Declaration on the freedom of the doctor to prescribe

Foundation: Comisión Central de Deontología de la Organización Médica Colegial Española (Central Ethics Commission of the Spanish Medical Association).
source : Comisión Central de Deontología de la Organización Médica Colegial Española.
language original: Spanish.
Approved by the CCD in 1984 and revised in 1998.
There is no record of its approval by the General Assembly.
Publication: Revista OMC 62, February 1999.
Copyright: No.
Checked on 16 May 2002.

Declaration of the WTO Central Commission on Deontology on freedom of prescription for doctors

Introduction

1. The Central Commission on Deontology, Medical Law and Visas of the Spanish Medical Association published a Declaration entitled "Principles on Freedom of Prescription" in 1984. Many changes have taken place in the medical profession and in society since then. Therefore, while the Declaration remains essentially valid and timely, there is every reason to update the text and adapt it to current circumstances.

2. Physicians, regardless of the modality in which they practise their profession - in the public or private sector, on their own account or for hire - must enjoy the necessary independence in caring for the patients entrusted to their care and, in particular, in making their diagnoses and prescribing their treatment. The physician's first ethical commitment is to provide the best possible service to his or her patients, with their consent, as dictated by professional ethics and sound clinical judgement.

3. In today's medicine, freedom, responsibility and skill are not only more closely intertwined than in the past, but also face much more complex scientific, partner-labour, economic and deontological issues.

Scientific aspects

4. On the one hand, medical knowledge has become more goal and demonstrable. On the other hand, patients want the doctor who treats them not only to be free to make the decisions that suit them best; they also want him or her to manager and to give an account of his or her actions when asked to do so, and to justify them as reasonable and in accordance with the medical art of the moment.

5. Physicians cannot act according to outdated concepts of clinical freedom based on intuition, anecdotal evidence or mere empiricism. They must do so in accordance with a modern notion of freedom of prescription, a freedom that today consists of the doctor's ability to choose, from among the available interventions, the one that is most suitable for his patient, after having weighed up its validity and usefulness; after having decided, in accordance with criteria of safety and efficacy, on the most suitable and appropriate one for the specific clinical circumstances of his patient and after having obtained the necessary consent from the latter. Fortunately, the instruments on which doctors can base their decisions are becoming increasingly abundant, accessible and precise. They are the various forms (large controlled clinical trials, clinical guidelines and protocols, programs of study goal -analytical, consensus statements) in which what has come to be called "evidence-based medicine" is expressed. Such instruments are not dogmatic, obligatory and permanent formulas, but flexible and temporary, but seriously evaluated clinical guidelines on the recommended courses of action in specific clinical situations.

Aspects partner-labour

6. Agreements, contracts or regulations that restrict the physician's legitimate freedom of decision or that impose on him or her, by coercion or award, conduct that the physician finds unjustified in his or her professionally founded judgement, are not in accordance with medical ethics. This is the case, for example, with certain types of programme contracts, or with certain incentives to induce medical savings. For this reason, the current Statutes state that physicians have the right and duty to submit their contracts to work for endorsement by their high school. Failure to do so constitutes a less serious disciplinary offence, as stated in R.D. 1018/1980 (General Statutes of the Spanish Medical Association) in its article 64.2.c).

Economic aspects

7. Freedom of prescription also implies taking into account the economic aspects of medical decisions. There is a deontological duty to prescribe with responsibility and moderation in preventing, diagnosing and treating illness. Physicians must not forget that the resources used to pay for their prescriptions are not their own, but those of the patient or of the institutions, public or private, that take them position. The physician is therefore particularly obliged to prescribe rationally and with good economic sense. This excludes the prescription, sometimes encouraged, of products of leave or no therapeutic usefulness or of higher-priced remedies when their efficacy is identical to that of others of lower cost.

Deontological aspects

8. Professional independence is a right and a duty of the physician, as stated in the current Code of Medical Ethics and Deontology at article 22, which also imposes the obligation to denounce, before patients, the managing bodies of attendance or the social community, those who unduly restrict this freedom. Physicians may not alienate their genuine freedom to prescribe.

9. The professional independence of physicians is, above all, a right of patients. This is proclaimed in the Lisbon Declaration of the World Medical Association association on patients' rights: "The patient has the right to be treated by a physician who is known to him to be able to make his clinical and ethical decisions freely and without outside interference". No patient can be denied the right to be treated by a competent, conscientious and free physician. Professional independence frees the physician from the danger of becoming an accomplice of others against the patient, protecting him or her from harmful influences from society, from the family or even from the physician himself or herself. It also frees the doctor from the risk of allying himself with the patient against the administration, social security or business and thereby gaining unfair advantages for the patient.

Madrid, 27-28 November 1998.