The importance of ethics in the practice of medicine has been recognised since the time of Hippocrates. Despite this, historically physicians have breached medical ethics in the name of scientific experimentation.
Clear guidelines on ethical conduct and behaviour by doctors are an essential element of a modern society in which scientific and medical knowledge advances so rapidly.
The publication of the sixth ethical guide by the Medical Council continues the tradition whereby council members update guidelines for medical practitioners during the latter part of their five year tenure. In his introduction, the council's president, Prof Gerard Bury, says: "Ethical principles are the very foundation of our role as doctors - the potential for damage to the bond of trust between doctor and a patient is very great". Reflecting on the period since the last ethical guide was published in 1998, he says it is "of great concern" that evidence has emerged "both in Ireland and abroad" of the harm done by doctors who do not put ethical practice at the heart of their work.
It has certainly been a period during which the public has been alarmed by the nature and extent of medical malpractice, especially that revealed by the fitness-to-practise investigation into the professional conduct of Dr Michael Neary, the Drogheda obstetrician and gynaecologist. It is reassuring to see the emphasis placed in the new guide on the whistle-blowing role of doctors. Where a doctor feels the work of a colleague is impaired by ill-health or substance abuse, detailed action is expected.
An entire new section on patients with disabilities is welcome. "Disability does not necessarily mean lack of capacity," it says, emphasising that such patients are entitled to the same treatment options and respect for autonomy as any other person. A small but important addition to a paragraph on the intimate examination of patients advises doctors to offer chaperones to men as well as women. With much evidence to suggest that many medico-legal claims originate in doctors' attitudes and poor communication skills, section 3.10 of the new guide should have been more direct in its advice to doctors to express regret in cases of patient dissatisfaction.
Prof Bury acknowledges that the council did not issue specific guidelines on the use of stem cells. Indeed, he states that the guide "does not deal in any depth with emerging biotechnology issues". While advances in the biotechnology industry will almost certainly warrant an amendment to the ethical guide during the lifetime of the incoming Medical Council, another industry, pharmaceuticals, would do well to note section 10.1 of the current guide.
In closely defining the terms under which a doctor may accept financial aid from a drug company, the guideline sends an unambiguous message to both physicians and the industry: ensure that educational grants are both proportionate and free of restriction.