Introduction
The Code of Conduct to be followed by doctors in India is a series of guidelines that must be followed by medical practitioners while performing their duties and the rules mentioned in the code of conduct must not be violated in either letter or spirit, thus making them inviolable in essence, and mandatory in adherence in a manner. The Code of Conduct lays down general principles that encompass ethical practices that must be followed by medical practitioners upon their honour.
Pledge- Code of Conduct
In the Indian Context, the pledge every stakeholder related to the Indian Medical Association, the biggest representative organization of medical practitioners in India,[1] includes a promise that the pledger shall not use their medical prowess or knowledge contrary to the benefit of humanity, followed by a series of positive obligations laid down such as the obligation to abide by the ethics of the medical field as laid down with regards to Indian Medical Council (Professional Conduct, Etiquette, and Ethics) Regulations, 2002, the obligation to maintain regard and respect for human life, for the profession and practice, the secrets confined by others whilst the practice of the profession, as well as respecting the dignity of the profession.
The Code of Conduct also stipulates obligations with regard to others, that the health of the patient must be the primary and foremost consideration for any practitioner and, those who have taught the practitioner the science of medicine shall also be accorded respect as well as gratitude. Further, colleagues of the practitioner must be treated with due regard. It also forbears any discrimination towards a patient on the grounds of religion, race, caste, gender, nationality or place of birth. Thus, it can be inferred that it lays down a wide range of stipulations for a good and holistic career and practices ahead for the practitioner.[2]
Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations 2002
Before the inclusion of any practitioner in the rolls of registered medical practitioners, signing the application made under the provisions of Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations 2002 is a rite of passage. Every applicant is mandatorily required to provide a copy of the declaration and certify in the affirmative that he or she shall comply with the laid down stipulations.
The Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations 2002 lays down several duties and responsibilities every practitioner must adhere to with regard to maintaining an optimum and good medical practice, ensuring the morally upright character of the practitioner, as well as the standards to be followed for maintenance of records, display of registration number given by Medical Council, for use of generic drugs, etc. It lays down guidelines pertaining to payment received for professional services, as well as legal intricacies and restrictions therein under Chapter 1 of the Regulations.
Chapters 2 & 3 of the Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations 2002, most vital to the adherence to the Code, lays down in detail the duties of every physician towards their patients, at every stage of their treatment, from diagnosis to discharge stage. Complementing the provisions laid down in Chapter 2, Chapter 3 further elaborates on the Duties of every physician towards their patients, during consultation in particular. Chapter 4 of the Regulations simply states the responsibilities bestowed to each practitioner pertaining to fellow practitioners.
Chapter 5 of the Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations 2002, is more in the nature of ‘in rem’ (against the world) regulations, stating the duties of the physicians towards the public at large, and towards the profession as a whole. Chapter 6 is the nemesis of the regulations, laying down the specificities of the unethical acts, which can further lead to penalty or punishment for the practitioner concerned. Chapters 7 & 8 clearly demarcate the different types of wrongdoings that have to be avowed and the punishments for the same. Chapter 8 specifically mentions the provision for disciplinary action. However. Punishments can also include criminal proceedings and subsequently, conviction if found guilty. Thus, the Regulations are all comprehensive and lay down detailed guidelines for facilitating smoother conduct in the profession.[3]
Compliance in Present Scenario
Despite the fact that the Indian Medical Council (Professional Conduct, Etiquette & Ethics) Regulations 2002 lays down several duties and responsibilities every practitioner must adhere to with regards to maintaining an optimum and good medical practice, there have been several instances of misconduct, which led to several amendments to incorporate better and more stringent provisions for adherence.
The Indian Medical Council (Professional Conduct, Etiquette and Ethics), Regulations 2002, which stipulated standards to be observed by medical practitioners in the nation, were changed by the notification on December 10, 2009.
Under the Amendment made in 2009, doctors are not permitted to accept gifts, travel benefits, hospitality, financial awards, funding for medical research, endorsements, etc. as per the revamped code.
Further, the self-regulatory group for doctors has been searching for measures to stop corruption in the industry, owing to several contemporary instances of the practice of the same. The Medical Council of India seeks to achieve two main goals by this modification to the current code of ethics. The First Goal is that no pharmaceutical firm should have any influence over a medical professional. Secondly, since pharmaceutical companies would spend less on marketing to doctors, it is anticipated that they will pass the savings on to patients by lowering medicine prices.[4] Thus, the amendment made in 2009 aimed to remedy several lacunae in the 2002 Regulations. However, even the current regulations fell short, leading to a proposal being made in 2019.
The National Medical Commission (NMC) Act, 2019, has finally been recommended for revisions by the Union Ministry of Health. The modifications will enable people to challenge negligent doctors if they are approved. The modifications follow a Supreme Court decision from November 2003 ordering the Medical Council of India to include clauses in the Ethics Regulations allowing patients to sue doctors for malpractice or professional misconduct. The addition of a fifth autonomous body, the Board of Examinations in Medical Sciences, to carry out a two-part exam for the registration of doctors, is another significant change being proposed to the National Medical Commission (NMC) Act, 2019[5]. Thus, it is clear that compliance and lack of regulation is still glaring issue pertaining to the present setup.
Conclusion
Thus, it can be concluded that the Code of Conduct to be observed by doctors in India is a set of standards that is imperative for medical professionals to abide by when carrying out their routine duties. While it leaves several provisions to the good conscience of the practitioner, in the recent past several instances of corruption and lack of adherence to technical requirements and standards have been observed which has led to demands for a comprehensive amendment.
There is a need for an oversight mechanism to regulate as well as oversee the adherence to the Regulations of 2009. More emphasis must be put on the penalties for non-compliance of the provisions laid down in all the regulatory mechanisms. The amendments proposed in the year of 2019 must be incorporated and subsumed into the Regulations of 2009 for giving more teeth to the Medical Council of India for stricter efficacy. Only in the long run can the effects of such amendments be gauged, which will pave the way for a strengthened and holistic practice in the medical field in the Indian Context.
[1] Stable URL- https://www.ima-india.org/ima/free-way-page.php?pid=
[2] Stable URL- https://www.ima-india.org/ima/free-way-page.php?pid=18
[3] Stable URL- https://wbconsumers.gov.in/writereaddata/ACT%20&%20RULES/Relevant%20Act%20&%20Rules/Code%20of%20Medical%20Ethics%20Regulations.pd
[4]Stable URL- https://www.downtoearth.org.in/news/health/amendments-proposed-to-national-medical-commission-act-allow-patients-to-appeal-against-erring-doctors-87043
[5] Stable URL- https://egazette.nic.in/WriteReadData/2019/210357.pdf