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[Nile Valley University - Faculty Of Medicine - Department of Community Medicine ‫بسم هللا الرحمن الرحيم‬ ‫جامعة وادي النيل‬ ‫كلية الطب والعلوم الصحية‬ BASIC OF MEDICAL PROFESSIONAL ETHICS...

[Nile Valley University - Faculty Of Medicine - Department of Community Medicine ‫بسم هللا الرحمن الرحيم‬ ‫جامعة وادي النيل‬ ‫كلية الطب والعلوم الصحية‬ BASIC OF MEDICAL PROFESSIONAL ETHICS Dr. Omima Abdalla Bashier Consultant of community medicine Assistant professor NVU.FOM 1  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine LEARNING OUTCOMES “ AIMS “ * By the of the course the student should know to : ❑ Describe and define what is meant by the word “ethically” ❑ Describe and define what is meant by the word “professional “ ❑ Explain the role of general ethical codes in good business practice e.g ( medical field ❑ Be fully conversant i.e.( up to date )with The Code of Conduct 2  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine A Brief History of Ethics ❑ Natural Behavior ▪ when observing the animal kingdom, there are clear signs of rules of behavior. ▪ The young monkey does not mess with the “big daddy” and when lions are feeding off a freshly killed carcass the hyenas keep a good distance. All of this behavior appears to be instinctual or intuitive but it serves the very clear purpose of maintaining order within the animal kingdom. ❑ Human Behavior ▪ Human ethical behavior has been observed from the earliest recorded data and anthropological and archeological studies have indicated that all primitive tribes have very definite rules of behavior. Christopher Boehm (1982) has hypothesized that the incremental development of moral complexity throughout hominid evolution was due to the increasing need to avoid disputes and injuries in moving to open savannah and developing stone weapons. * Human morality, though sophisticated and complex relative to other animals, is essentially a natural phenomenon that evolved to restrict excessive individualism and foster human co-operation. * Group morality develops from shared concepts and beliefs and is often codified to regulate behavior within a culture or community. * What are ethics and professionalism? What are Ethics? * Ethics is relevant to you in your everyday life as at some point in your professional or personal life you will have to deal with an ethical question or problem, e.g. what is your level of responsibility towards protecting another person from threat, or whether or not you should tell the truth in a particular situation? Definitions ❑ Ethics refers to standards of behavior that tell us how human beings ought to act in the many situations in which they find themselves as friends, parents, children, citizens, businesspeople, teachers, professionals, and so on. 3  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine ❑ From dictionary :Rules of behavior based on idea about what is morally good and bad. Usually we learn the right and wrong firstly from our parents or from those who take care of us ( those who raised us ). So ❖ Divisions of ethics (ethical theory) * Divisions of ethics 1. Normative Ethics (‫ )األخالقيات المعيارية‬: is focused on the creation of theories that provide general moral rules governing our behavior. Examples : Imagine that ethics is like football * The normative ethicist is like a referee interested in the rules governing play..i.e. (sets up the rules governing how the game is played) * What interests him is the general theories that govern our moral behavior; * how do we work out ,what is right and what is wrong? * Cont. Divisions of ethics 2. Meta-Ethicist : (‫ (األخالقيات الفوقية‬study of how we engage in ethics The meta-ethicist is like a football commentator. judges and comments on how the ethical game is being played rather than advancing practical arguments, or kicking the football, themselves For example, the meta-ethicist might discuss how people use moral language; or comment on the psychology of immoral people; or ask whether moral properties exist ❖ The benefits of professional ethics in medicine 1. Medical ethics is based on a set of values that professionals can refer to in the case of any confusion or conflict 2. Medical ethics forms the core of medical professionalism. ❖ Fundamental Ethical Principles ❑ There are four fundamental ethical principles : 1. patient autonomy (respect for patient), ‫استقاللية المريض‬ 4  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine 2. Mal-feasance (doing no harm to the patients) ‫المخالفات‬ 3. Beneficence (doing good), and ‫اإلحسان‬ 4. Justice (doing fairly).‫العدالة‬ 1. Autonomy Autonomy in developmental psychology and moral, political, and bioethical philosophy, autonomy is the capacity to make an informed, un compelled decision. Patient autonomy: The right of patients to make decisions about their medical care without their health care provider trying to influence the decision. Patient autonomy does allow for health care providers to educate the patient but does not allow the health care provider to make the decision for the patient. 2. Non-Malfeasance : Malfeasance mean : ( wrong doing or misconduct especially by public official ) Non-maleficence is a core principle of medical ethics stating that a physician has a duty to ‘do no harm’ to a patient. It directs a medical professional to consider the benefits of all procedures and weigh them against the potential risks and burdens on the patient. occasionally deeming no treatment to be the best treatment. In medical education, it also applies to performing tasks appropriate to an individual's level of competence and training (Author: Steven J Girdler, al.et ) 3. Beneficence : Beneficence is a core principle in medical ethics that guides practitioners to act as they believe is in the best interest of the patient. ▪ Beneficence mean an act of charity, mercy, and kindness with strong connotation of doing good to others including moral obligation ▪ Unlike non malfeasance , it goes beyond simply doing no harm and encourages to actively help others. It might be useful to think of beneficence as of the process of ranking the available options for the patient from best to worst, taking into consideration the following aspects: ▪ Will this option resolve this patient’s medical problem? ▪ Is it proportionate to the size of the medical problem? ▪ 5  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine ▪ Is this option compatible with this patient’s individual circumstances ”situation ? ▪ Is this option and its outcomes in-line with the patient’s expectations of treatment? 4. Justice : Justice – in medical ethics – is the principle that when weighing up if something is ethical or not, we have to think about whether it’s compatible with the law, the patient’s rights, and if it’s fair and balanced. In health care justice refers clearly to philosophical concept of distributive justices " this principle assert that all person\ patient will be treated fairly and equitably. It also means that we must ensure no one is unfairly disadvantaged when it comes to access to healthcare. The ethics of justice deals with moral choices through a measure of rights of the people involved and chooses the solution that seems to damage the fewest people. Rooted in a respect for the legal system, it applies in the Western democracy ideas like social contract theory to everyday moral decisions ❖ Principle of Health Care ethics ❑ The language of ethics related to healthcare ,commonly called bioethics, is applied across all practice settings, and four basic principles are commonly accepted. These principles include the above mentioned principles. Bioethics is the interdisciplinary study of ethical issues arising in the life sciences, health care, and health and science policy. Clinical ethics can help to identify, understand and resolve ethical issues that arise in patient care by helping to clarify why certain actions are right or wrong. ✓ Whatever their role, doctors must do the following: a) Engage with colleagues to maintain and improve the safety and quality of patient care. b) Contribute to discussions and decisions about improving the quality of services and outcome * Purpose of HealthCare Ethics Healthcare ethics is the collection of principles that guide doctors, nurses, and other clinicians in providing medical care. 6  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine * It combines moral beliefs — a sense of right and wrong — with a sense of the provider's duty toward others. * Healthcare ethics covers how providers treat patients. ❖ What is The main purpose of professional ethics for doctors ? ❑ The primary duty of all doctors is for the care and safety of patients. A professional person not only has particular knowledge and skills, acquired through training and refined by experience, but also agrees to conform “ obey “ to certain standards of personal behaviour and codes of practice. These values, which underpin the science and practice of medicine, form the basis for a moral contract between the medical profession and society. Each party has a duty to work to strengthen the system of healthcare on which our collective human dignity depends. Professionalism? What is Professionalism? ▪ from dictionary it means Conduct or qualities making professional person. ▪ Medical professionalism signifies a set of values, behaviors and relationships that underpin (strengthen) the trust ,the public has in doctors ▪ Medicine is a vocation “careers’ in which a doctor’s knowledge, clinical skills and judgment are put in the service of protecting and restoring human well- being. This purpose is realized through a partnership between patient and doctor, based on mutual respect, individual responsibility and appropriate accountability.’’ ❑ Professional ethics ▪ Professional ethics is a set of standards adopted by a professional community. which are often referred to as codes of ethics ▪ Professional people and those working in acknowledged professions implement specialist knowledge and skill. How the use of this knowledge should be governed when providing a service to the public can be considered a moral issue and is termed professional ethics 7  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine ▪ One of the earliest examples of professional ethics is probably the Hippocratic oath to which medical doctors still adhere to this day. ❖ Basic Professional Ethics ▪ Basic professional ethics are the standards of conduct that guide the behavior of people in a certain profession or occupation. ▪ The code of ethics is very important because it gives us boundaries that we have to stay within in our professional careers. ▪ Different professions may have their own codes of ethics that specify the ethical rules and responsibilities for their member working in partnership with members of the wider healthcare team 1. NUREMBERG-CODE -1947. 8  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine 2. DECLARATION OFGENVA 1948 9  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine 3. Helsinki Declaration1964 4. World Medical Association (WMA) ▪ World Medical Association (WMA) : It is the global organization of physicians , its core role is to ensure the highest possible standard of ethical practice of the medical profession. ▪ its establishment in 1947 in the result of one of the most egregious breaches ( breaks ) of medical ethical principles. ▪ WMA has adopted a comprehensive range of declarations, resolutions, and statements aimed at providing ethical and other guidance to the global medical profession. The WMA’s body of policies adopt are 3 core documents: ▪ Declaration of Geneva: The Physician’s Pledge (oath ) (DoG) ▪ Declaration of Helsinki (DoH), ▪ International Code of Medical Ethics (ICoME). 10  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine ▪ The one problem with the code of ethics is that we can't always have the answers black and white. ▪ Sometimes there are grey areas where the answers aren't so simple. “Ethical dilemma “ ▪ Code of ethics are also known as Ethical Business Practices ▪ medical code of ethics are based on principles such as. a. Honesty ( ‫(النزاهة‬ b. Trustworthiness ( ‫)جدير بالثقة‬ c. Transparency. ( ‫) الشفافيه‬ d. Confidentiality ( ‫السريه‬.) e. Objectivity ( ‫)الموضوعيه‬ f. Respectfulness ( ‫(االحترم‬ g. Obedience to the law ( ‫) االلتزام بالقوانين‬ h. Loyalty ( ‫) االستقالليه‬ i. Integrity ( ‫(االمانة او االستقامة‬ * Principles of Professional Ethical “ Ethics Code “ 1. Honesty ( ‫) النزاهة‬ ▪ Honesty refers to a part of moral character and signify positive and virtuous attributes such as integrity, truthfulness and straightforwardness , along with the absence of lying, cheating or theft. Honesty is valued in many cultures and religion 2. Integrity () ‫(االستقامه اواالمانه‬ ▪ Integrity is a concept of consistency of actions, values, methods, measures, principles, expectations, and outcomes. ▪ In ethics, integrity is regarded as the honesty and truthfulness or accuracy of one's actions. 3. Confidentiality ( ‫)السرية‬ 11  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine ▪ Confidentiality is a set of rules or a promise that limits access or places restrictions on certain types of information. Confidentiality is ensuring that information is accessible only to those authorized to have access 4. Transparency ( ‫الشفافيه‬ ) generally, implies to openness, communication, and accountability. ▪ Transparency is operating in such a way that it is easy for others to see what actions are performed. 5. Accountability (‫(المسئوليه المجتمعيه‬ In ethics and governance, accountability is answerability, blameworthiness, liability, and the expectation of account-giving 6. Objectivity ( ‫) الموضوعية‬ Law is a system of rules and guidelines which are enforced through social institutions to govern behavior. Laws are made by governments, specifically by their legislatures. The formation of laws themselves may be influenced by a constitution (written or unwritten) and the rights encoded therein. The law shapes politics, economics and society in countless ways and serves as a social mediator of relations between people. 7. Respectfulness ( ‫(متسم باالحترم‬ Respect gives a positive feeling of esteem for a person or other entity such as a nation or a religion, and also specific actions and conduct. ▪ Rude ( impolite ) conduct is usually considered to indicate a lack of respect, disrespect, ▪. Specific ethics of respect are of fundamental importance to various cultures and therefore key to success in any organization is Respectfulness. ▪ Obedience to the law law is a system of rules and guidelines which are enforced through social institutions to govern behavior. 12  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine ▪ Laws are made by governments, specifically by their legislatures and in organizations, by the Top Management.. ▪ The formation of laws themselves may be influenced by a constitution (written or unwritten) and the rights encoded therein. The law as erves as a social mediator of relations between people. And the employees working in an organization are bound to obey the Laws & Regulations of that organization * Importance of professional ethics ❑ Professional ethics is important because : A. It dictate to the proficient a series of rules related to the way the experts (professionals) acts towards the people with whom he/she relates professionally. B. It make the persons to follow the resonance, standardized ethical conduct to performing such jobs C. Professional ethics are principles that govern the behavior of a person or group in a business environment. Like values, * Value Systems ❑ Values are the unarticulated beliefs that form the foundation for ethical behavior, It is the system of established values, standers , or goal existing in a society.” i.e. practices that are viewed by our society as correct behavior. * Forms of Value Systems ‫القيم‬ It exist in different forms such as social values, organizational values, human values & personal values. Often these are defined in Citizen's Charters, Code of Conduct and as Leadership Attributes. * All forms of value systems are largely based on : ethics, morality and virtues. ❑ As a doctor you should acknowledge the fundamental importance of the following values both for yourself and your profession:- 1. Quality of life - people being satisfied with their whole life experience; 2. Freedom and responsibility - people being free and responsible in choosing how they will live their lives 13  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine 3. Justice : people living lives whose results are fair and right for everyone. 4. Health, human potential, empowerment, growth and excellence: - people being healthy, aware of the fullness of their potential, recognizing their power to bring that potential into being, growing into it, living it, and, generally, doing the best they can with it, individually and collectively; 5. Dignity, integrity, worth and fundamental rights of individuals, organizations, communities, societies, and other human systems 6. All-win attitudes and cooperation - people caring about one another and about working together to achieve results that work for everyone, individually and collectively; 7 Effectiveness, efficiency and alignment - people achieving the maximum of desired results, at minimum cost, in ways that coordinate their individual energies and purposes with those of the system-as-a-whole, the subsystems of which they are parts, and the larger system of which their system is a part;.8.. Authenticity and openness in relationships; 9. Holistic, systemic view and affected parties orientation - understanding human behaviour from the perspective of whole system(s) that influence and are influenced by that behaviour; recognizing the interests that different people have in the system's results and valuing those interests fairly and justly; 10. Wide participation in system affairs, confrontation of issues leading to effective problem Moral principles ‫المبادئ‬ ▪ Moral principles are the prevailing standards of behavior that enable people to live cooperatively in groups. ▪. They are based on what societies authorize as right and acceptable1. ▪ Some commonly recognized moral principles are respect for autonomy, beneficence, non-malfeasance, and justice ▪ Moral principles are guidelines that people live by to make sure they are doing the right thing. These include things like honesty, fairness, and equality. Moral principles can be different for everyone because they depend on how a person was raised and what is important to him in life > 14  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine ✓ Moral Codes of Conduct * Moral code examples throughout history are: 1. The „Golden Rule‟, ospel of Matthew (7:12): “In everything, do to others what you would have them do to you....” This rule of conduct is a summary of the Christian’s duty to his neighbour and states a fundamental ethical principle 2. The „Five Precepts‟ of Buddhism : are a set of five basic ethical guidelines that are common to all schools of Buddhism. They are: a) To refrain from harming living beings b) To refrain from taking that which is not given c) To refrain from sexual misconduct d) To refrain from false speech e) To refrain from intoxicants that cloud the mind 3. The „Noble Eightfold Path‟, or The Eightfold Path consists of eight practices: right view, right resolve, right speech, right conduct, right livelihood, right effort, right mindfulness, and right samadhi ('meditative absorption or union'; alternatively, equanimous meditative awareness). right path 4. The Egyptian code of Ma‟at, Standers of Moral Principles * The five principles, autonomy, justice, beneficence, non malfeasance, and fidelity are each absolute truths in and of themselves. * By exploring the dilemma in regards to these principles one may come to a better understanding of the conflicting issues. * The principles–Mission, Truth, Lawfulness, Integrity, Stewardship, Excellence and Diversity–reflect the of standard ethical conduct expected of all Intelligence Community personnel, regardless of individual role or agency affiliation * The eight core characteristics of professionalism are: * Competence, knowledge, conscientiousness, Integrity, Respect, Emotional Intelligence,. Appropriateness, and Confidence. But The revised Code establishes a conceptual framework for all professional accountants to ensure compliance with the five fundamental principles of ethics: 15  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine 1. Integrity. 2. Objectivity. 3. Professional Competence and Due Care. 4. Confidentiality. 5. Professional Behavior. What is professional ethics and human values? ▪ Professional organizations necessarily include components like integrity, honesty, transparency, respectfulness towards the job, confidentiality, objectivity etc. These values include the respect for autonomy, non-malfeasance, beneficence, and justice The four principles of medical ethics have been extremely important in the field of medicine and are fundamental for understanding the current approach to ethical assessment in health care. Medical professionalism Code of conduct of physician ❑ World Medical Association OF MEDICAL ETHICS (WMA) ❑ Historical Back Round Adopted by the 3rd General Assembly of the World Medical Association, London, England, October 1949 Revised by the 22nd World Medical Assembly, Sydney, Australia, August 1968, the 35th World Medical Assembly, Venice, Italy, October 1983, the 57th WMA General Assembly, Pilanesberg, South Africa, October 2006 and by the 73rd WMA General Assembly, Berlin, Germany, October 2022 ❑ The World Medical Association (WMA) has developed the International Code of Medical Ethics as a canon of ethical principles for the members of the medical profession worldwide. ❑ In concordance with the WMA Declaration of Geneva: The Physician’s Pledge and the WMA’s entire body of policies, it defines and elucidates the professional duties of physicians towards their patients, other physicians and health professionals, themselves, and society as a whole. 16  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine 1. The physician must be aware of applicable national ethical, legal, and regulatory norms and standards, as well as relevant international norms and standards. 2. Such norms and standards must not reduce the physician’s commitment to the ethical principles set forth in this Code. 3. The International Code of Medical Ethics, is addressed to physicians. But.encourages others who are involved in healthcare to adopt these ethical principles 1. General principle 1. The primary duty of the physician is to promote the health and well-being of individual patients by providing competent, timely, and compassionate care in accordance with good medical practice and professionalism. 2. T he physician also has a responsibility to contribute to the health and well- being of the populations the physician serves and society as a whole, including future generations. 3. The physician must provide care with the utmost respect for human life and dignity, and for the autonomy and rights of the patient. 4. The physician must practice medicine fairly and justly and provide care based on the patient’s health needs without bias or engaging in discriminatory conduct on the basis of : age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, culture, sexual orientation, social standing, or any other factor 5. The physician must strive to use health care resources in a way that optimally benefits the patient, in keeping with fair, just, and prudent stewardship of the shared resources with which the physician is entrusted 6. The physician must practice with conscience, honesty, integrity, and accountability, while always exercising independent professional judgment and maintaining the highest standards of professional conduct. 7. Physicians must not allow their individual professional judgment to be influenced by the possibility of benefit to themselves or their institution. 8. The physician must recognize and avoid real or potential conflicts of interest. Where such conflicts are unavoidable, they must be declared in advance and properly managed. 17  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine 9 Physicians must take responsibility for their individual medical decisions and must not alter their sound professional medical judgments on the basis of instructions contrary to medical considerations. 10. When medically appropriate, the physician must collaborate with other physicians and health professionals who are involved in the care of the patient or Who are qualified to assess or recommend care options. This communication must respect patient confidentiality and be confined to necessary information 11. When providing professional certification, the physician must only certify what the physician has personally verified (confirmed ). 12. The physician should provide help in medical emergencies, while considering the physician’s own safety and competence, and the availability of other viable options for care. 13The physician must never participate in or facilitate acts of torture, or other cruel, inhuman, or degrading practices and punishments 14. The physician must engage in continuous learning throughout professional life in order to maintain and develop professional knowledge and skills. 15. The physician should strive to practice medicine in ways that are environmentally sustainable with a view to minimizing environmental health risks to current and future generations 2. Duties to the patient 1. In providing medical care, the physician must respect the dignity, autonomy, and rights of the patient. The physician must respect the patient’s right to freely accept or refuse care in keeping with the patient’s values and preferences. 2. The physician must commit to the primacy of patient health and well-being and must offer care in the patient’s best interests. In doing so, the physician must strive to prevent or minimize harm for the patient and seek a positive balance between the intended benefit to the patient and any potential harm. 3. The physician must respect the patient’s right to be informed in every phase of the care process, The physician must obtain the patient’s voluntary informed consent prior to any medical care provided, ensuring that the patient receives and understands the information needed to make an independent, informed decision 18  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine about the proposed care. The physician must respect the patient’s decision to withhold or withdraw consent at any time and for any reason. 4. When a patient has substantially limited, underdeveloped, impaired, or fluctuating decision-making capacity, the physician must involve the patient as much as possible in medical decisions. In addition, the physician must work with the patient’s trusted representative, if available, to make decisions in keeping with the patient’s preferences, when those are known or can reasonably be inferred. When the patient’s preferences cannot be determined, the physician must make decisions in the patient’s best interests. All decisions must be made in keeping with the principles set forth in this Code. 5. In emergencies, where the patient is not able to participate in decision making and no representative is readily available, the physician may initiate an intervention without prior informed consent in the best interests of the patient and with respect for the patient’s preferences, where known. 6. If the patient regains decision-making capacity, the physician must obtain informed consent for further intervention. 7. The physician should be considerate of and communicate with others, where available, who are close to the patient, in keeping with the patient’s preferences and best interests and with due regard for patient confidentiality. 8. If any aspect of caring for the patient is beyond the capacity of a physician, the physician must consult with or refer the patient to another appropriately qualified physician or health professional who has the necessary capacity. 9. The physician must ensure accurate and timely medical documentation. If a physician is acting on behalf of or reporting to any third parties with respect to the care of a patient, the physician must inform the patient accordingly at the outset and, where appropriate, during the course of any interactions. 10.The physician must disclose to the patient the nature and extent of those commitments and must obtain consent for the interaction. 11. The physician must respect the patient’s privacy and confidentiality, even after the patient has died. A physician may disclose confidential information if the patient provides voluntary informed consent or, in exceptional cases, when disclosure is necessary to safeguard a significant and overriding ethical obligation to which all other possible solutions have been exhausted, even when the patient 19  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine does not or cannot consent to it. This disclosure must be limited to the minimal necessary information, recipients, and duration. 12. If a physician is acting on behalf of or reporting to any third parties with respect to the care of a patient, the physician must inform the patient accordingly at the outset and, where appropriate, during the course of any interactions. The physician must disclose to the patient the nature and extent of those commitments and must obtain consent for the interaction. 13. The physician must not allow commercial, financial, or other conflicting interests to affect the physician’s professional judgement 14. The physician must refrain from intrusive or otherwise inappropriate advertising and marketing and ensure that all information used by the physician in advertising and marketing is factual and not misleading 15. The physician must maintain appropriate professional boundaries. The physician must never engage in abusive, exploitative, or other inappropriate relationships or behavior with a patient and must not engage in a sexual relationship with a current patient. 16. When providing medical care remotely, the physician must ensure that this form of communication is medically justifiable and that the necessary medical care is provided. The physician must also inform the patient about the benefits and limitations of receiving medical care remotely, obtain the patient’s consent, and ensure that patient confidentiality is upheld. Wherever medically appropriate, the physician must aim to provide care to the patient through direct, personal contact 17. When providing medical care remotely, the physician must ensure that this form of communication is medically justifiable and that the necessary medical care is provided. The physician must also inform the patient about the benefits and limitations of receiving medical care remotely, obtain the patient’s consent, and ensure that patient confidentiality is upheld. Wherever medically appropriate, the physician must aim to provide care to the patient through direct, personal contact 18. The physician must maintain appropriate professional boundaries. The physician must never engage in abusive, exploitative, or other inappropriate relationships or behavior with a patient and must not engage in a sexual relationship with a current patient. 20  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine 19. In order to provide care of the highest standards, physicians must attend to their own health, well-being, and abilities. This includes seeking appropriate care to ensure that they are able to practice safely  N.B. This Code represents the physician’s ethical duties. However, on some issues there are profound moral dilemmas concerning which physicians and patients may hold deeply considered but conflicting careful beliefs. The physician has an ethical obligation to minimize disruption to patient care. Physician conscientious objection to provision of any lawful medical interventions may only be exercised if the individual patient is not harmed or discriminated against and if the patient’s health is not endangered. The physician must immediately and respectfully inform the patient of this objection and of the patient’s right to consult another qualified physician and provide sufficient information to enable the patient to initiate such a consultation in a timely manner. 3. Duties to other physicians, health professionals, students, and other personnel 1. The physician must engage with other physicians, health professionals and other personnel in a respectful and collaborative manner without bias, harassment, or discriminatory conduct. The physician must also ensure that ethical principles are upheld when working in teams. 2. The physician should respect colleagues’ patient-physician relationships and not intervene unless requested by either party or needed to protect the patient from harm. This should not prevent the physician from recommending alternative courses of action considered to be in the patient’s best interests. 3. The physician should report to the appropriate authorities conditions or circumstances which impede the physician or other health professionals from providing care of the highest standards or from upholding the principles of this Code. This includes any form of abuse or violence against physicians and other health personnel, inappropriate working conditions, or other circumstances that produce excessive and sustained levels of stress. 4. The physician must accord due respect to teachers and students. 4.Duties to society 21  [Nile Valley University - Faculty Of Medicine - Department of Community Medicine 1. The physician must support fair and equitable provision of health care. This includes addressing inequities in health and care, the determinants of those inequities, as well as violations of the rights of both patients and health professionals. 2. Physicians play an important role in matters relating to health, health education, and health literacy. In fulfilling this responsibility, physicians must be prudent in discussing new discoveries, technologies, or treatments in non- professional, public settings, including social media, and should ensure that their own statements are scientifically accurate and understandable. Physicians must indicate if their own opinions are contrary to evidence-based scientific information 3. The physician should avoid acting in such a way as to weaken public trust in the medical profession. To maintain that trust, individual physicians must hold themselves and fellow physicians to the highest standards of professional conduct and be prepared to report behavior that conflicts with the principles of this Code to the appropriate authorities 4. The physician should share medical knowledge and expertise for the benefit of patients and the advancement of health care, as well as public and global health. 22