
patient.
27 Disclosure required by law27.1 Incertainlimitedcircumstances,disclosureofpatientinformation
mayberequiredbylaw.Thesecircumstancesarenotlimitedtobut
mayinclude:
➤ whenorderedbyajudgeinacourtoflaw,orbyatribunal
orbodyestablishedbyanActoftheOireachtas,or
➤ wheremandatedbyinfectiousdiseaseregulations.10
➤ Intheseinstances,youshouldinformpatients
ofthedisclosureandthereasonsforit.
10 HealthProtectionSurveillanceCentre
www.ndsc.ie/hpsc/NotifiableDiseases/NotificationLegislationandProcess/
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 29
28 Disclosure in the interest of the patient or other people
28.1 Disclosure of patient information without their consent may be
justifiable in exceptional circumstances when it is necessary to
protectthepatientorothersfromseriousriskofdeathorserious
harm.Youshouldobtainconsentofthepatienttothedisclosureif
possible.
28.2 If you consider that disclosing patient information is justifiable,
youshouldcarefullyconsiderwhetheranonymisationoftheinfor-
mation(sharingitwithoutrevealingthepatient’sidentity)would
achievethesamepotentialbenefits.Youmustalsobecarefulto
disclosetheinformationtoanappropriateperson(orbody)who
understandsthattheinformationmustbekeptconfidential.You
shouldonlydisclosetheminimuminformationthatisnecessaryin
thecircumstances.
28.3 In the preceding instances, you should inform patients of the
disclosureunlessthiswouldcausethemseriousharm.
29 Disclosure in the public interest29.1 Disclosureofpatient informationwithout consentmaybe justi-
fiable in exceptional circumstances where it is necessary in the
publicinterest.Ifhealthprotectionstaffrequestit,youmayshare
relevant patient information where it is necessary to protect
the public. Before making such disclosures you should consider
thepossibleharmthatmay result to thepatient,aswellas the
benefitsthatarelikelytoarise.Paragraphs28.2and28.3arealso
applicabletosuchdisclosures.
30 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
29.2 Youmust report to theappropriatehealthauthorityand/or the
relevantstatutoryagencyanyseriousadverseeventthatharmed
apatient.Toimprovepracticesandlearnfromerrors,youshould
also ensure that less serious adverse events or near misses are
investigatedandreported.Seealsoparagraph18.
30 Disclosure to other healthcare professionals
30.1 Most people understand and accept that information must be
sharedwithinthehealthcareteamtoprovidesafeandeffective
care. Ifdisclosureofapatient’s information isnecessaryaspart
oftheircareandtreatment,youshouldtakereasonablestepsto
ensurethatyoumakesuchadisclosuretoanappropriateperson
whounderstandsthattheinformationmustbekeptconfidential.
30.2 Clinical audit andquality assurance systemsareessential to the
provisionofgoodcareandmustbesupportedbyaccesstohigh
quality reliabledata.Whenpatient information is tobeusedas
part of clinical audit andquality assurance systems, you should
anonymise the information as far as possible. Where anonymi-
sation is not possible or appropriate, you shouldmakepatients
awarethattheiridentifiableinformationmaybedisclosedforsuch
purposes.Theyshouldhavetheopportunitytoobjecttodisclosure
oftheirinformationandanysuchobjectionmustberespected.
30.3 Educationandtrainingofhealthprofessionals isessentialtothe
provision of safe and effective healthcare. When patient infor-
mation is to be used for education and training purposes, you
should anonymise it as far as possible.Where anonymisation is
notpossibleorappropriate,youshouldmakepatientsawarethat
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 31
theiridentifiableinformationmaybedisclosedforsuchpurposes.
Theyshouldhavetheopportunitytoobjecttodisclosureoftheir
informationandanysuchobjectionmustberespected.
31 Registers of illness31.1 With the increasing importance of audit in medicine and the
necessityforevidence-basedmedicine,youshouldrememberthat
you must adhere to the principles of confidentiality outlined in
paragraph24ifregistersofspecificillnessesarebeingkept.You
shouldalsobeawareofanyspeciallegislativeprovisionsinrelation
todiseaseregistries.
32 Recording32.1 Audio,visualorphotographicrecordingsofapatient,orarelative
ofapatient, inwhich thatperson is identifiable shouldonlybe
undertakenwith theirexpressconsent.These recordings should
bekeptconfidentialaspartofthepatient’srecord.
34 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
33 General principles33.1 You should ensure that informed consent has been given by a
patientbeforeanymedical treatment is carriedout. Theethical
andlegalrationalebehindthisistorespectthepatient’sautonomy
andtheirrighttocontroltheirownlife.Thebasicideaofpersonal
autonomyisthateveryone’sactionsanddecisionsaretheirown.
Therefore, thepatienthas the right todecidewhathappens to
theirownbody.
34 Capacity to consent34.1 Everyadultpatientispresumedtohavethecapacitytomakedeci-
sionsabouttheirownhealthcare.Astheirdoctor,youhaveaduty
tohelpyourpatientstomakedecisionsforthemselvesbygiving
theminformationinaclearandcomprehensiblemannerandby
ensuringthattheyhaveappropriatehelpandsupport.Thepatient
isalsoentitledtobeaccompaniedduringanysuchdiscussionby
anadvocateoftheirownchoice.
34.2 Sometimes aperson’s capacity togive consent canbe affected
byinfirmity.Peoplewhoareconsiderednottohavethecapacity
togivetheirconsentarestillentitledtothesamerespectfortheir
human dignity and personal integrity as any person with full
capacity.
34.3 Afunctionalapproachshouldbetakenwhenassessingan indi-
vidual’scapacity.Thisapproachassessestheindividual’sabilityto
maketherelevantchoicedependingon:
➤ theirlevelofunderstandingandretentionof
theinformationtheyhavebeengiven,and
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 35
➤ theirabilitytoapplytheinformationtotheirown
personalcircumstancesandcometoadecision.
34.4 Ifapatientisunabletounderstand,retain,useorweighupthe
informationtheyhavebeengiventomaketherelevantdecision,
oriftheyareunabletocommunicatetheirdecision,theymaybe
regardedaslackingthecapacitytogiveconsenttotheproposed
investigationor treatment.A judgment that a patient lacks the
capacitytomakeaparticulardecisiondoesnotimplythattheyare
unabletomakeotherdecisionsorwillbeunabletomakethisor
otherdecisionsinthefuture.
34.5 Where an adult patient is deemed to lack capacity to make a
healthcaredecision,youshouldtakereasonablestepstofindout
whetheranyotherpersonhaslegalauthoritytomakedecisionson
thepatient’sbehalf.Ifso,youshouldseekthatperson’sconsentto
theproposedtreatment.
34.6 Ifnootherpersonhas legalauthority tomakedecisionsonthe
patient’sbehalf,youwillhavetodecidewhatactiontotake. In
doingso,youshouldconsider:
➤ whichtreatmentoptionwouldprovidethe
bestclinicalbenefitforthepatient,
➤ thepatient’spastandpresentwishesiftheyareknown,
➤ whetherthepatient’scapacityislikelytoincrease,
➤ theviewsofotherpeopleclosetothepatient
whomaybefamiliarwiththepatient’s
preferences,beliefsandvalues,and
36 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
➤ theviewsofotherhealthprofessionals
involvedinthepatient’scare.
35 Informed consent to medical treatment35.1 Consentgivenbythepatientistheexerciseofavoluntarychoice;
it is the giving of permission for the intervention to be carried
outbycompetentprofessionals,wherepossibleinanappropriate
environment. You should explain the process in such a way as
toensurethatpatientsdonotfeelthattheirconsentissimplya
formalityorasignatureonapage.
35.2 Aspart of the informed consentprocess, patientsmust receive
sufficient information, in a way that they can understand, to
enable them to exercise their right to make informed decisions
abouttheircare.Thisreferstothedisclosureofallsignificantrisks
orsubstantialrisksofgraveadverseconsequences.
36 Information for patients36.1 Effectivecommunicationisthekeytoachievinginformedconsent.
Youshouldtakeappropriatestepstofindoutwhatpatientswant
to know about their condition and what they ought to know
abouttheircondition,itsinvestigationandtreatment.
36.2 Theamountof informationgivento individualpatientswillvary
accordingtofactorssuchasthenatureofthecondition,themode
ofinvestigation,thecomplexityofthetreatment,therisksasso-
ciated with the treatment or procedure and the patient’s own
wishes. For example, patients may need more information to
makeaninformeddecisionaboutaprocedurethatcarriesahigh
riskoffailureoradversesideeffectsoraboutaninvestigationfor
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 37
aconditionthat,iffoundtobepresent,couldhaveseriousconse-
quencesforthepatient’semployment,socialorpersonallife.See
alsoAppendixA.
36.3 Whenyouareprovidinginformation,youshouldconsiderpatients’
individual needs and priorities. For example, patients’ beliefs,
culture,occupationorother factorsmayhaveabearingon the
informationtheyneedtoreachadecision.Youshouldaskyour
patientwhethertheyhaveunderstoodtheinformationtheyhave
receivedandiftheywouldlikemoreinformationbeforemakinga
decision.
36.4 Youmustansweranyquestionsthepatientraisesasfullyasthe
patientwishes.Youmustnotwithholdfromapatientanyinfor-
mation necessary for decision making unless disclosure would
causethepatientseriousharm.Inthiscontext’seriousharm’does
notmean thepatientwouldbecomeupset or decide to refuse
treatment.
37 Timing of consent process37.1 Obtaining informed consent cannot be an isolated event. It
involvesacontinuingprocessofkeepingpatientsuptodatewith
any changes in their conditionand the treatmentsor investiga-
tionproposed.Wheneverpossible,youshoulddiscusstreatment
optionsatatimewhenthepatientisbestabletounderstandand
retaintheinformation.
37.2 It isnot recommended toseekconsentwhenapatientmaybe
stressed, sedated or in pain and therefore less likely to make a
calmandreasoneddecision.Wherepossible,youshouldexplain
riskswellinadvanceofanintervention.
38 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
38 Responsibility for seeking consent38.1 Ifyouarethedoctorprovidingtreatmentorundertakinganinves-
tigation,itisyourresponsibilitytodiscussitwiththepatient.As
thetreatingdoctor,youwillhaveafullunderstandingoftheproce-
dureortreatment,howitiscarriedoutandtherisksattachedtoit.
Ifitisnotpossibleforyoutodothis,youmaydelegatethediscus-
siontoanotherpersonaslongasthatpersonissuitablytrained
andqualified,hassufficientknowledgeoftheproposedinvestiga-
tionortreatmentandunderstandstherisksinvolved.Thetreating
doctorremainsresponsibleforensuringthatthepatienthasbeen
givensufficienttimeandinformationtomakeaninformeddeci-
sionandconsentedtotheprocedureorinvestigation.
38.2 Ingeneral,internsarenotconsideredappropriatepeopletounder-
takethisresponsibilityunlesstheprocedureisaminoronewith
whichtheinternisveryfamiliarandtheintern’smedicalsupervisor
hasclearlyexplainedtherelevantinformationabouttheprocedure
tothem.
39 Emergency situations39.1 In an emergency, where consent cannot be obtained, medical
treatmentmaybeprovidedtoanyonewhoneedsit,providedthe
treatmentislimitedtowhatisimmediatelynecessarytosavelife
oravoidsignificantdeteriorationinthepatient’shealth.
40 Refusal of treatment40.1 Everyadultwithcapacityisentitledtorefusemedicaltreatment.
Youmust respectapatient’sdecision to refuse treatment,even
if you disagree with that decision. In these circumstances, you
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 39
should clearly explain to the patient the possible consequences
of refusing treatment and offer the patient the opportunity to
receiveasecondmedicalopinionifpossible.
40.2 Theexplanationyougivethepatientandthepatient’srefusalof
treatmentshouldbeclearlydocumentedinthepatient’smedical
records.
40.3 If you have doubts or concerns about the patient’s capacity to
refusetreatment,theprovisionssetoutinparagraph34apply.
41 Advance healthcare planning41.1 Sometimespatientsmightwant to plan for theirmedical treat-
mentintheeventthattheybecomeincapacitatedinthefuture.
Thismightincludeanadvancerefusalofmedicaltreatmentand/or
arequestforaspecificprocedure.However,youarenotobliged
toprovidetreatmentthatisnotclinicallyindicatedforaparticular
patient.
41.2 Anadvancetreatmentplanhasthesameethicalstatusasadeci-
sionbyapatientat theactual timeofan illnessandshouldbe
respectedonconditionthat:
➤ thedecisionwasaninformedchoice,accordingtothe
principlesofinformedconsentinparagraph33,
➤ thedecisioncoversthesituationthathasarisen,and
➤ thepatienthasnotchangedtheirmind.
40 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
41.3 Ifthereisdoubtabouttheexistenceofanadvancetreatmentplan,
thepatient’scapacityatthetimeofmakingthetreatmentplanor
whether it still applies in thepresentcircumstances, youshould
maketreatmentdecisionsbasedonthepatient’sbestinterests.In
makingsuchadecision,youshouldconsultwithanypersonwith
legalauthoritytomakedecisionsonbehalfofthepatientandthe
patient’sfamilyifpossible.
42 Consent to genetic testing42.1 Genetictestingcanhelptodiagnoseanillnessorhelptopredict
the development of an illness in the future. An individual who
wishestohavesuchtestingcarriedoutmustbecounselledabout
the possible consequences of testing.11 Informed consent is a
requirementforgenetictesting.
43 Children and minors43.1 Childrenandyoungpeopleshouldbeinvolvedasmuchaspossible
indiscussionsabouttheirhealthcare.Whenyouaretalkingtoa
childoryoungperson,itisimportanttogivetheminformationin
anage-appropriatemanner, listentotheirviewsandtreatthem
withrespect.
11 DisabilityAct2005Part4
www.oireachtas.ie/documents/bills28/acts/2005/a1405.pdf
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 41
43.2 Patientsaged16yearsandoverareentitledbylawtogivetheir
ownconsenttosurgical,medicalordentaltreatment.12Thisenti-
tlement does not apply to other areas such as organ or tissue
donationorparticipationinmedicalresearch.
43.3 A refusal of treatment by a patient between 16 and 18 years,
whichisagainstmedicaladviceandparentalwishes,isofuncer-
tainlegalvalidity.Inthisevent,youshouldconsiderseekinglegal
advicebeforeactingonsuchadecision.
43.4 Wherethepatientisundertheageof16years,itisusualthatthe
parentswillbeaskedtogivetheirconsenttomedicaltreatmenton
thepatient’sbehalf.
43.5 In exceptional circumstances, a patient under 16 might seek to
makeahealthcaredecisionontheirownwithouttheknowledge
orconsentoftheirparents. Insuchcasesyoushouldencourage
thepatienttoinvolvetheirparentsinthedecision,bearinginmind
yourparamountresponsibilitytoactinthepatient’sbestinterests.
43.6 Whentreatingchildrenandyoungpeople,youshouldremember
yourdutiesofconfidentialityasprovidedinparagraph24,subject
toparentalrightsofaccesstomedicalrecordswhichmayariseby
law.13Youshouldtelltheseyoungpatientsthatyoucannotgivean
absoluteguaranteeofconfidentiality.
12 “Surgical,medicalordentaltreatment”includesanyprocedureundertakenfor
thepurposesofdiagnosis,includingtheadministrationofananaestheticwhich
isancillarytoanytreatment.
Non-FatalOffencesagainstthePersonAct1997,section23.
www.irishstatutebook.ie/1997/en/act/pub/0026/sec0023.html#zza26y1997s23
13 FreedomofInformationAct1997section28(6)Regulations1999
www.foi.gov.ie/regulations/regulation.2006-12-06.4301750217
44 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
44 Maintaining competence44.1 Youmustmaintainyourcompetencethroughoutyourprofessional
career by taking part in the professional competence schemes
establishedbytheMedicalCouncil.
45 Concerns about colleagues45.1 Ifyouhaveconcernsaboutacolleague’sconductorcompetence,
you should talk through your concerns initially with the doctor
inquestion.Insuchasituation,orwhereyouhaveaconcernin
relation to potentially unsafe systems, you must act to prevent
any immediaterisktopatientsafetybytakingappropriatesteps
to notify the relevant authority about your concern as soon as
possible.Ifyouarenotsurewhoyoushouldreportyourconcern
to,askaseniorcolleagueforadvice.
45.2 If you are concernedabout a colleague’s healthor professional
competence due to misuse of alcohol or drugs, a physical or
psychological disorder or other factors, you have an overriding
duty tomakesure thatpatientsareprotected.Thebestway to
support a colleague in such circumstances is to advise them to
seekexpertprofessionalhelportoconsiderreferraltotheMedical
Council’s Health Sub-Committee. However, if there is a risk
topatient safety, youmust inform theMedicalCouncil of your
concernswithoutdelay.
46 Relationships between colleagues46.1 Doctors working in multidisciplinary teams should ensure that
thereareclear linesof communicationandsystemsofaccount-
abilityinplaceamongteammemberstoprotectpatient
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 45
46.2 Subject to paragraph 45of this Guide, you shouldgive profes-
sional support to colleagues including medical students, junior
colleaguesanddoctors in training. Juniorcolleaguesshouldnot
beaskedtoperformtasksforwhichtheyarenotfullycompetent,
except under the direct supervision of senior colleagues. Junior
doctors should consult promptly with their senior colleagues
whereapatient’sconditiongivescauseforconcern.Seniordoctors
shouldencouragetheirjuniorcolleaguestodothis.Ifyoudelegate
tasks todoctors in training, youare still responsible formaking
surethetaskiscarriedoutsafelyandcompetently.
46.3 Youhaveadutytotreatallhealthcareworkers,includinghealth-
carestudents,withdignityandrespect.
46.4 Whendisputesarisebetweencolleagues,theyshouldbesettled
privately and as quickly as possible. Such disputes should not
impactonpatientcare.
46.5 Denigrationofacolleague isnot in the interestofpatientsand
shouldbeavoided.
46.6 Youmustnotdeliberatelydamagethepracticeofcolleagues.
47 Providing references47.1 Inkeepingwithyourdutytoprioritisepatientsafety,youhavea
dutyofcareinprovidingreferencesforcolleagues.Youmustmake
surethattheinformationandopinionsyougiveareaccurateand
honest.
46 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
48 Accepting posts48.1 Youhaveadutytomakesurethatpatientcareisnotcompromised
ifyoudecidenottoacceptajobofferortoleaveyouremployment
withoutgivingadequatenotice.
49 Healthcare resources49.1 Subjecttoyourdutytoactinthebestinterestsofpatients,you
have a responsibility to engage and advocate with the relevant
authorities to promote the provision of appropriate healthcare
resourcesandfacilities.
49.2 You have a duty to assist in the efficient and effective use of
healthcareresourcesandtogiveadviceontheirappropriateallo-
cation.Whilebalancingadutyofcare to the individualpatient,
you should be aware of the wider need to use limited health-
careresourcesefficientlyandresponsibly.Suchawarenessshould
informdecisionmakinginyourclinicalpractice.Forexample,you
are encouraged to prescribe bio-equivalent generic medicines
wheretheyaresafeandeffectiveandonlycommissioninvestiga-
tionsiftheyareclinicallyindicated.
50 Professional indemnity50.1 Youmustensurethatyouhaveadequateprofessionalindemnity
coverforallhealthcareservicesyouprovide.
51 Health problems51.1 Ifyouthinkyoumightbeinfectedwithaseriouscommunicable
disease,youmustseekappropriatemedicaladvicewithoutdelay
andensurethatyourconditiondoesnotposeanyrisktopatients
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 47
orothers.Thecolleague(s)youconsult inthisregardhasadual
roletobothhelpandcounselyouandtomakesurethatyoudo
notposea risk topatients andothers. If sucha riskexists, the
MedicalCouncilmustbeinformedassoonaspossible.
51.2 Ifyoubecomeill,youshouldseekadviceandhelpfromanother
doctor rather than treat yourself. Even as a doctor, you should
haveyourowngeneralpractitioner.
52 Treatment of relatives52.1 Exceptforminorillnessesandemergencies,itisnotadvisablefor
youtotreatmembersofyourownfamilyor issueprescriptions,
sickcertificatesorreportsforthem.
53 Clinical trials and research53.1 Ifyouactasaninvestigatorinaclinicaltrialoranyformofmedical
research,youmustsubmitandreceiveapprovalfromtherelevant
researchethicscommitteebeforetheresearchbegins.Youmust
ensurethatthetrialconformstotheDeclarationofHelsinki14and
anyrelevantnationallegislation.15
53.2 If you act as an investigator in any form of medical research,
youhaveadutytoensurethatthehighestethicalstandardsare
observedintheconductoftheresearch. Inparticular,youmust
ensure thatall researchparticipantsare fully informedaboutall
14 DeclarationofHelsinkiwww.wma.net/e/policy/b3.htm
15 ClinicalTrialsonMedicinalProductsforHumanUseRegulations2004
www.dohc.ie/legislation/statutory_instruments/pdf/si20040190.pdf
48 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
aspectsofthestudyandthattheyhavegiventheirconsentvolun-
tarily. You must ensure that the results and authorship of your
researchareaccuratelyrecorded.
53.3 Ifyouenrolyourpatientsasparticipantsinresearch,youshould
ensurethattheyunderstandthenatureoftheproposedinterven-
tion or treatment, particularly where you do not anticipate any
therapeuticbenefittothem.
53.4 Apatient’s refusal toparticipate in researchmustnot influence
yourcareofthatpatientinanyway.
53.5 YoumustcomplywiththeDataProtectionActs16andyoushould
beawareof theguidelinespublishedby theOfficeof theData
ProtectionCommissionerinrelationtomedicalresearch.17
53.6 Ifyouarepaid,directlyor indirectly,bypharmaceutical,medical
deviceorothercommercialcompaniesororganisationstoconduct
medicalresearch,youmustmakesurethatsuchpaymentdoesnot
influenceyourstudydesignorinterpretationofresearchdata.
53.7 Ifyoureceivepayment,directlyorindirectly,frompharmaceutical,
medicaldeviceorothercommercialcompaniesororganisationsin
connectionwithmedicalresearch,youmustaddressanypotential
conflictofinterestarisingfromsuchpaymentandmakeanappro-
priatedisclosureinanypublicationofresearchresults.
16 DataProtectionActs1988and2003www.dataprotection.ie
17 DataProtectionGuidelinesonresearchintheHealthSector
www.dataprotection.ie/documents/guidance/Health_research.pdf
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 49
54 Provision of information to the public and advertising
54.1 Theprovisionofinformationabouttheavailabilityofmedicalserv-
icesthroughthemedia,internetorothermeansisgenerallyinthe
publicinterestprovidedthattheinformationisfactuallyaccurate,
evidence-basedandnotmisleading.
54.2 You may advertise your practice by publicising the name and
addressofthepractice,thepracticehoursandcontactdetails.You
mayincludeyourareaofspecialityifitisonethatisrecognisedby
theMedicalCouncilandyouareenteredforthatspecialityinthe
SpecialistDivisionoftheRegister.
54.3 Thefeesyouchargeshouldbeappropriatetotheserviceprovided.
Patientsshouldbeinformedofthelikelycostsbeforetheconsulta-
tionandtreatment.
54.4 Ifyouconsiderpublicisinginformationfurtherthanthatspecified
inparagraph54.2inrelationtoservicesyouprovide,eitherdirectly
orindirectly,youmustmakesurethattheinformationpublished
intheadvertisementistrue,verifiable,doesnotmakefalseclaims
orhavethepotentialtoraiseunrealisticexpectations.Thisshould
includeinformationaboutanyinherentrisksassociatedwiththe
servicesprovided.
54.5 Youshouldavoidusingphotographicorotherillustrationsofthe
humanbodytopromotecosmeticorplasticsurgeryprocedures,as
theymayraiseunrealisticexpectationsamongstpotentialpatients.
54.6 Toensurethatmembersofthepubliccanidentifydoctorsregis-
teredinIreland,youmustincludeyourMedicalCouncilregistration
numberinanyinformationyoupublishaboutyourpractice.
50 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
54.7 Ifyouhaveawebsite,youmustmakeitclearonthewebsitethat
doctorsmayonlypracticeincountriesinwhichtheyareregistered.
54.8 Ifyouhaveawebsitethatinvitesuserstoenterpersonalinforma-
tion,aprivacystatementandadequatesecuritymeasuresshould
beinplacetosafeguardtheinformation’sconfidentiality.
55 Registered names55.1 Youmustpracticeinthename(s)underwhichyouareregistered
andalwaysuseyourregistrationnumberwhenrepresentingyour-
selfasaregisteredmedicalpractitioner.
55.2 You should always identify yourself to patients before you
commenceanyinterview,investigationortreatment.
56 Premises and practice information56.1 Patientsandmembersofthepublicareentitledtoexpectthatyour
premisesareclean,accessibleandsuitableformedicalconsulta-
tionsandexaminations. Thepremises shouldbe structuredand
used in a way that respects the privacy of patients during the
consultation.
56.2 Youmaydisplayaprofessionalplateandsignatyourplaceofprac-
ticeindicatingyourregisteredname,registerablequalificationsor
internationalequivalentsandregisterablespecialties. Itmayalso
indicate hours of attendance, telephone numbers, services you
provideanddetailsofemergencyservices.
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 51
56.3 In addition to the information contained in 56.2, your letter
headingsmustincludeyourMedicalCouncilregistrationnumber.
Theyshouldnotincludemembershipofassociationsorsocieties
otherthanthoserecognisedoraccreditedbyappropriatetraining
bodies.
57 Medical reports57.1 Ifrequested,youshouldprovidereportsforsolicitorsorinsurance
companiesinrelationtopatientsyouhaveseenortreatedprofes-
sionally.However,theprovisionofsuchreportsinthecontextof
potential litigationplacesadditionalobligationsonyou toavoid
anyactualorperceivedconflictofinterest.
57.2 Ifyouareaskedtoconductexaminationswhereresultsaretobe
communicated to third parties such as insurance companies or
legalrepresentatives,youshouldexplaintothepatientbeforehand
thenatureoftheactivityandthepurposeoftheexamination.You
should conduct these examinations and prepare the reports to
thesamestandardofprofessionalismasappliestothecareand
treatmentofanyotherpatient.
57.3 Reportsshouldbespecifictotheepisodeforwhichthereporthas
beenrequestedandshouldnotbepreparedordeliveredwithout
thepatient’spermission.Wherethereportrelatestothepatient’s
currentstateofhealth,youareencouragedtocarryoutanup-to-
dateexaminationwhereappropriate.
57.5 Reportsmustberelevant,factualandtrue.Theircontentmustnot
beinfluencedbyfinancialorotherinducementsorpressures.
57.6 Youmustprovidereportswithoutunreasonabledelaytoensure
thatnodisadvantageaccruestopatients.
52 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
57.7 Youareentitledtorequestaprofessionalfeeforprovidingareport.
Thetimeandmannerofsuchpaymentsisgenerallyamatterof
contractbetweenyouandthepersonoragencywhorequested
thereport.However,youmustnotnegotiateyourfeebasedon
theoutcomeoflitigation.
58 Certification58.1 In issuing certificates, reports, prescriptions and other formal
documents,youmustbeaccurateandmakesurethedocument
islegible.YoumustalsoincludeyourMedicalCouncilregistration
number.Normallyyoushouldonlysignacertificateorothersuch
prescription,reportordocumentforapatientfollowingreviewof
thepatient’scondition.
59 Prescribing59.1 Theprescriptionsyouissuemustbelegible,datedandsignedand
muststateyourMedicalCouncilregistrationnumber.
59.2 When prescribing medications, you must comply with the
misuseofdrugslegislationandotherrelevantregulationsand/or
guidelines.
59.3 You should ensure you have appropriate training, facilities and
supportbeforetreatingpatientswithdrugdependencyorabuse
problems.Youshouldreferpatientstootherservicesandsupports
wherethisisinthepatient’sbestinterests.
59.4 You must be aware of the dangers of drug dependency when
prescribingbenzodiazepines,opiatesandotherdrugswithaddic-
tivepotential.
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 53
59.5 You should not undertake treatment of opiate dependency
unlessyouhavebeenapprovedundertheMethadoneTreatment
Protocol. You should make reasonable efforts to ensure that
patientswithdrugdependencyarenotinappropriatelyobtaining
drugsfrommultiplesourcesandyoushouldliaisewithdrugtreat-
ment services, other doctors and pharmacists to safeguard the
patient’sinterestinthisregard.
59.6 Ifatelephoneprescriptionisnecessary,youshouldmakeanote
ofthecallinthepatient’snotesandrecordsandsendawritten
prescriptiontothepharmacistwithoutdelay.Electronicprescribing
mustcomplywiththeDataProtectionActs1988and2003and
anyotherrelevantlegislationand/orregulations.Youmustnotuse
electronicprescribingtorestrictapatient’schoiceofpharmacy.
59.7 Youmustensureasfaraspossiblethatanytreatment,medication
or therapy prescribed for a patient is safe, evidence-based and
inthepatient’sbest interests.Youshouldbeparticularlycareful
when prescribing multiple medications in case the combination
might cause side effects. You should also take particular care
whenprescribingforpatientswhomayhavean impairedability
to metabolise the medication prescribed. You should weigh up
thepotentialbenefitswiththerisksofdrugadverseeffectsand
interactionswhendecidingwhattoprescribe.Thisalsoappliesto
theexerciseoftheprescribingofgenericdrugs.Apatient’streat-
mentregimeshouldbereviewedperiodically.
59.8 Youmustkeepuptodatewithdevelopmentsinmedicationsafety.
Youshouldnotrelysolelyorexcessivelyonpromotionalliterature
distributed by pharmaceutical companies for information about
particular drugs. You should seek independent evidence-based
sourcesofinformationonthebenefitsandrisksassociatedwith
medicinesbeforeprescribing.
54 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
59.9 Yourchoiceof therapy foryourpatient shouldalwaysbemade
in the patient’s best interests. You are advised not to accept
gifts(includinghospitality)frompharmaceutical,medicaldevices
or other commercial enterprises. This does not preclude the
paymentofreasonablefeesifyouprovideprofessionalservicesto
commercialenterprises.Youshouldbeawarethatevenlow-value
promotionalmaterialsareofferedbycommercialenterpriseswith
theintentionofinfluencingprescribingandtreatmentdecisions.
59.10 In general, educational funding from commercial enterprises to
thehealthcaresectorshouldbechannelledthroughunrestricted
Education and Development Funds and be managed without
influencefromthecommercialenterpriseinquestion.
59.11 Ifyoureceivefinancialsupportorotherresourcesfrompharma-
ceuticalcompaniesand/orrelatedenterprisesinconnectionwith
professionalactivities,includinglectures,presentationsandpubli-
cations,developmentofclinicalservicesorconductingresearch,
youshouldaddressanypotentialconflictsofinterestthatarise.In
thesecircumstances, yourpatientsandanyother relevantparty
shouldbeinformedaboutanyprofessionalrelationshipyouhave
withthesecompanies.
60 Referral of patients60.1 Itisinthebestinterestsofthepatientthatageneralpractitioner
supervisesandguidestheoverallmanagementoftheirhealth.A
patient’s request for another opinion should normally be facili-
tatedbymakingcopiesofthepatient’smedicalrecordsavailable
toanotherregistereddoctornominatedbythepatientunlessthis
isdeemednottobeinthepatient’sbestinterests.
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 55
60.2 If you consider that it is in the best interests of the patient to
be referred for specialist opinion, you should consider relevant
professionalguidelinesandreferyourpatienttoaspecialistwho
iscompetentandappropriatelyskilledtodealwiththeparticular
patient’scondition.
60.3 Normally,consultantswillseepatientsfollowingreferralfromtheir
generalpractitionerorothertreatingdoctor.Insomecasesthere
mightbenosuchreferral.Ineitherinstance,thepatient’sgeneral
practitioner should be kept informed of the patient’s progress,
unlessthepatientspecificallyobjects.Seealsoparagraph28.1.
60.4 Itmaybeinthebestinterestsofpatientstobereferredbyconsult-
antstootherdoctorsaspartoftheircareandmanagement.To
ensurecontinuityofcare,thepatient’sgeneralpractitionershould
normallybekeptinformedofanysuchreferral.
60.5 Any arrangementwhereby a practitioner pays a fee to another
practitioner for referrals to them is contrary to the interests of
patientsandmustbeavoided.
61 Medical ionising radiation61.1 All doctors performing medical ionising radiation exposures
must comply with relevant national regulations and accepted
professionalstandards.Thesafetyofthepatientmustalwaysbe
paramount in the performance of radiation procedures. These
proceduresshouldbejustifiedandtheconsentofthepatientmust
besoughtaccordingtotheprinciplesinparagraphs33to41.
61.2 Ifyouarenotaradiologistandyouundertakeradiationprocedures
forpatients,youmustcompleteacourseoftraininginradiation
safety and techniques recognised by the Medical Council. The
56 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
MedicalCouncilwillthenissueacertificatepermittingyoutocarry
out such procedures on condition that they are undertaken in
hospitalpracticeinthepresenceofaradiologistoraradiographer
responsibletoaradiologist.
61.3 Radiologicalconsultationandinvestigativeproceduresshouldonly
beperformedattherequestofaregisteredmedicalpractitioner
orotherspecialistpractitionerandagreedwiththepractitionerin
charge(radiologist),usuallytheDirectorofRadiologicalservices.
Reportsofradiologicalproceduresshouldbereviewedandveri-
fiedbytheradiologistpriortofiling.
62 Telemedicine62.1 The practice ofmedicine throughweb-based telemedicine sites
orothertelecommunicationmethodsrequiresclearadherenceto
principlesofconfidentialityanddataprotection.Ifyoupractiseby
suchmeans,youmusthavestrongsecuritymeasuresinplaceto
protecttheprivacyofpatientinformation.Web-basedtelemedi-
cine sitesmustmake their informationpolicies clear tousers. If
youprovidetelemedicineorothertelecommunicationservicesto
patientswithintheState,youmustberegisteredwiththeMedical
Council.
62.2 Youmustensurethatthetransferofanypersonalpatientinforma-
tiontootherjurisdictionscomplieswithdataprotectionprinciples.
62.3 Tohelppatientstounderstandtelemedicine,youshouldexplainto
themthattheremaybeaspectsoftelemedicinethataredifferent
totraditionalmedicalpractice,forexampleaconsultationinvolving
physicalexamination.
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 57
62.4 Inrelationtoweb-basedadvertising,paragraphs54.1to54.7of
thisGuideapply.
63 Locum and rota arrangements63.1 Youshouldensurethatthesafetyandwelfareofyourpatientsis
protectedduringyourabsence.Ifyouarrangereplacementcover,
youmustensurethatthelocumdoctorisappropriatelyqualified,
registeredandingoodstandingwiththeMedicalCouncil.Asfar
aspossible,patientsshouldbetoldinadvanceaboutthetempo-
raryarrangementsthatwillbeinplaceduringyourabsence.
63.2 The locum doctor must ensure that they have appropriate and
comprehensiveindemnityinsuranceinplacetocovertheircareof
patients.
63.3 Toensurecontinuityofcareforyourpatients,alldetailsofclinical
careprovidedbythelocummustbeaccuratelyrecordedanddated
inthepatient’snotesandbemadeavailabletoyouwithoutdelay.
63.4 Ifyouparticipateinrotaarrangements,youmustensurethatthere
is clear communication among the participants and that each
knowswhoisondutyatanygiventime.
64 Centresofhealthcareandpharmacies
64.1 Ifyouhaveafinancialinterestinaprivateclinic,hospital,pharmacy
orotherinstitutiontowhichyoureferpatientsforinvestigationor
therapy, you must inform patients of your association with the
institution and make sure that financial considerations do not
influenceyourmanagementofpatients.
58 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS IN MEDICAL PRACTISE
64.2 If you are associated with private clinics or hospitals, you must
ensurethattheservicesofferedtopatientsconformtotheclinical
andethicalstandardsoftheprofession.
65 Retirement and transfer of patient care65.1 If you are thinking of retiring or reducing your patient list, you
shouldput transferarrangements inplaceand let yourpatients
knowbeforethesearrangementstakeeffect.Withthepatient’s
consent,allrelevantmedicalrecordsshouldbesenttothedoctor
takingoverthecareofthepatient.
65.2 Youshouldhaveaplaninplacetoensurecontinuityofcarefor
yourpatientsifyoubecomeunexpectedlyill.
60 | GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS
Information for patients prior to giving consent
➤ Theinformationthatpatientswantorshould
know,beforedecidingwhethertoconsentto
treatmentoraninvestigation,mayinclude:
➤ detailsofthediagnosis,andprognosis,andthe
likelyprognosisiftheconditionisleftuntreated;
➤ uncertaintiesaboutthediagnosis,includingoptions
forfurtherinvestigationbeforetreatment;
➤ optionsfortreatmentormanagementofthe
condition,includingtheoptionnottotreat;
➤ thepurposeofaproposedinvestigationortreatment;
➤ detailsoftheproceduresortherapiesinvolved,
includingmethodsofpainrelief;
➤ preparationfortheprocedureandwhatthepatient
mightexperienceduringoraftertheprocedure,
includingcommonandserioussideeffects;
➤ foreachoption,explanationsofthelikelybenefitsand
theprobabilitiesofsuccessanddiscussionofanyserious
orfrequentlyoccurringrisksandanylifestylechanges
whichmaybecausedorrequiredbythetreatment;
➤ adviceaboutwhetheraproposed
treatmentisexperimental;
GUIDE TO PROFESSIONAL CONDUCT AND ETHICS FOR REGISTERED MEDICAL PRACTITIONERS | 61
➤ informationabouthowandwhenthepatient’scondition
andanysideeffectswillbemonitoredorre-assessed;
➤ thenameofthedoctorwhowillhaveoverall
responsibilityforthetreatmentand,whereappropriate,
namesoftheseniormembersoftheirteam;
➤ whetherdoctorsintrainingwillbeinvolved;
➤ theextenttowhichstudentsmaybeinvolved
inaninvestigationortreatment;
➤ areminderthatpatientscanchangetheir
mindsaboutadecisionatanytime;
➤ areminderthatpatientshavearight
toseekasecondopinion;
➤ whereapplicable,detailsofcostsorcharges
whichthepatientmayhavetomeet.
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