PCP Code of Ethics

Medical ethics is currently based on the principles of respect for persons, beneficence, non-maleficence
and justice. The principle of respect for persons emphasizes respect for patient autonomy- the duty to
protect and foster a patient's voluntary informed choices, and truth-telling. The principle of beneficence
defines the duty to promote good and act in the best interest of the patient and the health of society. The
principle of non-maleficence refers to the duty to do no harm to patients. Finally, the principle of justice
must inform the physician's role as a citizen and his/her decisions on resource allocations. In facing
challenges to resolve many issues in the delivery of care, the physician needs the virtues of compassion,
courage and patience.

In preparing this set of guidelines, the Ad Hoc Ethics Committee was careful that it remains a reflection of
the ethical principles embodied in the PCP Code of Ethics. The Guidelines attempts to clarify how ethical
principles are applied to specific health care conditions like futile treatments, alternative care, terminal
illness, genetic testing, and reproductive health even as we strongly believe that these guidelines cannot be
a substitute for the wisdom gained from experience and the integrity of individual physicians.

Since these guidelines are also meant to be used as basis for decisions/ actions in the resolution of
conflicts, it defines the composition, duties and responsibilities of the members of the Ethics Committee and
describes the process by which ethical issues and complaints are addressed.

In putting together this set of Implementing Rules and Regulations, the Philippine College of Physicians has
made an important step in fulfilling its duty to set standards of behavior for its members towards their
patients, colleagues, other health professionals, and the health industry. Additionally, through this
Guidelines, the PCP upholds the duties of it members to the community and country. Clearly, it reminds of
the shared obligations and duties of the medical profession.

The PCP Ad hoc Ethics Committee

September 2008-March 2009

CODE OF MEDICAL ETHICS

PREFACE

All members (Affiliate Members, Full Members [Diplomate ], Fellows) of the College are deemed covered
by the provisions of this code.

The principles laid down in this code are of general application and will serve as the basis for the guidelines
in the practice of internal medicine concerning ethical practice and good conduct. They represent what we
espouse as true professionals and as an organization working for the highest standards of professionalism,
ethics and medical practice.

GENERAL PRINCIPLES

Section 1

All members shall be exemplary in their behavior as members of the community and of the profession.
They shall work harmoniously and regard as uppermost the best interest of patients who are entrusted to
their care. Although the internist is entitled to just compensation, patients’ welfare should be primary.

Section 2

The internist shall continuously update his professional knowledge and skill by participation and
involvement in all forms of relevant learning activities.

DUTIES TO PATIENTS

The internist shall ensure that the patient’s best interest is safeguarded. He is obliged to inform his patient
as to the nature of illness, diagnosis, progress of care and prognosis.
He is expected to respect confidentiality on all information entrusted to him by the patient unless a legal
waiver has been given and authorized.

The internist is entitled to a reasonable compensation commensurate to his efforts and expertise taking into
account the patient’s capacity to pay.

DUTIES TO COLLEAGUES IN THE PROFESSION

There must be harmonious relationship among the members. An internist shall be expected to render
gratuitous and just service to licensed practicing physicians and their immediate dependents.

The internist shall be circumspect when making remarks about other physicians.

RELATIONSHIP WITH ALLIED PROFESSIONS

Communications between the Internist and nurses and other allied professionals, shall be characterized by
mutual respect, always taking into account the welfare and best interest of the patient. Sharing of medical
opinions as to the condition of the patient should always be welcome.

RELATIONSHIP WITH PHARMACEUTICAL INDUSTRY

The internist’s decision for patient’s care which includes prescription of medicines and use of necessary
equipment shall be determined first and foremost by the patient’s welfare

Sponsorship to medical seminars and conventions by the pharmaceutical industry must ultimately redound
to the benefit of the patient particularly in the advancement of scientific knowledge of the Internist.

RELATIONSHIP TO THE COMMUNITY

The honorable standing of the profession should not be stained by any form of advertisement.

Advocacy in all matters affecting people’s health and the practice of the profession should be strongly
encouraged.
 IMPLEMENTING GUIDELINES OF THE PCP CODE OF ETHICS

These guidelines shall be used for decisions/actions related to the practice of Internal Medicine by the
members of the Philippine College of Physicians. The document is organized according to the principles
and provisions of the PCP Code of Medical Ethics and the PMA Code of Ethics.

DUTIES TO PATIENTS

1. The Physician shall not discriminate against a patient on the basis of gender, race, class, creed or
political affiliation.

2. The attending physician shall dedicate time and effort in conducting an appropriate communication
with the patient and/or family with regards to the following:

- the nature of the disease or illness and its prognosis

- management plan including alternatives or options
- possible responses to treatment
- resources required eg. cost of treatment, need for life support, etc.

It is understood that the above is a continuing process.

3. The Physician shall take time to listen to the patient and address concerns and/or questions
regarding the illness.

4. The Physician must be open to and encourage the participation of the patient in decisions
regarding the illness.

5. The physician shall perform the physical examination with care and respect. Propriety shall be
ensured in the presence of an appropriate third party with the consent of the patient.

6. The Physician should not release a patient’s personal medical information without the patient’s
consent. To uphold professionalism while protecting the patient’s privacy, a physician shall limit
discussion of a patient or patient care issue to professional encounters. Special care must be
observed in discussing a patient’s case in public places.

7. The Physician shall respect the refusal of the patient to undergo specific treatments even after
efforts had been exerted to make the patient understand the alternatives and consequences.

8. The Physician shall recognize his/her limitations and refer/transfer the care of the patient to the
appropriate medical practitioner (Other Physician) with the proper consent of the patient and/or
family. The preference of the patient for the Other Physician shall be respected.

9. In case of temporary absence, the attending physician shall so inform the patient and make the
necessary arrangements/endorsements (eg. written on the chart) for continuity of appropriate care.

10. The Physician shall be gracious in respecting the decision of the patient and /the family to seek a
second opinion regarding the illness and its management.

11. The Physician shall not take advantage of the physician-patient relationship to seek favors (eg.
sexual, financial, etc.)

12. Under exceptional circumstances, the Physician may discontinue the professional relationship,
provided that adequate care is available elsewhere and the patient’s health is not jeopardized in
the process. In these cases, proper notification and information must be provided to the patient
with compassion, sensitivity and civility.

13. The Physician shall respect the patient’s decision to discontinue the professional relationship and
provide the proper endorsement (eg. transfer of results of laboratory and diagnostic examinations)
regarding the patient’s illness.
14. The patient shall be allowed access to pertinent medical records that may include:

- the working diagnosis and course of illness while under the care of the Physician
- Results of the physical, laboratory and ancillary examinations
- medications and other treatment modalities given

15. The Physician shall exercise utmost compassion, sensitivity and judiciousness in the management
of the terminally ill patient with special consideration to family and economic circumstances. (See
guidelines on the care of the Terminally Ill Patient)

DUTIES TO COLLEAGUES IN THE PROFESSION

1. A Physician shall relate with colleagues with respect, openness and sensitivity especially on
matters pertaining to patient care.

2. When referring to another Physician, the attending physician shall specify the nature of the referral,
i.e., “for opinion”, “for management of a specific problem” or “for co-management”. The attending
physician shall, at all times, be informed of the comments/recommendations/decisions of the Other
Physician.

2.1 if “for opinion”, the Other Physician shall write his/her comments/ recommendations
addressed to the attending physician who will then decide whether or not to accept the
opinion.

2.2 if “for management of a specific problem”, the Other Physician shall limit his/her
actions/decisions to the specific problem.

2.3 if “for co-management”, the Other Physician may proceed to treat the patient based on
his/her assessment.

3. When disagreements arise regarding patient care, the concerned physicians must exert utmost
effort to arrive at a decision for the best interest of the patient.

4. A Physician must exercise utmost care in making any comments regarding patient management
outside of an academic setting in order to protect the reputation and dignity of our colleagues.

5. A physician shall not speak ill of a colleague in front of a patient.

6. Fee splitting, a practice whereby a physician receives a financial return (compensation/ incentive
from another individual or institution, outside of the professional fee) out of a referral or co-
management, is not allowed. It leads to a conflict of interest situation such that the interest of the
patient becomes secondary to economic gain.

7. The following shall be exempted from charging of professional fees:

7.1 medical colleagues

7.2 parents of a medical colleague
7.3 children and spouse of a medical colleague

DUTIES TO THE MEDICAL PROFESSION

1. The physician should bring honor to the medical profession.

1.1 by conducting himself with dignity at all times and in all places by leading a moral life

1.2 by being truthful and just (even against your colleagues and fraternity brothers and
sorority sisters). This also includes appropriate claims to authorship of papers or articles.
 1.3 by updating his medical knowledge and expertise. The physician should not rely solely on
industry-provided information or services as a substitute for an objective review of
literature and adequate understanding of the patients’ condition.

1.4 by presenting new developments ideas, and researches thru scientific fora and/or
publications

2 A Physician shall not participate in any form of advertisement of any commercial products.
Commercialism may stain the honorable standing and tarnish the dignity of the profession

3 The physician should not get involved in dubious financial transactions and businesses

4 The physician has the duty to report a colleague who is physically and mentally disabled and is a
threat to the health of the patient. This must be discussed with a higher authority that governs the
said physician.

5 The physician has the obligation to read, to know, to apply the Ethical guidelines.

DUTIES TO THE COMMUNITY AND COUNTRY

1. A Physician is strongly encouraged to advocate for, initiate, participate in and support programs
that promote the right to health of the Filipino people i.e. HERO program

2. A Physician shall place the needs of the country as a primary consideration in making professional
decision.

2.1 A Physician shall consider himself/herself as an important resource especially in times of

disaster and calamities.

2.2 A Physician shall endeavor to contribute to the development of appropriate health

programs and policies

3. A Physician shall support and adhere to the rules and guidelines of the PhilHealth program.

3.1 A Physician shall not recruit patients for purposes of gaining PhilHealth reimbursements.

3.2 A Physician shall clearly discuss with the patient the applicable PhilHealth package and
agree on the terms of payment.

4. A Physician shall not endorse products with no scientific basis, misleading patients of their
therapeutic value.

5 A Physician shall not fabricate certificates to enhance his/her profession.

RELATIONSHIP WITH ALLIED HEALTH PROFESSIONALS

1. A Physician shall relate with other health professionals with respect and shall endeavor to work
with them in a manner that will serve the best interest of the patient.

2 A Physician shall recognize that each member of the patient care team has equal moral status and
shall be open to the opinions of the other members.

3 A Physician shall not provide commissions or financial incentives to allied health professionals who
refer patients to him/her.

4. A Physician shall not seek commissions or financial incentives for referrals to diagnostic
laboratories and other facilities related to health care.
RELATIONSHIP WITH THE HEALTH INDUSTRY

1 Industry Gifts, Hospitality, Services and Subsidies

1.1 The physician should decline any industry gift or service that might be perceived to bias
their professional judgment and compromise patient care.

1.2 It is unethical for physicians to accept any industry gift or subsidy that is predicated on
recommending a particular product or taking a particular clinical action.

1.3 The Physician should not solicit any form of personal service/gifts/favors from the
Pharmaceutical Industries

2. Financial Relationships between Physicians and Industry

2.1 Physicians who have financial relationships with industry, whether as researchers,
speakers, consultants, investors, owners, partners, employees, etc., must not in any way
compromise their objective clinical judgment or the best interests of patients or research
subjects.

a) As owners with financial interests in medical resources

i) It is unethical for physicians to over-utilize resources or make

unnecessary referrals to goods and services for their own financial benefit.

ii) It is unethical to participate in any arrangement that links income

generation explicitly or implicitly to equipment or facility usage or revenues
generated by investor-physicians.

iii) In the event that physicians refer patients to resources in which they have
a material interest, they need to disclose their financial investments and,
to the extent practicable, specify alternative sources of goods and
services.

b) As Consultants, Speakers or Writers in behalf of Industry

i) Physicians should guard against conflicts of interest when invited to

consult or speak for pay on behalf of a health product/service company

ii) Physicians should accept honorariums only for services provided and
must disclose any industry sponsorship or affiliation and other potential
conflicts of interest to formal lecture audiences and publication editors

iii) Speakers should screen industry-prepared presentation aids (such as

slides and reference materials) to ensure their objectivity, and should
accept, modify, or refuse them on that basis

c) As Industry-Sponsored Researchers

i) Physicians are responsible for ensuring that any clinical research in which
they participate is potentially of significant value and is ethically conducted

ii) Physicians have an ethical obligation, based on the principle of patient

autonomy and informed choice, to disclose their commercial ties to
patients who are prospective study participants

iii) Physicians, who involve their own patients in trials, must also be aware of
potential conflicts between what is best for the patient-subject and what is
optimal for the conduct of the research and appropriately address such
 iv) Physicians must ensure that the results of the research are
truthfully/correctly published including negative results.

2.2 Physicians must disclose their financial interest in any medical facilities or office-based
research to which they refer or recruit patients.

SPECIFIC HEALTH CONDITIONS

1 Futile Treatments

(Background: Numerous definitions of futility have been proposed, but none have been universally
accepted. The concept of futility is sometimes used to describe any effort to achieve a result that is
possible but which experience suggests is highly improbable and cannot systematically be
reproduced. [Source: Schneiderman, LJ, Jecker, NS, and Jonsen, AR, "Medical Futility: Its
Meaning and Ethical Implications," Annals of Internal Medicine 112 (1990): 949-54]. The definition
most acceptable for physiological futility is a condition in which it is scientifically impossible to
recover from despite any intervention and from which no patient is ever known to have recovered.
The quantitative aspect of clinical futility requires a probabilistic judgment that an intervention is
highly unlikely to produce the desired result. This judgment arises from general clinical studies and
when available from clinical studies that demonstrate very low rates of success for particular
interventions. It has been suggested that if soundly designed clinical studies reveal less than 1
percent chance of success, an intervention should be considered futile.)

1.1 A clinical judgment that medical intervention is futile, that is, unlikely to achieve any of the
goals of medical treatment or, if it does so, will achieve them in a minimal or transitory way,
provides a sound basis for recommending that intervention be forgone.

1.2 A physician should carefully discuss futility of treatment with the patient or family. S/he
must be sensitively aware of the patient’s evaluation of what results should count as futile.

1.3 Futility should not be invoked when the real problem is frustration with a difficult case or to
reflect the physician’s negative evaluation of the patient’s future quality of life.

1.4 The right of the patient to choose does not imply the right to demand care beyond
appropriate options based on medical judgment and accepted standards of care . . .
[Source: AMA Council on Ethical and Judicial Affairs, "Ethical Considerations in
Resuscitation," JAMA 268 (1992): 2282-88.]

Adapted from Jonsen, Albert, et al. Clinical Ethics, 4th Edition pp. 26-27 and edited by Dr. Marita
Reyes

2. Alternative Care

(Background: Complementary and alternative medicine is defined as a group of diverse medical

and health care systems, practices and products that are not presently considered to be part of
conventional medicine. Complementary medicine is used together with conventional medicine
while alternative medicine is used in place of conventional medicine. Ref: National Ethical
Guidelines for Health Research, 2006. p.42. As health care workers, we should have a coherent
set of ethics. These include applying the best science, continuing our education and refining our
practice, and recognizing that knowledge is only valid if it is based in reality.)

2.1 A physician must try to attain a better understanding of the alternative healing systems and
to appreciate their beneficial features. The physician should be aware of the potential
impact of alternative treatment on the patient’s care.

2.2 A physician should encourage the patient who is using alternative treatment to seek
information from reliable sources.

2.3 The patient’s decision to select alternative forms of treatment should not alone be cause to
sever the patient-physician relationship.
3 Terminally Ill

3.1 A Physician shall recognize and attend to the special needs of the terminally-ill patient and
his/her family that require professional assistance, e.g., information regarding life-
sustaining treatments, care options, advanced care planning, etc.,

3.2 A Physician shall communicate with the patient and his/her family the health situation with
compassion, sensitivity and care.

3.3 A Physician shall respect the patient's right to refuse recommended life-sustaining medical
treatments. This requires empathy, thoughtful exploration of all possibilities, negotiation, or
compromise and may require time-limited trials and additional consultations.

3.4 A Physician shall give time and exert effort to discuss the issue of resuscitation with the
patient and family. The discussion shall include the indications for and outcomes of
cardiopulmonary resuscitation, the physical impact on the patient, implications for
caregivers, the do-not-resuscitate order, the legal aspects of such orders, and the
physician's role as patient advocate.

3.5 A Physician shall provide careful attention to the family's religious or other beliefs or need
for closure.

3.6 A Physician shall endeavor to ensure continuing care in coordination with the family and
other caregivers for the terminally ill.

GENETIC TESTINGS

A Physician shall engage in genetic testing only if s/he or another accessible person has the skills
necessary for pretest and post-test education and counseling. Genetic testing should not be undertaken
until the potential consequences of learning genetic information are fully discussed with the patient, i.e.,
potential impact on the patient's well-being; implications for family members; and the potential adverse use
of such information by employers, insurers, or other societal institutions.

REPRODUCTIVE HEALTH

1. A Physician shall respect the right of patients to relevant information and care regarding
reproductive health.

2. A Physician has the duty to inform the patient about care options and alternatives or refer the
patient for such information.

3. Physicians unable to provide the necessary treatment should transfer care as long as the health of
the patient is not compromised.

SANCTIONS AND PROCEDURES

1. The Committee on Ethics shall investigate any complaint arising out of any violation of the Code of
Ethics upon:
1.1 Written complaint to the PCP by any individual or member;
1.2 Referral by the Board of Regents of any of the committees of the PCP;
1.3 Referral from the Philippine Medical Association
2. Upon receipt of any written complaint or referral, the Committee on Ethics shall undertake the
following:
2.1 Immediately acknowledge in writing receipt of the complaint informing the complainant or
referee of the preliminary steps being undertaken to address the same;
2.2 Request the complainant to submit a Bill of Particulars and other supporting documents
should the complaint lack specificity. Said request should be included in the initial letter by
the committee acknowledging receipt of the complaint, should a bill of particulars be
necessary;
2.3 Inform the member complained of that there is a complaint filed against the said member,
attaching a copy of the written complaint and any relevant documents as may be
necessary and appropriate and requiring the member to answer the complaint within
fifteen (15) working days from the latter’s receipt of the same. No extension of the period to
file an answer shall be granted except for meritorious reasons.
2.4 The complaint shall be considered joined upon receipt by the respondent of the complaint
against him.
2.5 Upon receipt of the respondent’s answer, the committee shall decide to undertake the
following:

2.5.1 Consider the written submissions of the Complainant and Respondent sufficient
and submitting the complaint for decision;
2.5.2 Consider the written submissions insufficient, requiring the parties to submit further
evidence or supporting documents;
2.5.3 Require the parties to a hearing. In such an event,
a. The parties may jointly waive their right to a formal hearing in writing by
opting to submit their position papers in lieu of a hearing; or
b. Should the parties not agree, the Committee should call a preliminary
hearing of the case to determine the timetables for hearing.
c. The parties shall be accorded the right to have counsel present to assist
them.
2.6 All cases before the Committee shall be decided within sixty (60) days from the time the
issues have been joined.
2.7 All decisions of the Committee shall be in writing. The Committee or the Board shall state
whether or not the offense committed is a minor offense, a less serious offense, or a
serious offense.
2.8 Appeals
2.8.1 The party aggrieved by any decision of the Committee may appeal the same to the
Board of Regents within fifteen (15) days from receipt of the Committee’s decision.
2.8.2 All decisions of the Committee shall be final and immediately executory after the
lapse of the fifteen-day period without any appeal having been made to the Board
against the said decision.
2.8.3 The Board shall decide any appeal elevated to it following review of the parties’
submissions. No new submissions shall be entertained at this stage except on
exceptional and meritorious grounds.
2.9 Sanctions and Penalties
2.9.1 Sanctions and penalties shall be meted by the Committee only after the lapse of
the fifteen (15) day period required for appeal.
2.9.2 For minor offenses, the following penalties shall be imposed:
a. First offense – reprimand, to be recorded in the member’s file with the
PCP;
 b. Second offense – suspension of “good standing status” for a period of
three (3) months, the same being recorded in the member’s file;
c. Third offense – suspension of good standing status for six (6) months
recorded accordingly in the member’s file.
2.9.3 For less serious offenses
a. First offense – suspension of good standing status for six (6) months
recorded accordingly in the member’s file.
b. Second offense – suspension of membership for at least six months at the
discretion of the Board. It shall be understood that any suspension of
membership includes suspension of status as Fellow of the PCP.

c. Third offense- Suspension of membership for at least one year.

2.9.4 For Serious offenses

a. First Offense: alone or in combination suspension for at least one year or
more at the discretion of the Board of Regents. Depending upon the
degree of seriousness, any member may be expelled from the PCP on
the first offense, upon recommendation of the Committee on Ethics and
upon approval of the Board of Regents.

b. Second offense: Expulsion from membership with the PCP. It shall be

understood that any expulsion includes removal of status as Fellow of the
PCP. Such expulsion may include a recommendation to the Philippine
Medical Association and the Professional Regulatory Commission for
appropriate action, furnishing these bodies with the relevant documents
supporting the recommendation.