Recommendations from the Code of Ethics for the New Zealand Medical Profession.

1. Doctors should ensure that all conduct in the practice of their profession is above reproach. Exploitation of any patient, whether it be physical, sexual, emotional or financial, is unacceptable and the trust embodied in the doctor-patient relationship must be respected.
2. Doctors, like a number of other professionals, are involved in relationships in which there is a potential or actual imbalance of power. Relationships between doctors and their patients or students fall within this category. The NZMA expects doctors to be familiar with Medical Council policy in relation to sexual boundaries in doctor-patient relationships. It is the responsibility of the doctor to maintain appropriate sexual boundaries with their patients.
3. The NZMA considers that breaching sexual boundaries with a current patient is unethical and that, in most instances, a breach of sexual boundaries with a former patient would be regarded as unethical. It is acknowledged that in some cases the patient-doctor relationship may be brief, minor in nature, or in the distant past. In such circumstances and where a sexual relationship has developed from social contact away from the professional environment, impropriety would not necessarily be inferred. Any complaints about a sexual relationship with a former patient therefore need to be considered on an individual basis before being regarded as unethical.
4. Doctors should ensure that patients are involved, as far as possible, in understanding the nature of their problems, the range of possible solutions, and the likely benefits, risks and costs, to assist them in making informed choices.
5. Doctors should, within reason, provide adequate information to their patients about their assessment and treatment options, including those not readily available.
6. Doctors should take reasonable steps to ensure that each patient receives appropriate available investigation into their complaint or condition, including adequate collation of information for optimal management.
7. Doctors should recommend only those diagnostic or screening procedures and treatments which seem necessary to assist in the care of the patient or the management of public health risks.
8. Doctors should ensure that patients are promptly informed of any adverse event that occurs during care for which the doctor has individual or direct overall responsibility.
9. Doctors should access patient health records only when there is an appropriate reason.
10. Doctors should ensure that information is recorded in an accurate and timely manner.
11. Doctors have an obligation to guard against unauthorised access to any health information they have collected pertaining to identifiable patients, including when transferring data.
12. Doctors should keep in confidence information derived from a patient, or from a colleague regarding a patient, and divulge it only with the permission of the patient or in those unusual circumstances when it is clearly in the patient’s best interests or there is an overriding public good, including the risk of serious harm to another person. If there is any doubt, doctors should seek guidance from colleagues or an appropriate ethics committee.
13. When appropriate, doctors should communicate with colleagues who are involved in the care of the same patient. This communication should respect patient confidentiality and be confined to necessary information. Patients should be made aware of this information sharing, which enables the delivery of good quality medical care. Where a patient expressly limits possession of particular information to one practitioner, this must ordinarily be respected. Patients should be made aware in advance, if possible, where there are limits to the confidentiality that can be provided.
14. When it is necessary to divulge confidential patient information without patient consent, this must be done only to the proper authorities, and a record kept of when reporting occurred and its significance. Whenever possible, the patient should be informed this has occurred.
15. Where a doctor is performing an assessment on behalf of a third party, the patient must be clearly informed of the identity of the third party, the purpose of the assessment and the limits of confidentiality. Where the assessment occurs in the context of a treating relationship, the patient should be made aware that the doctor is ethically obliged to provide a complete and professional report.
16. Doctors should recognise the right of patients to choose their doctors freely.
17. Doctors have the right, except in an emergency, to refuse to care for a particular patient. In any situation which is not an emergency, doctors may withdraw from or decline to provide care as long as an alternative source of care is available and the appropriate avenue for securing this is known to the patient. Where a doctor does withdraw care from a patient, reasonable notice should be given and an orderly transfer of care facilitated.
18. When a patient is accepted for care, doctors should render medical service to that person without discrimination (as defined by the Human Rights Act).
19. Doctors should recognise the needs of patients to receive culturally sensitive and competent care.
20. Doctors should ensure that continuity of care is available to all patients, whether seen urgently or unexpectedly, or within a long-term contractual setting, and should assure themselves that appropriate arrangements are available to cover absence from practice or hours off duty, informing patients of these.
21. Doctors should respect the right of a patient to have access to further management in situations where there is a moral or clinical disagreement about the most appropriate course to take.
22. Doctors should recognise their own professional limitations and, when indicated, recommend to patients that additional opinions and services be obtained, and accept a patient’s right to request other opinions. In making a referral to another health professional, so far as practical, the doctor should have a basis for confidence in the competence of that practitioner.
23. When requested or when need is apparent, doctors should provide patients with information required to enable them to receive benefits to which they may be entitled.
24. When undertaking remote consultation, doctors should always exercise judgement as to whether diagnosis and treatment by this means is appropriate. It is essential that the doctor and patient be able to reliably identify each other when engaging in remote consultation. The interaction should be documented in the patient’s clinical record.
25. Doctors must be aware of statutory provisions and the codes of the Privacy Commissioner, the Human Rights Commissioner and the Health and Disability Commissioner, and the requirements of the Medical Council of New Zealand.
26. Doctors should accept that autonomy of patients remains important in childhood, chronic illness, ageing and in the process of dying.
27. When patients are not capable of making an informed choice or giving informed consent, doctors should consider any previously expressed preferences from the patient, the wishes of the family/ whānau, guardian or other appropriate person, and consult colleagues before making management decisions, which may include recourse to the courts for determination.
28. Doctors should always bear in mind the obligation of preserving life wherever possible and justifiable, while allowing death to occur with dignity and comfort when it appears to be inevitable. In such inevitable terminal situations, treatment applied with the primary aim of relieving patient distress is ethically acceptable, even when it may have the secondary effect of shortening life.
29. Doctors should be prepared to discuss and contribute to the content of advance directives and give effect to them. In the case of conflicts concerning management, doctors should consult widely within the profession, with the family/whānau and, if indicated, with ethicists and legal authorities.
30. In relation to transplantation and requests for organ donation, doctors should accept that when death of the brain has occurred, the cellular life of the body may be supported if some parts of the body might be used to prolong or improve the health of others. They should recognise their responsibilities to the donor of organs that will be transplanted by disclosing fully to the donor or relatives the intent and purpose of the procedure. In the case of a living donor, the risks of the donation procedures must be fully explained. Doctors are obliged to provide reassurance and support to all donors and/or their family/whānau members (in the case of a deceased donor). Doctors should ensure that the determination of death of any donor patient is made by doctors who are in no way concerned with the transplant procedure or associated with the proposed recipient in a way that might exert any influence upon any decisions made.