NMC Code of Medical Ethics: Doctors have to take a 14-pointed Physician's pledge

New Delhi: In the recently released National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023, the NMC has defined the Code of Medical Ethics that will serve as the set of commitments of the registered medical practitioners towards the patients, society, professional colleagues, and self. Apart from this, the new NMC Code of Medical Ethics also includes the Declaration of Geneva 2017 called ‘The Physician ’s Pledge ’.

Beneficence, empathy, non-maleficence, respect for patient autonomy and confidentiality, integrity, honesty, and justice- these have been defined as the ethical principles that underpin the code of ethics released by NMC.

"Medical practitioners are expected to uphold these principles for their inherent value in medical practice, and also to foster trust in patients and maintain the dignity of the medical profession," NMC mentioned in the Preamble to the Code of Medical Ethics, which has been framed as a set of guidelines reflecting professional as well as social expectations.

"NMC code of ethics is not intended to establish legal or clinical standards in practice but to provide a set of ethical guidelines according to which the doctor is expected to practice as a medical professional. Ethical guidelines must be differentiated from laws, as ethical standards expected of the medical professional may sometimes exceed legal requirements," the Commission further clarified.

Code of Ethics:

In order to highlight the significance of certain points, the Commission in the new Code of Medical Ethics has made use of the English language. NMC stated that "The words ‘must’, ‘shall / should ’and ‘may ’are used purposefully in these guidelines and indicate the degree of obligation that the doctor has to follow the guidelines. The word ‘must ’indicates a higher level of commitment and obligation required of the doctor, while in the case of ‘shall/should ’the level of obligation is less and there could be room for individual judgment." 

According to the Code of Medical Ethics, released by NMC, the following are the "Must" for medical practitioners:

1. Must provide care for the patient with compassion and respect, keeping the best interest of the patient in mind at all times.

2. Must protect patient confidentiality and privacy, and treat every patient equally, without discrimination.

3. Must not refuse to treat a patient in case of medical emergency, nor discriminate between patients based on gender, race, religion, caste, social, economic or cultural grounds. No patient should be abandoned.

Further, NMC has referred to the following as the "Shall/Should" for the medical practitioners:

1. Should be respectful of the patient’s rights and opinion, communicate clearly with the patient, and be honest and transparent in all professional interactions.

2. Shall ensure one’s competency and fitness to practice, and keep up to date with advancements in medical practice. They shall consult with other health professionals, as and when required for the benefit of the patient.

3. Should function in accordance with the laws of the land. When there is a conflict between ethics and law, the doctor is expected to advocate for changes in the law, in the interest of patient care.

4. Shall be responsive to individual and community health needs, and advocate for patients and the wider community they serve in matters of health and welfare.

5. Should practice according to his conscience and ethical guidelines, free from external pressures. They should not provide treatments that are not medically indicated, and must not participate in any act of torture.

6. Should promote and model the ethical standards of the profession in the work place, mindful of the moral and professional obligation owed to the patient and society who have reposed trust in the profession.

7. Should not hesitate to report unethical acts, fraud, incompetence, dishonesty, exploitation or misconduct on part of other health care professionals that could result in harm to the patient.

8. Should recognize conflict of interest situations that may arise in practice as they are detrimental to the patient and should avoid or minimize them. In such situations, the patient’s interest should take precedent over any other consideration.

9. Should not engage in endorsement or promotion of any drug or medical product for commercial purposes or for personal gains. In sharing findings of research with peers and scientific societies, the practitioner is expected to be neutral and unbiased in the interest of science and patient care.

10. Should protect and minimize risk of patients who participate in medical research, conscious that the dual role as researcher-practitioner would require disclosure to patients and additional regulatory and ethical compliance.

11. Should ensure that professional boundaries of the doctor patient relationship are respected and not violated.

Also Read: No Charak Shapath, No Hippocratic Oath: NMC proposes new Physician's Pledge

The Physician's Pledge: 

1. AS A MEMBER OF THE MEDICAL PROFESSION:

2. I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;

3. THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;

4. I WILL RESPECT the autonomy and dignity of my patient;

5. I WILL MAINTAIN the utmost respect for human life;

6. I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing, or any other factor to intervene between my duty and my patient;

7. I WILL RESPECT the secrets that are confided in me, even after the patient has died;

8. I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;

9. I WILL FOSTER the honour and noble traditions of the medical profession;

10. I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;

11. I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;

12. I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;

13. I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;

14. I MAKE THESE PROMISES solemnly, freely, and upon my honour.

Also Read: Should and Must: NMC proposes New Code of Medical Ethics in draft guidelines, Details

The Draft NMC RMP Regulations, 2022 guidelines were published by the Commission last year. Finally, over a year after putting its draft code of conduct in the public domain, NMC notified the NMC Registered Medical Practitioner (Professional Conduct) Regulations 2023 through a gazette notification.

Earlier, the suggestion from NMC, the apex medical body, to replace the Hippocratic Oath with the Charak Shapath had faced severe criticism from a major section of the medical fraternity. However, now junking both, the Ethics and Medical Registration Board (EMRB) of NMC has decided to stick to the Geneva Declaration of 2017 by including the Physician's Pledge in the recently released Regulations.

The Declaration of Geneva was first adopted by the 2nd General Assembly of the World Medical Association, Geneva, Switzerland back in September 1948. Following this, the Declaration went through several amendments over the years during the WMA meet. Finally, the 2017 amendment was adopted during the WMA General Assembly on October 14, 2017.

The revised Declaration, which came to be known as a pledge, refocuses the text to reflect changes over the decades in the relationship between physicians and their patients and between physicians themselves.

As a result, the pledge made specific reference for the first time to respecting the autonomy of the patient, which was not included earlier. It also included a new obligation for respect between teachers, colleagues and students. The previous Declaration said that students must respect their teachers, but there was no reciprocity.

Apart from this, the pledge included an obligation on the physicians to share medical knowledge for the benefit of their patients and the advancement of healthcare. Also, as per the pledge the physicians are required to attend their own health, well-being and abilities in order to provide care of the highest standard.

Earlier last year, the Country witnessed a huge debate concerning the Hippocratic Oath Vs Charak Shapath after NMC had reportedly proposed to replace the former with the latter.

The confirmation regarding this came from the Minutes of NMC discussion with all the medical colleges in India.

The Minutes of the meeting dated 07.02.2022, which had spread like fire on the social media platforms, mentioned, "No Hippocratic Oath. During white coat ceremony (with parents) the oath will be "Maharshi Charak Shapath" present in NMC website."

Although this change was set to be implemented from February 14, 2022, the proposal faced a huge backlash from the medical fraternity. Doctors across the country expressed their strong opposition to it and some even questioned how the students of modern medicine can take an oath in the name of someone belonging to Indian System of Medicine.

Medical Dialogues had recently reported that the National Medical Commission Registered Medical Practitioner RMP (Professional Conduct) Regulations, 2023 replaced the erstwhile Medical Council of India MCI's Code of Medical Ethics 2002. These new regulations have been enforceable since August 2nd 2023, the date of its publication in the official gazette.

Also Read: Doctors can refuse to treat Unruly patients, those patients who don't pay displayed fees - NMC notifies new code of conduct