UNIT-2 CODE OF

CONDUCT
CONTENTS
• History and development of code of conduct
• Atreya Anushasana
• Charaka Sambita
• Sushruta Samhita,
• Hippocratic Oath
• International Code of Medical Ethics
• Code of Ethics for Biomedical Research
• Code of Conduct for medical records professional
 INTRODUCTION
• Ethical code of conduct are important for any profession. It is all the more so for the
medical profession. The code of conduct can succeed only if the profession, as a whole,
feels responsible for its implementation.
• If the doctors as members of the profession fail to be responsible and do not take action
against those who do not observe the code, the code becomes ineffective.
• Ethical code is not legislation. But, it is equally forceful as it is approved by the profession.
• The final court in all actions is the conscience of the doctor(and of the patient).There
appears the voice which summons the doctor to do what is good & avoid what is evil.
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• There are many codes of conduct. Among them are
1) Atreya Anushasana
2) Charaka Samhita
3) Sushruta Samhita
4) Oath of Hippocrates
5) International Code of Medical ethics
6) Code of Ethics for Biomedical Research
7) Code of Conduct for medical records professional
8) Medical Council of India, Code of Ethics
HISTORICAL PERSPECTIVE
• The first recorded code of conduct(according to Ayurveda) is the Atreya Anushasana
• Mainly concentrate on the various duties of the physician
ATREYA ANUSHASANA
If you desire a success or fame as a physician
1) You shall pray for the welfare of all creatures; day and night you shall endeavor to relieve
their suffering with all your heart and soul
2) You shall not injure nor desert your patient even for the sake of your own life or living
3) You shall enter the patient’s house after due permission accompanied by a person known
to him, bent of head and shall conduct yourself with utmost care and caution.
4) Once inside the house, you shall devote your senses, mind and speech entirely to the
patient, his ailments and things concerning him but shall not let them go astray.
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5) You shall keep all information about the patient secret and shall not offend him by
revealing it to others
6) Even if the patient’s life was closing up, you shall not announce it either to him or to his
relatives in a manner as would injure their feelings
7) No offering of any kind, reward, present,eatables,et. Shall be accepted by you without the
permission of the head of the family especially from the ladies without the knowledge and
consent of their masters
8) You shall conduct yourself dignified, respect the traditions and customs of the house, speak
moderately, gently and rightly.
9) Listen to and act suitably even to others, if it be for the benefit of the patient
10) Boast not your knowledge, though possessing it
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11) You shall clean and modest in your attire and appearance
12) You shall not commit adultery even in thought
13) You shall not covet other’s professions and shall excercise restraint on your desires
14) You shall not associate with sinners,drunkards,criminals and the mean nor shall act as
their abettor
15) Reside not in places of ill-repute nor visit them
16) Harbour not jealousy towards elders, other physicians and respectables;regrd them,
consult them at times of doubt
17) Medical science is external and noble, follow it with diligence and faith,uphold its aims
and by so doing attain happiness here and hereafter
HISTORICAL PERSPECTIVE OF CHARAKA SAMHITA
• Recorded in 600 BC
• Code of conduct for would be physician
CHARAKA SAMHITA
1) Your action must be free from ego,vanity, worry, agitation of mind; your action must be
carefully planned with concern for the patient and in keeping with the instructor’s advice.
2) Your uncesing efforts must at all costs (sarvatmana) be directed towards giving health to
the suffering patients(aturanam arogya)
3) You must never harbor feelings of ill-will towards your patients, whatever the
provocation, even if it entails risk to your life
4) Never should you entertain thoughts (manasapi) of sexual misconduct or thoughts of
appropriating property that does not belong to you
5) Take no liquor, commit no sin, nor keep company with the wicked
6) Your speech must be soft, pleasant, virtuous, truthful, useful and moderate
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7) What you do must be appropriate to the place where you practice and the time and you
must be mindful in whatever you do
8) Your efforts must be unremitting (nityam yatnavata cha)
9) Do not reveal to others what goes on in the patient’s household (aturakula pravarthayah)
10) Even when your learned and proficient, do not show off
HISTORICAL PERSPECTIVE OF SUSRUTA SAMHITA
• Guidelines for surgeon and the surgical procedure
SUSHRUTA SAMHITA
1) Sushruta Samhita, which is equally ancient also gives guidelines particularly with respect
to surgeons & surgical procedures
2) Vagabhata the elder says”Friendship with all, sympathy towards the sick, feeling of
profound satisfaction upon recovery and overlooking even those who have ill-will towards
him are sufficient to fulfill the ethical requirements of a doctor”
3) Another ancient code of conduct for doctors is contained in the Hippocratic Oath. It is in
the form of an oath and therefore binding on the person.
HISTORICAL PERSPECTIVE OF HIPPOCRATIC OATH
• Written in 400 BC by Hippocrates, Father of Medicine
• Based on Greek tradition
OATH OF HIPPOCRATES
• The Hippocratic Oath is based on the Greek tradition. It continues to influence today.
• “I swear by Apollo Physician, by Aesclepeus, by Hygiea, by Panacea and by all the gods and
goddesses, making them my witnesses that I will carry out, according to my ability and
judgement, this oath and indenture.
HISTORICAL PERSPECTIVE OF INTERNATIONAL
CODE OF MEDICAL ETHICS
• Adopted by the 3rd General Assembly of the world Medical association, London, England,
October 1949.
• Amended by the 22nd world medical assembly Sydney, Australia, August 1968
• 35th world medical assembly venice Italy October 1983.
INTERNATIONAL CODE OF MEDICAL ETHICS
1) A Physician shall always maintain the highest standards of professional conduct
2) A Physician shall not permit motives of profit to influence the free and independent
exercise of professional judgement on behalf of patients
3) A Physician shall in all types of medical practice be dedicated to providing competent
medical service in full technical & moral independence with compassion and respect for
human dignity
4) A Physician shall deal honestly with patients and colleagues and strive to expose those
physicians deficient in character or competene or who engage in fraud or deception
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The following practices are deemed to be unethical conduct
a) Self advertising by physicians, unless permitted by the law of the country and the Code of
Ethics of the National Medical Association
b) Paying or receiving any fee or any other consideration solely to procure the referral of a
patient or for prescribing or referring a patient to any source.
5) A Physician shall respect the rights of colleagues and of other professionals and shall
safeguard patient confidence
6) A Physician shall act only in the patient’s interest when providing medical care which might
have the effect of weakening the physical & mental condition of the patient
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7) A Physician shall use great caution in divulging discoveries or new techniques or treatment
through non-professional channels
8) A Physician shall certify only that which he has personally verified
CODE OF ETHICS FOR BIOMEDICAL RESEARCH

Historical Perspective
• First international declaration was Nuremberg code in 1947.
• In 1964, 18th world medical assembly meeting at Helsinki, Finland, set up a code of conduct known
as declaration of Helsinki.
• Amended By:
• 29th world medical assembly, Tokyo,Japan,October 1975.
• 35th world medical assembly, Venice, Italy, October 1983.
• 41st world medical assembly,Hong Kong, September 1989.
• 48th world medical assembly, Somerset west, RSA,Oct 1996
• 52nd world medical assembly, Edinberg,Scotland, Oct 2000
• Indian council of medical research set up a code of conduct for biomedical research on human
subject in 1980.
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• The first International Code of Ethics for Research involving human subjects ‘The Nuremberg

Code’ was a response to the cruelties committed by Nazi Research Physicians revealed at the
Nuremberg war crimes trials. Thus, it was to prevent any repetitions by physician of such
attacks on the rights and welfare of human beings that human research ethics came into
being. The Nuremberg (1947) laid down standards for carrying out human experimentations,
emphasizing the subject’s voluntary consent. World Medical Association (1964) took a step
further to reassure society by adopting the ‘Declaration of Helsinki’, which laid down the
ethical guidelines for research involving human subjects.
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• The Indian Council of Medical Research (ICMR), New Delhi had brought a document in February 1980, ‘Policy
Statement of Ethical Considerations involved in Research on Human Subject’ prepared by the Ethical
Committee which is being used ,not only by ICMR, but also by Research Institutions, Government Agencies,
Non-government Agencies. However, need to update this was required keeping in view the modern biology
and recent developments in different medical fields. Therefore, the Central

• Ethics Committee on Human Research (CECHR) was constituted to consider various issues related to ethical,
social and legal aspects.

• The Committee identified the following major areas and set up sub- Committees of experts for drawing up a
set of guidelines related to clinical evaluation of drugs, epidemiological research, human genetic research,
transplantation research, assisted reproductive technologies and many more.
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• It was proposed that these guidelines be updated periodically, paripasu,with the development of the
area of medical science. In view of the circumstances of developing countries in regard to the
applicability of ‘Nuremberg Code and Declaration of Helsinki’, the Council for International
Organizations of Medical Sciences (CIOMS) and the World Health Organization (WHO) undertook
and issued the proposed international guidelines for biomedical research involving human subjects
(1982).

• The purpose of proposed guidelines was to indicate the ethical principles that should guide the
conduct of biomedical research involving human subjects, as set in the ‘Declaration of Helsinki’
which could be applied effectively and efficiently in developing countries.
CODE OF CONDUCT FOR MEDICAL RECORDS PROFESSIONAL

Historical Perspective:

American medical association, the American Hospital Association, many allied health association and
American Medical Records Association, in 1957, adopted a code of ethics which define basic principles for
the conduct of its member.

In 1977, the code of ethics was re-examined and redefined to provide those in medical records fields with
definite and binding guidelines of the conduct.

The terminology AMRA has been changed to AHIMA(American Health Information Management
Association) founded in 1928 to improve the quality of medical records and provide education and
certification to the professional specialized in health information management.
AMERICAN HEALTH INFORMATION MANAGEMENT
ASSOCIATION CODE OF ETHICS 2004
• Advocate, uphold and defend the individual’s right to privacy and the doctrine of
confidentiality in the use and disclosure of information.
• Put service and the health and welfare of persons before self interest and conduct
themselves in the practice of the profession so as to bring honor to themselves, their peers
and to the health information management profession.
• Preserve, protect and secure personal health information in any form or medium and hold
In the highest regard the contents of the records and other information of a confidential
nature, taking into account the applicable statutes and regulations.
• Refuse to participate in or conceal unethical practices or procedures.
• Advance health information management knowledge and practice through continuing
education, research, publications and presentations.
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• Recruit and mentor students, peers and colleagues to develop and strengthen professional
workforce.
• Represent the profession accurately to the public.
• Perform honorably health information management association responsibilities, either
appointed or elected, and preserve the confidentiality of any privileged information made
known in any official capacity.
• State truthfully and accurately their credentials, professional education and experiences.
• Facilitate interdisciplinary collaboration in situations supporting health information practice.
• Respect the inherent dignity and worth of every person.