Code of Ethics – Preliminary Statement

Preliminary Statement

The profession of medicine has a duty to maintain and improve the health and wellbeing of the people, and to reduce the impact of disease. Its knowledge and consciousness must be directed to these ends. The medical profession has a social contract with its community. In return for the trust patients and the community place in doctors, ethical codes are produced to guide the profession and protect patients. This document represents a further stage in that evolutionary process.

This document does not purport to set out rigid, immutable rules. It revises the Code of Ethics and provides guidelines endorsed by the Council of the New Zealand Medical Association. The Code will be reviewed at regular intervals and, to this end, comment and feedback is invited.1

The basis of the moral framework for medical practice has been developed gradually over several thousand years, and is therefore well established, whereas guidelines for professional behaviour must reflect the changing social and cultural environment in which doctors practise. The moral basis for practice has its expression through what is commonly termed medical ethics. Integral to an ethical basis for professional practice is the overriding acceptance of an obligation to patients,2 and recognition of their autonomy.3

Standard treatises on medical ethics cite four moral principles: autonomy, beneficence, non-maleficence and justice. Autonomy recognises the rights of patients to make decisions for themselves. Beneficence requires a doctor to achieve the best possible outcome for an individual patient, while recognising resource constraints. Non-maleficence implies a duty to do no harm. (This principle involves consideration of risks versus benefits from particular procedures.) Justice incorporates notions of equity and of the fair distribution of resources. In New Zealand today, there is also an increasingly wide recognition of the principle of partnership—between doctor and patient; profession and society; and different cultures—as an important aspect of the ethos of professional practice.

The concept of the autonomy of doctors also needs to be considered, although this principle has always been tempered with common sense and recognition of the duty to act within the limits of one’s own capabilities. Some ethicists are beginning to argue for a fifth principle, namely, the duty of doctors in some circumstances to recognise the need to work in collaborative groups, sharing their skills, experience and judgement with others. In today’s world, doctors have an increased ethical responsibility to participate in reviewing formally their own and others’ work to maintain standards of practice.

The concept of accountability, as applied to the medical profession, needs to encompass a widening set of relationships and contexts. An increasing number of statutory and commercial organisations interact with doctors in relation to issues of accountability. Increasingly, doctors are experiencing difficulty in balancing the requirements of their primary obligation to individual patients and families/whānau with their responsibilities to the wider community. Many commercial concepts, including that of intellectual property and that of contracting with various funding bodies, are challenging aspects of medical organisation and professional practice.4

Changes in the context of medical practice are reflected in a new section on Doctors in a Just and Caring Society to address the wider social responsibilities of doctors.

Faced with this complex and changing situation, the New Zealand Medical Association affirms its adherence to certain ethical principles. Patients have a legal right (under the Code of Health and Disability Services Consumers’ Rights) to services that comply with ethical standards such as this Code of Ethics. While the Medical Council of New Zealand has developed Good Medical Practice as a foundation document for professional and legal standards, the Council recognises the New Zealand Medical Association’s Code of Ethics as the key source of advice on ethics for the medical profession. The Association accepts responsibility for delineating standards of ethical behaviour expected of doctors in New Zealand and has consulted widely in the development of this Code.

The NZMA urges Members and all doctors to follow the standards set out in the Code of Ethics. Find these here.

References

  1. Comments should be sent to: New Zealand Medical Association, PO Box 156, Wellington.
  2. The NZMA strongly favours retention of the word “patient” because it reflects accurately the nature of the relationship between a doctor and the person seeking help.
  3. The NZMA recognises no distinction, in terms of accountability, between conventional and alternative medicine when practised by a registered medical practitioner. All treatments should be subject to the same standards in respect of the rigour with which they are subjected to scientific testing and the ethics applicable to their use.
  4. The concept of intellectual property and its protection is relatively recent. The patenting of inventions based on an individual’s thinking and research is becoming widespread. The ethical issues related to this are at present being defined and the present code cannot encapsulate any established pattern.