Statement on self-certification

Foundation: Comisión Central de Deontología de la Organización Médica Colegial Española.
sourceSpanish: Comisión Central de Deontología de la Organización Médica Colegial Española (Central Commission of Deontology of the Spanish Medical Association).
languageOriginal: Spanish.
Approval: General Assembly of 8 October 1992.
Publication: Revista OMC 24, Nov.-Dec. 1992, p.43.
Copyright: No.
Checked on 16 May 2002.

Statement of the WTO Central Deontology Commission on Self-certification

This Central Commission has been asked whether it is ethical for a salaried doctor to repeatedly certify himself or herself as being ill in such a way as to cause leavefor a prolonged period of time. This is a complex status, in which, as patient and doctor coincide in the same person, particular ethical tensions arise.

An ethical analysis of such a statusleads, however, to the conclusion that self-certification must be an exceptional internshipand that it can only be applied to situations of very short duration. Indeed, when he falls ill, the doctor has to decide in conscience whether the health disorder he suffers is a simple indisposition, which does not incapacitate him to continue to carry out his work work, or whether it is an illness that limits or prevents him from practising his profession for a foreseeable period of time. In the first case, as there is no place for leave, self-certification is not necessary. However, if the doctor considers himself ill to the point of being unable to attend to his patients, he must fully assume the role of patient and, for the duration of the illness, give up acting as a doctor. A colleague must stand in for him or her during this time.

It is an established custom in the professional tradition that a sick doctor should not treat himself but should call in a trusted colleague for treatment. It is the responsibility of that colleague certifyto check on the sick physician's state of health. This rule should always be followed for the sake of prudence and safety, and also to avoid the risk that the sick physician might use the privilege of certifygranted to him by his status as a member of the profession unfairly and to his own advantage. Good social order rejects that the sick person is the one who self-certifies his health in order to obtain the leavework. This rule does not exclude those patients who, incidentally, are doctors.

Only in exceptional cases, such as the impossibility of being immediately attended by a colleague, or in the case of self-limiting illnesses of very short duration, could the non-application of the aforementioned custom be admitted.

If the doctor's repeated self-certification were to be used for improper gain, such conduct would be condemnable from a deontological point of view on a number of grounds. It constitutes, to begin with, disloyal behaviour towards colleagues who have to perform the workthat he abandons without just cause. It is a malicious deception of the person who hired him, a deception that could become a fraudulent offence in subjectprofessional, a deontological offence classified as very serious in the General Statutes of the Spanish Medical Association. Lastly, it entails the issuing of certificates that are detrimental to the truth, which is a serious offence according to the same Statutes.