4 0 oO 8 THE CODE OF MEDICAL ETHICS IN NIGERIA Lav Tiss abd f MEDICAL AND DENTAL COUNCIL OF NIGERIATHE CODE OF MEDICAL ETHICS IN NIGERIA Published by: Medical & Dental Council of NigeriaA PREAMBLE .. Bi. PROFESSIONAL ‘CONDUCT B2. BIOMEDICAL RESEARCH INVOLVING HUMAN SUBJECTS... es C. MALPRACTICE. _ 4 3B IMPROPER RELATIONSHIP WITH COLLEAGUES OR PATIENTS...--1-.--- . 46 E PRIVATE PRACTICE 54 5 SELF ADVERTISEME RELATED OFFENCES, 5? G CONVICTION FOR CRI 62 H. 64 | aT J . od Objectives of the Code of Conduct... 3.0 General Principles of the Ethics of Medical and Dental Practices. 40 = Induction...... 5.0 Allegiance to the Professions, 6.0 Duty to expose Professional 7.0 Respect to Colleagues... 8.0 © Reguiation of Medical and Dentat Practices in Niger! 9.0 Legal Basis for Medical and Dental Practices. 9.4 Registration... 91a, Provisional Registration $.1b. Full Registration... $.1.c. Registration asa Specialist 9.1.0. Limited or Temporary Registra = owvomorsntsoen BAGH Tve= Cro ar Mn. Eta me Ra 1 fta2 10.0 10.2 10.3 104 W441 2 13 12.0 13.0 14.0 14.1 142 14.2a 14.2b 14.2c 14.3. 144 144a 14.4b 14d 15.0 16.0 17.0 18.0 13.0 Practising fees and Annual Licencing.................60.ce Guidelines for Practitioners who graduate from Limited Registration. Humanitarian Medical and Dental Practitioners. Exchange Programmes Medical and Dental The International Code of Medical | Ethics (Deciaration of Venice)..... Duties of Physician in General. Duties of Physician to the Sick. Duties of Physician to each other. Rights and Responsibilities of Members of the Medical and Dental Professions. Clinic Etiquette........... Classification of Health Care Institution; the environment of Practice and Application for Health Care Establishments. bee Health Services Organisations as Limited Liability Companies... Comprehensive Health Centre (Cottage Hospital). Secondary Health Institutions (General Hospitals), Tertiary Health Institutions. Teaching Hospitals Specialty Hospitals. Federal Medical Centres. Professional Service to Colleagues. Notice to Practitioners in the Locality. : Mutual Regard among Registered Practitioners. BAGH Tve= Cros Mra. Eta we Rar21.0 Informed Consent... 22.0 Management of Patients who Refuse Blood 22.1C The Unconscious Patient 23.0 Termination of Service by Patients. 24.0 New Frontiers of Knowledge and Pi 25.0 Management of HIV/AIDS and other jer Seely Dreaded Infectious Diseases. ... oeaieae ae PART BI PROFESSIONAL CONDUCT... Wisisindiliiiecea 2B 26.0 Professional Brethren of Good Riepute: and Competency ... aasaecciicencein Acts Amounting to Infamous ‘Conduct a Professional Respect ... 27.0 Failure to comply with the General Principles. 28.0 Attitude towards Members of the baesipinery Organs of the Profession... arn 28.1 The Medical and Dental Practitioners’ Investigating Panel... 26.2 The Medical and Dental Practitioners! Disciplinary Tribunal... cial 28.3 Co-operation with MDCN Inspectors 29.0 Professional Negligence... 29.1 Patients on Intravenous Therapy. 29.2 Nursing the Unconscious Patient. 29.3 Emergency Admissions........ 29.4 The following among others constitute Professional Negligence... 30.0 Recurrent Professional Negiigence. 31.0 Gross Professional Negligance..... 23 {BAGH Tve-Crooe or Mirna we Rar 1 vm |PART B2 1.0 BIOMEDICAL RESEARCH INVOLVING HUMA| SUBJECTS .. aac ‘ 32.0 Rules of Biomedical ‘Research inveving Human Subjects... 52:2 Medical Research Combined with Professional Cara 32.4 Proposal for National Grug Approval Process (NDAP). 324a Pre-Clinical Testing. 32.4b Investigation of New Drug Application (INDA).. PARTC MALPRACTICE.... 33.0 Maipraction | ina a General. Respect. 34.0 Professional Certificates, Reports and other Documents..... eadeaet ater t ania 35.0 Deceit of Patient to Extort Money snd 36.0 Aiding the Unenotnasional’ Practice of ‘Mecicinw:. and Dentisiry............... feet 37.0 Association with Chemists, Opticians, ‘Optometists, Dental Technologists, other Non-medically Qualified Persons and Insurance Agents... a3 30.0 Association with Midwives or Nurses eee Matemities or Nursing Homes... eerececcaetceiie: MOE 39.0 Association with Unqualified or Unregistered Persons Practicing Medicine, Dentistry or Midwifery (including Relationship with Persons Performing Functions Relevant ta Medicine, Surgery or Dentistry ay PARTD improper Relationship with Colleagues or Patients 40.0 — Instigation of Litigation, . 41.0 Case Referrals to Colleagi 42.0 Movement of Patients among Practitioners 43.0 Responsible Medical Officer ....... an Ce | vat44.0 45,0 452 48.0 A Medical or Dental Practitioner as a Witness is 47.0 Minimum Professional Fees and Service Charge... 52 48.0 Adultery and other Improper Conduct or Parte Private Practica............ 49.0 Aspects of Private Medical ‘or Dental Practice. 49.1. Private Practice by Registered Practitioners who are in full time Empicgmeent as Consultants in the 49.2. Private Practice by non-consultant Registered Practitioners who are in full time Seiya in the Public Service ne $0.0 Ethical Control by Practitioners in Management Appointments in Public Hospitals, 51.0 New Client and Unpaid Bills to Colleagues 62.0 Decency and Decorum in Professional Transactions. £ & Sag PART F Self Advertisement and Related Offences Fee with the Media... $3.0 The Practitioners and the intemet 54.0 Self- Advertisement or Procurement of Advertisement.... 54.3 Adjudicator Rules. $5.0 Media Publication af Pending Treatment and New Discoveries. 56.0 Media Publicity and Advertisement 57.0 Touting and Canvassing........... Ce 1 & |58.0 Signboards and Signposts... ParttG Conviction for Criminal Offences .. ical $9.3 Conviction for Misconduct ina | Professional Respect 60.0 Abortion... 61.0 Aiding Criminals in Clinic 0 or + Hospital Premises. 62.0 Retainership, Capitation | Rates aed Profixed Fees for Professional Services. 68.1 Physical Torture. 66.2 Biological and Chemi 66.3 Psychological Torture. 67.0 Euthanasia......... 68.0 Fitness to Practice. 68.2 Procedure to Determine fitness to Practice. Appendix 4: Appendix 2: The Duties of a Physician . Appendix 3a: Consent for Procedures. Appendix 3b: Consent for Surgery/Procedures. Appendix 4: The Gillick Competence. Appendix 5; Telemedicine.............. : National Health Research Ethics Committee. : Assisted Conception and related Practices. : Guidelines on Clinical Drug Trial BAGH Toe Cros or Bowen. Eta we Rat 1x IPARTA: PREAMBLE 1 The medical profession has been from time immemorial, and universally still remains among the most learned and noble professions of the world. Thera were originally three primary learned professionals:-the physician, the scribe (lawyer) and the priest, The physician was the foremost and it is the duty of every doctor to maintain this primary position in the society. ‘Over the ages, the physician has played a vital role in the life of every member of the society. Being the adviser on health, the most important aspect of life, the doctor also holds the position of a respected and trusted friend or guardian. The Code of Conductis a formal statement of the correct attitude expected of physicians universally. Every doctor or dentist must abide by its contents and members of the public should be familiarwith it, The medical and dental professions subscribe to a body of ethical statements developed primarily for the benefit of the patient. Members of the medical and dental profession shall place their responsibility to patients above every other consideration. Every practitioner shall acquaint himself/herself with the duties of a physician as contained in the international code of medical ethics, as stated in the declaration of Venice, (Annex 1).a breach of which will attract sanctions. ‘Objectives of the Code of Conduct 2,1 To enable medical and dental practitioners in Nigeria to maintain correct attitude universally expected of physicians. 2.2 Tomestthe prescriptions of the Medical and Dental Council af Nigeria with regards to ethics and the quality of professional practice. 2.9 To ensure that ail medical and dental practitioners carry on. their professional duties in a manner that earns the trust of the patient and the respectof the society for the profession 24° Toletthe public know whatthay can expect from doctors. ROH Toe: Gwe Mesa Epc me Rac30 2.5 Amongst other uses, it shall be used by the disciplinary organs of Council to determine professional conduct. General Principles of the Ethics of Medical and Dental Practice: a4 3.2 33 34 3.6 3.6 a7 38 Practitioners shall be dedicated to providing competent medical care, with compassion and respect for human rights and dignity, Practitioners shall uphold the standards of professionalism, be honest irvall professional interactions and strive to report to appropriate authorities, physician they know to be deficient in character or competence. or engaging in fraudor deception, Practitioners shall respect the Law and recognise a responsibility to seek changes in those requirements which are contrary to the best interests of the patients. Practitioners shall respect the rights of patients, colleagues and other health professionals, and shall safeguard patient confidences and privacy wilhin the constraints of the Law. Practitioners shall continue to study, apply and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues and the public, obtain consultation, and use the talents of other health professionals when indicated. Practitioners shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, the nature of care, with whom to associate and the environment in which to provide medical care. Practitioners shall recognise a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health, Practitioners shall, while caring for a patient, regard responsibility to the patient as paramount. HAO Toe Gwe Mei Epc me Rac39 3.10. 3.12, 3.43. 3.14. 3.45. Practitioners shall support access to medical care for all people. Practitloners shall have absolute discretion and authority in determining the nature of care to be given to a patient under their care and must accept responsibility for their actions. Practitioners shall not hesitate to seek the consultation of more experienced or appropriate specialist colleagues whenever they are in doubt or lacking competence with regard to the medical needsof their patients. Practitioners may associate professionally with non- medically qualified people where this is relevant to the care of patients but thay must ensure that in any collaboration with any of the allied professions or non- medical professions, the persons involved are recognised members of their disciplines and are competent to perform the tasks to be required of them. In all such relationships, practitioners shall retain the absolute authority and responsibility for the patient and should not delegate any exclusive professional medical or dental responsibility to any non-medical or non-dental person, Practitioners shall not certify what they have not personally verified; they must desist from compulsory treatment of a patient in the absence of iliness and must nol collaborale with other agencies to label anyone ill in the absence of any illness, but must always obtain consent of the patient or the ‘competent relatives or seek another professional opinion, before embarking on any special treatment procedures with determinable risks, In performing biomedical research involving human subjects, practitioners must conform to generally acceptable scientific and moral principles and must obtain informed consent from his subjects and take responsibility to ensure the protection of their integrity and confidence, CM The Conn in Me ke Kom Mi a40 3.16. 3.17. 3.18. Practitioners shall be entitled to charge fees for their professional services but such income should be limitad to professional services actually randerad, supervised or for missed appointments and should be commensurate with the service rendered and the patient's ability to pay. Fee- ‘splitting and payment for referrals are forbidden. Practitioners shall safeguard against any publicity in the media that may imply that he has special skills or that exposes the identity of a patient. He should be circumspect in the announcement of any new special procedures or discoveries and must always strive for anonymity for him/herself and the patient in any public forum, Practitioners shall be entitled to inscribe their professional academic ties (degrees) after their names bul in doing so they must use only the one registered by the MDCN in the Medical and Dental practitioners’ Register that connote extra skill and knowledge gained by examination or those complementary to them. This excludes honorary awards. Induction of Newly Qualified Medical Practitioner or Dental Surgeon 44 42 Newly qualified medical doctors and dental surgeons shall be inducted formally into the professions respectively at a ceremony during which the Physicians’ Oath shall be administered to them and shall obtain from them the pledge fo obey all the Rules and Regulations which guide medical and dental practices in Nigeria, The medical and dental graduates are expected to be already familiar with tha Code of Medical Ethics at the time of graduation. The induction ceremony is 4 solemn occasion during which they on their part announce publicly their commitment to abide by the norms, traditions and practice of the profession. The induction of new graduates of medicine and dentistry shall be conducted by the Colleges that trained them. A representative of the Medical and Denial Council of Nigeria shall be invited as a witness atthe ceremony. BRO Toe-Croor or Mowe. Ea we Rar43 44 The pledge which the new medical or dental graduate is required to make is in two consecutive parts namely: The Physician's Pledge (Declaration of Geneva) and the modified Hippocratic Oath 1Solemnly Pledge t 2. 3. a 10. n. To consecrate my life to the service of humanity; 1 WILL GIVE to my teachers the respect and gratitude that is their due; (WILL PRACTICE my profession with conscience and dignity; THE HEALTH OF MY PATIENT will be my firstconsideration; | WILL RESPECT the secrets that are confided in me, even after the Patient has died; | WILL MAINTAIN by all the means in my power, the honour and the noble traditions of the medical profession; MY COLLEAGUES will be my sisters and brothers; | WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient; I WILL MAINTAIN the utmost respect for human lite; | WILL NOT USE my medicai knowledge to viclaie human rights and clvilliberties, even under threat; MAKE THESE PROMISES solemnly, freely and upon my honour. Allegiance to the Professions 5.1 Fundamental to these ethical guidelines is a mandatory allegiance which every doctor or dentist owes to the ‘corporate body of the profession. This corporate body of the profession by tradition or convention through the ages has assumed the responsibility of maintaining and constantly ‘enhancing the standard of service provided to the public by ROH Toe: Gwe Mec pc me Rac5.2 5.3 5.4 5.5 5.6 the profession as well as protecting the profession from unwarranted encroachment by charlatans and quacks. There are two arms to this corporate body, namely a statuiory arm represeniad by the Medical and Dental Council of Nigeria, the regulatory body set up by law and the Nigerian Medical Association, a quasi-voluntary association of all medical doctors and dentists. Both bodies consist of medical doctors and dentists. They share the same objectives as stated in these Codes and command the allegiance of all doctors and dentists inthe land. The authority of the Council over all medical doctors and dental surgeons In Nigeria is statutory and backed by Law. ‘The laws setting up the Council and which spell out its functions and modus operandi are the (Medical and Dental Practitioners Act, Cap 221 Laws of the Federation of Nigeria 2004 of CAP M8 Laws of the Federation of Nigeria 2004, ) All medical doctors and dentists are duty-bound therefore to familiarize themselves with: ‘The Code of Medical Ethics, Le. rules of professional ‘conduct for medical and dentai practitioners in Nigeria prepared by Council. The constitution of the Nigerian Medical Association, alll its by-laws and standing orders at national and relevant state levels. All Medical and Dental Practitioners who have paid their annual practising fees become, automatically, financial members of the Nigerian Medical Association and for the purpose of the Medical and Dental Practitioners Act are ‘entitled to all rights and privileges appertaining ta members. All registered Practitioners are therefore encouraged lo participate actively in the affairs of the Association. In the exercise of the allegiance to, and for the maintenance of the good name of the profession, every practitioner is expected to keep the regulations and assist others to so do. 2M The! Cini Mc ae Kom Mid7.0. 8.0. Duty to Expose Professional Misconduct Medical and denta! practitioners should expose without fear or favour, before the Medical and Dental Council of Nigeria, either directly or through the Nigerian Medical Association, any corrupt, dishonest, unprofessional or criminal act or omission on the part of any médical practitioner or dentist. Such exposure must be motivated by the greater good of the entire profession and should be without malice. The Council may, on the recommendation of either of its disciplinary organs, communicate to a foreign Medical Council when appropriate, relevant information on a registered practitioner when it is obvious that the Medica! and Dental Gouncil of Nigeria is: being ignored on a matter of discipline by a registered practitioner who has been duly notified but who decides to practise medicine or dentistry in another country. The purpose of such communication will be to compel the registered practitioner to assist the disciplinary organs in treating such a matter before them, in which hels involved. Respect to Colleagues (Medical and dental practitioners should always accord the elder members of the profession their due respect both socially and professionally. Older members of the profession should consider the younger ones as their colleagues and strive to set good examples and give moral guidance at all times. This duty should manifest itselfin ail situations, Regulation of Medical and Dental Practices in Nigeria The Medical and Dental Professions in Nigeria are regulated by the: Medical and Dental Practitioners Act Cap MB Laws of the Federation of Nigeria, 2004 which sel up the Medical and Dental ‘Council of Nigeria with the following responsibilities: 8.1 Determining the standard of knowledge and skill to be attained by persons seeking to become members of the medical or dental profession and reviewing those standards fromtime to time as circumstances may permit. BRO Toe Cro Mee. Eta we Rara2 ag a4 B5 8.6 Securing. in accordance with provisions of the Act, the establishment and maintenance of a register of persons entitled to practise as members of the medical or dental profession and the publication from time to time of the lists of those persons; Reviewing and preparing from time to time, a statement as to the code of conduct which the Council considers desirable for the practice of the professions in Nigeria, and Performing the other functions conferred on the Council by the Act. By provision 8.3 above, the Council is empowered to make rules for professional conduct and is empowered to establish the Medical and Dental Practitioners’ Investigating Panel and the Medicai and Dental Practitioners’ Disciplinary Tribunal for the enforcementof these rules of conduct. This code of conduct serves a5 guiding standards for the relationship of medical and dental practitioners on the one hand, with the profession, their colleagues, their patients, members of allied professions and the public. on the other. Legal Basis for Medical and Dental Practices Registration Any person who practices medicine or dentistry anywhere in Nigeria without being appropriately registered with the Council contravenes the law, and so does his employers. The categories under which a practitioner may be registered are as follows: 9.1a Provisional Registration This registration entitles a qualified medical practitioner or dental surgeon to undertake internship under the supervision of registered consultants or specialists in a hospital approved by the Council for internship training. This registration lapses automatically when the registered practitioner is BAGH Tve- Cros Mra. Eta we Rar9.41b S.1¢ g.4d signed off from the intemship. While it subsists, it does not entitle the practitioner to set up and run an independent practice on his. own, Every new medical or dental graduate is required to complete his own internship within two (2) years of his graduation, or he may, unless he gives a reason satisfactory to the ‘Council, be subjected to an assessment examination by the Council, Full Registration A practitioner should obtain this registration after'a satisfactory completion of his internship and this ‘confers on him the legal right to practise on his own. However, the practitioner is expected to be able to recognise his limitations in the management of certain types of cases. Registration as a Specialist Every practitioner who has acquired specialist ‘qualification after undergoing the requisite training as prescribed by the National Postgraduate Medical ‘College, or any other training deemed to be the equivalent is required by law to be registered with the ‘Council a8 a specialist before he can practise and be recognised as such. A practitioner who is not registered with the Council as a specialist cannot validly sign off intems, and the Council upon enquiry will not back up his opinion asa specialist. Limited or Temporary Registration This is the type of registration issued to practitioners from foreign countries coming into Nigeria for specific purposes. Unlike the Full Registration, it has a specific period of validity after which it must be renewed. li is also tied to a specific employment. Any change of employment invalidates the registration and the practitioner must then process a new registration for the new job. A practitioner on Limited 260 Toe: Cir or Miroeray. acy we Abt92 Registration cannot set up or run a clinic or hospital ‘on his own. A practitioner on the Limited or Temporary Register is not allowed to own a private health institution. He must work in health institution owned by 3 goverment, a non-governmental organisation ora fully registered Practitioner. Practising Fees and Annual Licensing All practitioners must bear in mind at all times that by law as stipulated in Sections 14 and 18 of the Medical and Dental Practitioners’ Act CAP 221, Laws- of the Federation of Nigeria 1990 or CAP M8 Laws, of the Federation of Nigeria 2004 that: A person shail not hold an appointment or practise as a medical Practitioner or dental surgeon in Nigeria, unless he Is registered with the Council. No registered medical practitioner or dental surgeon shall practise @3 a medical practitioner or dental surgeon, as the case may be in any year unless he has paid to the Council in respect of that year the appropriate practising fee. Any medical practitioner or dental surgeon who in respect of any year and without paying the prescribed fee practises as such shall be guilty of an offence and shall be liable on conviction; 92a in the case of first offence, to a fine of twice the prescribed practising fee, and 9.2b in the case of a second or subsequent offence, to a fine of not less than ten times the prescribed practising fees or suspension for three months if taken tothe Tribunal. 9.2¢ alsolate payment shall altract a surcharge as may be determined by the Council from time to time, without prejudice to any other penal provisions in the statute §.2d Practitioners involved in professional misconduct committed at the time they had not paid they practising fee shall be liable ta sanction even if they subsequently paid the fee and the penalty for late BRO Toe Cro or Mean. Etc we Rarpayment. All doctors are advised to meet this commitment promptly, as the Council will view conviction under this section seriously, The Regulations of the Council expect practitioners to pay ‘their practising fee for the ensuing year before the 31st December of the preceding year in order to remain currently licansed on the first day of the New Year. The law further stipulates as follows: 9.28 Where @ practitioner wha is in employment has defaulted from payment of the practising fee; And if the medical or dental practitioner is in the employment of any person or institution, that person shall also be guilty of an offence and punished in like manner as the medical practitioner or dental surgeon unless he proves that the failure to pay the practising fee was without his knowledge, consent, connivance ornagligence, All members of the medical and dental profession who employ medical doctors or dental surgeons or who are professional heads of medical institutions, either public or private, are required to take due notice of this aspect ofthe law. 10.0 Guidelines for Practitioners who Graduate from Foreign Colleges: For the purpose of clarity, indigenous Medical and Dental Practitioners. shall be defined as all Medical and Dental Practitioners be they Nigerian nor not, who are trained in Nigeria. 10.1. Practitioners who graduate in Colleges in foreign countries will be required to pass the Assessment (Proficiency) Examination sat by the MDCN before they can be registered to practice in Nigeria if their colleges are not already fecognised by the MDCN. They can get full or limited fagistration. {BAGH Tve- Cro Mra. Eta Rar v10.2 10.3 10.4 Exempted from this examination are medical and dental Practitioners with mot lass than ten years cognate experience wishing to practise in Nigeria for not more than sixweeks. Limited Registration A.sucoess in the proficiency examination qualifies foreign- trained doctors to proceed to Provisional Registration or Limited Registration as appropriate. ‘On application for Limited Registration, the practitioner will submit, among other documents, a sworn affidavit that he does not fully own a health institution in Nigeria and would not do so during the period of his Limited Registration. Humanitarian Medical and Dental Practitioners All medical and-dental practitioners wishing to render humanitarian health services to the public are very welcome. However short or long the period of such service may be it is mandatory for incoming foreign practitioners to obtain Limited Registrations and current practising licances before undertaking such exercises. It shall be the responsibility of the organisation or individual responsible for bringing in such practitioners to ensure that they are duly registered and licensed prior or upon arrival in Nigeria. Exchange Programmes Medical and Dental Practitioners: Foreign doctors coming In as experts or general duty doctors on exchange programme basis shall be given Limited Registration to cover the period. They shall be ‘exempted from sitting the proficiency examination. Should thay wish to remain to practise after the programme's expiration, the Medical and Dental Council of Nigeria shall assess them further for retention on the Limited Register or request them to sit the proficiency examination. It shall be the responsibility of the Medical Director of the host institulion to ensure that appropriate registration provisions are complied with, 200 Thee Conn in Mae Kom acid11.0 THE INTERNATIONAL CODE OF MEDICAL ETHICS: (DECLARATION OF VENICE 1983) «please refer to Appendix 1 41.1, Duties of Physician in General A Physician shall always maintain the highest standards of professional conducts. 4 Physician shail not permits motives of profit to influence the free and independent exercise of professional judgement on behalf of patients; a physician shail deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence or who engage in fraud or deception, The followings are deemed to be the unethical conduct: Tita Self advertising by physician, 11.1b Paying or receiving any other consideration solely to procure the 14 A physician shall act only in the patient's interest when providing medical care, which might have the effect of weakening the physical and mental state of the patient. 11.144 A physician shall use great caution in divulging discoveries or new techniques or trealment through non-professional channels, 11.1e Aphysician must first publish all new discoveries and techniques through normal academic channels, Such as professional journals and lectures to peers. ‘Occasional explanation o the nature ofthe procedure on invitation of journalists may be considered proper, but frequent address to the press in a manner that would attract patients would amount to self- advertisement which is forbidden. 11.11 A physician shall certify only that which he has personally verified. Ce ee 1311.2. 11.3. Duties of Physician to the Sick 4 Physician shall always bear in mind the obligation of preserving human life. Aphysician shall owe his patients complete loyalty and all the resources of his science, Whenever an examination or treatment is beyond the physician's capacity he should summon another physician who has the necessary ability, A physician shall preserve absolute confidentiality on all he knows about his patient even after the patient has died_ A physician shall give emergency care a5 a humanitarian uty unless he is assured that others are willing and able to give such care. A physician shall in situations when he is acting for a third party, ensure that the patient has full knowledge of that situation, Apnysician shall not enter into a sexual relationship with his current patient or into any other abusive or exploitative elationship. When medically necessary, a physician communicates with colleagues who are involved in the care of the same patient. This communication should respect patient confidentiality and be confined to necessary information, Outies of Physician to each other A physician shall behave towards his colleagues, as he would have them behave towards him. Aphysician shall not entice patients from his collaaques. A physician shall observe the principles of the ‘Declaration of Geneva’ approved by the World Medical Association. Rights and Responsibilities of Members of the Medical and Dental Professions 21 ‘Only persons who have undergone the course of training based on the curriculum for medical and dental education as {BRO Toe Cro ar Mara. Eta Rar12.2 12.3 12.4 approved by the Medical and Dental Council of Nigeria and have obtained the certificates approved or recognised by the Council, and who beside all these have been registered and licensed by the Council shall practice as a physician or dental surgeon in Nigeria. In the context of a health institution, other members of the health team may perform procedures appropriate to their professions. However, sometimes these may include the procedures exclusive to the qualified physician or dentist, provided that these procedures are performed at the fequest, or under the supervision of the madical practitioner or dental surgeon who is in a position to obtain and appropriately interpret the health database that provides the: indications for thase procedures. In circumstances where the doctor is not available, the use of Standing Orders that provide clear guidelines for action will suffice a5 authority for initiating these actions by the Bppropriate members of the health team. In these situations, any actions outside the scope of the Standing (Orders are illegal and render such other professionals or technician liable. Such Standing Orders must be prepared in the first inslance by the supervising doctors, the institution, or the corporate medical profession. ‘Subject only to accepted standards of cara as determined by corporale professional opinion, a doctor must exercise absolute discretion and authority in determining the nature of care given by him including appropriate utilization of men, materials, money and time in order to achieve the best possible results for his patients. By the same token, he must accept the responsibility for the results obtained under his management To this end, he must refrain from doing anything repugnant to his sense of honour or against his considered judgment, even in the face of unreasonable demand from the patient or other persons, whether individual or corporate. 200 Thee Conn Mae ome Mri13.0 14.0 12.5 Similarly, in the face of inadequate or inappropriate fesources and facilities ha must exercisa ingenuity and initiative to secure the best possible results for his patient. He must not however, embark on any treatment for which he: does not have the requisite knowledge, competence or resources. 12.6 Registered practitioners are advised to protect their professional practice by regularly taking professional indemnity insurance. Clinic Etiquette In order to ensure the most constructive relationship between the Practitioner and the patient, practitioners; 13.1 Should provide appropriate privacy to their patients. 13.2 Should have in place a billing system appropriate for the: procedure and the environment that informs the Palientirelative about the fees changed for procedures before the patient gets committed to participate. 13.3. Should avoid smoking in the clinic or the hospital premises. (if a practitioner must smoke, it should only be in private in a separate room), 13.4 Must always be friendly to their patients and express appropriate empathy for their condition. 13.5 Should be at liberty to take prompt steps to protect themselves from unscrupulous and dubious patients who may be oul to deceive or manipulate them, 13.6 Should always take necessary steps to guard against situations that may provoke allegations of impropriety. ‘Classification of Health Care institution; the Environment of Practice and Appellation for Health Care Establishmen 14.1 Health Services Organisations as Limited Liability Companies ee ee14.1a Practitioners are advised to consider seriously the dangers inherent in the establishment of clinics and hospitals as strict business enterprises or limited liability companies, bearing in mind the strict ethical code of conduct in the profession. 14.1b Practitioners who become connected orinvolved with limited or publicly quoted organisation providing Ginical, diagnostic or medical advisory services such as public or private hospitals, clinics, screening centres, nursing homes, rehabilitation centres and advisory agencies, whether as partner, directors, employers, consultants or in whatever capacity in which their status as medical practitioners or dental surgeons would ba clearly construed to land support or foster the activities of the organisation, have the responsibility to ensure that the provisions of the code of Medical Ethics in Nigeria are complied with, The first source of problem is usually related to self advertisement and practitioners are well advised to be- ever conscious of this. 14.1c. The prospectus of such companies going public may contain the services to be offered by the organisations but it should not feature the expertise of individual practitioners. The rule equally applies to publicized information in the print and electronic media and on the intemet. 14.1d. Advertisements from such organisations should be factual but should not promote in any way the professional qualities or services of identified individual practitioners connected with such organisation or make unfavourable comparisons or allusions to services offered by other organisations, whether public of private, or infringe the confidentiality of patients who use the services of the organisations. They should also not mislead patients, éntice them with pramotional materials or interfere in any way with their rights to referral. 208 Tue: Cine or Mircea. acy we Abt14.1e.Practitioners should mot be directly involved in Promating the services of such organisations through such practices as public speaking, broadcasting, signing circulars, writing articies, putting publications In the information media and internet, permitting the use of their photographs and professional quaiifications in the promotional activities ofsuch organisations. Nigeria has adopted a three-tier health care system of primary, secondary and tertiary health care that should ideally be integrated. Primary health care is defined as the care of first contact. If the problem cannot be solved here, it is referred upwards to secondary and tertiary care levels. 44.2 Primary Health institutions consist of the following: 44.2a Clinics 14.2b Health Centres: 14.2 Comprehensive Health Centres (Cottage hospitals) 14.2a Clinic 14.2a (i) This refers to institutions where only consultation and out- patient trestment are conducted and practised. 14.22 (ii/institutions where the practitioner or practitioners restrict consultation and out-patient services to a particular area of areas of specialist discipline should be clearly designated as a specialist clinic for the discipline involved, for instance. OPHTHALMOLOGY (OR SPECIALIST EYE) CLINIC and not just broadly “specialist clinic.” 14.2a (ii/)Where more than one specialty is practised in a Clinic set-up, this may be referred toas a'Polyclinic’. 14.2b, Health Centres These are institutions in which out-patient 20M Thee Cima Mae ome Mid14.3 consultation takes place, but there is also a definite programme of care involving the components of primary health care as follows; Health education; Maternal and Child Health; Family Planning; Nutrition Education; Immunization; Diagnosis and treatment of common ailments; use of appropriate technology; the essential drug fist; record keeping and case reporting, effective communication and patient referral. Few bed spaces for observation may be available. 14.2¢ Comprehensive Health Centre (Cottage Hospital) ‘This incorporates the facilities of the health centre, but in addition, there are facilities for simple medical and surgical services supported by some bed complement which may be up to 30. The doctors in charge may include primary care doctors, general medical practitioners, family physicians or even surgeons and obstetricians, but there are no departmental boundaries. All necessary ancillary facilities for proper diagnosis and trealment of common ailments are available and all the doctors work together, irrespective of their areas of interest or their areas of specialization, taking emergency duties in tum. Secondary Health Institutions (General Hospitals) These are General Hospitals or Medical Centres, the reference destinations for primary health care institulions. They wary in size and services, but the essential components are: 14.38. 14.3b. (i) (i) (il) Accidentand Emergency Unit Atleast four basicdepariments ‘General Medicine ‘General surgery ‘Obstetrics and Gynaecology [BRO Tve= Cros ar Means. Eta we Rar ai]144 (iv) Paediatrics. 44.3¢ Those accredited for Internship must have at least four Consultants (registered practitioners with registrable postgraduate Fellowships) in the disciplines specified in 14.3b, and witha good complement of medical officers, and preferably, general duties doctors for the 14,3d, Pharmacy unit 14.36. X-ray and Laboratory diagnostic services 44.3f, Catering and laundry 14.39. Out-pathent consultation unit 14.3h. Wards divided into: Surgical ward Medical ward Paadiatric ward Obstetrics/gynaecology ward Labourward Postnatal ward 14.3) Treatment facilities featuring: |. Operating theatre ii, Other units, such as physiotherapy. Tertiary Health Institutions ‘There are three types of tertiary hospitals in Nigeria 44.44, Teaching Hospitals 14.46. Specialty Hospitals 14.4c. Federal Medical Centres: 14.4@ Teaching Hospitals These are health institutions associated with universities BAGH Toe Cros Blow. we Rarwhere undergraduate and postgraduate medical training of Soctors is conducted, largely by academic staff from the affiliated colleges of health sciences, The academic staff also conduct research. It is the apex of the referral system. This institution is fully developed, accredited for teaching and organized along departmental lines ao that there is any combination of the following departments: Anaesthesiology Dental Surgery ‘General Medical Practice (Family Medicine) Intemal Medicine ‘Obstetrics and Gynaecology Paediatrics Psychiatry Public Health ad Primary Health Care Radiology & Radio Diagnosis Pathology Each department may have any number of consultant units ‘or firms each with its own oul-patiant consultation sessions, ward units, theatre sessions (where appropriate) etc. Ordinarily, patients are not expected to come primarily tothe clinics of a teaching hospital which Is intended to be a referral hospital, but they would usually be referred from a lower order institution, the only exception being the cases that come through the casualty or accident. and unit. The teaching hospital is the most advanced form of hospital institution. 14.4b Specialty Hospitals These are hospitals dedicated to a single condition Orthopaedic, Psychiatric and Ophthalmic or eye problems are the examples common in Nigeria 2H Thee Cini Mr ae ome Mid15.0 16.0 4 hospital is not a specialist hospital simply because fis owner possesses a registrable specialist qualification in an area of medicine or dentistry, A specialist hospital is an institution featuring the following major components: 14.45 (i) aocident and emergency unit 14.46 (ji) diagnostic unit 14.4b (iil) out-patient consultation unit 14.45 (iv) wards unit 14.45 (v) treatment unit with the major difference thatall the facilities of the institution are devoted to the practica of one or more specific disciplines of medicine, e.g. paediatrics, orthopaedics, psychiatry, dentistry, obstetrics and gynaecology, etc. , 14.4c Federal Medical Centres These are general hospitals owned and usually belter funded by the Federal Government. They therefore operate at a higher level than other general hospitals. They are tertiary hospitals that operate in departments like the Teaching Hospitals, but are not associated with medical school. Practising asa Specialist No medical of dental practitioner shall practise asa specialist, or pass himself off as a specialist, without having a specialist qualification which is registered with the Medical and Dental ‘Council of Nigeria. Every practitioner who is a specialist should know that itis a contravention of the regulations for him to practise @5 a specialist without having been registered as a specialist by the ‘Council. Self-Medication by Registered Practitioners A medical or dental practitioner can offer first aid treatment to members of his family Severe ailments are best referred to colleagues where possible since they can treat the afflicted person with tess distracting emotions. Similarly, a doctor should avoid setf- BAGH Tve= Cro Brainy. Eta we Ra17.0 18. treatment unless the ailment is clearly minor or there is no access toacolleague. Professional Service to Colleagues lis the norm that no professional fee is charged when a doctor looks after a colleague. By this is meant that when a colleague is seen by a doctor, such a colleague would nol be expected to pay for registration (card) and consultation or the professional skills or expertise of the attending doctor. However, the cost of consumables may be borne by the doctor wha istreated. Notice to Practitioners in the Locality practitioner who is qualified and available to.actas aconsultantio other doctors in any branch of medicine or dentistry, may send to practitioners in his locality or publish in his local medical journal a brief and dignified announcement of his availability to serve other doctors in that capacity. Mutual Regard among registered Practitioners Registered practitioners must give due respect to their senior colleagues and acknowledge thelr seniority always, whether in a professional or in a social setting. Senior colleagues should be mindful of the interest of junior colleagues in all their interactions and should offer them appropriate guidance Discovery of Deception When a doctor discovers that some fraud or deception had been practised on him to accept a patient, particularly whan a criminal act is involved, he should make every effort to bring such discoveries to the notice of appropriate authorities, Doctors must be careful to distinguish between criminal deception and @ clinical situation thal is symptomatic of some psychiatric lliness or a personality defect in the patient. The latter should be treated asa symptom requiring appropriate clinical management. BRO Twe- Cro Bran. Etc me Rar21.0 Informed Consent Practitioners involved in procedures requiring the consent of the patient, his relation or appropriate public authority must ensure that the appropriate written and signed consent is obtained before such procedures, either for surgery or diagnostic purposes are done, be they invasive or non-invasive. Consent forms should be in printed or in written form either as a part of the case notes or in Separate sheets with the institution's name boldly indicated. 21.4. 21.3 in the case of children, the following will apply; Those within the ages of 16 to 1B years havea statutory right of their own to consent to procedures and this takes precedence over parental objections, but do#= not invalidate the right of others to consent on their behalf, However, where the child of this age group objects and parental consent is obtained in an amergency situation, appropriate treatment or procedure can be given. Children younger than 16 but not below 13, though considered as minors, but of clear mind and who can understand the benefits and consequences of accepting or rejecting a proposed treatment, "Gillick competence” can give anacceptable consent, In respect of children under 13, the well-being of the child is paramount and if after full parent consultation, treatment is refused, the practitioner should make use of the law by obtaining an order from the Court to protect the child's health interest. A child who needs blood transfusion or procedures in any emergency should be so given. A practitioner who stands by and allows his minor patient to die in circumstances which might be avoidable may be charged with negligence and is vulnerable fo criminal prosecution. However, if adults refuse blood transfusion on religious grounds, the practitioner has the obligation to adopt alternative strategies to save life. BRO Twe= Cro or Mata. Eta we Rar22. Management of Patients who Refuse Blood Transfusion 22.1 3.(i) Atthe moment of induction, all qualified doctors subscribe 22.1b to the Hippocratic Oath (as modified by the Declaration of Geneva) pant of which reads thus: ‘| will not permit consideration of religion, nationality, race, party, politics or social standing to intervene between my duty and my patient. in clear terms, whatever the religious orientation of the practitioner or the patient, it must not determine the quality of treatment so offered. (ii) Oftentimes, this commitment has led many practitioners into conflict with patients and relatives who refuse blood transfusion on religious grounds, and in some cases may result to litigation, The law does not permit the doctor to give any treatment against the patient's wishes. (il) However, practitioners should be aware that society, and indeed the law, recognises the individual's right ta accept or refuse medical treatment. The Jehovah's Witnesses’ refusal of transfusion with blood and blood products is perhaps the mast commonly encountered decline of clinical treatment that might be essential to save life, especiaily in emergencies, (i). In all situations where blood transfusion might be Necessary, itis essential to ask patients whether they abject to blood transfusion and to record such views in the case notes, It is important to establish the views held by each Jehovah's Witness patient as certain forms of transfusion, such as blood salvage techniques, haemodilution, haemodialysis, the use of fractions such aa albumin, immune globulins and clotting factors may be acceptable. Pre-donation is nol usually acceptable to Jehovah's Witnesses. The acceptance, and particularly the rejection of essential treatment should be recorded and witnessed, There are reasonable strategies that can be adopted for patients who refuse blood transfusion. In the first place surgeons should observe the principle of doing surgery with the minimum blood loss. Post-operative bleeding must be {BRO Tve= Cros Brn. Eta we Rar22.1b surgically stopped if significant enough to threaten life. Intravenous administration of erystalloids and other non- blood volume expanders should always be available In hospitals and clinics. (ii). In non-emergency. situations, the practitioner should decide if he is willing to accept the limitations in Management and, if so, offer optimal care; if not, the practitioner may decline care and refer such patients for further opinion orto other health care centre that might be willing to handle such cases. The Unconscious Patient ‘Some religious sects may carry cards (advance directives) containing treatment instructions that legally prohibit blood transfusion. Their clothing should be searched for such cards. Even if accompanying relatives present such cards, clinicians should convince themselves that such cards truly belong to the patient before them. In the absence of such cards, the priority of the practitioner in an emergency situation is to first save life by any available means. If relatives presenta persistant impediment and the clinical condition permits it, the doctor should obtain a court permit to surmount it. The practitioner should be wary of acting on. verbal instructions from relatives of unconscious patients. 23.0 Termination of Service by Patients Patients who are legally permitted to make their own decisions are. al liberty to discharge themselves (or, in the case of minors their next-of-kin can do so against medical advice, provided they sign a document to that effect. Should they later return to continue ‘treatment, the services should be restored without prejudice, New Frontiers of Knowledge and Practice Itis mandatory for registered practitioners to remain cunrent in the practice of their profession by participating in the continuing professional development, {BRO Tve- Cro rang. Eta we Rr25.0 Management of HIV/AIDS and other Socially Dreaded Infectious Diseases. Practitioners should be aware of the prevalence of highly hazardous (contagious) ailments. While adopting the fully accepted measures to prevent themselves fram becoming infected, they should in no way discriminate in handling and treating such patients, and should maintain appropriate confidentiality and adopt a multi-disciplinary approach. Referral of ‘uch patients should be strictly based on professional needs. Practitioners handling such conditions as HIV/AIDS, Tuberculosis, Hepatitis B, Lassa fever, Ebola fever etc should be sensitive to the psychological and social factors. Practitioners should ensure that they are not used as agents by ‘employers or others to deny affected palients thelr rights. Where investigations are clinically indicated, it is ethical for the practitioner to give pre and post test counselling, Informed consent is mandatory if an investigation is needed only for research or for collecting epidemiological data, but would not directly benefit the patient, BRO Tve- Cro Mra. Etc we RarPART B1: PROFESSIONAL CONDUCT Professional Brethren of Good Repute and Competency In all areas of their professional practice, conduct and ‘comportment, in their professional and other relationships with their patients as well as other persons, including colleagues, ail registered medical and dental practitioners shall be guided and bound by sound ethical practice. The general principle is that when a medical or dental practitioner, in the ee of his profession, has conducted himself in such a manner which would be regarded a5 disgraceful or dishonourable by his professional brethren of good repute and competency, then he is guilty of infamous conduct in a professional respect. ‘The list of acts that constitute infamous conduct in a professional respect is not exhaustive because the profession demands the highest ethical standard from its members. The acts listed in this code must therefore be regarded as examples of conduct which members of the professional must avoid, For the purpose of this Code of Medical Ethics, the members of the Medical and Dental Practitioners’ Investigating Panel and the Medical and Dental Practitioners’ Disciplinary Tribunal for the time being shall constitute the Professional Brethren of Good Repute and Competency for medical and dental practitioners. The duty of investigating the substance of any allegation of infamous conduct ina professional respect is vested in the Medical and Dental Practitioners’ Investigating Panel. Once the Panel concludes after due investigation that there is substance in the allegation against a practitioner, the matter is remitted to the Medical and Dental Practitioners’ Disciplinary Tribunal for trial. At ‘the trial the affected practitioner is given an opportunity to defand his actions and conduct. Where the Tribunal finds the practitioner guilty of infamous conduct in a professional respect as contained in ‘the charge preferred against him, the Tribunal can impose any of ‘the following statutory penattias depending upon the gravity of the [BRO Twe= Cro ar Brn. Eta we Rar28.4 ‘offence and the attitude of the practitioner before and during the investigation and/or trial: 26.1 Order the Registrar to strike the person's name off the relevant register or registers. 26.2 Suspend the person from practice for a period specified in ‘the directive, not exceeding six months. 26,3 Admonish the parson. ACTS AMOUNTING TO INFAMOUS CONDUCT IN A PROFESSIONAL RESPECT These are categorised as follows under rules 27 to 69 of the code of medical ethics in Nigeria: Failure to Comply With the General Principles Failure to adhere to any of the Preamble and General Principles as: ‘contained in Rules 1 to 26 of this Code, If reported, may amount lo infamous conduct for which the affected practitioner may, if found guilty, be punished, Attitude towards Members of the Disciplinary Organs of the Profession The Medical and Dental Practitioners’ Investigating Panel 28.1a The Medical and Dental! Practitioners’ Investigating Panel is @ court of first hearing in matters of alleged Infamous conduct in professional respect that are properly brought before the Medical and Dental Council of Nigeria, 28.1b A medical or dental practitioner should be punctual whenever he is summoned to appear before the Panel in the course of the investigation of any case which involved him, whether as the respondent doctor or as a witness, He should give prompt notice to the appropriate official of the Panel with regard to any circumstances that would cause his tardiness or absence. BAGH Tve-Crooe or Miran. Etc we Rat28.1¢ Aregistered practitioner who has been notified by the Panel of the necessity for his appearance before the Panel, for whatever reason, shail attend relevant hearings when Invited. In. case the practitioner would travel out of Nigeria whilst the matter is yet to be disposed of, he is required to duly notify the appropriate official of the Panel and obtain the necessary clearance in writing before travelling out. 28.10 A medical or dental practitioner who has been duly notified that he has to appear before the Panel in an ongoing investigation but who fails to appear, whenever due, without an acceptable excuse shall be fable to disciplinary action. A practitioner's duty to appear before the Panel is continuous from the time of first notification until the matter under investigation is finally conciuded. 286.1¢@ Any attempt to curry favour with panel members through flattery of inappropriate solicitude for personal comfort would constitute an infamous: conductin a professional respect. 28.1f. A medical or dental practitioner should rise when addressing, or being addressed by the Panel, unless the Chairman of the Panel directs otherwise. 28.19. Medical or dental practitioners who fall to respond to the request of the Panel in relation to matters under investigation may be deemed to be contemptuous of the Panel and shall be appropriately disciplined. 26.th The Council may, on the recommendation of either of its disciplinary organs, communicate to a foreign Medical Council when appropriate, relevant information on a registered practitioner. This may occur when @ medical or dental practitioner ignores the Medical and Dental Council of Nigeria on a matter for disciplinary process when duly notified but who 2600 Toe: Cine ar Mira. we Ratfather decides to practise medicine in another country, The purpose of such communication will be to compel the registered practitioner to assist the disciplinary organs in treating the matter beforethem, inwhich heis involved. 28.2 The Medical and Dental Practitioners’ Disciplinary Tribunal 26.2a The Medical and Dental Practitioners’ Disciplinary Tribunal has the status ofa High Court of the Federal Republic of Nigeria and practitioners who appear before it, whether as complainants, defendants or witnesses, whether or not they are also represented by lawyers, must conduct themselves as they would before a high court, This code of behaviour is equally applicable to counsels who appear before the Tribunal 26.2b Practitioners who make public comments on cases pending before the Medical and Dental Practitioners’ Investigating Panel or Disciplinary Tribunal, or cases where the time for appeal has not expired, shall be guilty of contempt of the Panal or the Tribunal, as the case shall be, and shall be liable ta appropriate disciplinary action. 28.3 Cooperation with MDCN Inspectors 276.3a. Practitioners are expected to fully cooperate with the inspectors of the Council any time they visit for verifying that both the practitioners and the- health institutions in which they function are complying with regulations of the MDCN, Failure to cooperate with inspectors and obstruction of their work will constitute professional misconduct, Professional Negligence The medical and dental practitioner's duty is to care for their patients in every professional relationship. The particular skill {BAGH Tve- Cro or Birt. Etc ne Rarwhich training, recognition and registration bestow on a practitioner should be exercised ina manner expected of any other member of the profession of his or her experience and status, In the fight of the rapid advances in science and medicine, it has become necessary for practitioners to regularly upgrade their knowledge and skills through activities of continuing professional development (CPD). Evidence of having participated in CPD activities has become a necessary condition for the renewal of practising licences based on the guidelines determined by the Council from time ta time. A practitioner shall see and attend to ail patients on admission under his care, as frequently as their conditions demand, and record in the case notes relevant clinical findings at each visit Practitioners should take note of this following guidelines with respect to the category of patients listed hereunder, 29.1 Patients on intravenous Therapy 29.12 All patients on intravenous therapy, and particularly blood transfusion, should be within the sight of Qualified supervising clinicians at all times, and must Not be left in the care of untrained individuals in aside ward even when they are relatives, 29.\b Obligatory observations of the pulse rate, blood Pressure, temperature, and respiration must be charted al least every 4 hours, and 24-hour fluid balance chart should be kept and reviewed together with possible electrolyte changes every 24 hours. 29.2 Nursing The Unconscious Patient Nursing of unconscious patient is a special science requiring the careful positioning, tha observation and charting of certain vital signs, and the patient should be in the view of the qualified supervising clinicians at all times. 29.3 Emergency Admissions Every emergency admission should be seen by the doctor or dentist.on call immediately, certainly not later than 4 hours 20M Thee Conn in Mirae Eom Mriafter admission, and where appropriate, by the Consultant ‘on call within 12 hours, At the scene of a road traffic accident, a passing doctor Is under no obligation to stop and render professional services: to the victims; but if he decides to stop and do so, he is bound by the ethics to exercise a degree of reasonable care and do everything that @ competent and registered practitioner would do in the circumstance. There are peculiar infrastructural and social problems in Nigeria that are outside the contro! of medical and dental professions, which create obstacles to the ability of the clinicians of these professions to apply their expertise to the full degree expected; this situation does not preciude the practitioner from acting within the degree of reasonable care thal is possible under the circumstances. Thus a registered practitioner who fails to exercise the skill or act with the degree of care expected of his experience and status in the process of attending to a patient is liable for professional negligence. 29.4 The following among others constitute Professional Negligence 29.4a Failure to attend promptly toa patient requiring urgent attention when the practitioner was in a position to do 80. 29.4b Manifestation of incompatence in the assessment of apatient. 29.4c Making an incorrect diagnosis particularly when the clinical features were so glaring that no reasonable skillful practitioner could have failed to notice them. 29.40 Failure to advise, or praffering wrong advice to, a patient on the risk involved in a particular operation or course of treatment, especially if such an operation or course of treatment is likely to result in serious side effects like deformity or loss of anorgan, orfunction. CM The! Conn in Mp ae Kom Mriau. 29.4e Failure to obtain the informed consent of the patient before proceeding on any surgical procedure or course of treatment, when such consent, was necessary. 29.4f Making a mistake in treatment; @.g. amputation of the wrong limb, carelessness that results in the termination of @ pregnancy, prescribing the wrong drug, of dosage in error for a correctly diagnosed ailment, etc. 29.4g.Failure to refer, or transfer a patient in good time, when sucha referral or transfer was necessary. 29.4h Failure to-do anything that ought reasonably to have been done under any circumstance for the good of the patient. 29.4] Failure to see a patient as often as his medical condition warrants or to make appropriate comments in the case notes of the practitioner's observations: and prescribed treatment during such visits. !t also includes failure to communicate with the patient or with his relatives as may be necessary with regards to any developments, progress or prognosis jin the patient's condition. Recurrent Professional Negligence A practitioner who appears before the Medical and Dental Practitioners’ Disciplinary Tribunal for the second time on a charge ‘of professional negligence, and is found guilty, shall not have the ‘option of being admonished. He shall be suspended from practice for a period not less than six months. A practitioner who Ls habitually negligent in a professional respect could have his name. struck off the relevant register. ‘Gross Professional Negligence Where the extent of the negligence had been such that itresulted in permanant disability or death of the patient, then the practitioner ‘will be quilty of gross negligence and is liable to: BRO Twe- Cros ar Bren. Etc we Rar{a} suspension for a period of six months; or {b} having his name struck off the medical or dental register, as the case may be.PART B2: BIOMEDICAL RESEARCH INVOLVING HUMAN SUBJECTS 32. Rules of Biomedical Research involving Human Subjects: Nigeria is a signatory to the Declaration of Helsinki that was. adopted by the World Medical Assembly In Helsinki, Finland, in June 1994 and finally at the 48th General Assembly, in Somerset ‘West, Republic of South Africa in October 1996. (See Appendix 6) A National Health Research Ethics Committee (NHREC) was established under the Federal Ministry of Health in 2006. It is ‘empowered to register sel up by the heads of institutions where Tesearch involving Health Research Ethics Committees (HREC) human subjects is likely to be conducted, Although the MDCN was not consulted during the formation of this important ethics body, it has a crucial if not central role. The responsibility of the doctor to the human subject in medical research is similar to that of the lawyer to his client in legal processes. i. Only a registered doctor can legally conduct research involving human subject. If done by anyone else, a registered doctor must still supervise it, otherwise the non-medical researcher can be charged with illegal practice of medicine-a criminal offence, i The informed consent of all human subjects must be given on the doctor's advice, and it must not be the doctor involved in the research. ii, The medical practitioner must supervise the safety of the hum jan subject throughout the research period iv. On no account should effective treatment be withheld for any teason whatsoever, ¥. Any violation of the health interest of participating human subject will make the supervising doctor liable to prosecution for professional misconduct. ‘The tole of the MOCN in the NHREC has not yel been determined, BAGH Tve- Cro ar Blown. Eta eR‘but was under consideration at the time of the revision of this Code. Medical practitioners need guidance when called upon to determine the interest of human research subjects, They should work according to the principles set out in this section. 32.1 The Following are some of the Basic Principles involved: 32.1a Biomedical research involving human subjects must conform to generally accepted scientific principles and should be based on adequately performed laboratory and animal experimentation and in thoraugh knowledge of the scientific literature. 32.lb. Biomedical research involving human subjects should be conducted only by scientifically qualified persons and under the supervision of a clinically competent medical person. The responsibility for the human subject must always rest on the medically Qualified person and never rest on the subject of the research even though the subject has given his orher own consent. ‘32.4c. The design and performance of each experimental procedure involving human subjects should be clearly formulated in an experimental protocol which should be submitted to the appropriate Ethical Committee in conformity with the laws and regulations of the Country, 32.10. The importance of the objective must in no way compromise protection against the inherent risks to the subject. 32.12. Every precaution must be taken to protect the privacy of the subject and to minimize the impact of the study on the physical and mental integrity and the personality of the subject. 32.1f. Physicians should cease any investigation if the hazards are found to outweigh the potential benefits. 32.19. In order to satisty the condition of informed consent 200 The! Conn Mra omc Mid322 by participating human beings, each subject must be informed of the aims, methods, anticipated benefits, potential hazards and the discomfort the research may entail. He or she must be informed that he or she is at liberty to abstain from participating in the study; and at liberty to withdraw participation at anytime. This consent must be freely given in writing, signed by the subject and witnessed by the supervising doctor, 32.1h. If the subject is in a dependent relationship to the investigator, then informed consent should be obtained by a physician who is not engaged in the investigation and who is completely independent of this official relationship. 324i. In case of legal incompetence, informed consent should be obtained from the legal guardian in @ocordance with national legislation. 32.4], In the case of mental incapacity or a minor, the consent from the responsible relative replaces that of the subject. 321k. The research protocol should always contain a statement of the ethical considerations involved and should indicate that the principles enumerated therein are complied with, Medical Research combined with Professional Care 32.2a. In treating sick persons, the physician is free to use. a new diagnostic and therapeutic measure, if in his judgement it offers hope of saving life, reestablishing health or alleviating suffering, 32.25 The potential benefits, hazards and discomfort of a new method should be weighed against the advantages of the best diagnostic and therapeutic methods. 32.2c. The patient must be sssured of the best-proven 20M Thee Conn Mpa Eom Mid