the guide to professional conduct and ethics for registered medical practitioners

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


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


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

Section AProfessional Conduct


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.


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


3 Court convictions3.1 Ifadoctorisconvictedofacriminaloffence,thiswillbenotified

totheMedicalCouncil,whichwill investigatethecircumstances

involved.Youmaynotbeabletoavoidaninquirybyclaimingthat

youwerenotondutyatthetimeoftheoffence.

Section BResponsibilities to Patients


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


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.


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.


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


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.


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.


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.


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 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.


22.6 Youmustnotparticipateinthedeliberatekillingofapatientby

activemeans.

Section CMedical Records and Confidentiality


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


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



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/


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.


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


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.

Section DConsent to Medical Treatment


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


➤ 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


➤ 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


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 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


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.


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


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

Section EProfessional Practice


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


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.


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


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


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.


17 DataProtectionGuidelinesonresearchintheHealthSector

www.dataprotection.ie/documents/guidance/Health_research.pdf


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.


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.


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.


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.


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.


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.


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


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.


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.


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.

Appendix A


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;


➤ informationabouthowandwhenthepatient’scondition

andanysideeffectswillbemonitoredorre-assessed;

➤ thenameofthedoctorwhowillhaveoverall

responsibilityforthetreatmentand,whereappropriate,

namesoftheseniormembersoftheirteam;

➤ whetherdoctorsintrainingwillbeinvolved;

➤ theextenttowhichstudentsmaybeinvolved

inaninvestigationortreatment;

➤ areminderthatpatientscanchangetheir

mindsaboutadecisionatanytime;

➤ areminderthatpatientshavearight

toseekasecondopinion;

➤ whereapplicable,detailsofcostsorcharges

whichthepatientmayhavetomeet.


Medical CouncilKingramHouse

KingramPlace

Dublin2

T.+35314983100

W.www.medicalcouncil.ie

the guide to professional conduct and ethics for registered medical practitioners

Documents