Statement on medical certification

Creation: Central Commission of Deontology of the Spanish Medical Association.
source : Comisión Central de Deontología de la Organización Médica Colegial Española.
language original: Spanish.
Approval: General Assembly of 8 October 1992.
Publication: Revista OMC 24, Nov.-Dec. 1992, pp.42-43.
Copyright: No.
Checked on 16 May 2002.

Statement of the WTO Central Commission of Deontology on medical certification

Copies of some medical certificates have recently been sent to this Central Commission, which are clear evidence of the well-meaning but irresponsible neglect by many members of the profession of the ethical rules to which medical certification should be subject. The Central Commission considers it appropriate to remind the membership of certain specific points of the ethics of certification. In view of this, it proposes to the committee General the publication of

Some ethical standards on medical certification

Article 12 of the Code of Medical Ethics and Deontology states that "it is the patient's right to obtain a certificate or report, issued by the physician, concerning his or her state of health or illness, or concerning the attendance he or she has given him or her. The content of the opinion shall be authentic and truthful and shall be given only to the patient or to another authorised person.

Therefore, the doctor has a duty to certify at the patient's request only. Under ordinary conditions, it is the patient himself who is deontologically the only one graduate to apply for and obtain a certificate. The physician may not certify at the request of a third party who has not received the corresponding power of attorney from the patient or who is not exercising judicial or legitimate guardianship functions over the patient, as this would violate the patient's privacy. Nor can he/she hand it over or pass it on to anyone other than the patient himself/herself or anyone he/she has designated for this purpose, as this would be a breach of professional confidentiality.

The physician's duty to certify is not only binding on the patient, but also on society. The medical certificate is a document that often has important legal, economic or employment-related effects, as provided for by certain regulations, contracts or laws. The compulsory use of the printed forms of the official medical certificate symbolises the social and public nature of the document. The certificate attests to certain facts: at certify, the doctor acts as an expert and qualified witness to the truth before society and before his patient, and as such enjoys the confidence of both. He is therefore obliged to judge whether or not what he is asked to certify is in accordance with the truth and the law, and must refuse any request for certificates that manipulate the truth, are false or potentially unjust.

Certification is a medical act to be taken with great seriousness, for it makes true - that is to say certify- what is recorded on certificate . As the London Code of the World Medical Association states, 'the physician should certify only what he or she has personally verified'. A physician should never issue a certificate without first verifying for himself or herself each of the matters stated therein.

The doctor is not an amanuensis who writes at the dictation of another: he is obliged to ascertain the reality of each of the data he certifies, and to distinguish clearly and unambiguously between what he observes or has observed in his patient and what the patient or any other person - a relative, an eyewitness, for example - may refer to him. The account of the patient's subjective and unverifiable experiences is not subject proper to certification, nor are the symptoms or pathological behaviours reported to the doctor by a stranger. Any certificate in which the physician implies that an individual, whom he has not examined and with whom he has had no professional relationship whatsoever, suffers from an illness, symptomatology or disability referred to him by a third party is deontologically reprehensible. The medical certificate cannot be a vehicle for judicial intrigue, nor can it be used to justify absenteeism or to gain unfair economic or academic advantages.

Every physician should remember that his or her right and duty to certify is one of the most important functions that society has assigned to him or her by virtue of his or her exclusive skill to ascertain and judge certain facts. No one but the physician enjoys this privilege B , which carries with it heavy responsibilities of fairness, honesty, truthfulness and independence. Physicians cannot forget that their obligation to do no harm extends beyond their patients to other persons and to social institutions. Nor can he or she become an accomplice of his or her patients in defrauding others, or give in to abusive pressures from third parties to diminish the just rights of his or her patients.