Ethics of the Medical Profession Regulations, 2008

L.N. 303 of 2008

HEALTH CARE PROFESSIONS ACT

(CAP. 464 )

Ethics of the Medical Profession Regulations, 2008

IN exercise of the powers conferred by articles 10(1)(d) and

51(1)(d) of the Health Care Professions Act, the Medical Council, as

authorised by the Minister for Social Policy, has made the following

regulations>-

(1) The title of these regulations is the Ethics of the Medical

Profession Regulations, 2008.

(2) The scope of these regulations is to inform the

practitioners of the particulars of the professional and ethical standards

adopted by the Council and of certain forms of conduct which may be

held by the Council to constitute misconduct in a professional respect.

For the purposes these regulations >

(Regulation 22)

ETHICS OF MEDICAL PRACTITIONERS

1. (a) The Medical profession occupies a position of trust in society. A doctor’s

calling is to serve humanity under all conditions. Members of the profession have built

up a tradition of placing the needs of the patient above all else.

(b) On admission to the medical field every new member not only succeeds

to benefit of its special place in society, but also takes upon himself the duty of

maintaining this high position. The justification for the freedom of medicine lies in the

hands of those who practise it.

2. In all matters bearing on faith or morals the catholic member of the profession

shall abide by the tenets of the Roman Catholic Apostolic Religion in terms of article

2 of the Constitution.

3. The attention of members of the medical profession is drawn to the General

Notice issued by the Medical Council for the guidance of members of the professions

upon which it exercises disciplinary jurisdiction.

4. In addition to the requirements of the Medical Council, there are customs

and ethical rules which are observed by the profession as a code of conduct. The endless

number of situations that might and do arise in the course of professional life cannot be

all specifically covered by any set of rules. The following rulings are accepted as

covering the major and the more common features of professional life and will serve to

illustrate the principles of behaviour. These principles can and should be applied to

such other problems and situations as may arise.

5. A doctor shall by his conduct and in all matters set a high standard.

6. A doctor in the pursuit of his profession must not allow himself to be influenced

by motives of profit.

7. A doctor shall neither instigate nor condone any advertisement relating to his

professional status of work. (Also see circular MC#435#93 of 1.10.1993 relating to the

publication of announcements about career and academic achievements.)

8. A doctor shall not accept conditions of service which do not ensure his

professional independence. (Also see circular MC#145#93 of 22.2.1993 on safeguarding

professional independence.)

9. A doctor shall not in any circumstances do, authorise to be done or condone

anything that would weaken the physical or mental resistance of a human being, except

for the prevention and treatment of disease.

10. A doctor must always bear in mind the importance of preserving human life

from the time of conception until death.

11. (a) A doctor shall not hesitate to propose or to accept consultation with a

professional colleague when, for any reason, this appears to be desirable in the interest

of the patient. The attendance of a consulting practitioner shall cease when the

consultation is concluded, unless another appointment is arranged by the medical

attendant.

(b) When a consultant sees a patient in his rooms at the request of his

medical attendant, it is his duty to write to the latter stating his opinion on the case and

the mode of treatment which he thinks should be adopted.

(c) Whenever an irreconcilable difference of opinion between practitioners

occurs, the circumstances should be frankly and impartially explained to the patient or

his relatives either by the consultant or by the medical attendant in the presence of the

former.

(d) When it becomes the duty of a practitioner occupying an official position

to see and report on a case of illness or injury, he should communicate with the patient

and inform him that he is entitled to ask his practitioner to be present during the

examination. The practitioner who is officially reviewing the case shall scrupulously

avoid any interference with, or remarks on, the treatment or diagnosis that has been

adopted. (Also see circulars MC#145#93 of 22.3.1993 and MC#180#99 of October 1999

on clarifying the procedure to be adopted during such visits.)

12. (a) A medical practitioner shall not voluntarily disclose without the consent

of the patient, preferably to be given in writing, any information, including any

certification, which he has obtained in the course of his professional relationship with

the patient. An exception to this rule may only be made in terms of the requirements of

local laws.

(b) Any conviction under this provision may also involve disciplinary action

to be taken by the Medical Council.

13. (a) When the medical practitioner is requested to attend a patient who is

already under the care of another practitioner, where the case is not one of emergency,

he shall decline to do so except in consultation with the practitioner in attendance or in

cases where the consultation is not agreed to, until the practitioner in attendance has

been informed, preferably in writing, that his services are no longer desired.

(b) A medical practitioner who has been called upon in an emergency to

visit a patient who, under ordinary circumstances, would have been attended to by

another practitioner, shall, after the emergency has been provided for, retire in favour

of the ordinary medical attendant but shall still be entitled to charge the patient for his

services.

(c) When a practitioner is consulted in his own office, it shall not be

necessary for him to enquire whether the patient is under the care of another practitioner.

14. It is desirable that the family doctor be present during operations and in that

case he shall charge a fee for his attendance. If he assists, his fee shall be included in

the fee for the operation and the patient or his family will be informed accordingly.

15. A medical practitioner shall not circulate professional cards to chemists or

opticians< nor should he have any salary or commission or any other arrangement with

a chemist or optician< he shall not have any financial interest either directly or indirectly

in a local chemist’s shop.

16. In respect of –

(a)

untrue certification or report<

(b) covering and association with unqualified or unlicensed persons<

(c) contravention of the Dangerous Drugs Ordinance, Cap. 101, and

regulations made thereunder<

(d) advertising, canvassing, lectures, broadcasting, etc.,

the attention of members of the medical profession is drawn to the General Notice

mentioned in paragraph 3 hereof issued by the Medical Council and published in the

Government Gazette of the 23rd June, 1981, with amendments as published in the

Government Gazette of the 27th January, 1984.

“the Act” means the Health Care Professions Act<

“practitioner” means a medical practitioner or dental surgeon

registered under the Act<

“the registers” means any of the registers mentioned in articles

11 and 12 of the Act.

(Regulation 22)

ETHICS OF DENTAL PRACTITIONERS

1. The attention of members of the dental profession is drawn to the General

Notice issued by the Medical Council for the guidance of members of the professions

upon which it exercises disciplinary jurisdiction, published in the Government Gazette

of the 23rd June, 1981, with amendments as published in the Government Gazette of

the 27th January, 1984.

2. In respect of –

(a)

abuse of a professional relationship<

(b) convictions<

(c)

untrue certification and reports<

(d) advertising, canvassing, broadcasting, etc<

(e) contravention of the Dangerous Drugs Ordinance, Cap. 101, and

regulations made thereunder<

(f)

covering<

(g) commissions<

(h) dichotomy<

(i) undercutting< and

(j) professional secrecy,

the attention of members of the dental profession is drawn to the General Notice issued

by the Medical Council and mentioned in paragraph 1 hereof.

3. Wherever the word “practitioner” is used in this Notice, it means a dental

surgeon or a dentist.

4. (a) A practitioner shall not hesitate to propose or to accept consultation

with a professional colleague when, for any reason whatsoever, such consultation

appears to be desirable in the interest of the patient. The attendance of a consulting

practitioner shall cease when the consultation is concluded unless another appointment

is arranged by the attending practitioner.

(b) When a practitioner sees a patient in his rooms at the request of his

medical attendant or of another practitioner, it shall be his duty to write to the latter

stating his opinion on the case and the mode of treatment he thinks should be adopted.

(c) Any difference of opinion should not be divulged unnecessarily< but

when there is an irreconcilable difference of opinion, the circumstances should be

frankly and impartially explained to the patient’s relatives. It would then be open to

them or to him to seek further advice, either preferably in consultation with the person

who is already in attendance or with the medical attendant or practitioner only.

(d) When it becomes the duty of a practitioner occupying an official position

to see and report on a case of illness or injury, such practitioner should communicate

with the patient informing him that he is entitled to ask his practitioner to be present

during the examination. The practitioner who is seeing the case officially shall

scrupulously avoid interference with, or remarks on, the treatment or diagnosis that

has been adopted.

5. A practitioner must not disclose voluntarily, without the consent of the patient,

preferably in writing, information, including certification which he has obtained in the

course of his professional relationship with the patient. Exception to this rule is made

only by the requirements of the local laws.

6. (a) When a practitioner is requested to attend to a patient who is already

under the care of another practitioner and where the case is not an emergency, he shall

decline to do so, except in consultation with the practitioner in attendance, or in case

the consultation is not agreed to, until the practitioner in attendance has been informed,

preferably in writing, that his services are no longer required.

(b) A practitioner called in an emergency to visit a patient, who under

ordinary circumstances would have been attended to by another practitioner, shall,

when the emergency has been provided for, retire in favour of the ordinary practitioner,

but shall still be entitled to charge the patient for his services.

(c) When a practitioner is consulted at his own office, it shall not be

necessary for him to enquire whether the patient is under the care of another practitioner,

but if that fact shall transpire, the interest of the patient for courtesy may require that

the practitioner or medical attendant be informed of the consultation and its results.

7. (a) No practitioner shall accept a commission or consideration for the

introduction of a patient to a consultant, to a private hospital or other institution, or to

a medical practitioner, chemist, nurse, midwife or other person or company and he

shall not pay a consideration for the introduction of patients to himself.

(b) A practitioner shall not participate in any division of sharing of fees of

which the patient is not aware, excluding a normal dental clinic partnership, and this

shall apply to consultations between practitioners or medical practitioners.

8. A practitioner shall neither instigate nor condone any advertisement relative

to his professional status or work.

9. The professional conduct of a dental practitioner is guided by principles

essentially similar to those adopted by the medical profession and the relations between

a medical practitioner and a dental practitioner shall be subject to the same

considerations.

Mitbug[ fl-Istamperija tal-Gvern – Printed at the Government Printing Press

€1.30

(1) The Council may open an inquiry into those convictions

for criminal offences committed by practitioners other than those

specifically mentioned in the Act.

(2) In considering a conviction the Council shall determine

whether the gravity of any offence committed by a practitioner renders

necessary the erasure of the name of such practitioner from the registers.

The following offences shall be deemed to be offences which

may entail erasure from the registers or any other disciplinary action>-

(a) acts of immorality, indecency or dishonesty or any other

act involving the abuse of a professional relationship<

(b) treating or attending to patients while the practitioner is

under the influence of any drink or drugs<

(c) driving or being in charge of a motor vehicle when under

the influence of drink or drugs, or being found drunk, or being

drunk and disorderly or incapable of properly looking after oneself<

(d) forgery, fraud, embezzlement and cognate offences<

(e) gross or prolonged neglect of duties and disregard of

personal responsibilities to patients, clients and the public<

(f) dealing in the commerce of drugs, medicinals and other

remedies by medical practitioners, dental surgeons and veterinary

surgeons.

(1) No practitioner shall for the purpose of being engaged Advertising and

canvassing.

by patients or of promoting his own professional advantage>

(a)

advertise or canvass directly or indirectly,

(b) employ or is professionally associated with anyone who

so advertises or canvasses,

(c) procure or acquiesce in the publication of notices

commending or drawing attention to his own professional skill,

knowledge, qualifications or services or depreciating those of other

practitioners.

(2) Any practitioner who is found guilty of any of the

offences referred to in sub-regulation (1) hereof shall be liable to

disciplinary action.

(3) The provision of factual information about the services

offered by a practitioner to patients shall not be deemed to be contrary

to the provisions of this regulation.

The factual information referred to in the preceding regulation Factual information.

(a)

be demonstrably true in all respects<

(b) not be misleading, vulgar or sensational<

(c) seek to maintain the decorum and dignity of the

profession<

(d) not contain any testimonial or endorsement of clinical

skills<

(e) not claim that any one doctor is superior to others, nor

contain any endorsement for any particular doctor<

(f) avoid aggressive forms of competitive persuasion, such

as those that prevail in commerce and industry<

(g) be honest and never exploit a patient’s vulnerability or

lack of medical knowledge<

(h) be presented discreetly so as to facilitate informed

decision making.

(1) Practitioners shall not >

(a)

publicly endorse any particular commercial product or

service<

(b) publicly associate themselves with any product, such as

a tobacco product, which clearly affects health adversely since

such action may give an inappropriate message to the public<

(c) overtly and publicly endorse advertisements for health-

related services, such as nursing homes and private clinics.

(2) When a practitioner becomes publicly associated with

a particular commercial product or service, the practitioner shall ensure

that endorsement is not inadvertently stated or implied.

(3) In the case of practitioners who have any kind of

financial or other involvement, directly or indirectly, with any

organisation, they shall exercise due diligence to ensure any advertising

conforms with these guidelines and avoid involvement in promoting

the services of the organisation.

(1) Signs exhibited in connection with a practice should not

exceed what is reasonably necessary to indicate to those who are seeking

the practice, the location and of the premises and entrance thereto.

(2) The name of every practitioner regularly attending

patients should be shown at the premises where he practises his

profession by means of a professional plate. The name of persons other

than practitioners, employed in the practice, need not appear on such

signs.

(3) The sign shall not indicate that a practitioner is in regular

attendance at a practice when he is not. The professional plate of a

former practitioner shall be retained for one year only if the name on

the plate is preceded by the word “late” or “formerly”.

(4) In those cases where the practice is carried on in a private

house>

(a) the entrance thereto may be illuminated by means of a

small lamp< and

(b) there should be no lettering other than the number or

the name of the house.

(5) If a practice is carried out in an office block or business

centre>

(a) the professional plate may conform with others in the

same place<

(b) no hanging sign or illuminated box shall be allowed<

(c)

daylight, flashing or neon signs are not permissible.

(6) The professional plate, letterheads used in professional

practice and any notice appearing in any medium accessible to the public,

may include the practitioner’s name, qualifications, degrees and special

qualifications registred with the Medical Council and any other diploma

or degree granted by universities, colleges or other recognised

professional bodies and a title describing the type of practice.

(7) All qualifications should appear in the usual abbreviated

manner, as approved by the institution awarding them, but the names of

hospitals where one has studied or held appointments shall not appear

on a nameplate.

(8) (a) The word “consultant” may only be used by persons

who hold or have held such an appointment.

(b) The word “specialist” may only be used by persons

who have completed their specialist training and are listed as such in

the Specialist Register held by the Medical Council.

(9) The nameplate may also give an indication of the hours

of attendance, provided that neither the plate nor the lettering are

unnecessarily large or brightly coloured. The exhibition of notices

describing the nature of treatment provided is not allowed.

(10) A practitioner shall be responsible for all signs, plates

and notices which are directly or indirectly related with his practice and

which are situated in the public part of the pharmacy or premises.

(11) The words “clinic”, “surgery”, “dental surgery”,

“office” or “consulting rooms” shall only be used to describe the place

where a practice is carried out.

It shall be the duty of every practitioner to ensure that the

windows and doors of his surgery and waiting rooms are adequately

screened from public view unless such waiting or consulting rooms are

situated within a pharmacy.

(1) While practitioners may be involved in publishing, it

television, and radio

shall however be ensured that there is no improper or undue advertising.

(2) In granting interviews to the media, practitioners shall

assume full responsibility for anything appearing in print or broadcast

as a result thereof and a practitioner involved in public activities should

be particularly careful to ensure that no publicity is given to his practice.

Practitioners may participate in the presentation and

discussion of medical, quasi-medical, dental or veterinary topics in

newspapers or on radio or television, however the information given

shall not in any way remark any unique or outstanding qualities or any

greater experience in a particular field and practitioners shall maintain

anonymity especially in circumstances where the practitioner refers to

his personal management of individual clinical matters.

(1)

Entries in telephone directories, including classified

lists>

(a)

shall be in normal type<

(b) shall include the practitioner’s name and address<

(c) may include his qualifications, degrees or special post-

graduate diplomas<

(d) may have an indication of his type of practice.

(2) No other special entries are allowed nor should an entry

appear which does not include the practitioner’s name and address.

(1) Communications to patients>

(a)

shall be sent in sealed envelopes< and

(b) shall not draw attention to the professional skill of any

practitioner.

(2) Recall cards should be sent only with the prior written

agreement of the patients to whom they are addressed.

(3) Communication with patients should be clear and

effective and in such a manner that the patient understands fully and

clearly what is being said.

(1) A practitioner shall not call upon or communicate with Canvassing.

any person who is not already a patient of his practice with a view to

providing advice or treatment unless he has been expressly requested

to do so by the person himself or by another person authorised to do so

on his behalf.

(2) A practitioner may, however, on acquiring a practice

notify persons whom he is reasonably entitled to assume to be patients

of that practice.

A practitioner shall not enter into any arrangements by which Illicit arrangements.

patients are referred to him by non qualified persons, nor should he pay

any commission or grant any special discount to any person or

organisation other than according to the provisions of these regulations.

A practitioner may be deemed to be involved in canvassing Inducement.

if, without the consent of the administrator of the institutions providing

professional services, he attempts to induce persons to contact him for

treatment or advice.

Any practitioner who signs and issues any certificate, report Certificates, reports,

notifications and

or other document containing statements which he knows, or ought to other documents.

know, to be untrue, misleading or otherwise improper, shall be liable to

have his name erased from the register.

(1) No practitioner shall enable an unqualified person to “Covering” and

association with

exercise his profession, attend in any manner to any matter requiring unqualified persons.

professional knowledge and skill, issue or procure the issue of any

professional document or otherwise act as if he were duly qualified or

registered.

(2) The preceding sub-regulation shall not apply when the

practitioner is supervising over any person so employed and retains

personal responsibility for the professional services rendered in the case

of>

(a) the training of medical, dental or any bona fide students,

or

(b) the legitimate employment of nurses, midwives,

physiotherapists and other persons trained to perform specialised

functions relevant to different professions.

Every practitioner shall abide by the obligations set out by

the Dangerous Drugs Ordinance and any regulations made thereunder.

Any breach of the provisions thereof shall render the practitioner liable

to his name being erased from the register.

It shall be the duty of practitioners to comply with the laws

of Malta.

(1) Practitioners shall neither circulate professional cards

through each other nor pay any commission or allow any discount or

any other arrangement with each other or with any proprietor of a

business concern.

(2) A practitioner may not accept a commission for the

introduction of a patient or a client to a consultant, to a private hospital

or other institution, or to a medical practitioner, or to a dental surgeon

or dentist, to a veterinary surgeon, apothecary, nurse, midwife or any

other person or company.

Practitioners shall not participate in any division or sharing

of fees of which the patient or the client is not aware.

(1) It shall be unlawful for any practitioner to charge a fee

less than that established in the official Tariff of Fees unless he is satisfied

that the patient does not have sufficient means to pay such fee.

(2) In special cases bills exceeding 30 euro may be decreased

by not more than 10 per cent.

Every practitioner shall abide by the relevant provisions of

the Laws of Malta and by the code of ethical standards for the general

guidance of the profession in Schedules A and B to these regulations.

Any change of address and of surgery hours may be

communicated to patients by a suitable notice being placed in the waiting

room and may also be announced for not more than three times through

the press provided such announcements are made in normal type.

(1) When a practitioner has reason to believe that a patient

is suffering from a condition arising from, or in connection with, dental

treatment, it is the duty of the practitioner concerned to recommend to

the patient to permit him to communicate with a dental practitioner.

(2) In those cases where the patient refuses this proposal,

the practitioner may give such treatment as may be necessary to deal

with the emergency condition.

(3) The practitioner shall not refer the patient to a second

dental practitioner unless he obtains from the patient permission to

disclose this fact to the first dental practitioner.

(4) (a) In those cases where a patient is not being followed

by a dental practitioner, it is acceptable, following the specific request

of the patient, for the medical practitioner to indicate the name of a

dental practitioner without indicating the treatment which he considers

should be given by the dental practitioner.

(b) The medical practitioner may, with the permission of

the patient, communicate with the dental practitioner and if the medical

practitioner requires a further medical or dental opinion, a pathological

or radiological report from a third party, or a reference to a hospital, he

shall inform the dental practitioner concerned of the proposed action

and of the subsequent outcome.

(5) When treating a patient, a dental practitioner may select

an anaesthetist to ssist him, but if the anaesthetist is not the patient’s

own medical practitioner no objection should be made to the patient

inviting his own medical practitioner to be present. Where the patient is

under medical care the dental practitioner may be expected to inform

the patient’s medical practitioner of any proposed operation requiring

an anaesthetic.