Ethics is knowing the difference between what you have a right to do and what is right to do. Potter Stewart. In law a man is guilty when he violates the rights of others. In ethics he is guilty if he only thinks of doing so.

Registered medical practitioners are licensed by the Medical Council, which exercises disciplinary control to ensure their ethical and professional conduct. Medical ethics, encompassing duties to fellow professionals, and professional conduct in medical practice are specifically codified. The Disciplinary Board's role is to reform those who commit infractions rather than to punish them as delinquents. Unethical acts and professional misconduct are clearly defined and codified to delineate the Council's disciplinary role and jurisdiction.

Q. What are the defined and named medical ethics in National Medical Commission Act and Regulations 2023?

Response: The National Medical Commission (NMC) Act and Regulations 2023 The NMC Act and Regulations 2023 outline several key medical ethics and professional conduct standards for registered medical practitioners. These regulations are designed to ensure that medical professionals adhere to high ethical standards and provide quality care to patients. Some of the key medical ethics defined in these regulations include:

Duties Towards the Public and Allied Healthcare Professionals:

• Public Education and Awareness: Medical practitioners have a responsibility to disseminate scientific advice on public health issues without self-promotion.
• Notification of Notifiable Diseases: Practitioners must notify public health authorities of any notifiable diseases under their care.
• Conflict of Interest: Practitioners should avoid conflicts of interest and disclose any relationships that may influence their professional judgment.

Professional Conduct:

• Advertising: Medical practitioners should not engage in self-promotion or advertising.
• Third-Party Educational Activities: Practitioners should avoid involvement in educational activities sponsored by pharmaceutical companies or allied health sectors.
• Social Media Conduct: Guidelines on the appropriate use of social media by medical practitioners.

Guidelines and Codes:

• Generic Drugs and Prescription: Guidelines on prescribing generic drugs.
• Continuing Professional Development (CPD): Accreditation and guidelines for CPD activities.
• Telemedicine: Guidelines for the practice of telemedicine.
• End-of-Life Care: Guidelines on providing care at the end of life.
• Consent in Medical Practice: Guidelines on obtaining informed consent from patients.
• Research by RMPs: Guidelines on conducting medical research.

These regulations aim to uphold the integrity and professionalism of medical practice in India, ensuring that practitioners provide ethical and high-quality care to their patients.

Conclusion
While ethical principles themselves are not laws, breaches of these principles that result in harm to patients can indeed form the basis for legal claims of medical negligence. The integration of ethical principles and legal standards helps ensure that medical practitioners adhere to high standards of care and accountability.

Your observation highlights the critical interplay between ethics and law in medical practice, ensuring that patient welfare remains at the forefront of healthcare delivery.

Q. Breach of medical ethics attracts disciplinary action by Medical Council and not punitive action that falls in the domain of law courts?

Response:
Generally, you are correct. Breaches of medical ethics typically result in disciplinary actions taken by medical councils or regulatory bodies, rather than punitive action by a court of law. Here's a more detailed look:

Disciplinary Actions by Medical Councils

• Medical Councils and Regulatory Bodies: These organizations, such as the National Medical Commission (NMC) in India, are responsible for overseeing the conduct of medical practitioners. They enforce professional and ethical standards.
   
• Types of Disciplinary Actions:
  • Reprimand: Issuing a formal reprimand to the practitioner.
  • Suspension: Temporarily suspending the practitioner's medical license.
  • Revocation: Permanently revoking the practitioner's medical license.
  • Fines: Imposing monetary fines.
  • Mandatory Training: Requiring the practitioner to undergo additional training or education.
     

Legal Action and Courts

• Criminal and Civil Liability: In cases where a breach of ethics also constitutes a violation of criminal or civil law (e.g., fraud, criminal negligence, assault), the practitioner may face legal proceedings and punitive actions by a court of law.
• Medical Negligence: Courts primarily handle cases involving medical negligence where harm has occurred. These cases can result in compensatory damages to the patient, but punitive damages are less common unless gross negligence or malafide intent is proven.
   

Integration of Ethics and Legal Standards

• Ethical Guidelines in Legal Proceedings: While courts do not enforce ethical guidelines directly, breaches of these guidelines can be considered in legal proceedings as evidence of negligence or misconduct.
• Collaborative Oversight: Medical councils and legal systems often work together to ensure accountability and protect patient welfare. Disciplinary actions by medical councils can be complemented by legal actions if necessary.

In summary, breaches of medical ethics typically lead to disciplinary actions by medical councils, but in cases where the breach overlaps with legal violations, courts may also be involved to impose appropriate sanctions. Your observation highlights the distinct roles of medical regulatory bodies and the legal system in maintaining ethical and professional standards in healthcare.
 

Q. Fraud, criminal negligence, assault are independent offences by themselves, not ethics dependent. Then why should ethics be invoked for criminal or civil negligence?

Response:

You're correct that offenses like fraud, criminal negligence, and assault are independent legal offenses and are not directly dependent on ethical principles. However, the relationship between ethics and law in cases of negligence, especially in the medical field, is nuanced. Here's how ethics interplay with legal proceedings:

Ethics and Legal Standards

• Ethics as a Foundation: While legal offenses like fraud and criminal negligence are defined by laws, ethical principles provide a foundational framework for professional conduct. In medicine, ethical principles such as beneficence and non-maleficence are integral to the duty of care that practitioners owe to their patients.
• Evidence of Negligence: In medical negligence cases, breaches of ethical principles can serve as evidence of a failure to meet the standard of care. For example, if a doctor fails to act in the best interest of a patient (beneficence) or causes harm that could have been avoided (non-malfeasance), it can support a claim of negligence.
   

Legal Context

• Criminal Negligence: In criminal cases, the focus is on whether the actions were so reckless or egregious that they warrant criminal liability. Ethical breaches can be part of the narrative that demonstrates the extent of the recklessness or disregard for patient safety.
• Civil Negligence: In civil cases, the focus is on whether there was a breach of the duty of care that resulted in harm. Here, ethical principles help define what constitutes reasonable and prudent medical practice, guiding the court in determining if there was negligence.
   

Professional Accountability

• Medical Councils: Disciplinary actions by medical councils are often based on breaches of ethical standards. While these actions are separate from legal proceedings, they underscore the importance of ethics in maintaining professional accountability.
• Legal Proceedings: Courts may reference ethical guidelines as part of their deliberations, but the legal outcomes are based on statutory laws and legal precedents. Ethical breaches provide context and help frame the expectations for professional conduct.

Summary
Ethics and law intersect in complex ways in medical negligence cases. While independent legal offenses are clearly defined, breaches of ethical principles help illustrate the standards of care expected in medical practice. Ethical guidelines provide a framework for understanding professional duties, and their breaches can support legal claims of negligence.

Your point underscores the importance of distinguishing between independent legal offenses and the role of ethics in framing professional standards and expectations in medical practice. This nuanced understanding helps ensure that legal proceedings are informed by the ethical obligations of healthcare providers.

Q. What are the defined codes of conducts for practice of medicine per Medical Council Act? What constitutes professional misconduct?

Response
The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 outline the codes of conduct for medical practitioners. Here are some key points:

Codes of Conduct

• Character and Conduct: Physicians must uphold the dignity and honor of their profession. They should be upright, diligent, and maintain good character.
• Service to Humanity: The primary objective is to render service to humanity, with financial gain being a secondary consideration.
• Good Medical Practice: Physicians should continuously improve their knowledge and skills, maintain medical records accurately, and provide the best possible care to patients.
• Professional Responsibility: Physicians must not permit considerations of religion, nationality, race, caste, creed, or social standing to intervene in their duties.
• Consent: Physicians must obtain informed consent from patients before performing any procedure.
• Advertising: Physicians should not engage in self-advertising or promote drugs or devices for personal gain.
• Professional Fees: Fees should be reasonable and not exploitative.
• Relationship with Pharmaceutical Industry: Physicians should avoid conflicts of interest and maintain professional integrity.

Professional Misconduct

Professional misconduct includes any conduct that is considered disgraceful or dishonorable by other doctors of good repute and competence. Some examples include:

• Violation of Regulations and Laws: Not adhering to the established medical standards and laws.
• Abuse of Professional Position: Misusing their position for personal gain or to harm others.
• Association with Incompetent Persons: Collaborating with or employing incompetent individuals.
• Absenteeism: Regularly failing to attend to patients or duties.
• Not Taking Consent: Performing procedures without obtaining informed consent from the patient.
• Advertising: Engaging in self-advertising or promoting drugs/devices for personal gain.
   

These regulations ensure that medical practitioners maintain high ethical standards and provide the best possible care to their patients. Violations can lead to disciplinary actions by medical councils, including suspension or revocation of medical licenses.
 

Q. How is medical malpractice defined under MCI provisions? Examples of the same?

Response: Under the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, medical malpractice is defined as any act or omission by a medical practitioner that deviates from accepted standards of practice in the medical community and causes harm to a patient. This can include negligence, incompetence, or unethical behavior.
 

Examples of Medical Malpractice

• Misdiagnosis or Delayed Diagnosis: Failing to diagnose a condition correctly or delaying the diagnosis, leading to harm or worsening of the patient's condition.
• Surgical Errors: Performing surgery on the wrong body part, leaving surgical instruments inside the patient, or other mistakes during surgery.
• Medication Errors: Prescribing the wrong medication or dosage, or failing to recognize harmful drug interactions.
• Failure to Obtain Informed Consent: Proceeding with a treatment or procedure without adequately informing the patient of the risks and obtaining their consent.
• Neglecting Patient Care: Failing to provide appropriate aftercare, follow-up, or monitoring, resulting in patient harm.
• Improper Treatment: Providing treatment that is not in line with standard medical practices, causing harm to the patient.
• Birth Injuries: Mistakes during childbirth that result in injury to the baby or mother.
• Wrongful Death: Any medical error that leads to the death of a patient.

These examples illustrate how deviations from standard medical practices can lead to serious consequences for patients and form the basis for medical malpractice claims.

Q. Is not standard of practice being mixed with standards of care? Having sexual relations with a patient is professional misconduct it is not-medical malpractice? Conducting unnecessary tests on a patient is a medical malpractice not a misconduct? Breach of standard of care results into harm to a patient, breach of professional conduct does not directly result into physical harm to the patient?

Response:
You're making crucial distinctions between different aspects of medical practice. Here's a clearer breakdown of the concepts:

Standard of Practice vs. Standard of Care

Standard of Practice

• Definition: Guidelines and protocols that medical practitioners follow in their profession, encompassing ethical, legal, and professional conduct expected of doctors.
• Examples:
  • Ethical behavior, such as maintaining patient confidentiality and avoiding conflicts of interest.
  • Professional behaviors, like maintaining accurate medical records.

Standard of Care

• Definition: The level of care and skill that a reasonably competent healthcare professional, in the same field, would provide under similar circumstances, focusing on clinical actions and decisions while treating patients.
• Examples:
  • Proper diagnosis and treatment of conditions.
  • Adhering to medical guidelines and protocols for specific treatments.

Professional Misconduct vs. Medical Malpractice

Professional Misconduct

• Definition: Violations of the ethical and professional standards set by medical regulatory bodies.
• Examples:
  • Having sexual relations with a patient.
  • Engaging in fraudulent activities.
  • Breaching patient confidentiality.
• Impact: Undermines the trust and integrity of the medical profession and can lead to disciplinary actions by medical councils.

Medical Malpractice

• Definition: Deviation from the accepted standard of care, resulting in harm to a patient.
• Examples:
  • Misdiagnosis.
  • Surgical errors.
  • Conducting unnecessary tests that lead to harm.
• Impact: Results in physical or psychological harm to the patient, leading to legal claims and compensation.

Key Points

• Different Domains: Professional misconduct deals with ethical and professional behavior, while medical malpractice involves clinical actions and decisions that result in harm.
• Consequences: Professional misconduct can lead to disciplinary actions by medical councils, while medical malpractice can lead to legal actions and compensation for the harmed patient.
• Overlap: Some actions can fall into both categories. For example, conducting unnecessary tests for financial gain could be considered both professional misconduct and medical malpractice if it causes harm.

In summary, while both standards and categories aim to uphold the quality and integrity of medical practice, they address different aspects of professional and clinical behavior.

Q. Ethics, Professional Conduct, Medical Malpractice fall in the domain of Medical Council. Is there any provision for adjudicating on medical negligence in the MCI Act?

Response:
Yes, the Medical Council of India (MCI) does have provisions for adjudicating medical negligence. The MCI's role is to ensure that medical practitioners adhere to professional standards and ethical guidelines. When a complaint of medical negligence is filed, the MCI can conduct an inquiry to determine whether there has been a breach of professional conduct.

Adjudication Process

• Filing a Complaint: Any aggrieved person can file a complaint with the State Medical Council or the Ethics and Medical Registration Board of the National Medical Commission (NMC).
• Inquiry: The State Medical Council conducts an inquiry, providing the medical professional with an opportunity to present their case.
• Decision: If the medical professional is found guilty of professional misconduct, the State Medical Council can impose disciplinary actions, such as suspension or revocation of the medical license.
• Appeals: The decision of the State Medical Council can be challenged before the Ethics and Medical Registration Board of the NMC, and further appeals can be made to the National Medical Commission.

Relevance in Legal Proceedings
The findings of the MCI inquiry can be relevant in legal proceedings for medical negligence. The inquiry report, prepared with the opinion of medical experts, can be used as evidence in compensation claims or criminal cases1.

In summary, while the MCI primarily handles professional misconduct, its findings can play a significant role in adjudicating medical negligence cases. This ensures that medical practitioners are held accountable for their actions and that patient welfare is protected.

Q. For ethics, conduct and malpractice there are specific provisions in MCI Act. Where is the provision for Medical negligence? They have no jurisdiction in the matter?

Response: The Medical Council of India (MCI) primarily deals with professional misconduct and ethical breaches through its regulations and disciplinary actions. However, the MCI does not have direct jurisdiction over adjudicating medical negligence cases. Medical negligence falls under the purview of the legal system, and patients typically seek recourse through civil courts for compensation.

Legal Framework for Medical Negligence

• Consumer Protection Act (CPA): Patients can file complaints under the Consumer Protection Act, 1986 (amended in 2019), which allows them to seek compensation for medical negligence.
• Civil Courts: Medical negligence cases are usually brought as civil suits for damages in the appropriate court. The courts assess whether the healthcare provider breached their duty of care, resulting in harm to the patient.
• Indian Penal Code (IPC): In severe cases, criminal charges may be brought against healthcare professionals if their negligence results in the death of a patient.

Role of MCI
While the MCI does not adjudicate medical negligence cases, its findings on professional misconduct can be relevant in legal proceedings. The MCI's disciplinary actions can serve as evidence of unethical behavior, which may support claims of medical negligence in civil courts1.

In summary, the MCI handles professional misconduct and ethical breaches, while medical negligence cases are adjudicated through the legal system. This separation ensures that both ethical standards and legal accountability are maintained in medical practice.

Q. The Code of Medical Ethics Regulations 2002 defines medical ethics as duties that a registered medical practitioner owes to his fellow physicians and paramedical staff in Chapters 2-4 Unethical acts such as advertising etc are specifically defined in Chapter 6. Professional misconducts are defined and detail in Chapter 7 - 7.1-7.24 is a long list of misconducts detailing how a medical professional should conduct himself in medical practice. Chapter 8 details punishments and disciplinary actions.

Medical Councils are quasijudicial bodies empowered to adjudicate for the defined Unethical acts and the specified misconducts and to take defined disciplinary action against a delinquent professional. Unethical act or professional misconduct do not, per se and directly, lead to harm. However, where a harm has resulted the patient has to approach the court for negligence claim.

The court will consider the relevance of unethical act or professional misconduct in causation of harm. Medical Councils are not legally authorized or competent to adjudicate or decide medical negligence when a complaint for professional misconduct is. Is this not the correct position?
Response: You are correct in summarizing the framework and limitations within which Medical Councils operate under the Code of Medical Ethics Regulations 2002. Here's a detailed breakdown:

• Medical Ethics and Duties: Chapters 2-4 of the Code outline the ethical duties that registered medical practitioners owe to their fellow physicians and paramedical staff.
• Unethical Acts: Chapter 6 specifically defines unethical acts, such as advertising, which are not in accordance with professional conduct.
• Professional Misconduct: Chapter 7 (Sections 7.1-7.24) provides a comprehensive list of what constitutes professional misconduct, detailing how medical professionals should conduct themselves in practice.
• Punishments and Disciplinary Actions: Chapter 8 outlines the disciplinary actions and punishments that can be imposed for professional misconduct.
• Role of Medical Councils: Medical Councils act as quasi-judicial bodies empowered to adjudicate cases of defined unethical acts and specified professional misconduct. They can impose disciplinary actions based on the misconduct outlined in the Code.
• Distinction between Misconduct and Negligence: Unethical acts or professional misconduct do not inherently cause harm. When harm does result, patients need to seek redress through the courts for claims of negligence. The court then considers whether the unethical act or professional misconduct contributed to the harm.
• Authority of Medical Councils: Medical Councils are not legally authorized to adjudicate or decide on cases of medical negligence. Their jurisdiction is limited to professional misconduct and unethical acts. When a complaint involves both professional misconduct and negligence, the role of the Medical Council is confined to assessing misconduct, while the courts handle negligence claims.
   

Thus, your understanding is accurate. Medical Councils can address issues of professional conduct but do not have the authority to adjudicate medical negligence, which is the purview of the courts.

• Guardians of Professionalism: The Medical Council's Role in Ethical Oversight
• Ethical Oversight Only: The Confined Jurisdiction of Medical Councils
• Professional Conduct and Ethics: The Core of Medical Council Disciplinary Actions

All medicine is made to make you better. If it did the opposite, it would be malpractice.

Chael Sonnen

In medicine, mistakes are inevitable but learning from them is essential. The Laws of Medicine

Written By: Dr Shri Gopal Kabra, MBBS, LLB, MSc, MS (Anatomy), MS (Surgery)
Ph no: 8003516198, Email: [email protected]