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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
Interprofessionalism.
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 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
13.
Part A: An introduction to medical ethics in the Commonwealth
8. 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
1
For a full list of Commonwealth member states, see Appendix A.

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.
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.
9. 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 globalisation.

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.
10. The medical practitioner as a professional.
10.1. The practitioner should make the care of their patients their first concern.
10.2. 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 pateients, are honest and trustworthy, and act
with integrity and within the law.
11. The exercise of judgement.
11.1. The proper practise of medicine requires that practitioners use their judgement
in applying ethical and legal principles to a variety of situations.

11.2. 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.
11.3. The practitioner should exercise their judgement:
11.3.1. in accordance with what the reasonable medical practitioner in the
particular branch of the profession would do; and
11.3.2. with due regard for and consideration of the rights of others.
11.4. 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.
12. Obligations regarding legal or disciplinary proceedings.
12.1. 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.
12.2. Practitioners should take reasonable steps to ensure that any information
provided is accurate, reliable and complete.
12.3. 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.

12.4. Practitioner should make clear the limits of their competence and knowledge
when giving evidence or acting as a witness.
13. The relationship of trust.
13.1. 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.
13.2. Practitioners should at all times demonstrate competence, honesty and
integrity in the practise of their profession.
13.3. Practitioners should at all times show respect for their patients, and should
not:
13.3.1. 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.
13.3.2. use their professional position to pursue a sexual or improper
emotional relationship with a patient or someone close to them.
14. 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.
1. Part B: Medical professionalism and the physician-patient relationship.
1. The qualities of the physician as a professional.
1.1. 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.
1.2. The physician need not possess the highest expert level of skill.
1.3. 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.

1.4. 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.
2. 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.
3. Patient rights and the doctor-patient relationship.
3.1. Practitioners should at all times honour patients’ rights, treat patients
with respect, and honour the patient’s dignity and privacy.
3.2. 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.
4. The relationship of trust.
5. Consent to treatment.
5.1. 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.
5.2. Physicians should not be compelled to provide treatment against their
clinical judgment.
5.3. 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.
5.4. 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.
5.5. 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.
5.6. On-duty physicians should be accessible to patients and colleagues
seeking information, advice or support.
6. 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.
6.1. Where the patient voluntarily gives authority to the practitioner or a third party
to make a decision.
6.2. 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.
7. Decision-making for mentally incompetent patients.
7.1. 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.
7.2. Proxy consent should be obtained from a legally authorized substituted
decision-maker.

7.3. 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.
7.4. In the event of conflict between parties claiming to be substitute decisionmakers,
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.
7.5. The principles applicable to informed consent (discussed at paragraph) are
equally applicable to substituted decision-making.
7.6. 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.
8. Medical confidentiality.
8.1. 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.

8.2. Confidentiality is central to the relationship between practitioners and patients
in that:-
8.2.1. it accords with the principle that physicians should respect the rights of
their patients, particularly their right to self-determination; and
8.2.2. it promotes a relationship of trust between practitioner and patient and
encourages patients to share information which is necessary for good
medical care.
8.2.3. 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.
8.3. 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:
8.3.1. 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.
8.3.2. 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.
8.4. The patient should be specifically advised of:
8.4.1. disclosure of information for purposes which they may not reasonably
expect or
8.4.2. which are made for reasons other than their own care, such as service
planning or medical research.
8.5. 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.
8.6. When communicating publicly, including speaking to or writing in the media,
you must maintain patient confidentiality.
8.7. Patient records or other patient information should be stored securely.
8.8. Exceptions to the duty of confidentiality.
Although confidentiality is an important duty, it is not absolute. Appropriate
information-sharing is essential to the efficient provision of safe, effective care, both
for the individual patient and for the wider community of patients.

8.9. Personal information can be disclosed if:
8.9.1. it is required by law.
8.9.2. the patient implicitly or expressly consents. As a general rule, such
consent may be made:
8.9.2.1. implicitly for the sake of their own care;
8.9.2.2. expressly for other purposes.
8.9.3. it is justified in the public interest.
8.10. It is recommended that even where such circumstances exist, information
about a patient is anonymised or coded information wherever possible.
8.11. Disclosures required by law
8.11.1. 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.
8.11.2. Where such circumstances appear to exist, reasonable steps should be
taken to ensure that any such disclosure is in fact required by law.

8.11.3. 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.
8.12. Practitioners should disclose information if ordered to do so by a judge or
presiding officer of a court.
8.13. 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.
8.14. 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.
9. Disclosures to the healthcare team.
9.1. 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.

9.2. 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.
9.3. 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.
9.4. 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.
9.5. 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.
9.6. 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.
10. Disclosures in the public interest.
10.1. 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.
10.2. 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.

10.3. The patient’s consent should still be sought, unless it is not practicable to do
so, or the putpose of the disclosure would be defeated.
10.4. 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.
10.5. Where reasonably practicable, the information should be anonymised or
coded.
11. Disclosures made to protect the patient.
11.1. 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.
11.2. 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.
11.3. Disclosure without consent may be justified if it is not practicable to seek a
patient’s consent.

12. Disclosures made to protect others.
12.1. 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.
12.2. In such circumstances the practitioner should, if reasonably practicable, seek
the patient’s consent to disclosure.
12.3. The reasons for any refusal must be considered in the circumstances.
12.4. The practitioner should, notwithstanding the patient’s refusal to consent,
disclose the information promptly to an appropriate person or authority:
12.4.1. 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
12.4.2. if it is not practicable or safe to seek the patient’s consent.
12.4. 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.
13. Disclosures about patients who lack capacity to consent.

13.1. 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.
13.2. the patient should take the following factors into consideration:
(a) 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;
(b) any evidence of the patient's previously expressed preferences;
(c) the views of any person:
the patient requests the practitioner to consult, or
who has legal authority to make a decision on their behalf, or
has been appointed to represent the patient.
(d) 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
(e) 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.
2
Work collaboratively with colleagues to maintain or improve patient care.
3
Openness and legal or disciplinary proceedings.

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
1. 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.
2. 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;
3. 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.
4. Practitioners should recognise that children and young people are a vulnerable
group, and should safeguard and protect their health, welfare and best
interests.

5. Practitioners should take into account the particular emotional,
communication and security needs of children and young people.
6. 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.
7. 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.
8. 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:
8.1. have regard to the child or young person as an individual with his or her
own values, likes and dislikes;
8.2. consider the child or young person’s best interests in a holistic way,
including what is clinically indicated in a particular case;
8.3. 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
8.4. 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.
9. Practitioners have the same duty of confidentiality to children and young
people as they have to adults as set out in paragraphs.

10. 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.
11. 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.
12. 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.
13. 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.
14. 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.
15. 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.

16. 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.
17. 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
18. 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.
19. 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
20. 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.
21. 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.
1. Develop and maintain your professional performance.
2. Record your work clearly.
3. Respond to risks to safety.
4. Honesty
Honesty in financial dealings
Consent
1. Consent to treatment.
2. Exceptions to informed consent by competent patients.
3. Decision-making for mentally incompetent patients.
4. 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.
13.

Part D: Medical professionalism and the relationship with colleagues and the
public.
1. Interprofessionalism. 4
2. The practitioner’s duty to the courts and the legal process. 5
3.
4.
5.
6. Glossary
7. “Practitioner” and “medical practitioner” means any person qualified to
practise medicine, no matter what their speciality.
4
Work collaboratively with colleagues to maintain or improve patient care.
5
Openness and legal or disciplinary proceedings.