|| Nepal Medical Council ||

A. HIPPOCRATIC OATH (425 BS)

I swear by Apollo Physician, by Aesclepius, by Health, by Heal-all and by all the gods and goddesses, making them witnesses that I will carry out, according to my ability and judgement, this oath and this indenture.

To regard my teacher in this art as equal to parents; to make him partner in my livelihood, and when he is in need of money to share mine with him; to consider his offspring equal to my brothers; to teach them this art, if they require to learn it, without fee or indenture; and to impart precept, oral instruction, and all the other learning, to my sons, to the sons of my teacher, and to pupils who have signed the indenture and sworn obedience to the physician' law, but to none other.
I will use treatment to help the sick according to my ability and judgement, but I will never use it to injure or wrong them, I will not give poison to anyone though asked to do so, nor will I suggest such a plan. Similarly I will not give a pessary to a woman to cause illegal abortion. But in purity and in holiness, I will guard my life and my art. I will not use the knife on sufferers from stone, but I will give place to such, as are craftsmen therein.

Into whatsoever houses I enter, I will do so to help the sick, keeping myself free from all intentional wrong-doing and harm, especially from fornication with woman or man, bonded or free.

Whatsoever in the course of practice I see or hear (or even outside my practice in social intercourse) that ought never to be published abroad, I will not divulge, but will consider such things to be holy secrets.

Now if I keep this oath and break it not, may I enjoy honour, in my life and art, among all men for all time; but if I transgress and forswear myself, may the opposite befall me.

In the name of suffering humanity, with humility, compassion, and dedication to the welfare of the sick according to the best of my ability and judgment, I will keep this oath and stipulations:

I will be honor with my patients in all medical matters. When this honesty reveals bad news, I will deliver it with understanding, sympathy and tact.

I will provide my patients with acceptable alternatives for various forms of diagnosis and medical and surgical treatment, explaining the risks and benefits as best I know them.

I will allow my patients to make the ultimate decision about their own care, In circumstances where my patients are incapable of making decisions, I will accept the decision of family members or loved ones, encouraging them to decide as they believe the patient would have decided.

I will not sit in moral judgement on any patient, but will treat their illness to the best of ability whatever the circumstances.

I will be empathetic to patients with illnesses caused by substances such as alcohol or drugs, or other forms of self-abuse usually believed to be under voluntary control.
Knowing my own inadequacies and those of medicine generally, I will strive to cure when possible but to comfort always.

I shall perform medical tests only if I believe there is a reasonable chance that the results will improve the outcome.

I will not perform any tests or procedures or surgery solely to make money. I will freely refer my patients to other physicians if I am convinced that they are better able than I to provide treatment.

I will freely furnish copies of medical records to patients or their families upon request.

I will do unto patients and their families only what I would want done unto my family or me. I will not experiment on patients unless the patients give truly informed consent. I will strive to instruct patients fully so their informed consent is possible.

I will remain a student all my professional life, attempting to leam not only from formal medical sources but also from by patients as well.

I will provide care to all patients seeking it, regardless of sex, race, colour, creed, sexual preference, life-style, or economic status. In particular, I will volunteer some of my time to providing free care to the poor, the homeless, the disadvantaged, the dispossessed, and the helpless.

I will turn away no patient, even though with dreaded contagious diseases.

I will encourage my patients to seek medical opinions other than my own before agreeing to accept my opinion.

I will treat my professional colleagues with respect and honour, but I will not hesitate to testify openly about physicians and medical institutions that are guilty of malpractice, malfeasance, cupidity, or fraud.

I will defend with equal fervour colleagues who are unjustly accused of malpractice, malfeasance, cupidity, or fraud.

Abstracted from: The Lancet, London, U.K. (1995): (345), 8962, 1423

Adopted by the 2" General Assembly of the World Medical Association, Geneva, Switzerland, September 1948, amended by the 22nd World Medical Assembly Sydney, Australia, August 1968, and the 35th World Medical Assembly, Venice, Italy, October 1983.

AT THE TIME OF BEING ADMITTED AS A MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE myself to consecrate my life to the service of humanity;

I WILL GIVE to my teachers the respect and gratitude that is their due;

I WILL PRACTICE my profession with conscience and dignity;

THE HEALTH OF MY PATIENT will be my first consideration;

I WILL RESPECT the secrets, which are confined in me, even after the patient has died;

I WILL MAINTAIN by all means in my power, the honour and the noble traditions of the medical profession;

MY COLLEAGUES will be my brothers;

I WILL NOT PERMIT consideration of religion, nationality, race, party politics or social standing to intervene between my duty and my patient,

I WILL MAINTAIN the utmost respect for human life from it's beginning even under threat and I will not use my medical knowledge contrary to the laws of humanity;

I MAKE THESE PROMISES solemnly, freely and upon my honour;

Adopted by the 38th World Medical Assembly
Rancho Mirage, Ca, USA, October 1986

The World Medical Association, Inc., recognizing the importance of the physician's independence and professional freedom, hereby adopts the following declaration of principles:
Physicians must recognize and support the rights of their patients, particularly as set forth in the World Medical Association Declaration of Lisbon (1981).

Physicians must have the professional freedom to care for their patients without interference. The exercise of the physician's professional judgment and discretion in making clinical and ethical decision in the care and treatment of patients must be preserved and protected.

Physicians must have the professional independence to represent and defend the health needs of patients against all who would deny or restrict needed care for those
who are sick or injured.

Within the context of their medical practice and the care of their patients, physicians should not be expected to administer governmental or social priorities in the allocation of scare health resources. To do so would be to create a conflict of interest with the physician’s obligation to his patients, and would effectively destroy the physician’s professional independence, upon which the patient relies.

While physicians must be conscious of the cost of medical treatment and actively participate in cost containment efforts within medicine, it is the physician’s primary obligation to represent the interests of the sick and injured against demands by society for cost containment that would endanger patient’s health and perhaps patient’ life.

By providing independence and professional freedom for physicians to practice medicine, a community assures the best possible health care for its citizens, which in turn contributes to a strong and secure society.

Life is short and the Art (of medicine) long, opportunity is fleeting, judgment difficult, and experience dangerous. The physician must do the right thing right time. – First aphorism of Hippocrates translated by Adams, a nineteenth century Aberdeen doctor and classical scholar.

WORLD MEDICAL ASSOCIATION DECLARATION OF MADRID ON PROFESSIONAL AUTONOMY AND SELF- REGULATION
Adopted by the 39th World Medical Assembly,
Madrid, Spain, October 1987.

The World Medical Association, Inc., having explored the importance of professional autonomy and self-regulation of the medical professional around the world, and reorganizing the problems and the current challenges to professional automony and self-regulation, hereby adopts and following declaration:

1. The central element of professional autonomy is the assurance that individual physicians have the freedom to exercise their professional judgment in the care and treatment of their patients, as set out more fully in the World Medical Association Declaration on Physician Independence and Professional Freedom, adopted in October, 1986 (see document 17.0).

2. The World Medical Association and its National Medical Associations re-affirm the importance of professional autonomy as an essential component of high quality medical care and therefore benefit due to the patient that must be preserved. The World Medical Association and its National Medical Associations therefore re-dedicate themselves to maintaining and assuring the continuation of professional autonomy in the care of patients, which is, an essential principle of ethics.

3. As a corollary to the right of professional autonomy, the medical profession has a continuing responsibility to be self-regulating. In addition to any other source of regulation that may be applied to individual physicians, the medical profession itself must be responsible for regulating the professional conduct and activities of individual physicians.

4. The World Medical Association urges its National Medical Associations to establish, maintain and actively participate in a system of self-regulation for the physicians in their respective countries. It is this dedication to effective self-regulation that will ultimately assure professional autonomy in patient care decision.

5. The equality of the care provided to patients and the competency of the physician providing that care must always be a primary concern in any system of self-regulation. Physicians have the expertise to make the necessary evaluation. These evaluations must be used for the benefit of patients to assure them continued quality care by competent physicians. Included in this area of responsibility is the need to monitor advances in scientific medicine and the use of therapeutic regimens that are safe and effective. Experimental procedures must comply with the protections required by the World Medical Association Declaration of Helsinki and other protections as may be required in each country. Discredited scientific theories must not be used on patients.

6. Cost consciousness is an essential element of self-regulation. The highest quality of care can be justified only by assurances that the cost of such care will allow access to that care for all citizens. Again, physicians are particularly qualified to make the evaluations that are necessary for cost containment decisions. National Medical Associations must, therefore, include cost containment activities in their respective system of self-regulation. Common issues in cost containment activities relate to methods of delivery of medical care, access to hospital and surgery, and the appropriate use of technology. Cost containment activities must not be used to deny patients needing access to necessary medical care. Nor should over-utilization of medical facilities be permitted to drive the cost of medical care upwards so that it will not be available to all who may need the particular care.

7. Finally, the professional activities and the conduct of physicians must always be within the bounds of the professional code of ethics or the principles of medical ethics governing physicians in each country. National Medical Associations must promote ethical conduct among physician for the benefit of their patients. Ethical violations must be promptly corrected, and the physicians guilty of ethical violations must be disciplined and rehabilitated. This is a responsibility that only National Medical Associations can undertake and perform effectively and efficiently.

8. There are, of course, many other areas of self-regulation for which National Medical Associations are urged to assist each other in coping with new and developing problems. The exchange of information and experiences between National Medical Associations is encouraged and the World Medical Association will assist in facilitating this exchange of information to improve self-regulation.

9. The World Medial Association and its National Medical Associations must also educate the public generally as to the existence of an effective and responsible system of self-regulation by the medical profession in each country. The public must come to recognize that it can rely on this system of self-regulation for an honest and objective evaluation of the issues relating to the practice of medicine and the care and treatment of patients

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