Live Surgery Broadcasts: What do NMC ethical advertising guidelines say?

Medical Dialogues had earlier reported that back in 2023, a Delhi-based Ophthalmologist had moved the Supreme Court highlighting the legal and ethical issues posed by live surgery broadcasts. Back then, a top court bench headed by Chief Justice D Y Chandrachud and also comprising Justices J B Pardiwala and Manoj Misra had issued notices to the Central Government, NMC, and others.

Placing the issue before the public domain, NMC had invited comments from all stakeholders and the general public seeking their opinion on the live surgery broadcasts conducted by the private hospitals.

Consequently, last year, the Ethics and Medical Registration Board of the NMC issued guidelines to regulate the conduct and broadcast of Live surgeries.

In the guidelines, the Apex Medical Commission has referred to the concerns related to the broadcast of live surgeries and addressed questions such as who can organise such live surgery procedures, who can perform the same, where it can be done, how it is to be done, the responsibility of organizers, prior permission of the regulatory body, etc.

♦ Who can organise Live Surgery/Procedures (Sponsor*/Supervisor)?

NMC had specified that the following individuals or institutes can organise the live surgeries:

 Sponsor/Supervisor should be under Indemnity insurance coverage.

NMC has defined 'Sponsor' as per the Temporary Registration Regulations available on the Commission's website.

 Supervisor person authorized by supervisor from organizing team should be from the same specialty and shall be there by the side of operating surgeon as a part of the operating team.

 In case of Foreign Medical Practitioner (FMP), temporary permission is required from Ethics & Medical Registration Board, NMC and a Specialty Expert team shall be nominated by the EMRB/NMC to permit the FMP.

 Before inviting the FMP to perform the Live Surgery, the sponsor needs to have prior permission from the concerned State Medical Council.

 Live broadcasts should not be used for promotion of the operating surgeon, hospital or product brand.

 Surgeons should not have a financial or commercial interest in the equipment or devices used during the surgery/ procedures.

♦ Who can perform Live Surgery/Procedures?

As per the Commission, the live surgery procedures can be conducted by the following:

 Registered Medical Practitioner (RMPs)/ Foreign Medical Practitioner (FMP) of modern medicine with expertise in the surgery/procedure (minimum 5 year experience post specialty certification)

 In case of FMP temporary permission is required from Ethics & Medical Registration Board, NMC and a Specialty Expert team shall be nominated by the EMRB/NMC to permit the FMP.

♦ Where can it be done?

 Hospital Accreditation: The hospital must be accredited by a recognized body to ensure it meets safety and hygiene standards.

 Essential Services: The OT should have all necessary pre-operative, operative, anaesthetic, post-operative, laboratory, radiological, and ICU and other required facilities to manage the cases of complications.

 Equipment Availability: All essential instruments for the surgery/ procedures must be readily available.

 Contingency Plan: A plan for managing complications during the live broadcast must be in place, with qualified standby staff and equipment readily available.

 Inspection and Screening: The OT/Procedure Room setup must be approved and screened by relevant Head of the Institution/ Sponsor/ Associations/SMCs to ensure compliance with safety and quality standards.

 Compromised Setup: If the setup is inadequate, the live broadcast will be deferred and only a recorded video may be used.

♦ How is it to be done?

 Patient Selection:

√ Patients with high-risk procedures, incomplete investigations, or unusual anatomy should not be included.

√ Patients should be medically fit and have no contraindications to the surgery/ procedures.

√ Financial incentives for participation should not be permitted. However, patients can be enrolled in insurance coverage to safeguard against any unforeseen incidents during live surgery/ procedures. Further, Patients should be informed about the availability and limitations of this insurance.

√ Any surgery/procedure related complications should be managed free of cost.

√ Live broadcasts can be done for new procedures, while recordings should be preferred for established procedures or high-risk cases.

 Informed Consent:

The informed consent process should be conducted by the operating surgeon/team and clearly explain:

√ The purpose of the broadcast (educational)

√ The risks and benefits of participating

√ Patient anonymity and confidentiality measures

√ The right to withdraw consent at any time

 Conduct during Surgery/procedures:

√ Operating doctor can broadcast but should not interact with audience during the surgery/procedures to maintain focus on the patient's safety.

√ Relevant step wise live commentary by an operating surgeon can be permitted without any two-way communication with the audience in special situations.

√ A designated moderator can provide commentary separate from the live feed.

√ High-risk procedures or those with a high potential for complications should be avoided for live broadcasts and edited recordings used instead.

 Ethical Considerations:

√ Patients should not incur any charges related to the surgery/ procedures, including implants, medications, disposables, and procedures.

√ Post-operative care should be provided by the operating surgical team.

√ Patient identity must remain confidential.

√ The surgery/ procedures should strictly adhere to established standard operative procedures.

♦ Responsibility

 Organizer's Responsibility:

√ Organizer should ensure patient safety, confidentiality, and welfare throughout the broadcast.

√ They must obtain explicit, informed, and written consent from patients before featuring surgeries in live broadcasts.

√ The organizer should ensure that the ethical guidelines and data privacy regulations are adhered to.

 Surgeon's Responsibility:

√ Surgeons are responsible for adhering to professional and ethical standards during the live broadcast.

√ They must prioritize patient welfare over any other considerations.

√ He should be involved in pre-operative discussion, PAC and post-operative treatment for at least 24 hours after surgery/ procedures.

G. Prior permission of Regulatory Body

 Prior Permissions:

√ Prior permission from the relevant regulatory body/Association/institution is mandatory for conducting live surgical demonstrations.

√ Approval must also be sought from relevant authorities based on the sponsorship of the hospital (e.g. - Dean for government hospitals, State Medical Council for private hospitals).

 Oversight and Compliance:

√ An apex committee should oversee arrangements to ensure compliance with ethical guidelines, safety protocols, and educational objectives.

√ Professional associations should self-regulate to prevent any promotional or commercial activities during live demonstrations.

Also Read: Doctors, hospitals cannot use AI generated promotional campaigns for commercial interest: NMC