code of medical ethics - tamil nadu medical council

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Code of Medical Ethics Publicationhttp://www.tnmedicalcouncil.org/logo.aspx?code=33

TABLE OF CONTENTS

Logo symbology

The Caduceus Medical Symbol

The Globe

The Lamp

The Balance

The Sheet Anchor

The Book

The Rose

The Corn Stem

Preamble

Chapter - 1 code of medical ethics

1.01 Display of Medical Degrees and Registration Number

1.02 Declaration

1.03 Duties and responsibilities of the Physician in general

1.04 The Physician's Responsibility

1.05 Maintaining good medical practice

1.06 Membership in Medical Society

1.07 Maintenance of medical records

1.08 Use of Generic names of drugs

1.09 Highest Quality Assurance in patient care

1.10 Exposure of Unethical Conduct

1.11 Payment of Professional Service

1.12 Evasion of Legal Restriction

Chapter - 2 Duties of physicians to their patients

2.01 Obligations to the Sick

2.01.1

2.01.2

2.02 Patience, Delicacy and Secrecy :

2.3 Prognosis:

2.4 The Patient must not be neglected:

2.5 Engagement for an Obstetric case:

Chapter - 3 : Duties of physician in consultation

3.1 Unnecessary consultations should be avoided3.1.1

3.1.2

3.2 Consultation for Patient’s Benefit

3.3 Punctuality in Consultation

http://www.tnmedicalcouncil.org/logo.aspx?code=33http://www.tnmedicalcouncil.org/logo.aspx?code=33


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3.4 Statement to patient after Consultation

3.4.1

3.4.2

3.5 Treatment after Consultation

3.6 Patients Referred to Specialists

3.7 Fees and other charges

3.7.1

3.7.2

Note:

Chapter - 4 : Responsibilities of physicians to each other

4.1 Conduct in consultation :

4.2 Consultant not to take charge of the case

4.3 Appointment of Substitute

4.4 Visiting another Physician's Case

4.5 Dependence of Physicians on each other

Chapter - 5 : Duties of physician to the public and to the paramedical profession

5.1 Physicians as Citizens

5.2 Public and Community Health

5.3 Pharmacists / Nurses

Chapter - 6 : Unethical acts

6.1 Advertising

6.1.1

6.1.2

6.2 Patent and Copyrights

6.3 Running an open shop (Dispensing of Drugs and Appliances by Physicians

6.4 Rebates* and Commission**

6.4.1

6.4.2

6.5 Secret Remedies

6.6 Human Rights

6.7 Euthanasia

Chapter - 7 : Misconduct

7.01 Violation of the regulations

7.01.1

7.01.2

7.02 Adultery or Improper Conduct

7.03 Conviction by Court of Law

7.04 Sex Determination Tests7.05 Signing Professional Certificates, Reports and other Documents

7.06

7.07

7.08

Note:

7.09

7.10

7.11

7.12

7.13 Should not refuse to give professional service on religious grounds7.14

7.15

7.16

7.17


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7.18

7.19

7.20 Research :

Chapter - 8 : Punishment and disciplinary action

8.01

8.02

8.03

8.04

8.05

8.06

Hippocratic oath

BRIEF NOTE ON HIPPOCRATIC OATH

HIPPOCRATIC OATH

Central / State medical Acts

The Indian Medical Degrees Act 1916

The Indian Medical Council Act 1956

The Drugs and Cosmetics Act 1940

The Drugs and Magic Remedies (Objectionable) Advertisement Act, 1954. (DMR ACT)

The Schedule

Penal Provisions against quacks

Supreme Court Judgement on Practice of other Systems of Medicine :

When a Medical Practitioner is called to appear as an expert witness:

An important Supreme Court judgement

No legal impediment for a medical professional to attend to an injured person needing his medical

assistance immediately says : Supreme Court of India :

History of allopathic medicine in india

State medical councils & their powers

Logo symbology

The Caduceus Medical Symbol

This is the universal symbol used to denote the field of Medicine. The mythical significance of this symbol is

that the caduceus is believed to be the magic rod of Hermes - the Greek messenger of the Gods. According to

legend, hermes is supposed to have pacified two fighting snakes by throwing the wand at them, and theystopped fighting and became entwined in the wand. Snakes are also revered in many cultures as they are

believed to have a long life span due to their ability to renew their cells and keep them ever youthful by

shedding their skin.

The Globe

This represents the far reaching impact of the TN Medical Council - with our doctors frequently taking the

banner of our medical heritage all over the world and making their invaluable contributions to the field of

medicine where ever they go.


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The Lamp

This is a cultural symbol that portrays the glorious traditions of Tamil Nadu. The lamp is also an universal

symbol to denote knowledge, throwing light, enlightenment, etc.,

The Balance

This is again an universal symbol that denotes Justice. To uphold justice is a core activity of the Council.

The Sheet Anchor

This denotes the stability and unshakeable nature of the Council even in facing adverse conditions. Like a

sheet anchor that firmly grapples and protects a mighty ship, the Council protects everybody under its hold -

the doctors as well as the general public - and ensures that the honourable practice of medicine is always

carried out for the maximum benefit of humanity.

The Book

The denotes the field of education, research and progress in the field of medicine and the Council's active part

in furthering the cause of medicine. The microscope denotes the field of research; the petri dish denotes the

subject of biological science; the beakers denote the drug research; and the syringe, tonic, capsules and

tablets denote the outcome of the research.

The Rose

The rose is a universally favourite object to describe the healthiness of a person, especially in poetry where ahealthy person is often described as being in the pink of his health. The thorns around the rose denote the

protection for the rose, to ensure that it is not destroyed by evil hands. This denotes the activity of the Council

as watch dog to protect the public from quacks and cheats.

The Corn Stem

This is a common feature in the insignias of Governments and educational institutions world wide. This

denotes the nature of the Council as a body supported by the Government.

Preamble

The Tamil Nadu Medical Council Code of Medical Ethics provides a set of fundamental principles, official set

of laws or regulations which should guide the Medical Practitioners in their professional conduct. Ethics is

defined as the science of moral principles. Ethics is an appeal to the conscience and more often than not, it

helps the people in treading/walking right paths. Medical Ethics deals with the moral principles which should

guide the members of the medical profession in their dealings with each other, their patients and the State.

Medical Etiquette deals with the conventional laws of courtesy observed between members of the medical

profession. Medical Etiquette deals with the conventional laws of courtesy observed between members of the

medical profession. Because of their special knowledge and expertise, the doctors have a responsibility to

improve and maintain the health of their patients who, are either in a vulnerable state of illness or for the


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maintenance of their health, entrust themselves to medical care. Over the centuries, doctors have held to a

body of ethical principles developed to guide their behaviour towards patients, their professional colleagues,

peers and society. The Hippocratic Oath* was an early expression of such a Code. As a member of medical

profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to

other health professionals, and to self. The lofty ideals set up by Charaka the ancient Indian Philosopher and

Physician in his enunciation, "Even if your own life be in danger, you should not neglect or betray the interest

of your patients", should be fondly cherished by all doctors. The medical profession is governed by legislation

and by a Code of Ethics and Etiquette. Enforcement of the Code is done by the Medical Councils. The

following principles adopted by the Tamil Nadu Medical Council are standards of conduct which define the

essentials of honourable behaviour for the physician. Advancing medical knowledge and technology create

new challenging ethical problems. The Ethics Committee of the Tamil Nadu Medical Council will address these

issues from time to time. The Code applies to physicians including house surgeons/residents and medical

students.

Chapter - 1 code of medical ethics

1.01 Display of Medical Degrees and Registration Number

Every physician shall display the registration number accorded to him by the State Medical Council / Medical

Council of India in his clinic and in all his prescriptions, certificates, money receipts given to his patients.

Physician shall display as suffix to their names only recognized medical degrees or such certificates/diplomas

and memberships/honours which confer professional knowledge or recognizes any exemplary

qualification/achievements.

1.02 Declaration

Each applicant, at the time of making an application for registration under the provision of Act, shall be

provided a copy of the declaration and shall submit a duly signed Declaration as provided in Appendix 1. The

applicant shall also certify that he/she had read and agreed to abide by the same.

1.03 Duties and responsibilities of the Physician in general

Character of Physician (Doctor with qualification of MBBS or MBBS with post graduate degree/diploma or with

equivalent qualification on any medical discipline) A physician shall uphold the dignity and honour of hisprofession.

1.04 The Physician's Responsibility

The prime object of the medical profession is to render service to humanity; reward or financial gain is a

subordinate consideration. Who-so-ever chooses his profession, assumes the obligation to conduct himself in

accordance with its ideals. A physician should be an upright man, instructed in the art of healings. He shall

keep himself pure in character and be diligent in caring for the sick; he should be modest, sober, patient

prompt in discharging his duty without anxiety; conducting himself with propriety in his profession and in all the

action of his life. No person other than a doctor having qualification recognized by Medical Council of India andregistered with Medical Council of India/State Medical Council(s) is allowed to practice modern system of

Medicine or Surgery. A person obtaining qualification in any other system of Medicine is not allowed to practice

Modern system of Medicine in any form.


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1.05 Maintaining good medical practice

The Principal objective of the medical profession is to render service to humanity with full respect for the

dignity of profession and man. Physicians should merit the confidence of patient entrusted to their care,

rendering to each a full measure of service and devotion. Physician should try continuously to improve medical

knowledge and skills and should make available to their patients and colleagues the benefits of their

professional attainments. The physician should practice methods of healing founded on scientific basis and

should not associate professionally with anyone who violates this principal. The honoured ideals of the medical

profession imply that the responsibilities of the physician extend not only to individuals also to society.

1.06 Membership in Medical Society

For the advancement of the profession, a physician should affiliate with association and societies of allopathic

medial professions and involves actively in the functioning such bodies. A Physician should participate in

professional meetings as part of Continuing Medical Education programmes, for at least 30 hours every five

years, Organized by reputed professional academic bodies or any other authorized organizations. The

compliance of this requirement shall be informed regularly to Tamil Nadu Medical Council.

1.07 Maintenance of medical records

Every physician shall maintain the medical records pertaining to his/her indoor patients for a period of 3 years

from the date of commencement of the treatment in a standard proforma laid down by the Medical Council of

India and attached as Appendix 3. If any request is made for medical records either by the patients/authorized

attendant or legal authorities involved, the same may be duly acknowledged and documents shall be issued

within the period of 72 hours. A registered medical practitioner shall maintain a Register of Medical Certificates

giving full details of certificates issued. When issuing a medical certificate he/she shall always enter the

identification marks of the patient and keep a copy of the certificate. He/She shall not omit to record thesignature and/or thumbmark, address and least one identification mark of the patient on the medical

certificates or report. The medical certificate shall be prepared as in Appendix 2. Efforts shall be made to

computerize medical records for quick retrieval.

1.08 Use of Generic names of drugs

Every physician should, as far as possible, prescribe drugs with generic names and he / she shall ensure that

there is a rational prescription and use of drugs.

1.09 Highest Quality Assurance in patient care

Every physician should aid in safeguarding the profession against admission to it of those who are deficient in

moral character or education. Physician shall not employ in connection with his professional practice any

attendant to who is neither registered nor enlisted under the Medical acts in force and shall nor permit such

persons to attend, treat or perform operations upon patients wherever professional discretion or skill is

required.

1.10 Exposure of Unethical Conduct

A Physician should expose, without fear or favour, incompetent or corrupt, dishonest or unethical conduct on

the part of members of the profession.


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1.11 Payment of Professional Service

The physician engaged in practice of medicine shall give priority to the interest of patients. The personal

financial interests of a should not conflict with the medical interests of the patients. Remuneration received for

such services should be in the form and amount specifically announced to the patient at the time the service is

rendered. It is unethical to enter into a contract of "no cure no payment". Physician rendering services on

behalf of the State shall refrain from anticipating or accepting any consideration.

1.12 Evasion of Legal Restriction

The physician will observe the laws of the country in regulating the practice of medicine and will also not assist

others to evade such laws. He should be co-operative in observance and enforcement of sanitary laws and

regulations in the interest of public health. Legislation and court decisions may also influence medical ethics.

Hence Medical Practitioners must be familiar with the various Acts, Rules and Regulations that are in force

and which have been enacted by the Central or State Government, Statutory bodies, Tamil Nadu Medical

Council and the Indian Medical Council. Unless he is familiar with all the relevant laws and regulations he may

find himself inadvertently contravening these and courting trouble. A Medical Practitioner must above all be a

good citizen and must uphold and defend the laws of the State and the Nation. A physician should observe the

provisions of the State Acts like Drugs and Cosmetics Act, 1940; Pharmacy Act, 1948; Narcotic Drugs and

Psychotropic Substances Act, 1985; Medical Termination of Pregnancy Act, 1971; Transplantation of Human

Organ Act, 1994; Mental Health Act, 1987; Environmental Protection Act 1986; Pre-natal Sex Determination

Test Act, 1994; Drugs and Magic Remedies (Objectionable Advertisement) Act, 1954; Persons with Disabilities

(Equal Opportunities and Full Participation) Act, 1995 and Bio-Medical Waste (Management and Handling)

Rules, 1998 and such other Acts, Rules, Regulations made by the Central/State Governments or local

Administrative Bodies or any other relevant Act relating to the protection and promotion of public health.

Chapter - 2 Duties of physicians to their patients

2.01 Obligations to the Sick

2.01.1

Through a physician is not bound to treat each and every person asking his services, he should not only be

ever ready to respond to the calls of the sick and the injured, but should be mindful of the high character of

his mission and the responsibility he discharges in the course of his professional duties. In his treatment heshould never forget that the health and the lives of those entrusted to his care depend on his skill and

attention. A physician shall while caring for a patient regard responsibility to the patient as paramount. A

physician should endeavour to add to comfort of the sick by making his visits at the hour indicated to the

patient. A physician advising a patient to seek service of another physician is acceptable, however, in case

of emergency a physician must treat the patient. No physician shall arbitrarily refuse treatment to a patient.

However for good reason, when a patient suffering from an ailment which is not within the range of

experience of the treating physician, the physician may refuse treatment and refer the patient to another

physician.

2.01.2Medical practitioner having any incapacity detrimental to the patient or which can affect his

performance vis-à-vis the patient is not permitted to practice his profession


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2.02 Patience, Delicacy and Secrecy :

Patience and delicacy should characterize the physician. Confidences concerning individual or domestic life

entrusted by patients to a physician and defects in the disposition or character of patients observed during

medical attendance should never be revealed unless their revelation is required by the laws of the State.

Sometimes, however, a physician must determine whether his duty to society requires him to employ

knowledge, obtained through confidence as a physician, to protect a healthy person against a communicable

disease to which he is about to be exposed. In such instance, the physician should act as he would wish

another to act toward one of his own family in like circumstances.

2.3 Prognosis:

The physician should neither exaggerate nor minimize the gravity of a patient’s condition. He should ensure

himself that the patient, his relatives or his responsible friends have such knowledge of the patient’s condition

as will serve the best interests of the patient and the family.

2.4 The Patient must not be neglected: A physician is free to choose whom he will serve. He should, however, respond to any request for his

assistance in an emergency. Once having undertaken a case, the physician should not neglect the patient, nor

should he withdraw from the case without giving adequate notice to the patient and his family. Provisionally or

fully registered medical practitioner shall not willfully commit an act of negligence that may deprive his patient

or patients from necessary medical care.

2.5 Engagement for an Obstetric case:

When a physician who has been engaged to attend an obstetric case is absent and another is sent for anddelivery accomplished, the acting physician is entitled to his professional fees, but should secure the patient’s

consent to resign on the arrival of the physician engaged.

Chapter - 3 : Duties of physician in consultation

3.1 Unnecessary consultations should be avoided

3.1.1However in case of serious illness and in doubtful or difficult conditions, the physician should request

consultation, but under any circumstances such consultation should be justifiable and in the interest of

the patient only and not for any other consideration.

3.1.2

Consulting pathologists/radiologists or asking for any other diagnostic Lab investigation should be done

judiciously and not in a routine manner.

3.2 Consultation for Patient’s Benefit

In every consultation, the benefit to the patient is of foremost importance. All physicians engaged in the case

should be frank with the patient and his attendants.


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3.3 Punctuality in Consultation

Utmost punctuality should be observed by physicians in making themselves available for consultations.

3.4 Statement to patient after Consultation

3.4.1

All statements to the patient or his representatives should take place in the presence of the consulting

physicians, except as otherwise agreed. The disclosure of the opinion to the patient or his relatives or

friends shall rest with the medical attendant.

3.4.2

Differences of opinion should not be divulged unnecessarily but when there is irreconcilable difference

of opinion the circumstances should be frankly and impartially explained to the patient or his relatives

or friends. It would be open to them to seek further advice as they as desire.

3.5 Treatment after Consultation

No decision should restrain the attending physician from making such subsequent variations in the treatment if

any unexpected change occurs, but at the next consultation, reasons for the variations should be

discussed/explained. The same privilege, with its obligations, belongs to the consultant when sent for in an

emergency during the absence of attending physician. The attending physician may prescribe medicine at any

time for the patient, whereas the consultant may prescribe only in case of emergency or as an expert when

called for.

3.6 Patients Referred to Specialists

When a patient is referred to a specialist by the attending physician, a case summary of the patient should be

given to the specialist, who should communicate his opinion in writing to the attending physician.

3.7 Fees and other charges

3.7.1

A Physician shall inform his fees and other charges to a patient before rendering service and not after

the operation or treatment is underway. Prescription should also make clear that the physician himself

dispensed any medicine.

3.7.2

A physician shall write his name and designation in full along with registration particulars in his

prescription letter head.

Note:

In Government hospital where the patient-load is heavy , the name of the prescribing doctor must be

written below his / her signature.


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Chapter - 4 : Responsibilities of physicians to each other

4.1 Conduct in consultation :

In consultations, no insincerity, rivalry or envy should be indulged in. All due respect should be observed

towards the physician in-charge of the case and no statement or remark be made, which impair the confidence

reposed in him. For this purpose no discussion should be carried on in the presence of the patient or his

representatives. The Physician should refrain from making comments which may needlessly damage the

reputation of a colleague or cause anxiety to a patient. A Physician at all times be in readiness to assist

colleagues with information or advice.

4.2 Consultant not to take charge of the case

When a physician has been called for consultation, the Consultant should normally not take charge of the

case, especially on the solicitation of the patient or friends. The Consultant shall not criticize the referring

physician. He/she shall discuss the diagnosis treatment plan with the referring physician.

4.3 Appointment of Substitute

Whenever a physician requests another physician to attend his patients during his temporary absence from his

practice, professional courtesy requires the acceptance of such appointment only when he has the capacity to

discharge the additional responsibility along with his / her other duties. The physician acting under such an

appointment should give the utmost consideration to the interests and reputation of the absent physician and

all such patients should be restored to the care of the latter upon his / her return.

4.4 Visiting another Physician's CaseWhen it becomes the duty of a physician occupying an official position to see and report upon an illness or

injury, he should communicate to the physician in attendance so as to give him an option of being present. The

medical officer / physician occupying an official position should avoid remarks upon the diagnosis or the

treatment that has been adopted.

4.5 Dependence of Physicians on each other

A physician should consider it as a pleasure and privilege to render gratuitous service to all physicians and

their immediate family dependants.

Chapter - 5 : Duties of physician to the public and to the

paramedical profession

5.1 Physicians as Citizens

Physicians, as good citizens, possessed of special training should disseminate advice on public health issues.

They should play their part in enforcing the laws of the community and in sustaining the institutions thatadvance the interests of humanity. They should particularly co-operate with the authorities in the administration

of sanitary / public health laws and regulations.


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5.2 Public and Community Health

Physicians, especially those engaged in public health work, should enlighten the public concerning quarantine

regulations and measures for the prevention of epidemic and communicable diseases. At all times the

physician should notify the constituted public health authorities of every case of communicable disease under

his care, in accordance with the laws, rules and regulations of the health authorities. When an epidemic occurs

a physician should not abandon his duty for fear of contracting the disease himself.

5.3 Pharmacists / Nurses

Physicians should recognize and promote the practice of different services such as, pharmacy and nursing as

pharmacy and nursing as professions and should seek their co-operation wherever required.

Chapter - 6 : Unethical acts

6.1 Advertising

6.1.1

Soliciting of patients directly or indirectly, by a physician, by a group of physicians or by institutions or

organizations is unethical. A physician shall not make use of him / her (or his / her name) as subject of

any form or manner of advertising or publicity through any mode either alone or in conjunction with

others which is of such a character as to invite attention to him or to his professional position, skill,

qualification, achievements, attainments, specialities, appointments, associations, affiliations orhonours and / or of such character as would ordinarily result in his self aggrandizement. A physician

shall not give to any person, whether for compensation or otherwise, any approval, recommendation,

endorsement, certificate, report or statement with respect of any drug, medicine, nostrum remedy,

surgical, or therapeutic article, apparatus or use thereof or any test, demonstration or trial thereof, for

use in connection with his name, signature, or photograph in any form or manner of advertising through

any mode nor shall be boast of cases, operations, cures or remedies or permit the publication of report

thereof through any mode. A medical practitioner is however permitted to make a formal

announcement in press regarding the following:

1. On starting practice.2. On change of type of practice.

3. On changing address .

4. On temporary absence from duty.

5. On resumption of another practice.

6. On succeeding to another practice.

7. Public declaration charges.

6.1.2

Printing of self photograph, or any such material of publicity in the letter head or on sign board of theconsulting room or any such clinical establishment shall be regarded as acts of, self advertisement and

unethical conduct on the part of the physician. However, printing of sketches, diagrams, picture of

system shall not be treated as unethical


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6.2 Patent and Copyrights

A physician may present surgical instruments, appliances and medicine or Copyright applications, methods

and procedures. However, it shall be unethical if the benefits of such patents or copyrights are not made

available in situations where the interest of large population is involved.

6.3 Running an open shop (Dispensing of Drugs and Appliances byPhysicians

A physician should not run an open shop for sale of medicine for dispensing prescriptions prescribed by

doctors other than himself or for sale of medical or surgical appliances It is not unethical for a physician to

prescribe or supply drugs, remedies or appliances as long as there is no exploitation of the patient. Drugs

prescribed by a physician or brought from the market for a patient should explicitly state the proprietary

formulae as well as generic name of the drug.

6.4 Rebates* and Commission**

6.4.1

A physician shall not give, solicit, or receive nor shall he offer to give solicit or receive any gift, gratuity,

commission or bonus in consideration of or return for the referring, recommending or procuring of any

patient for medical, surgical or other treatment A physician shall not directly or indirectly, participate in

or be a party to act of division, transference, assignment, subordination, rebating, splitting or refunding

of any fee for medical, surgical or other treatment.

6.4.2

Provisions of para 64.1 shall apply with equal force to the referring, recommending or procuring by a

physician or any other person, specimen or material for diagnostic purposes or other study/ work.

Nothing in this section, however, shall prohibit payment of salaries by a qualified physician to other duly

qualified person rendering medical care under his supervision.

6.5 Secret Remedies

The prescribing or dispensing by a physician of secret remedial agents of which he does not know the

composition, or the manufacture or promotion of their use is unethical and as such prohibited. All the drugs

prescribed by a physician should always carry a proprietary formula and clear name.

6.6 Human Rights

The physician shall not aid or abet torture nor shall he be a party to either inflection of mental or physical

trauma or concealment of torture inflicted by some other person or agency in clear violation of basic human

rights.

6.7 Euthanasia

Practicing euthanasia shall constitute unethical conduct. However on specific occasion, the question of

withdrawing supporting devices to sustain cardiopulmonary function even after brain death, shall be decided

only by a team of doctors and not merely by the treating physician alone. A team of doctors shall declare

withdrawal of support system. Such team shall consist of the doctor in charge of the patient, Chief Medical


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Officer / Medical Officer in-charge of the hospital and a doctor nominated by the in-charge of the hospital staff

from the hospital staff or in accordance with the provisions of the Transplantation of Human Organ Act, 1994.

Chapter - 7 : Misconduct

7.01 Violation of the regulations

7.01.1

If he/she does not maintain the medical records of his /her indoor patients for a period of three years as

per regulation 1.3 and refuses to provide the same within 72 hours when the patient or his / her

authorized representative makes a request for it as per regulation 1.3.

7.01.2

If he/ she does not display the registration number accorded to him/ her by the Tamil Nadu Medical

Council in his /her clinic, prescriptions and certificates etc. issued by him or violates the provision of

regulation 1.4.2 (display of recognized medical degrees)

7.02 Adultery or Improper Conduct

Abuses of professional position by committing adultery or improper conduct with a patient or by maintaining an

improper association with a patient will render a physician liable for disciplinary action as provided under the

Tamil Nadu Medical Registration Act, 1914 or the Indian Medical Council Act. 1956.

7.03 Conviction by Court of LawConviction by a court of Law for offences involving moral turpitude / Criminal acts.

7.04 Sex Determination Tests

On no account sex determination test shall be undertaken with the intent to terminate the life of a female

foetus developing in her mother's womb, unless there are other absolute indications for termination of

pregnancy as specified in the Medical Termination of Pregnancy Act, 1971. Any act of termination of

pregnancy of normal female foetus amounting to female foeticide shall be regarded as professional

misconduct on the part of the physician leading to penal erasure, besides rendering him liable to criminalproceedings as per the provisions of the above Act.

7.05 Signing Professional Certificates, Reports and other Documents

Registered medical practitioners are in certain cases bound by law to give, or may from time to time be called

upon or requested to give certificates, notification, reports and other documents of similar character signed by

them in their professional capacity for subsequent use in the courts or for administrative purposes etc. Such

documents, among others, include the ones given at Appendix – 4. Any registered practitioner who is shown to

have signed or given his name and authority any such certificate, notification, report or document of a similar

character which is untrue, misleading or improper, is liable to have his name deleted from the State MedicalRegister.


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7.06

A registered medical practitioner shall not contravene the provisions of the Drugs and Cosmetics Act* and the

Regulations made thereunder.

Accordingly.

A. Prescribing steroids / psychotropic drugs when there is no absolute medical indication.

B. Selling Schedule G, H, L & X drugs and poisons to the public except to his patient; in

contravention of the above provisions

shall constitute gross professional misconduct on the part of the physician.

7.07

Performing or enabling unqualified person to perform an abortion or any illegal operation for which there is no

medical, surgical or psychological indication.

7.08 A registered medical practitioner shall not issue certificates of efficiency in modern medicine to unqualified or

non-medical person.

Note:

The foregoing does not restrict the proper training and instruction of bona fide students, midwives,

dispensers, surgical attendants or skilled mechanical and technical assistants and therapy assistants

under the personal supervision of physicians.

7.09

A physician should not contribute to the lay press articles and give interviews regarding diseases and

treatments which may have the effect of advertising himself or soliciting practice; but is open to write to the lay

press under his own name (Without Self-Photograph) on matters of public health, hygienic living or to deliver

public lectures, give talks on the ratio/ TV/internet chat for the same purpose and send announcement of the

same to lay press.

7.10

An institution run by a physician for a particular purpose such as a maternity home, nursing home, private

hospital, rehabilitation centre or any type of training institution etc., may be advertised in the lay press, but

such advertisements should not contain anything more than the name of the institution, type of patients

admitted, type of training and other facilities offered and the fees.

7.11

It is improper for a physician to use an unusually large sign board and write on it anything other than his name,

qualification obtained from a University or a statutory body, titles and name of his speciality, registration

number including the name of the State Medical Council under which registered. The same should be the

contents of his prescription papers also. It is improper to affix a sign - board on a chemists shop or in places

where he does not reside or work.


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7.12

The registered medical practitioner shall not disclose the secrets of a patient that have been learnt in the

exercises of his / her profession except - In a court of law under orders of the presiding Judge; In

cirucumstances where there is a serious and identified risk to a specific person and / or community Notificable

diseases. In case of communicable / notificable diseases, concerned public health authorities should be

informed immediately.

7.13 Should not refuse to give professional service on religious grounds

The registered medical practitioner shall not refuse on religious grounds alone to give assistance in or conduct

of sterility, birth control, circumcision and medical termination of pregnancy when there is medical indication,

unless the medical practitioner feels himself/ herself incompetent to do so.

7.14

Before performing an operation the physician should obtain in writing the consent from the husband or wife,parent or guardian in the case of minor, or the patient himself as the case may be. In an operation which may

result in sterility the consent of both husband and wife is needed.

7.15

A registered medical practitioner shall not publish photographs or case reports of his/ her patients without their

permission, in any medical or other journal in a manner by which their identity could be made out. If the identity

is not be disclosed, the consent is not needed.

7.16

In the Case of running of a nursing home by a physician and employing assistants to help him/ her, the

ultimate responsibility rests on the physician.

7.17

A physician shall not use touts or agents for procuring patients.

7.18

A physician shall not claim to be specialist unless he has special qualification in that branch.

7.19

No act of invitro fertilization or artificial insemination shall be undertaken without the informed consent to the

female patient and her spouse as well as the donor. Such consent shall be obtained in writing only after the

patient is provided, at her own level of comprehension, with sufficient information about the purpose, methods,

risks, inconveniences, disappointments of the procedure and possible risks and hazards.

7.20 Research :

Clinical drug trials or other research involving patients or volunteers as per the guidelines of Indian Council of

Medical Research can be undertaken, provided ethical considerations are borne in mind.


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Violation of existing ICMR guidelines in drug or therapy which is not in consonance with the guidelines shall

also be construed as misconduct.

Chapter - 8 : Punishment and disciplinary action

8.01It must be clearly understood that the instances of offences and of professional misconduct which are given

above do not constitute and are not intended to constitute a complete list of the infamous acts which calls for

disciplinary action, and that by issuing this notice the Tamil Nadu Medical / Medical Council of India are in no

way precluded from considering and dealing with any other form of professional misconduct on the part of a

registered medical practitioner. Circumstances may and do arise from time to time in relation to which there

may occur questions of professional misconduct which do not come within any of these categories. Every care

should be taken that the code is not violated in letter or spirit. In such instances as in all others, the Tamil Nadu

Medical Council / Medical Council of India have to consider and decide upon the facts brought before the

council(s).

8.02

It is made clear that any compliant with regard to professional misconduct can be brought before the Tamil

Nadu Council for Disciplinary action. Upon receipt of any complaint of professional misconduct, the Tamil

Nadu Medical Council would hold an enquiry and give opportunity to the registered medical practitioner to be

heard in person or by pleader. If the medical practitioner is found to be guilty of committing professional

misconduct, the Tamil Nadu Medical Council may award such punishment as deemed necessary or may direct

the removal altogether or for a specified period, from the register of the name of the delinquent registered

practitioner. Deletion from the Register shall be widely publicized in local press as well as in the publications ofdifferent Medical Associations / Societies / Bodies.

8.03

In case the publishment of removal from the register is for a limited period, the Tamil Nadu Medical Council

may also direct that the name was ordered to be removed.

8.04

Decision on complaint against delinquent physician shall be taken within a time limit of 6 months.

8.05

During the pendency of the complaint the Tamil Nadu Medical Council may restrain the physician from

performing the procedure or practice which is under scrutiny.

8.06

Professional incompetence shall be judged by peer group as per guidelines prescribed by Tamil Nadu Medical

Council / medical Council of India.


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Hippocratic oath

BRIEF NOTE ON HIPPOCRATIC OATH

This is attributed to the Greek physician Hippocrates (460 BC - 377 BC) who is known as the "Father of

Western Medicine". Hippocrates was born and practiced in the island of Kos in Greece. His name is

synonymous with ethics and high proficiency in the art of healings. His writings were mainly responsible for

providing a firm scientific basis for medicine and also distinguishing it from philosophy and religion. From the

writings of Hippocrates one learns the medicine was not bound by superstition but based on careful

observation and inference. Hippocrates came to be regarded as the ideal physician in the 2nd century A.D.

and even to day people all over the world speak of the noble qualities embodied in the "Hippocratic world"

which serve as the conscience of the doctor in his sacred healing art. Great persons like Hippocrates are

always remembered for the contributions they have made to the betterment of the humanity In this context the

following immortal words of Hippocrates ring as true to-day as they did which they were uttered centuries age.

"Life is short and the Art (of medicine) long; the opportunity fleeting, experiment dangerous and judgement

difficult".

HIPPOCRATIC OATH

I solemnly pledge myself to consecrate my life to the service of humanity; I will give to my teachers the respect

and gratitude which is their due; I will practice my profession with conscience and dignity; The health of my

patient will be my first consideration; I will respect the secrets which are confided in me; I will maintain by all

the means in my power, the honour and the noble tradition of the medical profession; My colleagues will be my

brothers; I will not permit considerations of religion, nationality, race, party politics or social standing to

intervene between my duty and my patient; I will maintain the utmost respect for human life, from the time of

conception even under threat, I will not use my medical knowledge contrary to the laws of humanity; I makethese promises solemnly, freely and upon my honour.

Central / State medical Acts

The Indian Medical Degrees Act 1916

This Central Act was enacted to regulate the grant of titles implying qualification in Western Medical Science

and the assumption and use by unqualified persons of such titles. The above Act was subsequently amended

by the THe Indian Medical Degrees (MAdras Amendment) Act 1940 (Madras Act No. XX of 1940) in itsapplication to the province of MAdras for certain purpose.

The Indian Medical Council Act 1956

The Indian Medical Council Act 1933 extends to the whole of India. This Central Act was later repealed by the

Indian Medical Council Act 1956 as to provide for the reconstitution of Medical Council of India, the

maintenance of the Indian Medical Register and for matters connected therewith. The above Act was

subsequently amended in 1958, 1993 and 2001.

The Drugs and Cosmetics Act 1940

The aim of the Act is to regulate the import, manufacture, distribution and sale of drugs and cosmetics. The

above Central Act which partly relates to women's Health had been amended on eight occasions in keeping

with the changing circumstances. Drugs : The world Health Organization Scientific Group has defined a drug


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as "any substance or product that is used or intended to be used to modify or explore physiological systems or

pathological systems or pathological states for the benefit of the recipient". Cosmetic: means any article

intended to be rubbed, poured, sprinkled or sprayed on, or introduced into, or otherwise applied to, the human

body or any part thereof for cleansing, beautifying, promoting attractiveness, or altering the appearance, and

includes any articles intended for use as a component of cosmetic.

The Drugs and Magic Remedies (Objectionable) Advertisement Act, 1954.

(DMR ACT)

The Act provides for prevention of advertisement which may be exploited by unscrupulous and commercially

oriented personnel for inducing people for self-medication or fraudulent or exploitative or dangerous and

harmful nature. The undesirable aspects of advertisements include attempts at any of the following :

Procurement of miscarriage in women or prevention of conception in women. Correction of menstrual disorder

in women Maintenance or improvement of the capacity of human beings for sexual pleasure. Diagnosis, cure,

mitigation, treatment or prevention of any disease, disorder or condition specified in the Schedule of the DMR

Act.

The Schedule

Penal Provisions against quacks

The quacks practicing Allopathic medicine are liable to be punished under the provisions of the Indian Penal

Code 1860 (IPC) and other Central / State Act. I.P.C. Sections : 419 & 420, (for cheating the patients). I.P.C.

Sections : 338 (Injections of lethal medicine into Human Body) I.P.C. Sections : 471 (Possessing bogus (fake)

degrees). The Indian MEdical Degrees Act 1956, (Sections 15. 2(b) and 15 (3).) The Indian Medical Degrees

Act, 1916 as amended by the Indian Medical Degrees (Madras Amendment) Act 1940. (Section 6-A) TheDrugs and Cosmetics Act, 1940 [ Section 18(b) ] The Drugs and Magic Remedies (Objectionable)

Advertisement Act. 1954.

Supreme Court Judgement on Practice of other Systems of Medicine :

An MBBS Medical Practitioner registered with Tamil Nadu Medical Council is entitled to practice Modern

Allopathic Medicine only ie; in the system in which he has qualified, himself as per the Apex Courts case Law.

Dt. 10th May 1996. Similarly a physician who has obtained a recognized qualification in any other Indigenous

System of Medicine including Homeopathy is not allowed to practice Modern Medicine in any form.

When a Medical Practitioner is called to appear as an expert witness:

A doctor may be called to testify As an ordinary witness who saw something happen. As a medical practitioner

who treated the patient & As an expert to give his opinion on matter of science. In the first 2 conditions it is his

duty and obligation to testify. In the last condition he may refuse the request, if he feels that he is not

sufficiently qualified to testify, with any conviction in that particular case or if he feels that he cannot spare time

to prepare properly or to take long appearance in Court. A medical witness should strive to achieve respect,

understanding and credibility in Court. He must give the appearance of being an independent non - partisan

scientist. The doctor should not become partisan. Brouardel the French medico legal authority wrote, " if the

law has made you (the physician) witness, remain a man of science; you have no victim to avenge, no guilty

person to convict and no innocent person to save, you must bear testimony within the limits of science. The

attitude of a scientific witness should be the same whether he is called by the prosecution or by the defence.

The doctor really testifies neither for, nor against the prosecution or by the defence. The doctor's expertise is in


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the application of science to a legal controversy and the proper interpretation of scientific findings. His sole

obligation is to present the truth as he sees it, adding nothing, withholding nothing and distorting nothing. He

should not concern himself with the previous character of the accused or with other evidence in the case. He

should not be influenced in any way by emotional consideration, such as sympathy or antipathy. The doctor

must be honest, for confidence is inspired by honesty and success depends upon confidence.

An important Supreme Court judgement

No legal impediment for a medical professional to attend to an injured

person needing his medical assistance immediately says : Supreme Court

of India :

Hon'ble Supreme Court Judges Justice Ranganathan Misra and Justice G.L. Oza have made the following

observations in their judgement - Ref : AIR 1989 SC 2039, in response to a PIL filed. (The Secretary, Ministry

of Health F & F.W. of the Union of India, the IMC, the Indian Medical Association were impleaded asrespondents).

There is also no doubt that the effort to save the person should be the top priority not only for the medical

professional but even of the police or any other citizen who happens to be connected with the matter or what

happens to notice such an incident or a situation.

But on behalf of the medical profession there is one more apprehension which sometimes prevents a medical

professional in spite of his desire to help the person, as he apprehends that he will be a witness and may have

to face the police interrogation which sometimes may need going to the police station repeatedly and waiting

and also to be a witness in a court of law where also he apprehends that he may have to go on number of

days and may have to wait for a long time and may have to face sometimes long unnecessarycross-examination which sometimes may even be humiliating for a man in the medical profession and in our

opinion it is this apprehension which prevents a medical professional who is not entrusted with the duty of

handling medico-legal cases to do the needful, he always tries to avoid and even if approached directs the

person concerned to go to a State hospital and particularly to the person who is in- charge of the medico-legal

cases.

We therefore have no hesitation in assuring the persons in the medical profession that these apprehensions,

even if they have some foundation, should not prevent them from discharging their duty as a medical

professional to save a human life and to do all that is necessary but at the same time we hope and trust that

with this expectation from the members of the medical profession, the police, the members of the legalprofession, our law courts and everyone concerned will also keep in mind that a man in the medical profession

should not be unnecessarily harassed for purposes of interrogation or for any other formalities and should not

be dragged during investigations at the police station and it should be avoided as far as possible.

We also hope and trust that our law courts will not summon a medical professional to give evidence unless the

evidence is necessary and even if he is summoned, attempt should be made to see that the men in this

profession are not made to wait and waste time unnecessarily and it is known that our law courts always have

respect for the men in the medical profession and they are called to give evidence when necessary and

attempts are made so that they may have to wait for long.

We have no hesitation in saying that it is expected of the members of the legal profession which is the other

honorable profession to honour the persons in the medical profession and see that they are not called to give

evidence so long as it is not necessary.


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It is also expected that where the facts are so clear it is expected that unnecessary harassment of the

members of the medical profession either by way of request for adjournments or by cross-examination should

be avoided so that the apprehension that the men in the medical profession have which prevents them from

discharging their duty to a suffering person who needs their assistance utmost, is removed and a citizen

needing the assistance of a man in the medical profession receives it. we would also like to mention that

whenever on such occasions a man of the medical profession is approached and if he finds that whenever

assistance he could give is not sufficient really to save the life of the person but some better assistance is

necessary it is also the duty of the man in the medical profession so approached to render all the help which

he could and also see that the person reaches the proper expert as early as possible

History of allopathic medicine in india

For the past 10 centuries India earlier to Independence was the playground of cultural and religious conflicts.

The age long political strifes had their socio-economic and cultural repercussions with the result that the then

knowledge of indigenous medicine gradually dwindled, decayed and became polluted by self-seeking

uncultured quacks. The western allopathic medicine then came and captured the unprejudiced mind of the

educated people for its scientific outlook. The history of Indian Medicine such as those of Ayurvedha andSiddha which were then developing, is now a history of the past and we must reconcile to this fact. During the

British period, at the beginning of the second quarter of the 19th century Lord Bentinck tried to organise

medical education on a scientific basis and soon Calcutta and Madras Medical Colleges were established.

This was followed by establishment of medical schools in other leading cities of India. Medical education of

women began at the last part of the 19th century. Facilities for post-graduate education were few in those early

days and the teaching was more or less rigid.

State medical councils & their powers

"State Medical Council" means a Medical Council Constitutive under any law for the time being in force in any

State regulating the registration of practitioners of medicine. "State Medical Councils are functioning in a

manner similar to that of Indian Medical Council. The State Medical council are also responsible for exercising

diciplinary control over the Medical practitioners registered in the state. They are also required to inform the

Indian Medical council about any changes made in the State Register. The State Medical Council has the

Power to warn, refuse to register/ remove from register the name of a doctor who has been sentenced by any

court for any non-bailable offence or found to be guiltily of infamous conduct in any professional respect. The

State Medical Council has also the power to re-enter the name of the doctor in the register.