Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694831612032.pdf (Guyana)
388 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29Th NOVEMBER, 1 Hippocratic Oath.

Annexure 1.

4.

(1) The Hippocratic Oath of the medical practitioners is given in Annexurc I.
(2) A medical practitioner is required to have adequate knowledge of the following :- (a) rapid advances in medicine and medical technology; (b) high cost of providing good basic health care; (c) medical certificates; (d) health information availability; (e) law and litigation aspects; (I) pro-choice legislation; (g) consent to medical treatment; (h) medical research issues; (i) wide range of treatment choices and alternatives; 0) importance of modern technology, including the use of high technology in the diagnostic process and assisted fertility and cloning; (k) end of life issues and assisted death; (1) definition of death; (m) tissue transplantation related issues; (n) role of religion.
and human rights; and (o) patients' charter of rights.

Hotel.

- Professional ethics are those principles that regulate the conduct between professionals and others with whom the professionals come in contact with in the course of their work.

in the case of medical practitioners this usually refers to patients, colleagues and other health professionals.

Government departments, statutory bodies, courts, employers and third party payers.
Observance of these principles has always been considered important as sick or disabled persons and their relatives may be vulnerable to tional THE OFFICIAL GAZETTE LEGAL St IITLEMENT B 29'" NOVEMBER, 2008 .. exploitation in their efforts to obtain a cure or relief from pain or stiffening.

Note 2.- (i) The Hippocratic Oath represented an early attempt to codify the principles mentioned in Note I.
Although the languTge is archaic and die' concepts somewhat different from current verbal expressions, the I I ippocratic Oath does contain the basic tenets of good practice and sound ethics which still guide modern medical practitioners.

These are- (a) building on professional interrelationships; (b) documenting in good faith; (c) reproductive health; (d) avoiding unnecessary or unsafe treatment; and (e) avoiding improper relationships with patients or th del5endents.
(ii) Throughout the ages, the medical practitioners hay considered it their duty to uphold these principles.
The Medicti Council has the statutory responsibility to uphold standards a professional conduct and competence, either by suspending, a withdrawing the license of erring medical practitioners or ,bid imposing any other penalty admissible under the Act: At tlj international level several bodies have attempted to codify many medical practitioners generally regard it as an obligation t respect their patients' basic human rights.
These are referred to trs International Human Rights Instruments by the United Nat* Commission 'for Human Rights and have been taken int consideration while making these Regulations.

More importantly" in the course of their daily practice, the medical practitioners are often the first to become aware of abuse to human rights a therefore they should carry an even higher consciousness of wh these rights represent.

International 5.
International 5.

Every medical practitioner shall get himself aware of the various abuse 390 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] B 29"` NOVEMBE human ritihts instruments.

,knnexure 11.

Joint Code of Annexure human rights and become acquainted with the international human rights instruments listed in Annexure IL PART II JOINT CODE OF ETHICS 6.
Every medical practitioner shall comply will the provisions of the Join; Code of Ethics given in Annexure PART III RESPONSIBILITIES TO PATIENTS Note 1.-All patients are entitled to good standards of practice and care from, their medical practitioners.

Note 2.-Essential elements of good standard of practice are 'professional competence, good relationships with patients and colleagues and observance of professional ethical considerations.

Standards of care required.

7.


(1) Every medical practitioner shall practice the art and science of medicine to the best of his ability and shall knowingly never expose patients to avoidable risks.

(2) Every medical practitioner shall have due regard to the duties generally spec Annexure IV.

 in Annexure IV.
in Annexure IV.

(3) A good standard of care to be offered by a medical practitioner includes- (i) adequate assessment of the patient's conditions based on the hist and symptoms and, if necessary, an appropriate examination; (ii) providing or arranging investigations and treatment as necessary; (iii) taking suitable and prompt action, as and when necessary.
(4) A medical practitioner shall- (a) recommend only diagnostic procedures and therapy consi essential to assist in the care of a patient and shall recognize the responsi to advise the patient of the findings and make recommendations which help the patient to reach a mutually agreeable decision that he is cue THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — 13 291 " 2008 391 with: (b) have the responsibility to acquire up-to-date knowledge of relevant developments in the field of his practice and the patients should not be subjected to risks from unnecessary or outdated procedures; (c) recognize when his own professional knowledge, skill, competence and experience are inadequate and shall be willing to refer patients to suitably qualified and experienced colleagues as may be available; (d) practice medicine in a manner which is above reproach and shall take neither physical nor emotional or financial advantage of the patient; (e) listen to his patients, respect their views, and treat them with dignity and respect in a polite and considerate manner; (1) recognize the patients' right to choose their medical practitioners freely, accept or refuse treatment after receiving adequate information and seek a second opinion, if they so desire; (g) take steps to ensure the availability of medical care to his patients, and may only withdraw from the responsibility of continued care for his patients after adequate arrangements have been made for such continuity of care by another suitably qualified medical practitioner; (h) recognize his responsibility to render medical service to any person regardless of race, colour, religion, sexual orientation, age, place of birth or political beliefs or perceived -socioeconomic status; (i) appreciate that his primary obligation is to save the life and relieve pain and suffering of his patients; (j) ensure that his personal beliefs do not prejudice the care of his patients; (k) be considerate to the anxiety of patients and their families, and will cooperate with them to achieve the ultimate good health of the patient; (1) develop superior communication skills to allow him to successively 392 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29Th NOVEMBER.
2008 relate to his patient, regardless of.

the education or socio-economic level of the patient; (m) provide care when cure is no longer possible and will allow death to occur with dignity, respect and comfort when the demise of the patient appears to be inevitable.

(5) A medical practitioner shall not expose his patients to risks which may arse from a compromise of their own health status (e.g.

dependence on alcohol or other drugs, HIV infection, hepatitis and the like).
(6) A medical practitioner has the right to refuse to accept a patient except- (i) (ii) in case of emergency; and when no other medical practitioner is available to attend to patient.
• Act N, treats (7) In providing non-urgent medical care, a medical practitioner in a private cli setting shall be free to choose whom to serve on priority, with whom to associate, whom he should refer his patients and the environment in which to provi appropriate medical services but this type of preferences shall not be extended to public health care setting.

Points of caution.

8.
(1) Every medical practitioner shall be cautious that- (a) he may use any document or advice which could weaken physical: mental resistance of a human being only in the patient's interest; (b) he may use great caution in divulging discoveries or new techniques: treatment; (c) he should certify or testify only to that which he has personally yen* (2) A medical practitioner shall- (a) prescribe medicines or treatment, including repeat prescriptions, only wht he has adequate knowledge of the patient's health and medical needs; • THE OFFICIAL GAZETTE (LEGAL.
SUPPLEMENT] B 29 r" NOVEMBER, 2008 (b) report adverse drug reactions as required under the relevant reporti obligations and co-operate with requests for information from organizati monitoring thepublic health; (c) in his daily practice take care .
in keeping clear, accurate, legible contemporaneous patient records which report the relevant clinical findings, decisions made, the information given to patients and any medicine, appitzinLes treatment prescribed; Act No .26 of 2007 Consent to treatment.

(4) The records in respect of the patients shall be kept in accordance with th, requirements of the Health Facilities Licensing Act 2007.

Spcci vulllc i; I U1:1; 9.


(1) Every patient has a right to receive all relevant information about his condi .

and proposed treatment.

(2) The medical intervention in respect of a person shall not be undertaken wit his full, free and informed consent if he has the capacity to do so.
(3) Every medical practitioner has a responsibility to- (a) fully disclose to the patient or his attendant the extent of any r involved and be satisfied that the patient understands such risk; (b) provide information about possible niternat: ve intefventions, may be available and appropriate; (c) inform the patient as to whether the proposed treatment or proud is regarded as an experimmtal onc or not; (d) ensure that consent has not beer given under duress.
(4) If the patient is unconscious or of unsound mind, or is minor chiLL, otherwise unable to give valid consent, the attending medical practitioner has responsibility to obtain the consent of an appropriate relative or guardian but urg treatment should not be withheld in such cases if there is an immediate threat M. pat ient,e life or health.
()) Every patient has a right to enquire from the medical practitioner on t experience and ability to treat and the medical practitioner shall be totem attending to such queries and shall attempt to answer all such questions as simply ``f -1- —Jr 394 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] 29 NOVIDABBIL honestly as possible with patience and compassion.

Confidentiality.

10.


(1) Unless otherwise required by law or by the need to protect the welfare of the Spe veil] trot individual or the public interest, a medical practitioner shall not divulge confidential information in respect of a patient.
416 (2) A medical practitioner may divulge confidential information derived from a patient or from a colleague regarding a patient only with the permission of that patient and in the event of the patient's incapacity, the information may be divulged only with the consent of the patient's spouse, parent or guardian, responsible close relative or the holder of a duly executed power of attorney.
(3) When confidential information is required to be disclosed without the patient's consent for reasons of public health, the following principles shall be observed- (a) the disclosure of information should be strictly necessary and non- discriminatory; (b) the patient or his attending relative should be told that the disclosure of information is intended; (c) care should be taken to avoid any damaging consequences to the patient; (d) care should also be taken to avoid interference with the human rights and dignity of the individuals concerned; (e) disclosure of information should be done in a manner to avoid discrimination and stigmatization.
(4) Every medical practitioner shall take particular care to respect the confidence and rights of adolescents notwithstanding the tradition, which regards such information as the property of their parents or guardian.

(5) Every medical practitioner has an obligation to keep information about a patient confidential even after the death of the patient and the extent to which confidential' information may be disclosed after a patient's death will vary in each case depen upon the circumstances.
(6) The circumstances referred to in paragraph (5) may include the nature of THE OFFICIAL GAZFTTE [LEGAL SUPPLEMENT] — II 29Th NOVEMBER, 2008 345., • information, whether the information is already in public knowledge and how long back the patient died.

Note.

- Particular difficulties may arise when there is a conflict of interest between parties affected by the patient's death.
For example, if an insurance company seeks inlOrmation about a deceased patient in order to decide whether to make a payment under a life assurance policy or not.

A medical practitioner should not release information without the consent of the patient's executor, or a close relative, who bas been fully informed of the consequences of the disclosure of the information.

1 L. (I) Every medical practitioner charged with the medical care of prisoners, detainees and other institutionalized patients (e.g.
the mentally retarded) and other vulnerable groups has a duty to provide them with protection of their physical and mental health and treatment of disease of the same quality and standards as ate offered to those who are not in prison, detained or otherwise institutionalized.

(2) It is a contravention of medical ethics for a medical practitioner- Special vulnerable g► oups.
(a) to be involved in any professional relationship with prisoners, detainees or other institutionalized patients, the purpose of which is not solely to evaluate, protect or improve their physical or mental health; (b) to provide experimental treatment in research protocols without the knowledge or consent of the patients and the patients shall be free to withhold their consent to such experimental treatment or procedures without fear of any threat of withholding treatment; (c) to participate in arty procedure to restrain a prisoner, detainee or other institutionalized person, unless such a procedure is deemed necessary by purely medical criteria for the protection of that person's physical or mental health or safety or that of his fellows or guardian and presents no hazard to his physical or mental health; (d) to apply his knowledge and skills to assist in the interrogation of prisoners or detainees in a manner that may adversely affect the physical or mental health of such prisoners or certify or participate in the certification of their fitness for any form of treatment, punishment or interrogation which has 396 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] B 291" NOVEMBER, 2 the potential for such adverse effects; (e) to engage actively or passively in acts which constitute participation in, complicity with, incitement of or any attempt to commit, torture or any other cruel, inhuman or degrading treatment or pumstunem.
Reproductive teclmolthnes and practices.

12.

(1) A medical practitioner may regard artificial insemination, in vitro fertilization and organ donation as acceptable methods of treating infertility but these procedures should be carried out with due regard for the social and medical consequences, in particular, the risk of transmission of genetic defects, deformity and the general well- being of the resulting child.
(2) A medical practitioner participating in the procedures referred to in paragraph (1) shall acquaint himself with the international principles or guidelines and with any regulations that is in force in Guyana on such technologies.

(3) Every medical practitioner shall acquaint himself with the Medical Termination of Pregnancy Act of 1995 and should respect the choice, beliefs and customs of his Act No.7 of 1995. patients' when discussing medical termination of pregnancy.
(4) A medical practitioner has a right to refuse to terminate pregnancy or participate: in any such procedure when it is not in keeping with his personal or religious beliefs or custom of the community.

Sensitivity of language.

13.


(1) Every medical practitioner shall demonstrate sensitivity to his patients without having any prejudice and make every attempt to be sensitive, compassionate and temperate in his use of language and action so as to neither offend nor inflame the situation creating undue anxiety to the patients about their illness or disease.
(2) Every medical practitioner shall use "politically correct" terminology in sensitive situations, for example, "termination of 'pregnancy" as opposed to "abortion".

Medical practitioners and biomedical research.

14.
(1) Research involving human subjects shall be- (a) based on generally accepted scientific principles and where relev it shall be conducted with adequately performed laboratory and animal experiments; THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29" NOVEMBER, 2008 397 Ti (b) conducted by scientifically qualified persons under the supervision of a clinically competent registered medical practitioner, who shall remain responsible for the patient or subject; (c) preceded by a proper assessment of the probable risk to the subject in • comparison to the foreseeable benefits to the subject or to others.
ansph (2) Every medical practitioner involved in biomedical research shall consider himself to be the protector of the individual patient's life and health at all times and shall also be prepared to discontinue the research or withdraw patients from the investigation, if it is his reasoned view that any continued involvement may be harmful to the individual or the group.
(3) The design and performance of experimental procedures involving human subjects shall be cledrly formulated in a research protocol which shall be approved by an appropriate Ethics Committee of the Ministry of Health, which is independent of the investigator and sponsor of the research.
(4) Before initiating any clinical research involving human beings, the medical practitioner shall have a duty to ensure that the research protocol has been submitted for review by an appropriate Ethics Committee of the Ministry of Health and in case of any doubt the Chief Medical Officer shall be consulted.
(5) A medical practitioner shall- (a) not engage in human research unless he is satisfied that the hazards involved are predictable; (b) be prepared to discontinue a research if the risks appear to outweigh the potential benefit; (c) ensure that- (i) the interests of the subject prevail over those of science or the society; (ii) the right of the subject to safeguard his integrity, including the withdrawal of consent is respected; Medic; certific THE OFFICIAL GAZE E [LEGAL SUPPLEMENT] B 29" NOVEMBER, 2 (iii) all precautions are taken to safeguard the individuals' physical and mental well being as well as his privacy and personality.
(d) be free to use new diagnostic or therapeutic modalities when in his judgment it offers hope of saving life, alleviating suffering or restoring health and the potential risks, benefits and discomforts of such modalities are considered against those of the best available standard techniques.

(6) A medical practitioner may combine medical research with his professional care of the patient as long as it is justified by the potential for diagnostic or therapeutic value to that patient.
(7) Each potential subject of human research as well as the legal guardian in situations where the subject may not be legally competent to give his own consent must be adequately informed of the aims, objectives methods, potential risks and benefits of the study and of any discomfort or side effects it may entail.
(8) The person subjected to research shall also be informed that he is at liberty to abstain from participation or withdraw from the study at any time and the consent should always be obtained in advance in writing.

(9) Where a minor child is intellectually capable of understanding the risks and benefits of the research, the consent of the child must be obtained besides that of the legal guardian.
(10) Every medical practitioner shall be- (a) cautious when obtaining consent from the patients who may be held to have consented under duress (e.g.

prisoners) or who may be in a dependent relationship to the researcher; (b) careful to preserve the integrity of the results in publication of research findings.
(1 1) The refusal of a patient to participate in a study shall not- (a) prejudice the future treatment of the patient; or (h) interfere in any way with the ongoing relationship between the medical practitioner and his patient.
THE OFFICIAL GAZETTE [LEGAL SUPPLEM 1 ENT, - B 29" NOVEMBER, 2008 399 (12) The research protocol shall contain a statement of the ethical considerations involved and indicate compliance with the principles enunciated in these Regulations and the United Nations "Declaration of Helsinki".

organ antation.

 15.
(1) Subject to written law, organs may be removed from the bodies of deceased persons for the purpose of transplantation but such removal should occur only if- (a) all legal requirements have been met, as per tissue transplantation or cadaver harvesting relevant to hospital policy and the law, if any, on the subject; (b) written liying-will donation of the deceased; (c) written consent has been obtained from the spouse or in the absence of the spouse, parents or other close relative of the deceased, in that order of precedence; and (d) there is no reason to believe that the deceased person objected to such removal.
(2) A medical practitioner certifying the death of a potential donor of any organ shall not be directly involved in the removal of the organ, subsequent transplantation procedures or the care of potential recipients of such organs.

.

(3) An organ may be transplanted from the body of an adult living-donor if that donor gives free consent and is competent to give such consent.
(4) A medical practitioner involved in the transplantation of any human organ shall ensure that the potential donor is free of any undue influence or coercion Laid capable of understanding the risks, benefits and consequences of consent.
(5) A medical practitioner shall not engage in transplantation of any human organ where he has reason to believe that the organ concerned has been the subject of commercial transaction or has been obtained through illegal means such as after offering payment*reward or other compensation.

cal rates.

 16.
cal rates.

 16.

(1) Medical certificates given to patients for presentation to employers, school authorities, examination boards and the like shall specify the date and time of 400 THE OFFICIAL GAZE11E, [LEGAL SUPPLEMENT] 29" NOVEMBER, 200 examination, fitness or unfitness of the individual concerned on medical grounds and if required by the individual, mention the nature of the medical condition.
(2) In all cases of issuance of medical certificates, the medical practitioner shall disclose his full identity and maintain confidentiality about the patient to the extent possible.

Medical reports.

17.

(1) Medical reports contain data and statements made about a patient's medical r ferrLi condition with the patients consent, and are usually meant for presentation to a third party, e.g., employer, pension authority, school, insurance company, legal representative, etc.
(2) A medical practitioner may charge fee for issuance of a medical report and different rates of fee may be charged for different kinds of medical certificates, depending on the examination and clinical or laboratory examination required and rates of such fee should be displayed or otherwise made available to the patients in advance but in the case of a medical practitioner from the Public Health Sector such charges are subject to the policies of the Ministry of Health.
PART IV WORKING WITH OTHERS-SHARING RESPONISBILITIES WITHIN THE MEDICAL PROFESSION AND OTHER HEALTH CARE PROFESSIONALS Note I.

- The Medical Council has recognized the fact that health care is increasingly - provided by multi-disciplinary teams and appreciated the increasing contribution made to health care by other health care professionals.

Note 2.
Note 2.

- The Medical Council has further recognized the fact that leading or working in a team would not change the medical practitioner's personal accountability for his professional conduct and the care he should provide.

**ins Note 3.
**ins Note 3.

- The Medical Council has also recognized that in many areas of professional practice a medical practitioner cannot at all times attend himself to all his patient's and therefore it is both necessary and desirable that arrangements should be made whereby the professional responsibilities of a medical practitioner may be undertaken during his absence from duty by a suitably qualified professional colleague.

The '1111,.. OFFICIAL OAZETTE LEom.


St IPPLEMI:NT 1-1 '9'" NOVEMBLIR, All standards of conduct for the inter-proh:ssional rdationship› that are thi.r, de\ etopm., amone, medical practitioners and between int.‘di,:u1 praeution,!rs ,ind ht...1101 professionals ate dealt ,,with in this Part.

Delegation and IS.

fl ) When a medical pracfitioner deloptes care or if 1:":1!Irt'nt in ,U11- b.)

referral.
referral.

 colleague health prutessional, the medical praeationer shall ensure that the pi.1 `tin to whom he delegates i competent to carry out the proccdttie or provide the thempv involved and take care to always pass on sufficient intOtanat ton ah!..111 thc path sill the treatment needed and the mohcai practitioner who haa e•.

it at treatment skill continue to be responsible :'or the overall inana,:ement or the p;itieni (2) A medical practitioner may refer a patient to anotlwr medic;,!
praehitoner am d this is not the case, the medical practitioner shall sausty Ininsell that :till health tare professional to whom he refers a pationt Is accornitable to the relevant yahoo, \ remilatory body, and that a registered medical practitioner, usually a practitioner, attains overall responsibility of the health care of the patient (3) For the purposes of this regulation and regulation (a) "delegation.'
includes asking another medical raett!touer„i !oast: or other health care worker to provide treatment oi care on behalf of the attending or treating merited" practitioner having the o‘ecall responsibility; (b) "referral" includes transferring some or all of ',hc icsponsibil dies of ,he patient's care, usually temporarily and for a particular purpose, suoi additional investic,ation, cart: or tratmeni, which fills ()inside the competence.

of or not available to the attending inr.dica rsrunit tone.
.Working, i n a 19.

When working as a member of a medical team, a medic,i!

paciltione!

iyiedical team.

(a) respect the skills and contributions of his colleagues; (b) maintain professional relationship with patients: (c) communicate effectively with colleagues within and outside the team, (d) make sure that his patients and colleagues understand his speci!
!c professional status and specialty, his role and responsibilities in the team -4( -a< -4- 402 THE OFFICIAL GAZF im [LEGAL SUPPLEMENT] 29'" NOVEMBER," 1 HI and as to who is responsible for each aspect of the patients' care; (e) participate in regular reviews and audit of the standards and performance of the team and take steps to remedy any deficiencies; (0 be willing to deal openly and supportively with problems in the performance, conduct or health of members of the team.
Responsibilities 20.

If a medical practitioner leads a medical team, he has the responsibility to ensure tiursinw.

in leading a that- medical team.
(a) the members of the medical team meet the standards of conduct an care set in these Regulations; (b) any problem that might prevent his colleagues from other professions following guidance from their own regulatory bodies are brought to his attention and addressed; (c) all members of the team understand their personal and collective responsibility for the care and safety of patients, and for openly and honestly recording and discussing problems; (d) each patient's care is properly co-ordinated and managed and that the patients know whom they have to contact if they have any question or concerns; (e) arrangements are in place to provide cover at all times; (f) regular reviews and audit of the standards and performance of the team are undertaken and all deficiencies are addressed and remedial measures taken; (g) systems are in place for dealing supportively with problems in tht performance, conduct or health of members of the team.
escriptioi medica up pract.

Sharing Of medical 21.

(1) A medical practitioner shall always ensure that the patients are informed about how medical information is to be shared within a medical team and between information those who will be providing their care.

with colleagues.
with colleagues.

(2) If a patient objects to any disclosure of his medical information an ma, '3 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT) — B 291 " NOVEMBER, 2008 403 members of a medical team attending the patient, the medical practitioner explain to him the benefits to his care in the MR:Inflation being shared, but shall not disclose any intbrmation if the patient after understanding the clarification continue to maintain the objection.

(uses and Ming.

22.


(11 The services provided by the nursing profession in the care and prevention of illness arc essential and complementary to the work of the medical practitioners.
(2) It is the duty of a medical practitioner to support and, ‘vhertiever necessary, guide the work of nurses to the end that both professions, while remaining true to their respective codes of ethics and obligations of professional standards, will cooperate as a harmonious team in providing an optimal service to all patients under their care.

•riptions medication.

 23.
For a medical practitioner, prescribing medicines or providing treatment is not an isolated action, but a part of a global phannaco-therapy plan, inter alit', requiring- (a) adequate knowledge of the health and medical needs of the patient, based on thorough assessment of the patient's then existing condition and symptoms, as well as the patient's history and record of the patient; (b) giving clear and understandable instructions to the patient, when possible in plain language, including informing him on the possible side effects and on'their own responsibility, both in following the prescribed medication and treatment according to instructions and in reporting any undesirable secondary effects; (c) close collaboration with other health care professionals, including through documentation of the prescribed treatment plan in the patient's record and the transfer of clear instructions in case of delegation or referral.
practice.

 24.

(1) A medical practitioner shall not practice medicine or surgery in partnership with any person who is not duly registered to practice medicine or surgery.
(2) When a medical practitioner is practicing in' association with other medical practitioners in a gictup, he shall insist that the standards and code of ethics THE OFFICIAL GAM I 1h [LEGAL SUPPLEMENT] B 29Th NOVEMBER, THE enunciated in these Regulations are adhered to by all the members of the group.

(3) A medical practitioner may enter into a contract with an organisation only it organisation allows the maintenance of professional independence and integrity.
(6 przt Con (4) When documenting on behalf of a third party, t ie medical practitioner s ensure that the patient understands the medical practitioner's legal responsibility the third party before proceeding with examination or treatment or both.
Note.- Whatever is right and becoming for a medical practitioner is eq applicable while working in association with other medical practitioners in clini other groups; and whatever is obligatory upon the individual medical practitioner equally obligatory upon the group.

Working with colleagues in consultation.
25 (1) It is the duty of every medical practitioner attending to a patient to accept opportunity of a second medical opinion, if available, in any illness that is seri obscure or difficult or when consultation is desired by the patient or by any pe authorized to document on behalf of the patient.

(2) The attending medical practitioner may request the opinion of an approp colleague acceptable to the patient when diagnosis or treatment requires spec' input or if the patient requests for it.
(3) While the medical practitioner should name the consultant he prefers, he she!

not refuse to meet the medical practitioner of the patient's choice, though he urge, by voicing his opinion, if he thinks so, that such consultant does not have qualifications or the experience that the existing situation demands.

(4) The attending medical practitioner shall make available all relevant inform and should indicate clearly whether the consultant is to assume the continuing the patient during the illness.
(5) Consultants in turn are expected to report in detail all pertinent findin recommendations to the attending medical practitioner, and may outline an o or options to the patient and shall continue the care of the patient only at the r of the attending medical practitioner and with the consent of the patient.

per.

one cim pro; 0!
his con dia; tut; and abs op; and THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT — B 29" NOVEMBER, 2008 (6) In the following circumstances it is desirable that the attending medical practitioner, while dealing with an emergency, should, whenever possible, secure consultation with a colleague- (a) when the propriety of performing an operation or of adopting a course of treatment which may entail considerable risk to the life, abilities or capacities of the patient has to be considered and particularly when the condition which it seeks to relieve by the treatment in itself is not dangerous to life; (b) when operative measures involving the death of a foetus or of an unborn child are contemplated particularly if labour has not begun; (c) when there are grounds for suspecting that the patient has been subjected to an illegal operation, or is the victim of criminal poisoning.
(7) Since consultation is designed wholly for the benefit and good of the sick person, there should not enter any trace of insincerity, rivalry or envy between the attending medical practitioner and the consultant and before seeing the patient, the consultant should be given a brief history of the case by the attending medical practitioner.
(8) After consultation, the joint decision should be communicated to the patient and his family by the attending medical practitioner, supplemented, if necessary, by the consultant.
(9) If agreement between the consultant and the attending medical practitioner as to diagnosis and treatment is not possible, and if the consultant is convinced that the future well-being of the patient is the source of concern, he should inform the patient and his family in the preence of the attending medical practitioner of the points of disagreement, with substantiation.
(10) The consultant must be specially careful and to document, if and when, the circumstances which made it necessary for him to perform his examination in the absence of the attending medical practitioner and he should communicate his opinion and suggestions for treatment directly to the attending medical practitioner .and not to the patient.
406 THE OFFICIAL GAZFTTE [LEGAL SUPPLEMENT] B 29Th NOVEMBER, (11) Despite making consultation with Specialists, the responsibility for the patient's care rests with the medical practitioner in attendance.

the co;; (12) Every medical practitioner shall work with his colleagues in a manner that best serve the interests of the patients.
(13) A medical practitioner shall not discriminate against colleagues because of personal views about their lifestyle, culture, beliefs, race, colour, sex, sexual preferences or age, and should not make unnecessary or unsubstantiated comments about them.

Emergency calls.

 26.


When a medical practitioner is called in the absence of the attending medical practitioner, or in emergency he will, on arrival of the attending medical practitioner hand over all care and responsibility and retire from the case.

Care of colleague medical professionals.

27.
27.

(I) A medical practitioner shall, while providing medical services to a colleague or any dependent of his colleague, be guided by the principles previously enunciated in these Regulations for the care of patients in general.

(2) Every medical practitioners shall appreciate that — (a) professional courtesy is a privilege and not a right and is extended only at.
the wish of the attending medical practitioner; (b) many services may actually incur a significant cost to the attending medical practitioner; (c) self-treatment or treatment of his own first degree relatives and dependents' should be limited to minor or emergency services only and such treatments': should normally be done without charging any professional charges or leek PART V RESPONSIBILITY TO THE PUBLIC Working with 28.
(1) In documenting clinical practice, the medical practitioners shall include.the Referral hospital `Code of duct n ical titior.

THE OFFICIAL GAZETTE !LEGAL SuPPLEMENTI — B 29" NOVEMBER, 2008 407 the community.

 promotion of healthy lifestyles and the education of their patients in disease prevention.
Nene.- The medical practitioners, by reason of their training.. expertise and status to the community are in an exceptionally favorable position to draw attention to an increasing number of hazards to the health of the country's population.

(2) Livery medical practitioner shall strive to improve the standards of medical services in the community and accept a share of the responsibility of the medical profession to.
the public in matters relating to the health and safety of the public and implementing legislation affecting the health or well-being of the community.

(3) Every medical practitioner shall respect the laws of Guyana and shall also consider it as his duty to suggest changes in the laws which may be contrary to the best interest of patients, the environment or the community.

(4) A medical practitioner shall not only be content with the practice o.f medicine, but also like any other.
citizen should strive to make a contribution towards the well- being and betterment of the community in general.

29.

(I) When a patient has been sent for admission to any hospital under a consultant's care, it is the duty of the referring medical practitioner to give as much information as possible to the consultant.

(2) It is the duty of the consultant to report his findings to the referring medical practitioner.
(3) The medical practitioners practicing in hospitals shall ensure that findings or suggestions of value concerning any patient at the time under their care in the hospital are sent to the medical practitioner usUallyda_attendance on that patient.

30.

The Examining Medical practitioners shall also follow the.
additional code of conduct given belowr (a) an examining medical practitioner must be satisfied that the individual to be examined consents personally or through ,his legal representative or in the, case of a minor child, his guardian to submit to medical examination and 408 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] B 29'" NOVEMBER, Ma understands the reason for it except in special cases where the written law makes such examination mandatory; (b) when the individual to be examined is under medical care, the examining, medical practitioner shall cause the attending medical practitioner to be given such notice of the time, place and purpose of his examination as will enable the attending medical practitioner to be present should he or the patient so desire; (c) exception may be taken to the procedure laid down in paragraphs (a) and (b) only where circumstances justify an immediate examination and where the examining medical practitioner undertakes such immediate examination he shall promptly inform the attending medical practitioner of the findings of his visit and the reason for his conclusions; (d) if the attending medical practitioner fails to attend at the time arranged for immediate examination, the examining practitioner shall be at liberty to proceed with the examination; (e) an examining medical practitioner shall avoid any word or indication which might disturb the confidence of the patient in the attending medical practitioner, and must not, without the consent of the latter proceed to do anything which involves interference with the treatment of the patient; (f) the examining medical practitioner shall confine himself strictly to such investigation and examination as are necessary for the purpose indicated by the third party and agreed to by the patient; (g) any proposal or suggestion which an examining medical practitioner may wish to put forward regarding treatment shall be first discussed with the attending medical practitioner; (h) when in the course of the examination there are material clinical findings of which the attending medical practitioner is believed to be unaware, the examining medical practitioner shall, with the consent of the patient, inform the attending medical practitioner of the relevant details; (i) an examining medical practitioner shall not utilize his position to influence dustr ial di a) cers.
THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29'1 ' NOVEMBER, 2008 the person examined to choose him as his medical attendant; U) when the terms of reference of his employing body interfere with the Ire,c application of the code of conduct laid down in these Regulations.

an • examining medical officer shall make honest endeavor to obtain, the necessary amendment of his contract himself or through the Medical.

Association.

Note.
Association.

Note.

- often happens that a medical practitioner's patient has to be examined for some particular purpose by a medical practitioner representing an interested third party.

These examinations may occur in connection with life insurance, grant el invalid pension, superannuation, entry into certain employment, litigation, niedira legal cases, and requests from the police or the like reasons.
The medical practitioner presenting the interested third party is the Examining Medical Officer in such case,:.

ay 01 ati S Industrial medical officers.

 zi.

(1) A medical practitioner appointed to work in any industrial establishment (hereafter referred to as the industrial medical officer) needs to exercise constant care in his relationship with the management.
(2) While an industrial medical officer holds his appointMent from management, his duties primarily concern the health and welfare of the workers individually arid collectively and in the course of his duties he will constantly be dealing with patents tta ui of other medical practitioners.
(3) As his contribution towards achieving and maintaining hiss vital relationship with his colleagues, the industrial medical office' shall be guided by the following:- (a) save in emergency, an industrial medical officer is required to undertake treatment which is normally the responsibility of the woiker's generll medical practitioner only in cooperation with him and this procedure applies both to treatment .personally given and to the use of any special ?s(.. facilities and staff, which may exist in his department; (b) when the industrial medical officer makes findings which he believes should in the worker's interests be made known to the general medical 4io THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] B 29TH NOVEMBER.
2008 practitioner or similarly, when details of treatment given should be passed on he should communicate with the general medical practitioner; (c) if, for any reason the industrial medical officer believes that the worker should consult his general medical practitioner, he should advice him to do so; (d) save in emergency, the industrial medical officer should refer a worker direct to hospital only in consultation or by prior understanding with the general medical practitioner; (e) it is normally the function of an industrial medical officer to verify justification for absence of a worker from work on grounds of sickness; (1) If the industrial medical officer proposes to examine a worker who is absent for health reasons he should inform the general medical practitioner concerned of the time and place of his intended examination and a failure to receive a reply from the worker's medical general practitioner within a reasonable time can be assumed to indicate no objection by the general medical practitioner to the intended examination of the industrial medical officer; (g)the industrial medical officer should not, without the consent of the parties concerned express an opinion as to liability in accidents at work or .
industrial or occupational diseases except when so required by a competent court or tribunal; (h)the industrial medical officer shall not influence any worker in his choice of a general medical practitioner; (i) the personal medical records of workers maintained by the industrial medical officer for his professional use are confidential documents and access to them must not be allowed by any other person save with the medical practitioner's consent and that of the worker concerned or by order of a competent court, tribunal or authority.
(j) the industrial medical officer is solely responsible for the custody of his records, which, on termination of his appointment he should hand over THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 291" NOVEMBER, 2008 only to his successor in office and if there is no successor he should retain the responsibility for the custody of these records; (k)the industrial medical officer shall not in any 4ircumstance disclose knowledge of industrial process acquired in the course of his duties except with the consent of the management or by order of a competent court or tribunal.
Note.

-The industrial medical officer and the general medical practitioner have a common concern that is the health and welfare of the individual workers coming under their care.

Less often this concern may be shared with the hospital's medical practitioner, the medical officer of health or some other professional colleague.
As in all cases where two or more medical practitioners are so concerned together the greatest: possible degree of consultation and co-operation between them is essential at all times, subject 'only to the consent of the individual concerned.

PART VI PROFESSIONAL CONDUCT AND DISCIPLINE.

A.

PROFESSIONAL CONDUCT Note.


- It is the duty of the Medical Council to ensure that proper standards of professional conduct in the medical profession and proper standards of general fitness to practice medicine or surgery are adhered to and followed by the medical practitioners registered under the Act.

Professional misconduct.

32.
It shall be deemed to be a professional misconduct for a person registered under the Medical Council, if= (a) for the purpose of procuring his registration, he makes a statement which is false in any material particular; (b) in any institiition, being a person engaged within or about that institution in the practice of medicine or surgery and documenting concert with any other person so engaged, refuses without reasonable excuse to render treatment to any patient needing treatment; or (c) lie is otherwise guilty of willful negligence or incompetence in the 412 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29Th NOVEMBER, performance of his functions as a medical practitioner or of serious professional misconduct.
Serious professional misconduct.

 33.
(1) For the purposes of paragraph (c) of regulation 32, "serious professional misconduct" includes the preparation of any document or doing any thing by a person registered under the Act that is contrary to the generally recognized duty and responsibility of such a person to his patient or that is contrary to medical ethics, or the failure to do any thing with respect to a patient in accordance with generally - recognized medical ethics and practice and, without limiting the generality of the foregoing, includes- ) improper conduct or association with a patient; (b) any unethical form of advertising, canvassing or promotion, either directly or indirectly, for the purpose of obtaining patients or promoting his otvn professional advantage; (c) willful or deliberate betrayal of a professional confidence; (d) abandonment of a patient in danger without sufficient cause and without allowing the patient sufficient opportunity to obtain the services of another medical practitioner; (e) knowingly giving a certificate with respect to birth, death, state of health, vaccination, disinfection orwith respect to any other matter relating to life; health, disease or accidents which the medical practitioner knows or ought.
to know is untrue, misleading or otherwise improper; (1) the sharing or division with any person who is not a partner or assistant of any fees or profits resulting from consultations or other medical or surgical procedures without the patient's knowledge or consent; (g) the abuse of intoxicating liquor or drugs; (h) the impersonation of another medical practitioner; (i) association with unqualified or unregistered persons whereby such pers are enabled to practice medicine or surgery, except where such persons s of sion ndut h ma: plii inf THE OFF ICI A L. G AZETTE ILcu AL.
Sl IPPLEME.NT 29 "1 NOVEMBER.
2008 students from accredited educational or training programmes; (j) the holding out directly or indirectly Div a medical practitioner to the public that he is a specialist or is specially qualified in any particular b inch of Ati medicine unless he has taken a special course in that branch and such special qualification has been registered in accordance with the provisions Of the Act or any olher written law on medical practitioners' qualifications; (k) any willful or negligent misrepresentation as to the curative efficiency possessed bn,, a drug or any substance whether inherently oi by administration or application thereof; (V) knowingly practicing medicine or treating a patient other than in a case of emergency while suffering from a mental or physical condition or while under the influence of alcohol or drugs to such an extent as to constitute a dapger to the public or a patient; (w) the doing of ur failure to do any document or thing in connection with professional practice which, in the opinion of the Medical Council, is unprofessional or discreditable; and (n) conviction on an indictable offence.
(2) Any disclosure of confidential information pertaining to a patient by a medical practitioner shall not be deemed to be willful or deliberate where such disclosure is required by any law for the treatment of that patient or for subserving the common good or protection of others against any epidemic, infectious or contagious disease ur serious injury or health hazard.

Forms of 34.
Forms of 34.

(1) In discharging their respective duties, the Medical Council, the seating on a professional misconduct which may lead to disc4niaxy proceedings.

hearing procedure and the Disciplinary Committee shall proceed as an unbiased body and follow the principles of natural iustice.

Note,- (i) The listing of the types of professional.
Misconduct does not see be a complete code of professional ethics and does not specify all c. offences or forms of professional misconduct, which may lead to di documentation.

With the changing circumstances, the Medical Council' 414 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29' NOVEMBER, It ilas tried note of new forms of professional misconduct.
(ii) Any abuse by a medical practitioner of any privileges and opportunities' afforded to him or any grave dereliction of professional duty or serious breach of medical ethics may give rise to a charge of serious professional misconduct.
(2) Only after considering the evidence tendered before the Disciplinan Committee in each case the Medical Council shall determine ti-u; gravity of the alleged misconduct of the medical practitioner and decide whether his behavio amounts to serious professional misconduct or not.

(3) A medical practitioner who seeks detailed advice on professional conduct in particular circumstances should consult the Medical Council in writing.
(4) The areas of professional conduct or personal behavior which need to be considered are broadly as under- (a) neglect or disregard by a medical practitioner of his professiong responsibilities to patients for their care and treatment; (b) abuse of professional privileges or skills by a medical practitioner; (c) personal behavior or conduct derogatory to the reputation of the medical profession or a conduct of unbecoming of a medical practitioner; (d) self-promotion, canvassing and related professional offences.
Note.

- These broad classifications have been adopted for convenience, but such classifications can only be approximate and not exhaustive.

In most cases the nature of the offence or misconduct will be readily apparent.

In some cases, such as those involving personal relationships between medical practitioners and patients or questions of advertising, medical practitioners may experience difficulty in recognizing the proper principles to apply to various circumstances.
Neglect of personal responsibilities 35.

(1) In accordance with its primary duty to protect patients and the public at large, the Medical Council may institute disciplinary proceedings when a medical practitioner prima facie appears to have seriously disregarded without.

adequate THE OFFICIAL GAZETTE( LEGAL SUPPLEMENT) — 13 29'11 NOVEMBER, 2008 415 to patients.
reasons or neglected his professional duties, for example, by failing to visit or to provide or arrange treatment for a patient when necessary.

(2) A registered medical practitioner is expected to afford and maintain a good standard of medical care to the persons seeking his medical care and attention.

kill tia lik 1 )1 36.

(1) The standards of medical care required to be provided by a medical medical care.
practitioner include- (a) conscientious assessment of the history of symptoms and signs of a patient's condition; (b) sufficiently thorough professional attention, examination and, where necessary, diagnostic investigation; (c) competent and considerate professional management; (d) appropriate and prompt documentation upon evidence suggesting the existence of a condition requiring urgent medical intervention; (e) readiness, where the circumstances so warrant.
to consult professional colleagues; and (t) the patient's right to have access to information from his medical records.

(2) The patient's access to medical information may be refused if in the considered opinion of the medical practitioner that it will cause comparatively more harm to the patient or compromise to a third party.
(3) A comparable standard of practice is to be, expected from every medical practitioner, whose contribution to a patient's care is indirect, for example, those in pathological laboratory and radiological specialties.
(4) The Medical Council shall be concerned with errors in diagnosis or treatment, and with the kinct„„of matters which give rise to action in civil courts for nei;ligence and only when the medical practitioner's conduct in the case has involved such a disregard of his professional responsibility to patients or such a neglect of his professional duties as to raise a question of serious professional misconduct, the 416 THE OFFICIAL GAZE I I E. [LEGAL SUPPLEMENT] — B 29TH NOVEMBER, 2 Medical Council may intervene.
(5) A question of serious professional misconduct may also arise from a complaint MeLl or information about the conduct of a medical practitioner, which suggests that he has idangered the welfare of patients by persisting in unsupervised practice of a branch of medicine in which he dues not have the appropriate knowled ge and skill and has not acquired adequate experience, which is necessary, (6) Apart from the personal responsibility of a medical practitioner to his patients, the medical practitioner who undertake to manage, direct or perform clinical work for organizations offering private medical services should satisfy himself that those organizations provide adequate clinical and therapeutic facilities for the services offered.
(7) A medical practitioner who improperly delegates to a person who is not a registered medical practitioner any function requiring the knowledge and skill of a medical practitioner shall be liable to disciplinary proceedings.

(8) The Medical Council may institute disciplinary proceedings against a medical practitioner who employs any assistant who is not qualified to.conduct his practice.
(9) The Medical Council may proceed against a medical practitioner who, by signing certificates or prescriptions or in any other way enables persons who are not registered as medical practitioners, to treat patients as though they were so registered.

(10) The prescription of controlled medicines is reserved to members of the medical pr, and of certain other professions, and the prescribing of such medicines is subject to statutory restrictions.
; I I) The Medical Council may regard the prescription or supply of drugs of dependence otherwise than in the course of bona fide treatment as a serious professional misconduct.

(12) The Medical Council may also take disciplinary action against medical practitioners who are convicted of offences against the laws which control drugs where such offences appear to have been committed in order to gratify the medical practitioner's own addiction or the addiction of other persons.

erin pregn.
erin pregn.

Act 995, 'le s ase o urgic t busy niCE: 40 THE OFFICIAL GAZET E [LEGAL SUPPLEMENT] — B 29TH NOVEMBER, 200E tirti8 Medical certificates.

 37.

(1) Any Medical practitioner who, in, his professional capacity, signs- ak certificate, report or similar document containing statements which are known to him as untrue, misleading or otherwise improper renders him liable to disciplinary: proceedings.
Nole.- A medical practitioner's signature is required on certificates for a variety purposes on the presumption that the truth of any statement.

which the medical practit ioner may certify, can be accepted without question.

- (2) Every medical practitioner shall exercise due care and diligence in issuing certificate and similar documents and shall not certify statements which he has not verified or has reason to disbelieve.

fern) i nal ion of 3S.


In the matter of medical termination of pregnancies, the medical practitioners oo pregnancy, required to be guided by the provisions of the Medical Termination of Pregnancy Act tinai transL, 1995.

Act No.7 of 1995.

Life savings in 39.

(1) Where any person does an act in good faith, for the purposes of medical or case of medical surgical treatment, an intention to cause death shall not be presumed from that surgical treatment.

Abuse of privileges confertud by custom.


treatment or the surgical procedure used.

(2) Any act which is done, in good faith and without negligence, for the purpuses of medical or surgical treatment of a pregnant woman is justifiable, although it causes or is intended to cause abortion or miscarriage, or premature delivery, or the death of.

the child.

40.

(11 The patients may grant medical practitioners privileged access to their homes,: I t and confidences.
(2) Good medicAl practice may depend upo,n the maintenance of trust betweet medical practitioners and their patients and the families of the patients, and t1 understanding by both that proper professional relationships wilt be strictly observed.
(3) In the circumstances mentioned in paragraph (2), the medicalpractitioners shall 418 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29Th NOVEMBER,2 exercise great care and discretion in order not to damage this crucial relationship and act by a medical practitioner, which breaches this trust, may be treated as an act of serious professional misconduct.
(4) The following areas may be identified in which1he trust between the medical practitioners and their patients may be breached- (a) a medical practitioner may improperly disclose information, which he had obtained in confidence from or about a patient; (b) a medical practitioner may improperly exert influence, upon a patient to lend him money or to alter the patient's will in his favour; and (c) a medical practitioner may enter into an emotional or sexual relationship with a patient (or with a member of a patient's family) which disrupts that patient's family life or otherwise damages, or causes distress to, the.
patient or his family.

ci Conduct 41.

The following areas of personal behaviour may be identified as act of derogatory to unbecoming of a medical practitioner which may occasion him liable to disciplinary;' the reputation of proceedings - the profession.

(a) personal misuse or abuse of alcohol or other drugs; (b) dishonest behavior; (c) indecent or violent behaviour.
Note.- The public reputation of the medical profession requires that every member the profession should observe proper standards of personal behaviour, not only in his professional activities, but also at all times.

This is the reason why a medi practitioner's conviction of a criminal offence may lead him liable to discipli proceedings even if the offence is not directly connected with the medi practitioner's profession.

Personal misuse 42.
Personal misuse 42.

A medical practitioner – or abuse of alcohol or other (a) who treats patients or performs other professional duties while under influence of alcohol or narcotic drugs; or THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29Th NOVEMBER 2008 419 (b) who is unable to perform his professional duties because he is under the influence of alcohol or narcotic drugs, is liable to disciplinary proceedings.
Noie.- In the opinion of the Medical Council, convictions for drunkenness or other offences arising from misuse of alcohol or narcotic drugs (such as driving a motor car when under the influence of alcohol) indicate habits, which are discreditable to the profession and may be a source of danger to the patients of the medical practitioner.

After the first conviction for drunkenness, a medical practitioner may be given a warning letter.
Further convictions may lead to an inquiry by the Medical Council leading to further disciplinary action.

mane i a I sactions.

 43.

(1) A medical practitioner is liable to disciplinary proceedings if he is convicted of criminal deception (obtaining money or goods by false pretences), forgery, fraud, theft or any other offence involving dishonesty, or any conviction for commission of an indictable offence.
(2) The Medical Council may take a serious view of preparation of documents dishonestly committed in the course of a medical pyactitioner's professional practice, or against his patients or colleagues and such action, including- knowingly and improperly seeking to obtain from an insurance company, any payment to which the medical practitioner is not entitled, if reported to the Medical Council, may result in disciplinary proceedings.
(3) The Medical Council may take a serious view of the prescribing or dispensing of drugs or appliances by a medical practitioner for 'improper motives.

(4) A medical practitioner's motives may be regarded as improper if he has prescribed a product manufactured or marketed by an organization from which he has accepted an improper inducement or illegal gratification.

(5) The .Medical Council.

shall.
regard wits-concern arrangements::for ,fee splitting a -c under which one medical practitioner Would receive part of a feepaid,.by a patient to another medical practitioner ,and the, association of a medical Pra4ti,tiCttier with any - commercial :enteiprise engaged in- the manufacture: or • sale:Lot Any; medicine or 420 THE OFFICIAL GAZETTE (LEGAL SUPPLEMENT] B 29Th NOVEMBER, 2006 equipment which is claimed to be of value in the prevention or treatment of disease but is of undisclosed composition or nature.
Indecency and violence.

44, (1) Indecent behavior to, or a violent assault on, a'patient by a medical practitioner shall be regarded as a serious professional misconduct.

(2) Any conviction for assault or indecency shall render a medical practitioner liable to disciplinary proceedings and shall be regarded, with particular gravity, if the offence were committed in the course of the professional duties of the medical practitioner or against his patients or colleagues.
Self-promotion, canvassing and related professional misconduct.

45.

(1) For the purposes of this regulation, the term "advertising" means the provision of information about medical practitioners and their services, in any form, to the public or other members of the profession.

(2) Advertising in health matters shall be considered as an integral part of modem medicine and it helps in the patient-medical practitioner relationship and in the patient's knowledge of diseases and health care.
Commend about profession colleagues (3) In assessing the nature of advertisement, consideration shall be given to- (a) the need for patients to be informed of the rapid advances in the diagnosis and treatment of diseases; (b) the needs for patients to be informed of the diverse spectrum, disease profile and the medical practitioners' portfolio within a given medical specialty; (e) the need for, and the use of, mass media medical health programmes at the local and national levels., for health -promOtion.
Notel.

- The Medical Council may encourage medical practitioners to provide factual infoimatidn—about -their :qualifications; 'experience - -and services' as a general decent, honest and truthful.
The reqUirernent and any advertising 'must be 'Medical Countil may imPose additional -restrictions on the idvektising of the services oPthe' ineditallOraCtitioner4 In Order to ensiare 'that the'Ptiblic -iitiof misled or put to terminal f the natt THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] 29" NOV.N.J3Ep.1 2008 risk in any way.
Note 2 - It is the duty of all medical practitioners to satisfy their that the content, and,-• presentation of any material published about their qualifications, experience.,and-... - services, and the manner in which it is distributed, conforms to the provisions ofthis“,i Part.

This applies irrespectively of whether a medical practitioner personally arranges • for such publication or permits or acquiesces in its publication by others.
Failure to abide by these Regulations and Medical Council's guidance may call for the medical practitioner's professional conduct into question.

(4) A medical practitioner shall not distribute any advertising material so frequently or in such a manner as to put recipients, including prospective .•ptients, under pressure to consult them or take treatment from them.

Comments 46.
Comments 46.

(1) A medic-al practitioner may make honest comment on a colleague provided about professional colleagues.

that it is carefully considered, fair and truthful and can be justified that it is offered in good faith and that it is intended to promote the best interests of patients.

Note.

- Medical practitioner's are frequently called upon to express views.

about a;,.

colleague's professional practice.


This may, for example, happen in the course of as medical audit or peer review procedure, or when a medical practitioner is asked to give a reference about a colleague.

It may also occur in a less direct and explicit way when a patient seeks a second opinion, specialist advice or an alternative form of treatment.
(2) It is the duty of a medical practitioner, where the circumstances so warrant, to inform an appropriate person or body about a colleague whose professional conduct or fitness to practice may be called in question or whose professional performance appears to be in some way deficient or questionable.
(3) A gratuitous and unsustainable comment of a medical practitioner which, whether directly or by implication, sets out to undermine trust in the knowledge or skills of a profeSsional colleague and such a comment is unethical midis prohibited.

Discipl in.

OMMItti Determination 47.

(1) The Medical Council may, after considering the evidence in each individual of the nature of - case, determine, in accordance with.
section 17 of the Act; as to whether an alleged Powers :functions OFFICIAL GAZETTE (Lectiu.

SuPPLEmErrr] — B 29Th NOVEMBER, serious professional misconduct or action by a medical practitioner is a serious professio professional misconduct or malpractice requiring disciplinary action.

misconduct or malpractice.


(2) Paragraph (1) applies equally to the categories of professional misconduct described in regulations 32 to 46 (both inclusive) and t‘i the situations contemplate) in regulations 58 and 59 (both inclusive).

B. DISCIPLINARY PROCESS Complaints 48.

A complaint that a medical practitioner registered under the Medical Council against professional misconduct.
been guilty of professional misconduct or malpractice may be made to the Medi Council in writing by any person and shall have the date, full postal address, e address and phone number(if any) and the signature of the complainant but subject this, there shall in no particular form for the complaint.

Complaint 49.
Complaint 49.

(1) Where a complaint is made to the Medical Council directly, the Medi hearings .and Council may convene a specific hearing, to be known as the complaint hearing, suspension, of examine the complaint.

registration.
registration.

(2) Where a complaint against the alleged misconduct or malpractice of a medi practitioner has been referred to the Medical Council, the Medical Council s make such preliminary investigations into the matter as the Chairperson may deem advisable and shall, as soon as possible, advise the Disciplinary Committee of isciplir ommitt preliminary findings of the Medical Council.
(3) The Secretary to the Medical Council shall notify the alk:led medi practitioner against whom the complaint is made of the nature of the complaint call upon him to state in writing not less than fourteen days before a specified (which day shall allow a reasonable interval for the purpose) any explanation representation he may wish to make in respect of the complaint.
(4) The complaint hearings by the Medical Council having regard to explanation or representation made by the person against whom the complain owers tions iplini THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — 13 291'4 NOVEMBER, 2008 423 made may- (a) determine that the complaint is not prima facie established and that no further inquiry need be held; or (b) refer the matter in whole or in part to the Disciplinary Committee.
(5) If, during the complaint hearings, the Medical Council determines that no inquiry shall be held, the Secretary to the Medical Council shall inform the complainant and the person against whom the complaint is made of the decision in such manner as the Medical Council may direct.
(6) Where the Medical Council is of the opinion that a complaint so made might, if factually established, call for the application of disciplinary measures, the Medical Council shall refer the matter to its Disciplinary Committee to hear and report its findings and recommendations to the Medical Council to determine the case.
(7) If the Medical Council is of the opinion that it is inexpedient or dangerous or not in the public interest that a person under inquiry should continue to practice during the pendency of a disciplinary proceeding, the Medical Council may, by order in writing, suspend the registration of the medical practitioner, pending the outcome of the inquiry.

iplinary mince.

 50.


(1) For the purposes of regulation 49, the Medical Council shall appoint a Disciplinary Committee, consisting of a sitting or retired Justice of the High Court or any other judicial officer nominated by the Chief Justice as the Chairperson of the Committee and two members of the Medical Council.
(2) In dealing with the complaints, the Disciplinary Committee shall, subject to the provisions of these Regulations, decide its own procedure but shall have due regard to the principles of natural justice.

ers and 51.
ers and 51.

(1) For the purpose of its inquiry, the Disciplinary Committee of the Medical 1011S of the Council shall have the same powers as of the Medical Council has to summon plinary witnesses, call for the production of books and documents and examine witnesses 424 TAE pFFIcIAL GA7FTTE [LEGAL SUPPLEMENT] — B 29TH NOVEMBER, Committee.
and parties concerned on oath or any person it deems necessary to establish the facts of the case, patient records and regardless of the character, private or public of the health care facility from which such documentation is required.
(2) The Disciplinary Committee of the Medical +Council shall hear all the complaints referred to it by the Medical Council and in dealing with the complaints the Committee shall ensure that- (a) adequate notice of the proceedings is given to the person complained against; (b) the complaint against the medical practitioner concerned is specified in the form of a charge in such notice; (c) any party to the proceedings may, if he so desires, be heard by the Disciplinary Committee either in person or by a counsel and attorney- • at-law of the choice of the party concerned; (d) the parties are given list of witnesses and list of documents proposed to be relied upon.
(3) Except with the consent of the person complained against, the date for hearing shall not be fixed for a date earlier than fourteen days after the notice has been served on him.

(3).

The notice of hearing shall be served personally or by prepaid registered post at !_the .address shown on the Medical Register or at his last known address, if that address differs from that on the Medical Register.
(4) In any case where there is a complainant, a copy of the notice of hearing shall be :sent to the complainant.

'The - person complained-against shall be entitled to receive free copies of or be allowed access to and inspect any ddcurnentary evidence relied-on for the purpose -Of the hearing and he shall also be given upon request a copy of the evidence (including copies of documents tendered in evidence) after the hearing is completed, *Lion (0).

: The.
: The.

person complained against shall have the right tp.be represented ept,tose): or,:attorney-ot7law.

: of ;his choice ,in.

any: disciplinary .prod edings is 'pi Committee is of the opinion that the evidence is insufficient, it may recommend to the Medical Council to dismiss all or any of the charges without calling upon the person complained against for his defense.
(12) If at the conclusion of the hearing, the Disciplinary Committee is of the opinion that the person complained against is not guilty of professional misconduct or malpractice it shall dismiss the complaint and accordingly report the matter to the Medical Council.
411 (13) If, at the conclusion of the hearing, the Disciplinary Committee finds that the person complained against is found guilty of any misconduct or act of malpractice, the Disciplinary Committee shall make its findings and by way of an inquiry report 'make its recommendations to the Medical Council for imposing on the medical ;-practitioner concerned appropriate penalty in accordance with section 17 of the Act.

Action on the 52.
Action on the 52.

(1) HaVing established that a medical practitioner is guilty of professional report of the :‘,misconduct or malpractice, the Disciplinary Committee shall recommend to the Disciplinary Medical Council such action of a disciplinary nature as it thinks fit, in accordance Ap the Me Cot Rem rani egi star iStri 426 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29Th NOVEMBER, 2008 Committee.

 with section 17 of the Act.


(2) Every recommendation made by the Disciplinary Committee to the Council shall be prefaced by a statement of the Committee's findings on each charge with respect to the facts of the case and shall be signed by /he Chairperson of the Disciplinary Committee.
(3) The Medical Council may, on consideration of the findings and recommendations submitted to it by the Disciplinary Committee, and if it is considered necessary, after giving the medical practitioner a further opportunity of being heard, by order, - (a) censure the medical practitioner; (b) direct the Secretary to the Medical Council to proceed to remove the medical practitioner's name from the Register; (c) suspend the registration of the medical practitioner for a period not exceeding one year; (d) order the payment of penalty of costs or of such sum as the Medical Council may consider a reasonable contribution towards the cost incurred in connection with those proceedings.
(4) If the Medical Council is satisfied that it is necessary for the protection of members of the public or would be in the best interest of that person or the medical profession to do so, it may make an order for the removal of the name of the medical practitioner from the register or for the suspension of his registration.
(5) Every order of the Medical Council under this regulation shall take effect from the date of its issue or a subsequent date as specified in the order or in accordance with this regulation as under- (a) where no appeal is brought against the order, within the period of limitation permissible for filing of the appeal, on the expiration of that (b) where all appeal is brought and is withdrawn o struck out for want prosecution, on the withdrawal or striking out of the appeal; Appe the o Medi Coun Remo name registt rorat tratt THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT!
— B 29" NOVEMBER, 2008 427 (c) where an appeal is brought and is not withdrawn or struck out, if and when the appeal is determined by the upholding of the order, and not otherwise.

Appeal against 53.

(l) Any person aggrieved by an order of the Medical Council under regulation 52 the orders of the may prefer an appeal under section 19 of the Act to-a Judge of the I lig!)

Court in Medical Council.


 Chambers within six weeks of the communication of the decision of the Medical Council to him.

(2) The Judge of the High Court in Chambers may issue directions to terminate any suspension of registration of a medical practitioner including a direction as to the cost of the appeal.

Removal of name from register.

54.


(1) The Secretary to the Medical Council shall remove the name ofany registered medical practitioner from the Register of Medical Practitioners- (a) upon the application of that person; or (b) upon the taking effect of a disciplinary order of the Medical Council.
(2) Where the name of any person has been removed from the Register or his registration has been suspended, any license issued to him shall cease 'to have effect for as long as his name remains off the Register or for the period that the suspension continues in force.
(3) Where the name of any person has been removed from the Register, the Medical Council may, in writing, direct the person concerned to return his license to the Secretary to the Medical Council within such time as may be specified in the direction and the person concerned shall comply with that requirement.

• of 55.

(1) The Medical Council may, at any time, upon application made by any person registration.
whose name has been removed from the Register or whose registration has been suspended, determine, if it thinks fit, that such person's name shall be restored to the Register or that his suspension shall cease to have effect from such date as the 428 THE OFFICIAL GAZETTE 'LEGAL SUPPLEMENT) — B 291" NOVEMBER, 2008 Medical Council may appoint, and shall forthwith give notice of any such decision to the Secretary to the Medical Council.
(2) On receipt of notice of an order made by the Medical Council under paragraph (1) the Secretary to the Medical Council shall forthwith cause the name of the medical practitioner in question to be restored to the Register or, as the case may be, cause a note of the cessation of the suspension to be entered therein.

Pers relat bet mei prat and Appeal to High 56.


(1) Any person aggrieved by the failure or refusal of the Medical Council to Court against register him under the Act may prefer an appeal to a Judge of the High Court in non-registration.

Chambers in accordance with section 19 of the Act.

(2) The decision of the Judge shall mutatis mutandis apply as if the matter in respect of which the appeal is brought were a judgment or order of the High Court.
C. ADVICE ON STANDARDS OF PROFESSIONAL CONDUCT AND ON MEDICAL ETHICS.

Duties of the 57.

The Medical Council shall give general advice on- Medical Council to render advice on certain matters.
(a) personal relationships between medical practitioners and patients; (b) professional confidence; (c) the reference of patients to and acceptance of patients by specialists; (d) circumstances in which difficulties in relation to self promotion by medical practitioners most commonly arise; and (e) relationship between the medical profession and the pharmaceutical and allied industries.
(2) The Medical Council may also respond to inquiries from individual medical practitioners about questions of professional conduct, at its discretion, although.

; some instances medical practitioners may be advised to consult their professio association or other counsel.

THE OFFICIAL GAZETTE (LEGAL SuppeEmErrrl — B 29Th NOVEMBER, 2008 Personal relationship between - medical practitioners and patients.

58.
58.

(1) Medical practitioners shall exercise great care and discretion in not d the crucial relationship between medical practitioners and patients, and shall the areas in which experience shows that this trust is liable to be breached.
(2) Where a medical practitioner indecently exposes himself to a patien attending him professionally, the medical practitioner may render himself lib criminal proceedings besides being proceeded against by the Medical Counci such action as a professional misconduct on preponderance of probability, eve absence of a criminal conviction by a court of law.

Note I.
Note I.

- The Medical Council may take a serious view of a medical practitior uses his professional position in order to pursue a personal relationship emotional or sexual nature with a patient or the close relative of a patient.

Such of a medical practitioner's professional position may be aggravated in a num ways.
Fdr example, a medical practitioner may use the pretext of a professio to a patient's home to disguise his pursuit of a personal relationship with the (or, where the patient is a child, with the patient's parent) or he may u knowledge, obtained in professional confidence, of the patient's marital diffic take advantage of that situation.

But these are merely examples of particular ab Note 2.
- The trust which should exist between a medical practitioner and his pa can be severely damaged when, as a result of an emotional relationship betty medical practitioner and a patient, the family life of that patient is disrupted.

may occur even without sexual misconduct between the medical practitioner patient.

Note 3...

Note 2 refers to personal relationship between medical practition4 their patients or the close relatives of patients and not with others.

Note 4.
Note 4.

- Innocent medical practitioners are put to inconvenience or are subj anxiety by unsolicited declarations of affection by patients or threats that a co, .

will be made on the grounds of a relationship which existed only in the imagination.
All complaints received by the Medical Council are, iherefo screened most carefully and action is to be taken only when the evidence re 430 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] B 29T" NOVEMBER, 2008 sufficient to require investigation.

Professional 59.

(1) Except in the cases mentioned in paragraph (3), it is a duty of a medical confidentiality.
practitioner to strictly observe the rules of professional ecrecy by refraining from disclosing voluntarily to any third party information about a patient, which he has learnt directly or indirectly in his professional capacity as a registered medical practitioner.

(2) The death of the patient does not absolve the medical practitioner from his obligations under this regulation.
(3) The circumstances where exceptions to the rule of professional secrecy in respect of confidential information about a patient may be permitted are as follows- (a) if the patient or his legal adviser gives written and valid consent, information to which the consent refers may be disclosed; (b) confidential information may be shared with other registered medical practitioners who participate in or assume responsibility for clinical management of the patient to the extent that the medical practitioner deems it necessary for the performance of his particular duties; (c) confidential information may also be shared with other co- professionals such as nurses, radiologists and other health care professionals who are assisting and collaborating with the medical practitioner in his professional relationship with the patient and it is the medical practitioner's responsibility to ensure that such individuals appreciate that the information is being imparted in strict professional confidence; (d) if in particular circumstan,:s the medical practitioner believes that it undesirable on medical grounds to seek the patient's consent, information regarding the patient's health may sometimes be given in confidence to a close relative or a person in a similar realm* THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] - B 29Th NOVEMBER, 2008 431 to the patient; s) if in the medical practitioner's opinion disclosing of any information about a patient to a third party other than a relative, would be in the best interests of, the patient, it is the medical practitioner's duty to make every reasonable effort to persuade the patient to allow the informatibti to be given and if the patient still refuses to given hiS' consent, then only in exceptional.cases should the medical practitioner feel himself entitled to disregard the refusal of the patient; (f) information about a patient may be disclosed to the appropriate authority in order to satisfy a specific statutory requirement, such as notification of an infectious or contagious disease; (g) if the medical practitioner is directed to disclose information about a patient by a judge or other presiding officer of a court before whom he is appearing to give evidence, information may, at that stage, be disclosed; (h) information about a patient may also be disclosed to a coroner or his nominated representative to the extent necessary to enable the coronet to determine whether an inquest should be field; (i) where.
litigation is in prospect, unless the patient has consented to the disclosure or a formal court order has been made for disclosure, information about the patient should not be disclosed merely in response to demands from other persons such as another party's counsel or attorney-at-law or an official of the court without lawful authority of a court.
(j) the disclosure may rarely be justified on the grounds that it is in the public intewst or health of the community at large which, in certain circumstances such as, for example, investigation by the police of a grave or very serious crime, might override the medical practitioner's duty to maintain his patient's confidence; 432 THE OFFICIAL GAZE1 h [LEGAL SUPPLEMENT] — B 29Th NOVEMBER, (k) information may also be disclosed if necessary for the purpose of a medical research project, which has been approved by a recognized Ethical Committee of the Medical Council.
(4) A medical practitioner shall, always be prepared to justify his actions, if he has disclosed confidential information in respect of a patient.

(5) if a medical practitioner is in doubt as to whether any of the exceptions mentioned in this regulation would justify him in disclosing information in a particular situation he may seek advice from the Medical Council or a professional - association.
(6) Where an individual below the age of sixteen years consults a medical practitioner for medical advice or treatment, and is not accompanied at the consultation by a parent or a person in loco parentis, the medical practitioner should particularly have in mind the need to foster and maintain parental responsibility and family stability.. (7) Before offering advice or treatment to any person, the medical practitioner shall satisfy himself, after careful assessment, that the individual has sufficient maturity and understanding to appreciate what is involved.
(8) If a medical practitioner is satisfied of the individual's maturity and ability to understand as set out in this regulation, he should nonetheless seek to persuade the individual, if a child to involve a parent, or another person in loco parentis, in the consultation and if the child nevertheless refuses to allow a parent or such other person to be told, the medical practitioner must decide, in the patient's best medical interests, whether or not to offer any advice or treatment.
(9) If the medical practitioner is not so satisfied, he may decide to disclose the information learned from the consultation; but if he does so he should inform the patient accordingly, and his judgment concerning disclosure must always reflect both the patient's best medical interests and the trust the patient places in the medical practitioner.
Note.- Special problems in relation to confidentiality of information relating to a patient can arise in circumstances where medical practitioners have responsibilities THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29Th NOVEMBER, 2008 both to patients and to third parties, for example, in the practice of occupational': medicine.

(10) An occupational medical practitioner should ensure that any employee whom.
he examines or counsels in that capacity understands the duty of the occupational medical practitioner in relation to the employer and the purpose of the consultation.

(11) Where an occupational medical practitioner is asked by the employer to assess .the fitness of an employee to work he should not undertake such assessment except with the informed consent of the employee.
(12) The extent to which disclosure of medical information after the death of a patient is regarded as improper shall depend on a number of factors such as- (a) the nature of the information disclosed; (b) the extent to which such information has already appeared in published material; (c) the circumstances of the disclosure, including the period which has elapsed since the patient's death.
(13) If the Medical Council is unable to specify an interval of years to apply in all such cases mentioned in paragraph (12) and a medical practitioner who discloses such information without the consent of the patient or a survivIng, close relative of the patient may be required to justify his action.

.
(14) The provisions of these Regulations on confidentiality shall apply net only to information which a medical practitioner has received in a clinical relationship with a patient, but also information which he has received, either directly from the patient or indirectly, in the course, of administrative or non- clinical duties, for example when employed by a public or private health authority, commercial firm, insurance company or other comparable organization, or as a medical author or medical journalist.
k15) Where one medical practitioner shares confidential information with another • medical practitioner, the interests of the patient require that the medical practitioner.

with whom the information is shared must observe the same rules of professional secrecy as the medical practitioner who originally obtained the information from the 434 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] - B 29111 NOVEMBER, 2008 patient had to.
(16) Every medical practitioner connected with organizations offering clinical diagnostic or medical advisory services shall satisfy higiself that the organization discourages patients from approaching it without first consulting their own general medical practitioners.
(17) In expressing the views, the Medical Council shall recognise and accept that in some areas of practice specialist and hospital clinics customarily accept patients referred by sources other than their general medical practitioners and in these circumstances also every specialist has the duty to keep the genera) medical practitioner informed.

PART VII PHYSICAL ARRANGEMENTS, ADVERTISING AND FINANCIAL RELATIONSHIPS Premises of the 60.
The medical practitioners shall preserve both the security of their patients as well health facilities.

as the dignity of the medical pliofession and satisfy the minimal standards set for every.

category of health care facility as prescribed in regulation 3 of the Health Facilities Licensing Regulations 2008 made under section 29 of the Health Facilities Act No.

26 of 2007.

Licensing Act 2007 or any other written law.

Ethical advertising.

 61.


(1) Good communication between medical practitioners and patients and between one medical practitioner and another is fundamental to the provision of good patient care, and the ethical dissemination of relevant factual information about medical practitioners and their services is required to be strongly encouraged.
(2) Paragraph (1) facilitates an informed choice by patients seeking medical care, enables a medical practitioner's existing patients to be aware of and to make best use of the services available and assists general medical practitioners in advising their patients on a choice of specialist.
(3) Good communication referred to in paragraph (1) is helpful for the professional standing of medical authors to be indicated in their books and articles, since that will assist the profession in fulfilling its duty to disseminate information about advances THE OFFICIAL GAZETTE [LEGAL SUPPLEMENTI — B 29T" NOVEMBER, 2008 435 in medical science and therapeutics.
(4) Patients are best able to make an informed choice of a medical practitioner if they have access to comprehensive, up-to-date, well-presented and easily understood information, about all the medical practitioners practicing in Guyana.
(5) Lists including factual information presented in an objective and unbiased manner about the medical practitioners and their professional qualifications, the litcilities available and the practice arrangements' should be distributed by the Medical Council widely to the public and full use should be made of the places in each area where members of the public can expect to find local information.
(6) In the interest of the general public the material referred to in paragraph (5) may be published by a body with statutory responsibilities for primary care services or by some other body which has no reason to favour individual medical practitioners or their practices.

(7) As far is possible, material published in the manner specified in paragraph (6) should provide the same items of information about each medical practitioner and his practice.
(8) The Medical Council shall ensure that persons seeking medical assistance are protected from misleading promotional advertising and improper competitive activities among medical practitioners.
(9) The persons seeking medical assistance are also entitled to expect that medical practitioners will help them to obtain comprehensive advice about their medical problems, including second opinions where appropriate and guidance on alternative treatments and failure to respect either of these entitlements can cause anxiety and distress, and can erode the trust between a medical, practitioner and his patient on which good medical practice depends.
(10) Every medical practitioner shall be cognizant of the disadvantages or negative impact of his self-promotional material.

Note.

- A medical practitioner who is the most successful at achieving publicity may • not be the most appropriate for a patient to consult and people seeking medical attention and their families are often vulnerable to persuasive influence.
This THE OFFICIAL GAZE I IE [LEGAL SUPPLEMENT] — B 29Th NOVEMBER, 2008 influence could be.a source of danger to the public and in the extreme cases raises illusory hopes of a cure.

(11) Medical practitioners publishing information about their services should not abuse the trust of patients or attempt to exploit their lack 2f medical knowledge, especially, they must not offer, guarantees to cure particular complaints.
(12) The advertising material should contain only factual information and shall not include any statement which could reasonably be regarded as misleading or as disparaging the services provided by other medical practitioners, whether directly or by implication.

(13) No claim of superiority should be made either for the services offered or for a particular medical practitioner's personal qualities, professional qualifications, experience or skill.
Note.- The promotion of the medical practitioners medical services as if the provision of medical care were no more than a commercial activity is likely both to under-mine public trust in the medical profession and, over passage of time, to diminish the standards of medical care which patients have a right to expect and such advertising shall be considered by the Medical Council as unethical and may lead to a charge of serious professional misconduct.

roadcasi rcludin tel Advertising and 62.


(1) Based on his ability, competence, integrity and personal credibility, a medical addressing the practitioner may build a professional reputation and may advertise professional public.

services or make professional announcements as permitted either generally or specifically by the Medical Council.
(2) Every medical practitioner shall avoid advocacy of any particular product or service when identified as a member of the medical profession and shall avoid the implied use of secret remedies.
(3) Every medical practitioner shall recognize the responsibility to give consensus opinion when interpreting medical or scientific knowledge to the public arid when presenting an opinion, which is contrary to that generally held by the profession; he should indicate this and avoid any attempt to enhance his personal professional THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] - B 29Th NOVEMBER, 2008 reputation.

Medical lectures 63.


Every medical practitioner who proposes to deliver electure at any function sha to the public.

 before any particulars of his professional status or attainments are announced made known to the public, request the Chairperson or the Presiding Officer, as lb case may be, to circumspect the factual accuracy in any introductory remark concerning him.

Press Interviews.

 64.


Every medical practitioner shall exercise the greatest caution in granting a pres interview, and the same principle shall be applied to the publication of writte articles.

Note.- A seemingly innocuous remark is often open to misinterpretation and may, easily form the subject of a damaging headline.

This may place the medical\ practitioner in a position of embarrassment and danger.
In certain circumstances, i may be preferable to promise a prepared statement than to give an impromptu interview; or if an interview is to be granted, to ask for an opportunity to approve k statement in proof before it is broadcast or otherwise published.

Broadcasting, i5.

(I ) Medical practitioners taking part in public discussions in any medium; including including radio and television should avoid any statements which in i tend to giy, television.
them personal professional advantage.

Note.

- It is legitimate and even desirJ)le that topics relating to both medical sei and policy and to public health and welfare should be discussed by medig practitioners who can speak with authority on the question at issue.

The medic practitioners should personally observe this rule and take care that the announcer, introducing them, makes no laudatory comments and no unnecessary display of thett medical qualifications and appointments.
There is a special claim that medica: • practitioners of established position and authority should observe these conduiorr; foe: their example must necessarily influence' the actions of their less recogniza colleagues.

(2) A medical practitioner serving in an official public capacity is in a different?

lc on rm mi ga for.
lc on rm mi ga for.

out edi: act., 438 THE OFFICIAL GAZE ITt, [LEGAL SUPPLEMENT] B 29Th NOVEMBER, position, but he should also ensure that it is his public office, rather than himself, that is exalted.

Advertisements in the press.

66.

(1) The use of advertising columns of the lay press to publicize the professional activities of individual medical practitioners, even in case of absence of a name (e.g.

by using a box number) is unethical.


(2) A particularly reprehensible form of advertising of the type mentioned in paragraph (1) is the submission to the press directly or through an agent of information concerning the personal movements, vacation or new appointments of a medical practitioner.

Association with conunercial enterprises.

67.


(1) It is considered improper for a medical practitioner to be directly associated with any commercial enterprise engaged in the manufacture or sale of any substance which is claimed to be of value in the prevention or treatment of any disease and which is recommended to the public in such a fashion as to be calculated to encourage the practice of self-diagnosis or self-medication or is of undisclosed nature or composition.
(2) A similar view shall be taken by the Medical Council of tile association of a medical practitioner with any system or method of treatment which is not tinder medical control and which is advertised in the public press.

Information 68.
Information 68.

(1) The medical practitioners who have any kind of financial or professional about relationship with any organization, or who use its facilities, are deemed by the organizations Medical Council to bear some responsibility for the organization's advertising and offering; medical this regulation shall also apply to medical practitioners who accept for examination services.

or treatment patients referred by any such organization.

Note.
Note.

- Medical services are offered to the public not only by individual medical practitioners but also by a wide variety of organizations such as hospitals, health centres, diagnostic centers, nursing homes, advisory bureaus or agencies and counseling centers.
Hence, the advertisements should not make invidious comparisons with other organizations, or with the services of particular medical In forma compan: firms an similar organiza Informal about associati( medical -practition THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29" NOVEMBER.

2008 439 practitioners, nor should they claim superiority for the professional services offered by them or for any medical practitioner connected with the organization.
(2) The medical practitioners shall, to acquaint themselves with the nature and content of the advertising of the organization offering medical services, and shall exercise due diligence in an effort to ensure that it conforms to these Regulations.
Note.- If any question arises as to a medical practitioners' conduct in relation to an organization offering medical services, it will not be sufficient for an explanation to be based on the medical practitioner's lack of awareness of the nature or content of the organization's advertising, or lack of ability to exert influence over it.
(3) Every medical practitioner shall avoid personal involvement in canvassing or promoting the medical services of any organization, for example, by public speaking, broadcasting, writing articles or signing circulars, and should not permit the organization's promotional material to claim superiority for their professional qualifications and experience.
(4) A medical practitioner shall not allow his personal address or telephone number to be used as an inquiry point on behalf of an organization offering medical services.

Information to 69.

(1) A medical practitioner who wish to offer medical.
services such as medico- companies- legal or occupational health services or medical examinations to a company, factory, firms and similar firm, a school or club, or a professional practitioner or association may send factual information about his qualifications and services to a suitable person of the company, organizations.

 factory , firm or organization, as the case may he.
(2) A medical practitioner shall not use the provision of such services referred to in paragraph (1) as a means to put pressure upon any individual to become his patient.

Information about association of medical practitioners.

70.

Any association of medical practitioners which proposes to release lists of its members in response to requests made by the public shall first consult the Medical Council for guidance as to the form which the list should take.

• Note.
• Note.

- Members of the public who are seeking medical advice or treatment occasionally approach an association of medical practitioners for a list of its members.
Such a list may be released in response to a direct requpst, but it is essential that no list should imply that the persons mentioned the list are the only 440 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29Th NOVEMB medical practitioners who are qualified to practice in a particular branch of medicine or that the inclusion of a medical practitioner's name in the list carries some form of recommendation.
The lists, which are released, should include those medical practitioners who are eligible for registration by the Medical Council as having completed higher specialist or vocational training.

prof the phar and; Financial 71.


(1) A medical practitioner who recommends that a patient should attend at, or be relationships admitted to, any private hospital, health centre, nursing home or similar institution, between medical whether for treatment by the medical practitioner himself or by another person, must do so only in such a way as will best serve, and will be seen best to serve, the practitioners medical interests of the patient.
and independent organizations providing clinical, diagnostic or medical advisory services.

(2) Every medical practitioner shall avoid accepting any financial or other inducement from such an institution which might compromise, or be regarded by others as likely to compromise, the independent exercise of his professional judgment and dignity of the profession.
(3) Where a medical practitioner has a financial interest in an organization to which he proposes to refer a patient for admission or treatment, whether by reason of a capital investment or a remunerative position, he should always disclose that he has such an interest before making the referral.
(4) The seeking of acceptance by a medical practitioner from an institution of any inducement of the nature referred to in paragraph (3) for the referral of patients to that institution, such as free or subsidized consulting premises or secretarial assistance, may be regarded as improper.

(5) The offering of inducements to colleagues by medical practitioners who manage or direct such institutions as referred to in paragraph (3) may be regarded as improper.

Relationships between the medical 72.


(1) A medical practitioner prescribing medicines or appliances shall, while choosing medicines or appliances, ensure that the prescription is made on the basis of his independent professional judgment and having due regard to economy and to best THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] B 29' NOVEMBER, 2008 professions and serve the medical interests of his patient.

the pharmaceuticals and allied industries.


(2) Every medical practitioner shall avoid accepting any pecuniary or material inducement which is likely to compromise, or be regarded by others as likely to compromise, the independent exercise of his professional judgment in prescribing medicines, laboratory test and appliances.
(3) The medical practitioners shall not seek or accept any sums of money or gilts except ordinary exchange of gifts on festivals and special occasions Iron) commercial firms manufacturing, or marketing drugs, or diagnostic or therapeutic agents or appliances and any such action of unusual nature shall be considered as improper.

(4) A medical practitioner shall not he held responsible for any act of voluntary supply of samples of medicines or equipment by any manufacturing company or medical representative.
.1Vote 1.

- The medical profession and the pharmaceutical industry have common interests in the research and development of new drugs of therapeutic value and in.

their production and distribution for clinical use.

Medical practice owes much to the important advances 'achieved by the pharmaceutical industry over recent decades.

In addition, much medical research and postgraduate medical education are facilitated by the financial support of pharmaceutical Firms.
:'Vote 2.- Advertising and other forms of sale promotions by individual firms within the pharmaceutical and allied industries are necessary for their commercial viability and can provide information useful to the profession.

Clinical trial of drugs.

 73.
It may be improper for a medical practitioner to accept- (a) per capita or other payments from to pharmacetitical firm in relation to a research project such as the clinical trial of a new, drug, mile.ss the payments have been specified in a protocol for thz: project which has been approved by the relevant &leaf,: committee; (b) per capita or other payments under arrangements for recording clinical assessments of a licensed medicinal product, whereby he unship tiers tents 442 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] 29Th NOVEMBER, 2008 FI1E is asked to report observations which he has observed in patients for whom he has prescribed the drug, unless the payments have been specified , in a protocol for the project which has been approved by the relevant ethical committee; (c) payment in money or kind which could influence his professional 4Nn assessment of the therapeutic value of a new drug.
Gifts and loans.

 74.

It is considered improper for any medical practitioner to accept from a pharmaceutical firm monetary gifts or loans or expensive items of equipment for his personal use except in case of a hire-purchase or grants of money or equipment by firms to institutions such as hospitals, health centres and university departments when they are donated specifically for purposes of research or for the welfare of poor people.

Acceptance of 75.
Acceptance of 75.

(1) It is considered improper for individual medical practitioners or groups of hospitality.

 medical practitioners to accept lavish hospitality or travel facilities under the terms of sponsorship of medical postgraduate meetings or conferences or the like.
(2) The acceptance of hospitality at an appropriate level, which the recipients might normally adopt when paying for themselves whether by an individual medical practitioner of a grant, which enables him to travel to an international conference or by a group of medical practitioners who attend a sponsored postgraduate meeting or conference shall not be considered as improper under paragraph ( I).

 Professional 76.
Professional 76.

(1) Medical practitioners who are practicing otherwise than under obligation of an fees.

 employment or contract are entitled to charge fees for consultations, special examinations such as laboratory tests, ECG examinations, etc.

and thr special procedures such as surgical operations, both minor and major, and for issuing medical reports.
(2) Issuance of medical certificates stating illness or fitness, per centage of incapacity and the like of a patient is an integral part of the consultation as are ionship ween icaj nioners tients.

THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — t I 29 )1 NOVEMBER, 2N.H18 443 prescriptions for medicines and appliances, advice on diet, physical or rehabilitation exercises, rest and the like and the fee for issuance of such certificates when necessary arc included in the consultation fee.
Note - The medical practitioners should adopt general rules and standards regarding fees.

It should be deemed a point of honor among medical practitioners to adhere to these standards with as much iuliformity as varying conditions may allow.

PART VIII ADVICE ON HIV AND AIDS Note.- This Part deals with the guidance of the Medical Council on the ethical problems surrounding HIV and AIDS.
It deals with the principles of the 'medical practitioner-patient relationship and the medical practitioner's duty towards patients.

It also deals with specific matters, including the duties of medical practitioners who may themselves be infected and the need to obtain patients' consent to investigation or treatment.

In all areas of medical practice, the medical practitioners are required to make judgments, which they may later have to justify.
This is applicable both of clinical matters and of the complex ethical problems, which arise regularly in the course of providing patient care because it is not possible to set out a code of practice which provides solutions to every such problem which may arise.

unship l tuners lents.

77.


It is unethical for a medical practitioner- (a) to refuse treatment or investigation for which there are appropriate facilities on the ground that the patient suffers or may suffer from a condition which could expose the medical practitioner to personal risk; (b) to withhold treatment from any patient on the basis of a moral judgment that the behavior or lifestyle of the patient might have contributed to the condition for which the treatmenrwas being sought.
Note 1.

- The relationship between a medical practitioner and his patients is founded on mutual trust, which can be fostered only when' information is freely exchanged 444 THE OFFICIAL GAZETTE (LEGAL SUPPLEMENT] B 291 " NOVEMBER,20011 between the medical practitioner and his patients on the basis of honesty, openness and understanding.

Acceptance of that principle is fundamental to the resolution of the questions which have been identified in relation to AIDS.

Note 2.
Note 2.

- The Medical Council has noted the •significant increase in the understanding of AIDS and AIDS-related conditions, both within the medical profession and by the general public, which appears to have occurred.
Although most medical practitioners are generally prepared to regard these conditions as similar in principle to other infections and life-threatening conditions and are willing to apply established principles in approaching their diagnosis and management rather than treating them as medical conditions quite distinct from all others, the Medical Council has concern about the level of knowledge at the individual level about the management of the disease.

Note3.
Note3.

— The Medical Council expects that medical practitioners will extend to patients who are HIV positive or are suffering from AIDS the same high standard of medical care and support which they would offer to any other patient.

The Medical` Council has serious concern at reports on medical practitioners having refused or.

; neglected to provide such patients with necessary care and treatment.

Note 4.
Note 4.

- It is entirely proper for a medical practitioner who has a conscientious objection to undertaking a particular course of treatment, or who lacks the necess knowledge, skill or facilities to provide appropriate investigation or treatment for.

patient, to refer that patient to a professional colleague.

Duties of medical 78.


(1) It is unethical for a medical practitioner who knows or believes himself to be infected with HIV to put patients at risk by failing to seek appropriate counselling or practitioners in by failing to document upon it when given.

certain HIV infected cases.


(2) A medical practitioner who knows that a health care worker is infected with HIV and is aware that the person has not sought or followed advice to modify his professional practice has a duty to inform the appropriate regulatory body and an appropriate person of the employing authority of the concerned health care worker who will usually be the senior- most medical practitioner.

ghts edica!
ghts edica!

ctitiC ected V. risen estig tine; THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] 29Th NOVEMBER, 2008 Note 1.-Considerable public anxiety has been aroused by suggestions that medical practitioners who are HIV positive might endanger their patients.

The risk is very small.


It is imperative, both in the public interest and on.ethical grounds, that any medical practitioner suspected of being infected with HIV should seek appropriate diagnostic testing and counseling and, if found to be infected, have regular medical supervision.

Note 2.

- Medical practitioners who are 111V positive should also seek specialist advice on the extent to which they should limit their practice in order to protect their patients.
Such advice will usually be obtained locally from a consultant in occupational health, infectious diseases or public health, who may in turn seelt guidance on an anonymous basis, from the UK Advisory Panel of the lixper Advisory Group on AIDS.

Medical practitioners must document upon that advice which, in some circumstances, would include a requirement not to produce or to limit their practice in certain ways.
No medical practitioner should continue in clinical practice merely on the basis of his own assessment of the risk to patients.

This; 1.; intended to prevent the transmission of infection from medical practitioners to patients.

lidcnii< II V Rights of medical 79.
Medical practitioners who become infected with HIV are entitled to expect the confidentiality and support afforded to other patients and only in the most practitioners exceptional circumstances, where the release of name of the medical practitioner is infected with essential for the protection of patients, may a medical practitioner's HIV status be 1-11V.

 disclosed without his consent.

Consent to 80.
Consent to 80.

A medical practitioner shall treat a patient only on the basis of consent of the investigation or patient, his parent or guardian either explicit or in unavoidable circumstances by treatment.

 implicit consent.
implicit consent.

Note 1.- The medical practitioners are expected in all normal circumstance* to be sure that their patients' consent to the carrying out of investigative procedures trivolvg the removal of samples or invasive techniques, whether those investigations are performed for the purposes of routine screening, for example, in pregnancy or prior THE OFFICIAL GAZE!

1'E.

[LEGAL SUPPLEMENT] B 29TH NOVEMBER, 204 to surgery, or for more specific purpose of differential diagnosis.
A patient's consent may in certain circumstances be given implicitly, for example, by agreement to provide a specimen of blood for multiple analysis.

In other circumstances it needs to be given explicitly, for example, before undergoing a specified operative procedure or providing a specimen of blood to be tested specifically for a named condition.
As the expectations of patients, and consequently the demands made upon medical practitioners, increase and develop, it is essential that both medical practitioner and patient feel free to exchange information before investigation or before the treatment is undertaken.

Need to obtain 81.

(1) In the case of a patient presenting with certain symptoms, which the medical consent for practitioner is expected to diagnose, the process of obtaining consent should form testing for 111V part of the consultation.
infection.

(2) Where blood samples are taken for screening purposes, as in ante-natal clinics, there will usually be no reason to suspect HIV infection but even so the test should be carried out only where the patient has given explicit consent.

Similarly, those handling blood samples in laboratories, either for specific investigation or for the purpose of research should test for the presence of H1V only where they know that onfiden nd HIV the patient has given explicit consent.
(3) Testing without explicit consent of a patient can be justified only in most exceptional circumstances where a test is imperative in order to secure the safety of persons other than the patient and it is not possible to obtain the prior consent of the patient.

(4) It would not be unethical for a medical practitioner to perform a test without the patient's consent, provided that the medical practitioner is able to justify that documentation as being done in the best interests of the patient.

Note 1.
Note 1.

- The Medical Council has advised that the principle of having the consent of the patient for treatment and for conducting tests should apply generally, but it is particularly important in the case of testing for HIV infection, not because the condition is different in kind from other infections, but because of the possible serious social and financial consequences which may ensue for the patient from the mere fact of having been tested for the condition.
These are problems which would- THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] B 29Th NOVEMBER, 2(X)8 447, be better resolved by developing a spirit of social tolerance than by medical action, but they do raise a particular ethical dilemma for the medical practitioner in connection with the diagnosis of HIV infection or AIDS.
They provide a strong argument for each patient to he given the opportunity, in advance, to consider the implications of submitting to such a test and deciding whether to accept or decline it.

Note 2.

- A particular difficulty arises in cases where it may be desirable to test a child for 1.11V infection and where, consequently, the consent of a parent, or a person in loco parentis, would normally be sought.
However, the possibilities that the child having been infected by a parent may, in certain circumstances, distort the parent's judgment so that consent is withheld in order to protect the parent's own position.

The medical practitioner faced with such a situation must first judge whether the child is competent to consent to the test on his own behalf.

if the child is judged competent in this context, then, consent can be sought from the child.
lf, however, the child is judged unable to give consent, the medical practitioner must decide whether the interest of the child should ovenide the wishes of the parent.

dentiality 82.

(1) When a patient is seen by a specialist who diagnoses HIV infection or AIDS, V status.
and a general practitioner is or may become involved in the care of the patient, then the specialist should explain to the patient that the .general practitioner caRnot be expected to provide adequate clinical management and care without full knowledge of the patient's condition.

Note 1.
Note 1.

- The medical practitioners are generally familiar with .the need to make judgments as to whether confidential information should be disclosed or not in particular circumstances, and the need to justify their documentation where such a disclosure is made.
The Medical Council has held the view that, where I-11V infection or AIDS has been diagnosed, any difficulties concerning confidentiality which arise will usually he overcome it medical practitioners are pre/ pared to discuss openly and honestly with patients the implication of their condition, the need to secure the safety of others, and the importance for continuing medical care of ensuring that those who will be involved in their care know the nature of their condition and the particular needs which they will have.
The Medical C:iuncil has held the view that any medical practitioner who discovers that a patient is 111V 448 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29Th NOVEMBER, 2008- positive or suffering from AIDS has a duty to discuss these matters fully with the patient.

The Medical Council considers that the majority of the patients will readily be persuaded of the, need for their .general practitioners to be informed of the or 0 park:, diagnosis.
(2) If the patient refuses to consent to the specialist for giving full knowledge about his condition to the general practitioner, then the specialist has two sets of obligations to consider and these are the obligations to the patient to maintain confidence, and obligations to other care-giver whose own health may be put unnecessarily at risk.
(3) In the circumstances mentioned in paragraph (2), the patient should be counseled about the difficulties which his condition is likely to pose for the team responsible for providing continuing health care and about the likely consequences for the standard of care which can be provided in the future.
(4) If, having considered the matter carefully in the light of such counseling, the patient still refuses to allow the general practitioner to be informed then the patient's request for privacy should be respected except where the medical practitioner judges that the failure to disclose the information would put the health of any member of the health care team at serious risk.

Note.
Note.

- The Medical Council considers that, in a situation mentioned in paragraph (4), it would not be improper to disclose such information, as that person needs to know.

The need for such a decision is likely to arise only rarely, but if it is made, the medical practitioner must be able to justify his documentation.

Similar princip apply to the sharing of confidential information between specialists or with o health care professionals such as nurses, laboratory technicians and dentists.
persons receiving such information must consider themselves under the same gen obligation of confidentiality as the medical practitioner principally responsible for patient's care should have.

ion or mp lain!

LSI I71∎ tltiorlt informing the 83.


( 1 ) When a person is found to be infected in the manner specified in Note 1, patient's spouse medical practitioner must discuss with the patient the question of informing a spouse • THE OFFICIAL GAZETTE 'LEGAL SUPPLEMENT' B 29'" NOVEMBER, 2008 or other sexual or other sexual partner of the patient.

partner.
partner.

(2) In case of AIDs patients, the medical practitioners shall make their (;,,,,n judgments of the course of action to be Ibllowed in specific circumstances.

Note I.- Questions of conflicting obligations also arise when a medical practitioner, faced with the decision whether the document that a patient is HIV positive 'et sot-tering from AIDS should be disclosed to a third party, other than another hcalk care professional, without the consent of the patient.
The Medical Council is of th( view that there are grounds for such a disclosure only where there is a serious and identifiable risk to a specific individual who, if not so informed, would he exposed:th infection.

Note 2.
Note 2.

- The Medical Council considers that most patients with HIV positive or suffering from AlDswill agree to disclosure in the circumstances mentioned in Note but where such consent is withheld the medical practitioner may consider it as hi duty to ensure that any sexual partner is informed, in order to safeguard such per so from infection.

Note 3.
Note 3.

- It is emphasized that the advice set out in this Part is intended to guide the medical practitioners in approaching the complex questions which may arise in the context of infections referred to in Note I.
The instructions in this Part may be talecii • as only general guidelines and individual medical practitioners must always he prepared, as a matter of good medical practice, to make their own reasonable judgments of the 'appropriate course of action to be followed in specific circumstances, and be able to justify the decisions which they make.

PART IX MISCELLANEOUS Action on complaint 84.


(I) Any person aggrieved by the non-compliance with any of the provisions of these Regulations by a medical practitioner by indulging in any professional against medical misconduct or malpractice may make a written complaint to the Medical Council.

practitioners.
(2) Upon receipt of a complaint under paragraph (1), the Medical Council shall send a notice to the medical practitioner concerned along with a copy of the witne: folio \-\ substa brothe precep Own 5( oath ac conside 'Piscine counsel persons enter I \ and esp women with me- e pract is Oath 450 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] B 29m NOVEMBER, 2008 Till complaint and afford him a reasonable opportunity to furnish his answer to the allegations made in the complaint.
(3) If upon receipt of the written reply to the complaint, the Medical Council is satisfied that the medical practitioner is found guilty of professional misconduct or indulged in malpractice it may by reasoned order impose a suitable penalty on th Medical practitioner as it may deem just and proper in accordance with section 17 of the Act.

Penalty for 85.
Penalty for 85.

(1) Every person who contravenes any of these Regulation shall on summary fol low in contravention of conviction be liable to a fine not exceeding nineteen thousand five hundred doll= regulations.
and imprisonment not exceeding two years and in the case of a continuing offence further penalty of one thousand nine hundred and fifty dollars for each day d which the contravention continues but the penalty so imposed shall in no case ex the penalty specified in section 15 of the Act.

(2) No prosecution under these Regulations shall be instituted without the previ sanction of the Medical Council.

• bstanc, others ecept, I wri son: acct nsider ischiev, sel, ons h er wi espec or Al W actic.
ath THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] - B 29Th NOVEMBER, 2008 451 ANNEXURE I [See reg.4 THE HIPPOCRATIC OATH I swear by Apollo the Physician, by Aesculapius, Hygeia and Panacea, and I take to witness all the gods and goddesses, to keep according to my ability and judgment of the following Oath: To reckon him who taught me this Art as dear to me as my parents, to share my substance with him and relieve his necessities if required; to look on his offspring as my own brothers and to teach them this Art without fee or stipulation if they wish to learn •it; that by precept, lecture and every other mode of instruction I will impart a knowledge of the.Art to my own suns and the sons of the master who taught me and to disciples bound by stipulation and oath according to the law of Medicine, but to none others.
I will follow that system of regimen which according to my ability and judgment I consider best for the benefit of my patients and abstain from whatever is deleterious and mischievous I will give no deadly medicine to anyone if asked nor will I suggest any such counsel.

In like manner I will not give a woman a pessary to procure abortion.

Nor will I cut :persons laboring under the Stone, but will leave this to men who are practitioners at this work.
With purity and holiness will I pass my life and practice my Art.

Into whatever houses I enter I will go into them for the benefit of the sick and will abstain from all intentional ill-doing and especially from the pleasures of love with those I come into contact with therein, be they women or men, free or slaves.

All that may come to my knowledge in the exercise of my profession or daily commerce with men which ought not to be spread abroad I will keep secret and never reveal.
While I continue to keep this Oath inviolate may it be granted to me to enjoy life and the practice of the Art, respected by all men and in all times, btu should 1 trespass and violate this Oath may the reverse be my lot!

452 THE OFFICIAL GAZETTE [LEGAL SUPPLEMEhti — B 29T" NOVEMBER.

TH ANNEXURE II [See reg.

5] INTERNATIONAL HUMAN RIGHTS INSTRUMENTS I .

 2.

3. International Covenant on Economic, Social and Cultural Rights.

International Covenant on Civil and Political Rights.
Optional protocol to the International Covenant on Civil and Political Rights International.

4.

Convention on the Elimination of all forms of Racial Discrimination.

5. International Convention on the Suppression and Punishment of the Crime of Apartheid.

6. International Convention against Apartheid in Sports.

 7.

Convention on the prevention and Punishment of the Crime of Genocide.

R. Convention on the Rights of the Child.

9.
9.

 Convention on the Elimination of all forms of Discrimination against Women.

 10.

 Convention un the Political Rights of Women.

11.

 Convention on the Nationality of Married Women.

 12.

Protocol amending the Slavery Convention of 1926.

13.

14.

15.

Supplementary Convention on the Abolition of Slavery and Similar institutions.

Convention' relating to the Status of Refugees.

Protocol relating to the Status of Refugees.
Guy: Hea ple r.alth tore bes mmo ursin mple e relc THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] - B 29 r" NOVEMBER, 2008 453 ANNEXURE 111 [Sec reg.6] JOINT CODE OF ETHICS 411 Whereas the right to health is anchored in the Constitution of the Co-operative Republic of Guyana; And whereas the National Health Plan of Guyana (2003-2007) recognises that regulation of Health Care Professions is a key element in improving the quality of care of health of the people of Guyana; And whereas the health professionals acknowledge and respect the basic human rights to health and arc aware of their responsibility to promote human rights to prevent diseases, to restore health and to alleviate suffering; And whereas the major health professions emphasize their joint responsibility to ensure the best possible standard of professional conduct through the code of ethics that will serve as a common code for all medical practitioners, dentists, pharmacists, nurses and medex; 1 tcalth profes.
mai nta of elhi, And whereas the Medical Council, Dental Council, Pharmacy Council and General Nursing Council and the Medical Board have agreed to this Joint Code of Ethics to be complementary to the specific Code of Conduct made under the relevant enactment governing ciplt owed aith fessic the relevant health professions; NOW.

THEREFORE, the following Joint Code of Ethics is made: I 454 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] 29Th NOVEMBER, Citation.

1.
1.

This Code may be cited as the Joint Code of Ethics for Health Professionals 2008.

Interpretation.

 2.

In this Joint Code of Ethics - (a) "Council" means — Act No.16 of 1991.

(i) the Medical Council of Guyana established by section 3 of the Medical Practitioners Act 1991; (ii) the Dental Council established by section 3 of Act No 16 of 1996. the Dental Registration Act 1996; (iii) the Pharmacy Council incorporated under section 3 of the Pharmacy Practitioners Act Act No.9 of 2003.
2003; Cap 137 Cap 134.

Act No.16 of 1991.

Act No.16 ol 1996.

Act No.9 of 2003.

Cap.137.


Act No.19 of 1978 or (iv) the General Nursing Council for Guyana established under the Nurses and Midwives Registration Ordinance; or (v) the Medical Board established by section 16 of the Colonial Medical Service Ordinance; (b) "health professional" means a person registered under- (i) the Medical Practitioners Act 1991; (ii) the Dental Registration Act 1996; (iii) the Pharmacy Practitioners Act 2003; (iv) the Nurses and Midwives Registration Ordinance; (v) the Medex Act 1978.
Aims of health professionals.

3.The aims of the health professionals are- (a) to protect the patients; (b) to promote confidence in health professionals; Health profess) maintai of ethic Print folio' healti pro fe THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] - B 29'" NOVEMBER, 2008 alth ofessionals to aintain code ethics.

(c) to serve as a strong partner in health care regulation and policy; and (d) to promote health and well-being for everyone:.

4.
4.

(1) Every health professional shall maintain the common code o f ethics while discharging his functions by- (a) timely registering him in accordance -.
with the requirements of relevant law for carrying on his profession; (b) delivering safe, competent care of patients; (c) setting standards of practice and conduct; (d) ensuring quality of health care professional education; (e) ensuring that the professional knowledge and skills arc kept up-to-date; (f) strengthening patient protection; (g) encouraging receipt of feed-back from the patients regarding the services rendered; (h) developing awareness for the wider determinants of health., (2) Every health professional shall observe this Joint Code of Ethics, maintain his integrity and honour and dignity of the health profession and encourage other health professionals to act similarly.
nciples to be Mowed by alth lessionals.

5.
Every health professional shall be responsible for doing the following- (a) putting the interest of patients first and acting to protect them; (b) respecting the dignity of patients, their rights and choices; (c) pr,gtecting the confidentiality of information received; (d) cooperating with other health professionals in the interest of patients; (e) maintaining the required professional knowledge and 456 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29TH NOVEMBER, 2 TH competence; (1) acting with honesty, integrity and compassion; and (g) advocating for health promotion at the individual, community and social levels.
Saiepiarding interests of pations.

(.
Every health professional shall carry out the principle of putting the interests of patients first and acting to protect them by- (a) working within one's limits and referring to colleagues for second opinion or further treatment, if considered necessary; (b) keeping accurate records concerning the patients and protecting the confidentiality of the records to the extent necessary; (c) taking complaints from the patients seriously and reacting in an appropriate and sympathetic way; (d) protecting the patients from risks arising from one's professional performance, behaviour or health status; (e) not asking for or accepting any payment, gift or hospitality that may affect or appear to affect one's professional judgment; (I) ensuring continuity of care in the event of closure of the health care facility or conflict with moral beliefs and referring the patient to appropriate care; (g) observing generally accepted scientific standards for research involving patients and respecting the right of every patient to safeguard his integrity including withdrawal of consent.
Protection or dignity, etc, of patients.

7.

Every health professional shall observe the principle of respecting the dignity, rights and choices of the patients by- (a) listening to the patients with empathy and a sense of compassion; (b) treating the patients politely and with respect to their dignity and rights as individuals and in accordance with the established procedure; (c) delivering care without discrimination on the ground of sex, age, Protectie: confident of inform.

Principle operation.
itenam tessitinz wledge THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 29T" NOVEMBER, 2008 dS Ti Pronto health race, ethnic origin, culture, spiritual or religious beliefs, lifestyle or any other irrelevant considerations; • (d) recognizing and promoting the responsibility of patients to make decisions about their body and health including the terminally ill and in respect of the need for the consent of the patents; (e) giving appropriate and understandable information so that the patient can make independent decisions; (1) maintaining appropriate boundaries between the health professionals and the patients in their relationship and not abusing the relationship.
Protection of confidentiality of information.

8.
8.

Every health professional shall observe the principle of protecting the confidentiality of information received by him by- (a) treating all information given by the patients as confidential and using them only for the purpose for which it was given; (b) keeping the information secure at all times and prevent unauthorized access; and (c) getting appropriate advice, if the health ptofessional needs to reveal confidential information in the interest of the public or the patient.
Principle of co- operation.

 9.

Every health professional shall co-operate with other health professionals by - (a) co-operating with the team members, colleagues and other health professionals and respecting their role and competence; (b) treating -all team members and other colleagues fairly: (c) sharing information, knowledge and skills with other team members and.

colleagues as are necessary in the best interest of the patients.
Maintenance of professional knowledge and 1(1.

Every health professional shall strive to acquire and maintain professional knowledge and competence bn,.- 458 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] B 29Th NOVEMBER, THE competence.
(a) developing and updating his professional knowledge and skills throughout his working life; (b) continuously reviewing the knowledge, identifying the gaps and understanding the limitations and strengifis thereof and by getting involved in reviewing of the policies and procedures and staying abreast with the up-to-date knowledge and research; (c) keeping oneself informed of and following the laws, regulations and guidelines that affect one's work, premises, equipment and business.

'trustworthiness.

11.


Every health professional shall — Tomotio ealth an sing.
(a) act honestly and with integrity to justify the trust of the patients and the general public; (b) apply the principle of trustworthiness to all professional, educational and business activities; (c) maintain appropriate standards in all aspects of the health professional's private and public life; and (d) contribute to the prestige and reputation of the profession by complying with every code of conduct concerning the profession.
THE OFFICIAL GAZFTTE [LEGAL SUPPLEMENT] - B ' • 29TH NOVEMBER, 2008 459 or 12.
Every health professional shall observe the principle of advocatiiig ramotion icalth and well- for health and well-being at the individual, comMunity and societal levels by- (a) getting involved in health promotion and by advocating for well-being in the community and the betterment of society in general; (b) promoting and facilitating healthy environments and lifestyles conducive to health; (c) promoting and facilitating effective and appropriate health care systems according to the principles of the primary health care approach that enable equal, appropriate and affordable access to care; (d) working for organizational structures and resources that ensure safety, support and respect for all health care professionals in their work setting; and (e) promoting and protecting in particular health and well-being of vulnerable groups.
460 THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B 291" NOVEMBER, 2 ANN EXURE IV [See reg.7 (2)1 DUTIES OF A MEDICAL PRACTITIONER REGISTERED WITH THE MEDICAL COUNCIL I Patients must be able to trust medical practitioners with their lives and well being.

To justify that trust, the medical practitioners, being members of the medical profession, have a duty to adhere to the code of conduct and maintain good standard of practice and care and to show respect for human life.

2.
2.

In all these matters a medical practitioner must never discriminate unfairly against his patients or colleagues and a medical practitioner must always be prepared to justify his actions to the patients.

3.
In particular, as a medical practitioner one must- ) take the care of his patient as his first concern; (ii) treat every patient politely and considerately; ) respect the dignity and privacy of the patients; (iv) listen to the patients and respect their views; (v)give patients information in a way they can understand; (vi) respect the rights of patients to be fully involved in decisions about their care: (vii) keep one's professional knowledge and skills up to date; (viii) recognize the limits of one's professional competence; (ix) be honest and trustworthy; (x) respect and protect confidential information; ( x i) ensure that his personal beliefs do not prejudice the care of patients; (xii) act quickly to protect patients from risk if the medical practitioner has good I THE OFFICIAL GAZETTE [LEGAL SUPPLEMENT] — B TH NOVEMBER, 2008 reasons to believe that he or a colleague may not be fit to practice; (xiii) avoid abusing his position as a medical practitioner; zu-id (x iv) work with colleagues in the ways that best serve patients' interests.
Made this 3 lad day d • 2008; ti Minister of Itealth