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The Commonwealth Medical Law Society
Ethical Guidelines
Part A: An introduction to medical ethics in the Commonwealth
1. An introduction to the common law.
2. Medical law in the Commonwealth.
3. The medical practitioner as a professional.
4. The exercise of judgment.
5. Obligations regarding legal or disciplinary proceedings.
6. The relationship of trust.
8. Partnerships with patients.
7. Communicating information.

Part B: Medical professionalism and the physician-patient relationship.
The qualities of the physician as a professional.
The relationship between physician and patient. Patient rights and the doctor-patient
relationship. The relationship of trust Consent to treatment.
Exceptions to informed consent by competent patients. Decision-making for mentally
incompetent patients.
Medical confidentiality.
Exceptions to the duty of confidentiality.
Disclosures required by law
Disclosures to the healthcare team.
Disclosures in the public interest.
Disclosures made to protect the patient Disclosures made to protect others.
Disclosures about patients who lack capacity to consent
Sharing information with a patient's partner, carers, relatives or friends Genetic and other
shared information.
Disclosure after a patient's death
Inter-professionalism.
The practitioner’s duty to the courts and the legal process.

Part C: The maintenance of professional standards: knowledge, skills and
performance.
Develop and maintain your professional performance.
Record your work clearly.
Respond to risks to safety.
Honesty in financial dealings
Consent
Consent to treatment.
Exceptions to informed consent by competent patients.
Decision-making for mentally incompetent patients.
The patient’s best interests.
Medical confidentiality.
5. The general duty to respect confidentiality.
a. Disclosures required by law.
6. Consent to disclosure of information.
a. Circumstances in which patients may give implied consent to disclosure.
b. Disclosures for which express consent should be sought.
c. Disclosures in the public interest.
7. Disclosures to protect the patient.
8. Disclosures to protect others.
9. Disclosures about patients who lack capacity to consent.

10. Sharing information with a patient's partner, carers, relatives or friends.
11. Genetic and other shared information.
12. Disclosure after a patient's death.
Part A: An introduction to medical ethics in the Commonwealth
1. An introduction to the common law.
One third of the world's population (approximately 2.3 billion people) live in common
law jurisdictions or in systems mixed with civil law. Common law originated during the
Middle Ages in England, and from there was propagated to the colonies of the British
Empire, including India, the United States, Pakistan, Nigeria, Bangladesh, Canada and
all its provinces (except Quebec), Malaysia, Ghana, Australia, Sri Lanka, Hong Kong,
Singapore, Burma, Ireland, New Zealand, Jamaica, Trinidad and Tobago, Cyprus,
Barbados, South Africa, Zimbabwe, Cameroon, Namibia, Liberia, Sierra Leone,
Botswana, Guyana, and Fiji. 1
The common law forms the basis of the legal systems of most states in the
Commonwealth, formally known as the Commonwealth of Nations, which is made up of
53 member states united by language, history, culture, and their shared values of
democracy, human rights, and the rule of law.
1
For a full list of Commonwealth member states, see Appendix A.

The Commonwealth dates back to the mid-20th century with the decolonisation of the
British Empire through increased self-governance of its territories. The Commonwealth
was formally constituted by the London Declaration in 1949, which established the
member states as "free and equal". The Commonwealth covers more than 29,958,050
km2 (11,566,870 sq mi), almost a quarter of the world land area, and spans all continents.
The Commonwealth in 2014 produced a nominal gross domestic product (GDP) of
$10.45 trillion, representing 17% of the gross world product when measured in
purchasing power parity (PPP) and 14% of the gross world product when measured
nominally.
2. Medical law in the Commonwealth.
Although there are marked similarities between the legal systems of the Commonwealth
countries, each jurisdiction has developed its own principles and structures. The specific
legal principles therefore vary from one country to the next. However, a good deal of
common ground exists. This is becoming increasingly so as the effects of information
technology make their impact felt. The Ethical Guidelines are a collection of principles
which reflect a broad international consensus on the applicable principles governing
medical law, seen through the lens of the foundational values of the Commonwealth: the
promotion of democracy and development, commitment to democracy, good governance,
human rights, gender equality, and a more equitable sharing of the benefits of
globalization.
Due to the multinational character of the duties and principles contained in the Ethical
Guidelines, the expression “the practitioner should” is frequently used. This reflects the
guidance as a set of foundational principles which supplement and inform the applicable
national principles. Practitioners should ensure that they understand the legal principles

which apply in their country, and should use these guidelines as supplementary to those
legal principles. Whenever in any doubt, proper legal advice and, if necessary,
representation should be obtained.
3. The medical practitioner as a professional.
3.1. The practitioner should make the care of their patients their first concern.
3.2. Patients must be able to trust doctors with their lives and health. To justify
that trust the practitioner must show respect for the rights of the patients,
colleagues and other parties, and ensure that their practice meets the
standards of competence of the reasonable medical practitioner.
Practitioners should ensure that they are competent, keep their knowledge and
skills up to date, establish and maintain good relationships with patients and
colleagues, respect the rights of patients, are honest and trustworthy, and act with
integrity and within the law.
4. The exercise of judgement.
4.1. The proper practise of medicine requires that practitioners use their
judgement in applying ethical and legal principles to a variety of situations.
4.2. The exercise of judgement is an integral part of the practitioner’s
professional duties, whatever field of medicine the practitioner works in, and
regardless of whether the practitioner routinely sees patients.

4.3. The practitioner should exercise their judgement:
4.3.1. in accordance with what the reasonable medical practitioner in the
particular branch of the profession would do; and
4.3.2. with due regard for and consideration of the rights of others.
4.4. The practitioner should be able to provide a rationally defensible explanation
for any decision made, based on the criteria referred to in paragraph 5.3.
5. Obligations regarding legal or disciplinary proceedings.
5.1. Practitioners should be honest and trustworthy when giving evidence to courts or
tribunals and that any evidence you give or documents you write or sign are not
false or misleading.
5.2. Practitioners should take reasonable steps to ensure that any information provided
is accurate, reliable and complete.
5.3. Practitioners should co-operate with formal inquiries and complaints procedures
and must offer all relevant information while ensuring that the confidentiality of
personal information is respected.
5.4. Practitioner should make clear the limits of their competence and knowledge when
giving evidence or acting as a witness.

6. The relationship of trust.
6.1. As professionals, practitioners should ensure that their conduct justifies and
contributes to the patient’s trust in the individual practitioner and the public’s trust
in the profession as a whole.
6.2. Practitioners should at all times demonstrate competence, honesty and integrity in
the practise of their profession.
6.3. Practitioners should at all times show respect for their patients, and should not:
6.3.1. express their personal beliefs (including political, religious and moral
beliefs) to patients in ways that exploit the patient’s vulnerability or are
likely to cause them distress.
6.3.2. use their professional position to pursue a sexual or improper emotional
relationship with a patient or someone close to them.
7. Partnerships with patients.
Practitioners should strive to work in partnership with patients. This should include
providing such information as will enable the patient to make decisions about their care,
respecting the confidentiality of the patient’s personal information, supporting patients in
caring for themselves and improving and maintaining their health, and working with
patients to serve their best interests.
Practitioners should listen to patients, encourage patients to share their views, and
respond honestly to patients’ questions.

Information should be provided to patients in a way that they can understand. The
practitioner should take reasonable steps to meet patients’ language, communication and
cultural needs.
Practitioners must provide support to those close to the patient and be sensitive and
responsive in their dealings with them, while respecting the rights of the patient.
Written documents (including clinical records) should be clear, accurate and legible.
Written records of events should be made as soon as reasonably after such events.
Clinical records should include:
a) relevant clinical findings
b) the decisions made and actions agreed, and who is making the decisions and
agreeing the actions
c) the information given to patients
d) any drugs prescribed or other investigation or treatment
e) who is making the record and when.
8. Communicating information.
i. The practitioner should show reasonable skill, care and diligence when
communicating in writing, such as when writing reports, medical notes,
prescriptions and any other document.
ii.
The practitioner should take reasonable steps to ensure that any information given
is accurate and reliable.

iii.
The practitioner should not leave out relevant information, whether deliberately or
through oversight.
iv.
The practitioner should indicate the limits of his or her knowledge when
communicating information to patients.
Part B: Medical professionalism and the physician-patient relationship.
9. The qualities of the physician as a professional.
9.1. The physician is expected to display a standard of skill, care and diligence in
practising his or her profession which is in keeping with the standard of the
ordinary skilled person in that particular branch of the profession.
9.2. The physician need not possess the highest expert level of skill.
9.3. The physician is judged according to the standard of the ordinary practitioner in
the particular field under consideration. That means that specialists may be judged
according to a higher level of skill than generalists.
9.4. The level of experience of the practitioner is ordinarily irrelevant to the
determination of whether the physician complied with the standard of the ordinary
practitioner. However, where the inexperienced practitioner seeks advice or
consults with a more experienced colleague, this will very often result in the
conduct being regarded as complying with the necessary standard.
10. The relationship between physician and patient.

The relationship between physician and patient has undergone a profound change in the
last few decades, and seems set to continue. The traditional emphasis on the physician’s
judgment to the exclusion of patients’ involvement has given way to an approach where
the autonomy and self-determination of the patient is playing an increasing role. In many
countries, the law is placing an increasing emphasis on the rights of patients to be
involved in the process, and traditional deference to the physician is being replaced by a
balancing of rights and duties between physician and patient.
11. Patient rights and the doctor-patient relationship.
11.1. Practitioners should at all times honour patients’ rights, treat patients with
respect, and honour the patient’s dignity and privacy.
11.2. Practitioners should not discriminate against or victimize a person in relation
to the terms on which the health service is provided on any arbitrary ground
such as religion, gender, race, sex, pregnancy, marital status, ethnic or social
origin, colour, sexual orientation, age, disability, conscience, belief, culture
or language.
12. The relationship of trust.
13. Consent to treatment.
13.1. The physician should respect the patients’ right to self-determination, that
is, their right to make their own decisions. The patient has the right to such
information as is reasonably necessary to make such decisions.
13.2. Physicians should not be compelled to provide treatment against their
clinical judgment.

13.3. Seeking a patient’s consent to disclosure of information shows respect, and
is part of good communication between doctors and patients. The patient
should understand clearly the purpose of any test or treatment, what the
results would mean, and the implications of withholding consent.
13.4. A mentally competent adult person has the right to give or withhold consent
to any diagnostic procedure or therapy, even where such refusal may result
in the patient’s disability or death.
13.5. Effective communication is essential to obtaining informed consent. Patients
should be given the information they want or need to know in a way that
they can understand. Reasonable arrangements should be made to meet the
patient’s language or communication needs. Maintain record-keeping.
Record your work clearly, accurately and legibly.
13.6. On-duty physicians should be accessible to patients and colleagues seeking
information, advice or support.
14. Exceptions to informed consent by competent patients.
Practitioners should encourage the patient to make their own decisions and should be
reluctant to accept the authority to make such decisions. Where this is unavoidable, the
decision should be made in the patient’s overall best interests.
14.1. Where the patient voluntarily gives authority to the practitioner or a third party to
make a decision.
14.2. Where disclosure of information could cause harm to the patient, the concept of
therapeutic privilege may allow the physician to withhold medical information.
The privilege is potentially open to abuse and should only be relied on in extreme
circumstances.

15. Decision-making for mentally incompetent patients.
15.1. In certain circumstances, patients are not competent to make legally valid
decisions. Examples of such patients are young children, individuals affected by
certain psychiatric or neurological conditions and patients which are unconscious
or comatose.
15.2. Proxy consent should be obtained from a legally authorized substituted decisionmaker.
15.3. Where the consent of a substituted decision-maker is not possible, consideration
should always be given to obtaining the authority of a court. Where the situation is
one of such urgency that to obtain such authority would result in harm to the
patient. In these narrow circumstances, a decision in accordance with the best
interests of the patient must be made.
15.4. In the event of conflict between parties claiming to be substitute decision-makers,
or in the event that the substitute decision-maker and the practitioner disagree as
to the best interests of the patient, the authority of a court should be obtained.
15.5. The principles applicable to informed consent (discussed at paragraph) are equally
applicable to substituted decision-making.
15.6. The physician should strive to give effect to the patient’s wishes where these are
known, such as when an advance directive has been given, or the patient’s wishes
have been communicated to the substituted decision-maker.
16. Medical confidentiality.

16.1. The general duty to respect confidentiality. The physician should respect a patient's
right to confidentiality, and is under a duty to not to disclose, without the consent
of the patient, information which the physician has gained in his or her professional
capacity.
16.2. Confidentiality is central to the relationship between practitioners and patients in
that:-
16.2.1. it accords with the principle that physicians should respect the rights of
their patients, particularly their right to self-determination; and
16.2.2. it promotes a relationship of trust between practitioner and patient and
encourages patients to share information which is necessary for good
medical care.
16.2.3. Many regulatory bodies have codes of practice governing how they will
access and use personal information, and practitioners should have
knowledge of and comply with these codes.
16.3. It is recognised that appropriate information-sharing is essential to the efficient
provision of safe, effective care for the patient and the broader community. Such
information-sharing should occur on the following basis:
16.3.1. The general approach should be that such information should only be
shared with the consent of the patient. and reasonable steps to ensure that
the patient is properly advised should be taken.
16.3.2. Reasonable attempts should be made to advise patients of the extent to
which information will be shared and, in particular:

a. whether their personal information may be disclosed only for the sake of
their own care within the healthcare team, or
b. whether the information will be disclosed for any other purpose.
16.4. The patient should be specifically advised of:
16.4.1. disclosure of information for purposes which they may not reasonably
expect or
16.4.2. which are made for reasons other than their own care, such as service
planning or medical research.
16.5. Practitioners should be alert not to disclose information unintentionally, and care
should be taken about unintentionally disclosing information in a public setting, or
where access to information can be obtained by third parties (such as codewords
or patient files). Practitioners should bear in mind that communications made in
the social media or which are intended for friends or family are subject to the same
rule regarding confidentiality.
16.6. When communicating publicly, including speaking to or writing in the media, you
must maintain patient confidentiality.
16.7. Patient records or other patient information should be stored securely.
16.8. Exceptions to the duty of confidentiality.

Although confidentiality is an important duty, it is not absolute. Appropriate informationsharing
is essential to the efficient provision of safe, effective care, both for the individual
patient and for the wider community of patients.
16.9. Personal information can be disclosed if:
16.9.1. it is required by law.
16.9.2. the patient implicitly or expressly consents. As a general rule, such
consent may be made:
16.9.2.1. implicitly for the sake of their own care;
16.9.2.2. expressly for other purposes.
16.9.2.3. it is justified in the public interest.
16.10. It is recommended that even where such circumstances exist, information about a
patient is anonymised or coded information wherever possible.
16.11. Disclosures required by law
16.11.1. In certain circumstances, practitioners are obliged to disclose
information to satisfy a specific statutory or legal requirement, such as
provisions relating to notification of a known or suspected case of
certain infectious diseases.
16.11.2. Where such circumstances appear to exist, reasonable steps should be
taken to ensure that any such disclosure is in fact required by law.

16.11.3. It is generally desirable that patients are informed about such
disclosures even if their consent is not required. However, it is not
necessary to provide such information where that would undermine the
purpose of the disclosure.
16.12. Practitioners should disclose information if ordered to do so by a judge or presiding
officer of a court.
16.13. Practitioners should not disclose personal information to a third party such as a
solicitor, police officer or officer of a court without the patient’s express consent,
unless it is required by law or can be justified in the public interest.
16.14. In circumstances where information is requested, but not required by law,
practitioners should seek the patient’s express consent before disclosing personal
information. If a patient refuses to consent, or if it is not practicable to seek their
consent, the practitioner should contact the appropriate regulatory body for advice
on whether the disclosure can be justified in the public interest.
17. Disclosures to the healthcare team.
17.1. As a general rule, practitioners should seek a patient’s express consent before
disclosing identifiable information within the healthcare team or with others
providing care.
17.2. The practitioner should respect the wishes of any patient who objects to particular
information being shared within the healthcare team or with others providing care,
unless disclosure would be justified in the public interest.

17.3. If a patient objects to a disclosure that the practitioner considers essential to the
provision of safe care, the practitioner should explain that the patient cannot be
treated or referred without disclosing the information.
17.4. The practitioner should ensure that anyone who receives personal information is
aware that the information is being given in confidence, and that such person is
under a duty to respect the confidentiality of the personal information.
17.5. Where a patient cannot provide consent to the disclosure of information, for
example in a medical emergency, the practitioner should pass on necessary and
relevant information promptly to those providing the patient’s care. If and when
the patient is capable of understanding, the fact tthat the information ws passed on
should be disclosed to the patient.
17.6. Where a practitioner is asked to provide information to third parties, such as a
patient’s insurer or employer or a government department or an agency assessing
a claimant’s entitlement to benefits the practitioner should:
(a) be satisfied that the patient has sufficient information about the scope, purpose
and likely consequences of the examination and disclosure, and that relevant
information cannot be concealed or withheld.
(b) Obtain written consent to the disclosure from the patient or a person properly
authorised to act on the patient’s behalf.
(c) only disclose factual information you can substantiate, presented in an unbiased
manner, relevant to the request. The handing over of the whole record is not
generally advisable.

(d) It is generally advisable to offer to show the patient, or give them a copy of,
any report you write about them for employment or insurance purposes before
it is sent, unless there are good reasons not to do so. Such reasons may include
the fact that disclosure would be likely to cause serious harm to the patient or
anyone else, or disclosure would be likely to reveal information about another
person who does not consent.
18. Disclosures in the public interest.
18.1. In exceptional cases, personal information may be disclosed in the public
interest without the patient’s consent, if the benefits to an individual or to
society of the disclosure outweigh both the public and the patient’s interest in
keeping the information confidential.
18.2. Disclosure in the public interest may occur where it is necessary to protect
individuals or society from risks of serious harm, such as serious
communicable diseases or serious crime.
18.3. The patient’s consent should still be sought, unless it is not practicable to do
so, or the purpose of the disclosure would be defeated.
18.4. The practitioner should weigh the harms that are likely to arise from nondisclosure
of information against the possible harm both to the patient, and to
the overall trust between doctors and patients, arising from the release of that
information.

18.5. Where reasonably practicable, the information should be anonymised or
coded.
19. Disclosures made to protect the patient.
19.1. A competent adult patient’s refusal to consent to disclosure should be
respected, even if their decision leaves them, but nobody else, at risk of
serious harm or death.
19.2. The practitioner should take reasonable steps to provide patients with the
information and support the patient needs to make decisions in their own
interests, and to this end it may be appropriate for the practitioner to encourage
patients to consent to disclosures which are considered necessary for the
protection of the patient, and to warn the patient of the risks of refusing to
consent.
19.3. Disclosure without consent may be justified if it is not practicable to seek a
patient’s consent.
20. Disclosures made to protect others.
20.1. Disclosure of personal information about a patient without consent may be
justified in the public interest if failure to disclose may expose others to a risk
of death or serious harm.

20.2. In such circumstances the practitioner should, if reasonably practicable, seek
the patient’s consent to disclosure.
20.3. The reasons for any refusal must be considered in the circumstances.
20.4. The practitioner should, notwithstanding the patient’s refusal to consent,
disclose the information promptly to an appropriate person or authority:
20.4.1. Where a patient’s refusal to consent to disclosure leaves others
exposed to a risk so serious that it outweighs the patient’s and the
public interest in maintaining confidentiality, or
20.4.2. if it is not practicable or safe to seek the patient’s consent.
20.4.3. The practitioner should inform the patient before disclosing the
information, if practicable and safe, even if the information will be
disclosed without the patient’s consent.
21. Disclosures about patients who lack capacity to consent.
21.1. When making decisions about whether to disclose information about a
patient who lacks capacity, the practitioner should:
a. make the care of the patient their first concern;
b. respect the patient’s dignity and privacy; and
c. support and encourage the patient to be involved, as far as they want and
are able, in decisions about disclosure of their personal information.
21.2. the patient should take the following factors into consideration:

21.2.1. whether the patient's lack of capacity is permanent or temporary
and, if temporary, whether the decision to disclose could reasonably
wait until the patient regains capacity;
21.2.2. any evidence of the patient's previously expressed preferences;
21.2.3. the views of any person:
1. the patient requests the practitioner to consult, or
2. who has legal authority to make a decision on their behalf, or
3. has been appointed to represent the patient.
21.2.4. the views of people close to the patient on the patient’s preferences,
feelings, beliefs and values, and whether they consider the proposed
disclosure to be in the patient's best interests, and
21.2.5. what the practitioner, in consultation with the healthcare team,
know about the patient's wishes, feelings, beliefs and values.
If a patient who lacks capacity asks you not to disclose personal information about their
condition or treatment, you should try to persuade them to allow an appropriate person to
be involved in the consultation. If they refuse, and you are convinced that it is essential
in their best interests, you may disclose relevant information to an appropriate person or
authority. In such a case you should tell the patient before disclosing the information and,
if appropriate, seek and carefully consider the views of an advocate or carer. You should
document in the patient’s record your discussions and the reasons for deciding to disclose
the information.
You may need to share personal information with a patient’s relatives, friends or carers
to enable you to assess the patient’s best interests. But that does not mean they have a
general right of access to the patient’s records or to have irrelevant information about, for

example, the patient’s past healthcare. You should also share relevant personal
information with anyone who is authorised to make decisions on behalf of, or who is
appointed to support and represent, a mentally incapacitated patient. Disclosures when a
patient may be a victim of neglect or abuse. If you believe that a patient may be a victim
of neglect or physical, sexual or emotional abuse, and that they lack capacity to consent
to disclosure, you must give information promptly to an appropriate responsible person
or authority, if you believe that the disclosure is in the patient’s best interests or necessary
to protect others from a risk of serious harm. If, for any reason, you believe that disclosure
of information is not in the best interests of a neglected or abused patient, you should
discuss the issues with an experienced colleague. If you decide not to disclose
information, you should document in the patient’s record your discussions and the
reasons for deciding not to disclose. You should be prepared to justify your decision.
A. Disclosures about patients who lack capacity to consent.
B. Sharing information with a patient's partner, carers, relatives or friends.
You should establish with the patient what information they want you to share, who with,
and in what circumstances. This will be particularly important if the patient has
fluctuating or diminished capacity or is likely to lose capacity, even temporarily. Early
discussions of this nature can help to avoid disclosures that patients would object to. They
can also help to avoid misunderstandings with, or causing offence to, anyone the patient
would want information to be shared with.
If a patient lacks capacity, you should share relevant information in accordance with the
advice in paragraphs 57 to 63. Unless they indicate otherwise, it is reasonable to assume
that patients would want those closest to them to be kept informed of their general
condition and prognosis.

If anyone close to the patient wants to discuss their concerns about the patient’s health,
you should make it clear to them that, while it is not a breach of confidentiality to listen
to their concerns, you cannot guarantee that you will not tell the patient about the
conversation. You might need to share with a patient information you have received from
others, for example, if it has influenced your assessment and treatment of the patient. You
should not refuse to listen to a patient’s partner, carers or others on the basis of
confidentiality. Their views or the information they provide might be helpful in your care
of the patient. You will, though, need to consider whether your patient would consider
you listening to the concerns of others about your patient’s health or care to be a breach
of trust, particularly if they have asked you not to listen to particular people.
Genetic and other shared information.
Genetic and some other information about your patient might at the same time also be
information about others the patient shares genetic or other links with. The diagnosis of
an illness in the patient might, for example, point to the certainty or likelihood of the same
illness in a blood relative.
Most patients will readily share information about their own health with their children
and other relatives, particularly if they are advised that it might help those relatives to:
(a) get prophylaxis or other preventative treatments or interventions
(b) make use of increased surveillance or other investigations, or
(c) prepare for potential health problems.
However, a patient might refuse to consent to the disclosure of information that would
benefit others, for example where family relationships have broken down, or if their
natural children have been adopted. In these circumstances, disclosure might still be

justified in the public interest (see paragraphs 36 to 56). If a patient refuses consent to
disclosure, you will need to balance your duty to make the care of your patient your first
concern against your duty to help protect the other person from serious harm. If
practicable, you should not disclose the patient’s identity in contacting and advising
others of the risks they face.
Disclosure after a patient's death
Your duty of confidentiality continues after a patient has died. Whether and what personal
information may be disclosed after a patient’s death will depend on the circumstances. If
the patient had asked for information to remain confidential, you should usually respect
their wishes. If you are unaware of any instructions from the patient, when you are
considering requests for information you should take into account:
(a) whether the disclosure of information is likely to cause distress to, or be of benefit to,
the patient’s partner or family.
(b) whether the disclosure will also disclose information about the patient’s family or
anyone else
(c) whether the information is already public knowledge or can be anonymised or coded,
and
(d) the purpose of the disclosure.
There are circumstances in which, by law, you should disclose relevant information about
a patient who has died.

Interprofessionalism. 2
The practitioner’s duty to the courts and the legal process. 3
Show respect to patients and colleagues. Work collaboratively with colleagues to
maintain or improve patient care. Show respect for patients.
Teaching, training, supporting and assessing.
The best interests of the patient.
Physicians should be sensitive to cultural as well as personal factors in assessing the
patient’s best interests.
Medical law is complex and fast-changing, and differs across the Commonwealth.
Practitioners will need some understanding of the law as it applies where they practise.
This guidance cannot be a substitute for up-to-date legal advice in individual cases. When
in doubt as to their responsibilities, doctors should seek the advice of experienced
colleagues, named or designated doctors for child protection, or professional or
regulatory bodies.
Children and Young People
General principles
22. Practitioners should be aware of the ethical and legal principles which apply to
children and young people, irrespective of whether they routinely see children and
young people as patients.
23. Children and young people are individuals with their own rights, and practitioners
should at all times protect and respect those rights. These include:
a. their right to be heard, their views taken into account and their decisions
respected; and
b. their right to confidentiality;
2
Work collaboratively with colleagues to maintain or improve patient care.
3
Openness and legal or disciplinary proceedings.

24. All actions taken and decisions made by a practitioner should take into account and
protect, promote and respect the best interests of children and young people.
25. Practitioners should recognise that children and young people are a vulnerable
group, and should safeguard and protect their health, welfare and best interests.
26. Practitioners should take into account the particular emotional, communication and
security needs of children and young people.
27. When treating children and young people, doctors must also consider parents and
others close to them; but their patient must be the doctor’s first concern.
Assessing best interests.
28. Practitioners who act or make decisions on behalf of a child or young person who
lacks decision-making capacity must do so in the best interests of the child or young
person.
29. The practitioner should take all relevant circumstances, both medical and nonmedical,
into account. In considering the best interests of the child or young person,
the practitioner should:
29.1. have regard to the child or young person as an individual with his or her own
values, likes and dislikes;
29.2. consider the child or young person’s best interests in a holistic way,
including what is clinically indicated in a particular case;
29.3. incorporate a strong element of 'substituted judgment', taking into account
both the past and present wishes and feelings of the child or young person
and, where appropriate, also the factors which the child or young person
would consider, if he or she were able to do so, including the beliefs and
values which would be likely to influence his or her decision; and
29.4. engage in appropriate consultation and consider the views of parents and
others with a valid interest in the child or young person's welfare.

Communication.
30. Practitioners have the same duty of confidentiality to children and young people as
they have to adults as set out in paragraphs.
31. Information should be shared with parents, persons with parental responsibility and
others interested in the child or young person’s welfare in accordance with the law
and the guidance in paragraphs .
Making decisions.
32. Practitioners should always attempt to obtain parental authority for treatment.
Practitioners should involve children and young people as much as possible in
decisions about their care, even when they are not able to make decisions on their
own.
Practitioners can provide medical treatment to a child or young person with their
consent if they are legally competent to make such decisions.
33. Where a child or young person is not legally competent to make such decisions, the
consent of a parent is required.
In the event of a dispute between the practitioner and the parent the authorization of
a court should be obtained. It may be permissible, where such consent or court
authorization is not reasonably possible, for emergency treatment to be provided
without consent in order to save the life of, or prevent serious deterioration in the
health of, a child or young person.
34. Where the law permits young people to consent to treatment, the practitioner must
decide whether the young person is able to understand the nature, purpose and
possible consequences of the proposed investigations or treatments, as well as the
consequences of not having treatment. Only if the young person is able to
understand, retain, use and weigh this information, and communicate their decision
to others can they consent to the proposed investigation or treatment.
35. Practitioners should ensure that all relevant information has been provided and
thoroughly discussed before deciding whether or not a child or young person has the
capacity to consent.

36. Where a child or young person lacks the capacity to consent, parental authority
should be obtained. It is usually sufficient to have consent from one parent.
37. Where a young person has capacity to consent, the practitioner should encourage
the involvement of parents in making decisions. However, as a general rule, the
practitioner should respect any decision by a young person who has the capacity to
make decisions. Where a practitioner has any concerns or misgivings, other
members of the multi-disciplinary team or other suitable persons can be involved.
38. Where a young person refuses treatment, particularly treatment that could save their
life or prevent serious deterioration in their health, the practitioner should seek legal
advice. The right to refuse treatment is a valid exercise of a patient’s autonomy and
the young person’s decision should be respected. However, a court should assess
the young person’s capacity to make the decision, and whether the decision is in the
young person’s best interests.
Procedures undertaken mainly for religious, cultural, social or emotional reasons
39. Practitioners should be permitted to undertake procedures that do not offer
immediate or obvious therapeutic benefits for children or young people, provided
this is in their best interests and performed with consent.
40. In assessing best interests, the practitioner should consider the religious and cultural
beliefs and values of the child or young person and their parents as well as any
social, psychological and emotional benefits.
Conscientious objections
41. If carrying out a particular procedure or giving advice about such procedure conflicts
with a practitioner’s religious beliefs or conscience, the practitioner should attempt
to provide alternative treatment options. This should, where appropriate, include an
approach to the practitioner’s employer or colleagues.
42. The conflict should be explained to the patient, who should be advised that they
have the right to see another practitioner. Reasonable steps should be taken to assist
in making such arrangements as soon as possible.

Glossary
References to “children” are usually to younger children who lack the maturity to make
important decisions for themselves.
References to “young people” are to persons who are mature enough to make such
decisions, but have not reached the recognised age of majority (in most jurisdictions this
is either 18 or 21 years of age).
References to “parent” in this guidance usually means a person with parental
responsibility for the child or young person in question.
“Parental responsibility” means the rights and responsibilities that parents have in law for
their child, including the right to consent to medical treatment for them
Part C: The maintenance of professional standards: knowledge, skills and
performance.
43. Develop and maintain your professional performance.
44. Record your work clearly.
45. Respond to risks to safety.
46. Honesty.
47. Honesty in financial dealings
Consent
48. Consent to treatment.
49. Exceptions to informed consent by competent patients.
50. Decision-making for mentally incompetent patients.

51. The patient’s best interests.
Medical confidentiality.
52. The general duty to respect confidentiality.
52.1. Disclosures required by law
53. Consent to disclosure of information.
53.1. Circumstances in which patients may give implied consent to disclosure
53.2. Disclosures for which express consent should be sought
53.3. Disclosures in the public interest
54. Disclosures to protect the patient
55. Disclosures to protect others
56. Disclosures about patients who lack capacity to consent
57. Sharing information with a patient's partner, carers, relatives or friends
58. Genetic and other shared information
59. Disclosure after a patient's death.
60.
Part D: Medical professionalism and the relationship with colleagues and the public.
61. Interprofessionalism. 4
4
Work collaboratively with colleagues to maintain or improve patient care.

62. The practitioner’s duty to the courts and the legal process. 5
63.
64.
65.
66. Glossary
67. “Practitioner” and “medical practitioner” means any person qualified to practise
medicine, no matter what their speciality.
5
Openness and legal or disciplinary proceedings.