Commentary on the Code of Medical Ethics and Deontology
Table of contents
Chapter VII: Relationships of doctors to each other
Never, least of all today, have the basic purposes of the medical profession - to care for the individual patient and promote the health of society - been achieved by isolated physicians working alone. To achieve these basic ends, physicians need to cooperate with each other. This partnership is an obvious necessity in the complex medicine of modern hospitals and outpatient clinics, where physicians live side by side. It is also a necessity in home medicine, where general practitioners and specialists must work together to solve their patients' problems appropriately.
Collegiality, being colleagues, makes it easier for physicians to appreciate each other, financial aid to work together, and to forget, while serving their patients, differences or estrangements of any kind subject that may separate or even set them against each other. Professional enmity between physicians can cause serious harm to patients.
article 33.1. Fellowship between doctors is a primary duty: only the rights of the patient take precedence over it.
This article defines (1) that relationships between physicians should be friendly and fraternal, and (2) that they should be subordinate to the good of the patient.
1. The old Hippocratic ideal of treating the teacher as if he were a father and his children as if they were brothers and sisters remains in the present duty of collegiality. This ideal of fraternity is reaffirmed in the Declaration of Geneva: "I will regard my colleagues as brothers". But professional fraternity, understood as a purely friendly relationship, would be threatened by the danger of degenerating into a selfish esprit de corps, with disregard for the rights of patients; into a closed preserve of qualified knowledge, in which experts take the actions of their colleagues for granted in any case; or into a cronyism to exploit the sick or society economically. To prevent this degeneration of professional fellowship, the London Code imposes on physicians, in addition to the duty to treat colleagues honestly and to regard them as brothers and sisters, the obligation to denounce those who engage in fraud or deceit.
2. The obligations of mutual respect, support, defence and protection imposed by the Code on physicians are many and have a priority character. But article 33.1 states that they have a limit: the rights of the patient. A physician may not, in the event of conflict, always and in all circumstances take sides in favour of his colleagues: if the actions of a colleague fall below the standard of competent medical care that every patient in the given circumstances has a right to expect, the defence of the patient's rights takes precedence over that of the colleague.
article 33.2. Physicians must treat each other with due deference, respect and loyalty, regardless of the hierarchical relationship between them. They have a duty to defend a colleague who is the subject of attack or unjust allegations and shall share their scientific knowledge without any reservation .
This article states (1) that professional fellowship is universal: its duties are imposed over and above any hierarchical or generational barriers. It lists (2) the features that characterise the deontological attention between colleagues. It imposes (3) on physicians the duty to come to the defence of colleagues who are victims of injustice or abuse. Finally, it points out (4) the obligation to share medical knowledge.
1. The universality of the duty of fellowship.
The registration in a high school makes doctors colleagues, confirms them in a fellowship, in a common professional vocation, by which they share the same ideals of service to society and to each patient, and the same scientific and humanitarian instructions . Any interprofessional relationship must be marked by concord. Above and beyond all legitimate differences (of professional opinion, hierarchical order, generational, ideological, modality of practice, etc.), doctors are colleagues, companions, who must put aside their disagreements whenever these may cause deficiencies in the care of patients.
2. The reciprocal attention informed by deference, respect and loyalty.
Deference signals a willingness to condescend, to show agreement with the opinion of the other, when no significant questions of science or conscience are involved. The physician encounters on his work countless problems or situations that do not have a single answer: for the same well-determined and objective data , there are many different solutions, from which he must choose one. Out of professional deference, the physician will not disavow his colleague's opinion in front of the patient, but will rather try to make it his own, or at least to justify it.
Respect for colleagues consists, to begin with, of simple social respect, which obliges us to recognise the value of each one as a person and to treat them with courtesy and propriety. But deontological respect is more extensive and intense than the respect of the good Education. Respect for colleagues must be strong enough to overcome difficulties arising, for example, from differences of opinion on professional matters or tensions over the division of responsibilities and competences. It is disrespectful, for example, for those who, taking advantage of their greater age or hierarchy, burden certain colleagues with the most unpleasant part of their own work, or subject them to an unfair and discriminatory attention . Respect for colleagues also manifests itself in recognising their right to hold and maintain their personal scientific and professional convictions and in creating an atmosphere of tolerance for ideological diversity, which allows for peaceful and constructive coexistence.
Loyalty, which is a statutory obligation (article 43, c of the EGOMC), adds to intercollegial relations a sense of solidarity, which facilitates the fulfilment of common collegial commitments and gives binding force to mutual duties. Loyalty cannot be falsified and turned into corporatism, that regrettable abuse of power that protects colleagues from misconduct to the detriment of patients or other physicians. The first obligation of collegial loyalty is to be the patient's advocate. The second, which is financial aid to the colleague, is clearly marked by its specific field of application: the achievement of the lofty goals of the profession. Therefore, collegiality can never become a cover for the incompetent conduct of a colleague.
3. The defence of the unjustly attacked colleague.
There is no lack of occasions in professional life to act on financial aid for colleagues: advising them in a difficult case or in making an important professional decision; assisting them at critical moments that undermine their performance; if they are in danger of abusing alcohol or psychotropic drugs; when, through inadvertence or ignorance, they make repeated mistakes. There is no shortage of occasions to exercise with the colleague a discreet and irreplaceable task of committee and moral support.
The article states that this moral duty to financial aid is particularly strong when a colleague is the victim of unjust attacks or denunciations, discrimination or attention vexatious. It is then necessary to come to the defence of the comrade who is the victim of injustice. This defence includes the speech to high school of "any harassment or abuse of a colleague in the exercise of their professional duties of which they are aware" (article 43, c of the EGOMC). The high school has as a specific skill "to defend the rights and prestige of the members they represent or of any of them, if they are the object of vexation, undermining, disregard or disrespect in professional matters" (article 34, b of the same statutes). It is understood that the righting of such wrongs must be carried out in the strictest justice: it is unethical to repress or compensate for a wrong by committing a greater wrong. Doctors who enjoy a reputation in a certain area of knowledge are particularly obliged, if requested to do so, to assist as experts, either by means of their influence on public opinion or by acting as witnesses, in defence of the unjustly accused colleague.
4. The obligation to communicate professional knowledge to each other.
Science is public, goal and testable. Only what is published can become scientific, while what remains hidden or clandestine will never be scientific. The fellowship encourages the unreserved sharing of scientific knowledge. In contrast to article 24.2, which prohibits secrecy and any professional activity without scientific basis, this article 33.2 encourages physicians to disseminate their findings among colleagues for the better service of patients. From an ethical point of view it is essential that physicians communicate or publish their scientific observations in the correct place and in the correct manner, thus avoiding any risk of turning information to colleagues, which is an ethical duty, into advertising, which is a mistake to be avoided at all costs. For their publications, physicians should use the means of professional speech , preferring those that submit what they publish to an expert peer review entrance examination .
The societies that bring together doctors according to their specialities play an important role in the function of speech and scientific criticism. At the institutional level, the WTO aims to maintain close relations with the scientific institutions of medicine, for which it has a body advisor of the committee General: the Commission for Relations with Medical Societies and Royal Academies of Medicine (art. 23 of the EGCOM).
article 33.3. Physicians shall refrain from disparagingly criticising the professional actions of their colleagues. Doing so in the presence of patients, their relatives or third parties is an aggravating circumstance.
Slander, inconsiderate or derisive remarks and any verbal or written expression that may damage the reputation of a colleague are condemned. Such conduct is aggravated when the disparaging criticism is made to patients or persons outside the profession.
It is common and logical for doctors to disagree agreement about the behaviour that other colleagues have followed or intend to follow in the face of a particular clinical status . Such differences of opinion can lead to confrontations which, if they arise in a relationship previously fraught with hostility or mutual misunderstanding, can easily degenerate into overly vehement or aggressive disputes.
Deontology requires that differences of opinion should not result in harm or scandal to the patient, nor in personal offence between doctors. Although such reactions are often born out of a zeal for the good of the sick, it is never ethically justified to insult a colleague, even subtly. It is bordering on charlatanism for a doctor to comment to his patient or his patient's relatives on how unwise or incompetent another colleague's diagnostic or therapeutic performance was, but fortunately he was there in time to prevent an irreparable catastrophe from being consummated.
article 33.4. Disagreements on medical matters, whether scientific, professional or ethical, shall not give rise to public controversy and should be discussed in private or in appropriate sessions. In the event of failure to reach an agreement agreement, physicians shall refer to high school, which shall have an arbitration role in such disputes mission statement .
This article imposes two obligations: (1) not to make public controversies on professional matters on place ; and (2) to seek a peaceful resolution of clashes of opinion among the members of the profession through the bodies that exist within the profession.
1. The spirit of this article has nothing to do with limiting the right to freedom of thought or free expression. The ethical maturity of the physician must manifest itself in tolerance for legitimate diversity of professional opinion, in criticism of the ideas of others that is compatible with respect for individuals. The Hippocratic precept that the first thing to do is to do no harm has a clear field of application here. This article does not impose ideological uniformity: it recognises and promotes professional freedom when it establishes precisely the obligation to practise it correctly and, in particular, not to harm the colleague who practises it, when we disagree with him or her. It reminds members that airing legitimate differences of opinion in public can have undesirable effects from an ethical perspective, as it is obvious that they can generate confusion among those who follow the controversy, give rise to undue publicity for procedures or persons, and create occasions for mutual attention disrespectful . Heated controversy is not the best way to inform or educate the general public or to maintain good relations with colleagues procedure .
2. The article adds that dissent between members on specifically professional and scientific matters has a suitable venue for its expression: verbal discussion in private; open sessions held at the Schools or Academies of Medicine, in the Scientific Societies or in the Colleges themselves; and also exchange of writings in the professional press.
There are certain professional issues in which, if the interested parties do not reach an agreement agreement, they have no choice but to turn to high school to settle the conflict as arbitrator. Indeed, as stated in article 45 of the EGOMC, it is the responsibility of the Boards of Directors of the Colleges or of the committee General, as the case may be, to mediate and arbitrate in disputes between members. The Boards of Directors or the members appointed to mediate must act with impartiality and tolerance, bearing in mind that many problems have no other solution than polite disagreement. There are, in medicine, many open questions that admit of several solutions, none of which is so superior to the others that all should feel urged to follow it. They will judge only after hearing both sides and will always try to favour mutual tolerance.
Only after this collegial means of conciliation has been exhausted, without a satisfactory and fair solution having been reached in the opinion of one of the parties, can it be acceptable to appeal to the legal route. However, experience shows that the gap between what is required by ethical standards and what is tolerated by lax court rulings is widening. The gap between legality and morality regarding what is to be understood as inadmissible in the field of interprofessional relations has become too wide. It does not seem possible to construct a deontology of interprofessional relations on the basis of the most recent jurisprudential trends.
article 33.5. It is not a breach of the duty of fellowship for a physician to report to his or her high school, objectively and with due discretion, breaches of the rules of medical ethics and professional skill by colleagues.
Doctors are made of the same moral dough as other men, and it is therefore inevitable that there will be doctors whose conduct falls below the standard required by the correct professional internship . The occasional, unnoticed, virtually unavoidable error arising from the complexity or misleading appearance of certain clinical situations is not subject reportable. On the other hand, repeated careless, incompetent and irresponsible conduct in the care of patients should be reported.
It is very unpleasant to denounce an incompetent or immoral colleague, but it is an obligation that is part of the physician's fundamental duties. The International Code of Medical Ethics (London Code) of the World Medical Association ( association ) states that one of the general duties of physicians is to "report physicians who are weak in character or deficient in skill and those who engage in fraud or deceit".
In order for the complaint to be in accordance with professional ethics, it must be objectively founded, it must be made to written request and in a way that does not cause gratuitous damage to the person being denounced. The complaint should not be made without first having had the opportunity to hear what explanations the alleged offender has given for his or her conduct. A good way to proceed at this preliminary stage is for the colleagues involved to exchange written notes on the problem that concerns them. Writing forces them to reflect and to put things in order. The alleged complainant will send a letter to his colleague in which he states his suspicions clearly enough and specifies that he is considering the possibility of lodging a complaint with high school if he is not offered a satisfactory explanation. The alleged offender will respond in writing to the allegations made. The complainant shall submit these two documents, where appropriate and at the time of formalising his complaint, to the board management of the high school, so that the latter may decide whether it is appropriate to initiate a deontological transcript .
There are two antithetical attitudes to be avoided with regard to whistleblowing: on the one hand, malicious and false whistleblowing, and, on the other hand, refraining from whistleblowing because of complicity with the guilty party. It cannot be denied that there is a tendency within the profession to regard false reporting as a very serious offence, while, on the other hand, not reporting the guilty colleague is seen as a sign of humanity and tolerance. However, this view, which is certainly widespread, is extremely damaging to the profession. Whistleblowing at subject is a deontologically important duty of justice towards patients and colleagues. Refraining from reporting is, correlatively, a grave injustice that entails the risk that the immoral colleague, in the certainty that he will not be reported, will persist in his guilty conduct. Sooner or later, many of these abuses and misconduct are reported by the public to the courts. The loss of moral prestige experienced by the medical profession is therefore great, as it becomes evident how careless it is in fulfilling its public commitment to "safeguarding and observing the deontological and ethical-social principles of the medical profession and its dignity and prestige" (article 3º, 2, of the EGOMC).
article 33.6. In the interests of the patient, care should be taken to replace the temporarily incapacitated colleague when necessary. The doctor who has replaced the colleague must not attract the latter's patients to himself or herself.
There are two rules imposed by this article: (1) that of substituting for the disabled colleague, and (2) that of not turning the substitution into an opportunity to harm him or her by alienating him or her from his or her patients. And all this is in the interest of the patient: substitution must not result in a deterioration of the quality of the services provided to patients.
1. The obligation to substitute. Substitution, like most of the rules of fellowship, is justified primarily as resource to serve the legitimate interests of patients. This is the primary reason for the physician's customary willingness to substitute for a colleague who is unable or absent for reasonable cause, and for a specified and well-defined period of time. Reasons for substitution include illness and the fulfilment of certain important or unavoidable duties, be they family, social, collegial ( article 85 of the EGOMC details certain aspects of the substitution of doctors who hold collegial posts when they are absent because their collegial representation so requires), work (such as holidays), or those imposed by the duty of the permanent Education (attendance to courses or scientific congresses).
The ethical problems linked to substitutions have very different characteristics depending on the medical demography: they are very different in a hospital with a well-equipped medical staff staff than in rural areas, where there may be objective difficulties, due to an excess of work or difficulties with speech, which make it impossible for a given doctor to substitute another.
Conflicts of the opposite sign may also arise: the abuse of a doctor who has himself or herself replaced for unjustified reasons; and the unwilling refusal to assume the substitution reasonably requested by a colleague.
It is unethical to apply for and to obtain a temporary substitution when, in the absence of reasonable impediments, feigned reasons are invoked. It is particularly unfair to abuse a hierarchical position to impose substitutions on subordinates to the advantage of the superior. Any substitution that is not conditioned by serious reasons must necessarily be based on the free and voluntary acceptance of the substitute, and on fair financial compensation or reciprocity of benefits.
Refusal to substitute for a sick or temporarily incapacitated colleague would be unethical if it were born out of laziness or ill will. It may, however, be justified by the impossibility of the doctor abandoning his own patients, whose care would be impaired. Lack of the necessary skill is also an ethical reason for not accepting a substitution. In many cases, when the substitution can be foreseen in good time, it is necessary to contact high school to recommend a colleague who can take on the substitution position . The Colleges should be vigilant to ensure that substitutions do not degenerate into situations of abuse or exploitation.
2. A doctor who has replaced a colleague shall not take the latter's patients into his own care. Once the agreed time has elapsed or the impediment that caused the substitution has disappeared, the substitute shall cease his activity substitute membe and shall communicate to the substituted colleague all the observations that the latter should be aware of for the better future care of the patients treated in his absence. An elementary duty of loyalty prohibits the substitute doctor from taking advantage of the substitution to attract the clientele of the colleague being substituted. He/she must therefore refrain from discrediting the replaced colleague or expressing, directly or indirectly, negative judgements about his/her professional skill (see article 7).
article attendance 34.1. No physician shall interfere with the care of a patient by another physician except in cases of urgency or at the request of the patient.
This article states that physicians should not introduce themselves on their own initiative into the care of patients who are already being cared for by another colleague. This traditional rule of the medical label admits, however, two exceptions. The first concerns emergencies. The second one enshrines the patient's freedom of choice.
1. True urgency overrides, by its own force, any other rule that could delay or prevent the immediate and effective care of the patient. This is required by Articles 4.5 and 11.3 of the Code. If the physician treating a patient cannot be reached or is not available when the emergency status occurs, any physician must intervene to provide essential first aid. Once the critical status is over, or when the doctor treating the patient can be reached at position , it is natural for the doctor who intervened in the emergency to leave the case in the hands of his or her colleague, unless the patient or those close to him or her instruct him or her otherwise.
2. It also establishes the conduct of colleagues when, other than in an emergency, a physician is called upon to treat a patient who is already under the care of a colleague. Two different situations may arise: either the patient has decided to go to the new physician, bypassing the first, or the patient exercises his or her right to a second opinion.
In the latter case, the doctor called in shall, before visiting the patient, endeavour to inform the doctor who has been treating the patient, in order to obtain his or her financial aid. The relationship between the two doctors is that of an ordinary mutual enquiry , which is governed by the provisions of article 34.2. No doctor may oppose the patient's request for the opinion of another colleague, among other reasons because no one may be deprived of the right to freely choose the doctor with whom he or she wishes to consult, or of the right to obtain a second opinion; moreover, all doctors must respect and facilitate the exercise of these rights of the patient (article 15 of this Code).
If, on the other hand, the patient wishes to change doctor, he shall inform the new doctor accordingly, and the new doctor shall ensure that the patient himself or his relatives inform the former doctor. The new physician shall judge, in view of the needs of the case and in the interests of his patient, whether to communicate with the colleague who preceded him in the care of the patient, but shall respect the patient's wishes if the patient objects to this speech.
article 34.2. The physician shall, when he or she considers it appropriate, propose the colleague he or she considers most suitable as consultant, or accept the colleague of the patient's choice. If their opinions differ radically and the patient or the patient's family decides to follow the opinion of consultant, the physician who has been treating the patient shall be free to fail his or her services.
The call at enquiry to another colleague may be made either on the physician's own initiative, as specified in article 21.2, or at the wish of the patient or his or her relatives. In this case, respect for the patient's freedom of choice obliges the physician to behave in a specific way. He will recommend that the colleague he considers most competent be called, but he may not impose it. He will normally accept the consultant proposed by the patient or the patient's family and, only for serious reasons, he may refuse to conclude enquiry with the patient or the patient's family. Should this occur, he may withdraw from the case.
Any enquiry to a colleague, in hospital or at the patient's home, should have a specific and well-defined purpose. It is important to establish in advance what the purpose is: to know the opinion of consultant on a specific aspect of the illness or to transfer to him or her the full responsibility for the case or for one of its partial aspects in the future. The best interests of the patient and a well-understood fellowship oblige both the doctor who has been treating the patient and consultant who has been called in to exchange all relevant information and to reach an agreement on the course of action agreement . The decided plan should be recorded in writing in the medical record or on a separate report .
If enquiry concludes with irreconcilable views on what should be done, this should be communicated to the patient or the patient's family, who should decide which view prevails. No physician is the master of the patient's fate and must respect the decision of the patient or the patient's family. In such situations of conflict, the physician who has been treating the patient continues to enjoy full professional independence and may fail his or her care for the patient if the patient decides to follow the advice of the physician called at enquiry.
The rules on medical enquiry are not a vestigial remnant of the ceremonial surrounding enquiry in the past. In today's hospitals, countless consultations take place between and within the various Departments and departments. Relations between doctors must always adhere to the rules of medical enquiry : respect for the professional independence of each doctor, whatever his or her position in the hierarchy; acceptance of the patient's decision in the face of the different options offered to him or her: the consensual agreement on the specific problem posed.
article 35.1. The practice of medicine as a team must not lead to excessive medical performance.
Physicians have the right to form groups or teams for professional purposes. The groups thus formed may be very different, in terms of the issue of their members, the stable or transitory nature of the association and the different legal forms they may take. These associations can provide considerable advantages: better scheduling of work, on-call and breaks; greater facilities to ensure continuity of care for patients; rationalisation of investments and amortisation of equipment and instruments; a more dignified and efficient material and service infrastructure (place of work and auxiliary and general services).
This article prohibits any economic abuse and, in particular, the abuse of diagnostic or therapeutic prescriptions. The desire for greater economic efficiency of persons or facilities may never lead to the ordering of superfluous consultations, examinations or treatments. Any medical intervention must be justified on the basis of a specific need and must be free from any suspicion of collusion or self-interested profit.
Consultation of other colleagues on the physician's own initiative must never give rise to abuses such as dichotomous practices (see Art. 44.3) or superfluous consultations or examinations. Every physician, regardless of his or her specialization, must be competent in the more general aspects of medicine and in the treatment of common diseases. It would be distressing if a specialist had to request the financial aid of a colleague to treat, for example, a common cold.
article 35.2. Without prejudice to any subsidiary liability, the individual responsibility of the physician does not disappear or be diluted by the fact of working as part of a team.
Being part of a team does not change a physician's responsibility towards his or her patients. Each physician retains his or her freedom to prescribe and his or her responsibility independently, nor can he or she act anonymously towards his or her patient. His or her name must be known to the patient; his or her clinical documentation, reports and prescriptions must bear his or her letterhead with his or her personal data ; he or she must sign his or her name to the notes in the records and the orders he or she prescribes. He is manager to keep the medical records under his control staff; to respond personally to calls made to him, to ensure that his patients receive the treatment he orders.
In the teams of work there are no masters and serfs, masters and mercenaries. Their reciprocal relations are always established on a plane of respect for freedom staff and the resulting responsibility. This determines that the constitution document of any group or association of doctors must indicate in sufficient detail the rights and obligations of each doctor, such as the participation in general expenses, the conditions of use of the facilities, timetables, system of on-call and substitutions, holiday plan, etc.
Some regulations on this subject may give rise to situations where, as indicated on this article, certain organisations or physicians assume certain subsidiary responsibilities with respect to group members.
article 35.3. The hierarchy within the team must be respected, but may never constitute an instrument of domination or exaltation staff. The person in charge of group shall ensure that there is an atmosphere of ethical demands and tolerance for the diversity of professional opinions, and shall accept abstention from acting when one of its members has a reasoned scientific or conscientious objection.
This article recognises (1) the need for hierarchical organisation in the work groups of physicians, establishes (2) the deontological substance of hierarchical relationships, and sets (3) standards of tolerance for diversity of opinion within hierarchical groups.
1. Whenever two or more physicians join together to cooperate in the care of the sick, to programme or conduct clinical research or to educate students or graduates, it is necessary that one of them assume ultimate responsibility for group to the patient, the sponsoring institution research or the academic authority. At the same time, it is necessary that he or she is given and recognised the power to coordinate the contribution of each to the common task. In this sense, hierarchical organisation responds to a basic functional need: it is a legitimate way of creating order and efficiency in a group of people who have to work together.
2. Ours is a very demanding time for those who govern. It is not enough to be in charge; it is necessary to win the support of the governed on a daily basis by means of skill, honesty and example. Assuming that the person in command has the technical ability to make decisions, his management must be based on moral and scientific authority, but also and above all on the capacity of work, on the rationality of orders and on respect for subordinates. The article implies that authority should be conceived as a service to others, not as an opportunity to exercise despotic domination. Hierarchical authority among colleagues is not a award granted to mere seniority in the ranks or a prebend to political servility. It is a moral authority.
The director of group is manager to supervise not only the internal actions of the members of group, but also those that, as members of group, they carry out externally, such as, for example, communications to congresses or articles for scientific publications, prepared with the material and experience of group. Logically, this supervisory task should involve fair criticism, timely advice and recommendations, and respect for differences of opinion. In case of disagreement at subject scientific or professional, the group editor may require the authors to include an exclusion of liability clause on their work . This will state in the published article that the ideas expressed therein by the authors do not represent the collective opinion of the group.
3. Among the most significant phenomena of contemporary society are, on the one hand, the recognition of ethical pluralism as a reality to be lived with and, on the other hand, the acute sensitivity to individual human rights. Both phenomena are embodied, among other things, in the need to respect the convictions of others and in the condemnation of physical or moral violence as an instrument of coercion.
Respect for ideological diversity must be present in hierarchical relations between colleagues. Whoever directs the distribution of work must accept and respect the objection to certain actions that some or all members of group may invoke because of their scientific or conscientious convictions. It is true that such objections, by breaking established routines, may cause inconveniences of a certain amount, but they do not have a negative significance: they are the price to be paid for the moral progress of society and, first and foremost, of group.
No one may invoke a scientific or conscientious objection as a ploy to get out of unattractive work. The moral integrity of the objector requires him to accept a burden from work that fairly compensates for what he has failed to do by virtue of his abstention. And whoever has the government of group must provide, without arbitrariness for or against, that this compensation is made in justice.
At times, a civil, ecumenical and peaceful ethic has been invoked as the minimum common ethical dividing line for the coexistence of all in today's pluralistic society. And since fanatics of the best ideas are never lacking, some claim that such a civil ethic must be compulsorily accepted by all, which is nothing less than a tyrannical pretension and the death of ethical pluralism. It is much more congruent with the internship of freedom, and infinitely more humane, to respect the convictions of each individual than to authoritatively force, even if only one, to violate his conscience, putting him in the alternative of abjuring his beliefs or abandoning a work that he lives vocationally and to which he has given his existence.
article 35.4. The Colleges shall not authorise the formation of groups in which exploitation of any of their members by other members could occur.
One of the fundamental purposes of the WTO is to regulate, within the scope of its skill, the practice of the medical profession and to defend the professional interests of its members (article 3, 1, of the EGOMC). At the provincial level, the medical associations assume this responsibility and are therefore obliged to defend the rights of their members at subject (article 34, b of the EGOMC). In order to regulate associations between doctors whose purpose is to practise the profession, the first condition is to establish the group in a written document, which must be sent to the high school for approval. Failure to submit such contracts to the respective high school for approval constitutes a deontological offence classified as less serious (article 64, 2, c, of the EGOMC).
The existence of such a document creating and regulating the association is necessary, otherwise the latter would take place in a legal vacuum. Only by complying with this rule can one avoid the potential risk of abusing one of the partners and condemning them to defencelessness when, at any later time, difficulties may arise and the group is dissolved.
The member is obliged to submit this written document to high school, preferably before signing it, for approval or comments. Whatever the form of this written document (contract, statute or regulation), its submission to speech at high school serves not only to prevent it from containing secret or abusive clauses, but also to detect any defects that could lead to deontological or legal risks. The high school will inform the parties concerned of the clauses that conflict with the rules in force and the penalties attached to them, so that they can amend them. But above all, it will ensure that the professional independence of each doctor, the freedom of choice of patients, the conditions under which each member of group participates in the financing and operation of the work team, the individual remuneration of each doctor and, finally, the mechanisms ensuring, where appropriate, the correct and equitable dissolution of group are satisfactorily guaranteed.
The termination of a contract or the dissolution of a group can never imply the subsequent limitation of the physician's freedom to prescribe treatment performed while he/she was a member of group, or to receive patients he/she treated while he/she was a member of group.