Deontological code

Issuer: Medical College of Romania

Published in: Official Monitor no. 418 of Mai 18, 2005

Annex no. 2 to decision no. 3 of March 25, 2005 regarding the approval of the Statute and the Medical Deontological Code of Medical College of Romania 

CHAP. I
Scope and general principles

ART. 1
This Code contains mandatory norms of conduct connected to the exerting of rights and professional duties of the physician.
ART. 2
The stipulations of this code, both those reminding about moral rules that each physician should respect, and those concerning technical aspects, as well as the behavior towards confreres, are compulsory for the physicians in evidence of the Medical College of Romania. Physicians having educational activities are responsible for respecting the stipulation of this code towards those under mentoring.
ART. 3
Human health is the supreme goal of medical act. The obligation of the doctor is to protect human physical and mental health, to alleviate the suffering, in respect of life and human dignity, without discriminations based on age, sex, race, ethnicity, religion, nationality, social status, political ideology or any other reason, during peacetime, as well as during wartime. The respect owed to the individual goes on even after the death of the person.
ART. 4
In exerting his profession, the physician gives priority to the interests of the patient, which is prior to any other interests.
ART. 5
In exerting his profession, the physician is compelled to respect the fundamental human rights and the ethical principles in Biomedical field. The Medical College of Romania will periodically update the stipulations of this code in accordance with the declarations and conventions to which Romania takes part, regarding the Ethics in Biomedical field.
ART. 6
The physician is forbidden, during the exercise of his profession, to impose onto the patient his personal opinions of any kind.
ART. 7
The physician must never stop, acquire new and improve his medical knowledge, during his professional life.
ART. 8
According to his skills and knowledge, the physician must contribute to objectively inform the public and medical authorities in what regards the medical problems. The physician providing medical information in media must check the way his allegations are made public and to stand up in case of their distortion.

CHAP. II
General duties

SECTION A
About the professional independence of the physician and responsibility

ART. 9
The physician has absolute professional independence, absolute freedom of prescriptions and of medical documents which he deems necessary, within his competence, and is responsible for these. In case of limiting his independence by administrative and / or economic constraints, the physician is not responsible.
ART. 10
The physician will not guarantee the healing of the affection addressed by the patient.
ART. 11
In the medical activity developed in teams (hospital watds, medical residence educational process), the responsibility for the medical acts belongs to the team leader, within the limits of administrative coordination attributions, and to the physician who directly performs the medical act, within his professional competence and within the role assigned by the team leader. In interdisciplinary teams, the team leader is considered to be the physician from the specialty where the major diagnosis of hospitalization was decided to be, if there are no special regulations to state otherwise.
ART. 12
Total or partial consignment of personal commitments to other persons, without self control, represents a deontological deviation.
ART. 13
The statement of the acknowledged consent of the patient for treatment does not remove the responsibility of the physician for potential professional errors.

SECTION B
Professional secrecy

ART. 14
Professional secrecy is compulsory, except the cases stated by law.
ART. 15
The object of professional secrecy is everything that the physician, during the exercise of his profession, has directly or indirectly found out connected to the private life of the patient, the family, the owners, as well as other problems of diagnosis, prognosis, treatment, various circumstances linked to the disease. The professional secrecy goes on also after the end of the treatment or the death of the patient.
ART. 16
The professional secrecy must be kept also towards the owners, if the patient does not desire otherwise.
ART. 17
The professional secrecy must be kept towards colleagues, medical staff and medical institutions that are not involved in the medical act of the patient in question.
ART. 18
In scientific communications, the cases will be thus presented so the identity of the patient can not be recognized.
ART. 19
In case it is not contrary to the interests of the patient, the family doctor will allow media access to the patient only with his permission. Chief physicians of medical units are required to take all measures so that the access of media to the patient be done only with the consent of the family doctor and of the patient. Providing information regarding a particular case can be made only with the consent of the patient, the family doctor and the chief of the medical unit.
ART. 20
Medical records must be kept as professional secret material.

SECTION C
General behavior rules in medical activityl

ART. 21
The doctor can’t treat a patient without prior medical review, personally. Only in exceptional cases of urgency or in cases of force majeure (illness on ships which are in gear, on flying aircrafts , Sasu inaccessible places in time)there will be given indications of treatment by means of telecommunications.
ART. 22
The doctor may perform medical activities only if it has sufficient training and practice for this.
ART. 23
The doctor may only use diagnostic or treatment devices authorized and has sufficient training or practice for controlling them.
ART. 24
If after an examination or during treatment the doctor considers that he has no sufficient knowledge or experience to provide appropriate assistance, he will request a consultation, by any means, with other specialists or will guide the patient to them.
ART. 25
In case of imminent danger of death, the doctor will remain near the patient so long it takes to give his professional help.
ART. 26
The incurable patient will be treated with the same care and same attention as the patient who has a chance of healing.
ART. 27
The doctor will inform the patient of his disease, appropriate treatment and chances of recovery. The doctor will avoid to arouse through his behavior a more serious image of the disease than it is in reality.
ART. 28
The doctor will keep an attitude of strict neutrality and noninterference in the affairs of the patient’s family, expressing their opinion only if asked and if intervention is motivated by the interests of patient health.
ART. 29
The doctor should not get involved in issues related to material interests of the patient or family.

SECTION D
Mandating healthcare

ART. 30
The doctor who is found in the presence of a sick or injured patient in danger is required to give assistance when and where is possible at that time or to ensure that the concerned receives appropriate care.
ART. 31
In the event of disasters or mass injury, the doctor is obliged to respond to calls, even voluntarily offer health services as soon as he heard about the event.
ART. 32
The doctor may refuse to grant health care for personal reasons, or professional training, guiding the patient to other health care sources except for emergencies. The doctor is obliged to provide all medical information of the case to the colleague who takes over the patient.

SECTION E
Maintenance and use of professional knowledge. Continuing Medical Education

ART. 33
Doctors have a duty to continuously improve their professional knowledge.
ART. 34
he use of new therapeutic methods the interest of the patient must prevail, and they cannot be used until the risk-benefit assessment.

SECTION F
Integrity and medical images

ART. 35
The doctor must be model-professional ethical behavior, contributing to higher levels or professional and moral authority and prestige of the medical profession to deserve the esteem and confidence of patients and colleagues.
ART. 36
The doctor should not use an elective mandate, an administrative function or other authorities in order to increase clientage.
ART. 37
The doctor may use only the title to which is entitled, as his professional training.
ART. 38
The information on health services are accepted only if they are correct, and may refer to:
a) the professional office, operating hours, leading medical institution;
b) specialty and the title of the doctor;
c) diagnostic and treatment methods used. This information should relate only to methods of diagnosis and treatment scientifically and accepted in the medical world. Must not contain inaccurate or misleading which may induce patients;
d) charges.
This information should not induce patients to think that if they don’t appeal to medical services may jeopardize the physical or mental health.
ART. 39
The doctor can’t advertise for medicine or medical goods consumption. Indicating the name of medicines or medical supplies in the content of articles, books, made for scientific purposes is not considered advertising.
ART. 40
The doctor should not make propaganda in non-medical environments or medical diagnostic procedures or treatment of insufficient evidence, without taking out and reserves which have to assert.
ART. 41
Its unethical making arrangements between the two doctors, between doctors and pharmacists or the medical and ancillary framework for obtaining material benefits.
ART. 42
It is prohibited to the medical practitioner to get involved in the distribution of remedies, devices or medicinal products authorized or unauthorized.
ART. 43
It is prohibited the practice of activities of a doctor that dishonors the medical profession. A doctor must refrain, even outside working life, from acts likely to lead to disregard it.
ART. 44
The doctor can’t be bounded to practice under conditions that could compromise the quality of health care and professional acts, except for vital surgical emergencies.
ART. 45
The doctor can not propose or implement to the patient free illusory remedies or procedures or insufficient evidence as beneficial or risk. Any unscientific practice is prohibited.
ART. 46
It is prohibited providing incentives, collaboration or support to any person who illegally practices medicine. The doctor is required to investigate the existence of territorial College of Physicians.

SECTION G
Fees and attract patients

ART. 47
It is prohibited to issue any medical document that unduly benefit or illegal material to the patient.
ART. 48
Doctor practicing unfair competition is prohibited, including the practice of minimum rates, obviously disproportionate to the actual cost of medical service in order to attract customers. Free service is recognized for philanthropy, the Territorial College of Physicians information no later than 3 days after delivery of healthcare.

CHAP. III
Duties to the sick persons

SECTION A
Respect the rights of individuals

ART. 49
The physician should respect the rights of the person in terms of free choice of doctor or practitioner and even facilitate this possibility.
ART. 50
A doctor who is asked or is required to examine a person deprived of liberty or give care in the prison environment can neither directly nor indirectly, if only by mere presence, to caution neither physical nor mental integrity of any prisoner, including his dignity. If your doctor finds that the person deprived of liberty has suffered ill-treatment is required to inform the judicial authority.

SECTION B
Relationship to patient

ART. 51
Medical Practice should not be made impersonal, but trying to establish a human relationship with the patient, because, if necessary, by your compassion not seem a formal act.
ART. 52
is prohibited for doctors to have sexual relations with his patients or to subjugate them and degrading acts to human beings.
ART. 53
The doctor must show the maximum diagnosis, appropriate treatment and avoid complications predictable in patients who are dependents.
ART. 54
Prescription should be formulated as clear, ensuring that the doctor was fully understood by the patient and his entourage, up to attempt to monitor implementation of treatment.
ART. 55
Once he responded to a request, the doctor is automatically morally committed to provide patient care in case conscientious and dedicated, including by sending the patient to a medical unit or a relevant specialist degree.
ART. 56
The doctor is required to make any steps to facilitate patient care or obtaining its rights arising from illness.
ART. 57
In case of war, cataclysms, epidemics and terrorist attacks, the doctor is not entitled to leave sick people, unless a formal order of the competent authority under the law.

SECTION C
Consent 

ART. 58
For any diagnostic or therapeutic medical intervention is necessary the patient’s informed consent.
ART. 59
Consent patient will be expressed in the law.
ART. 60
Consent will be given after informing patients about diagnosis, prognostic, therapeutic alternatives, risks and their benefits.
ART. 61
When the patient is minor, incompetent or cannot express their will, consent will be for the legal representatives. If the doctor considers that the decision’s legal representative is not in the interest of the patient, it is a special arbitration committee to review the case and decide.
ART. 62
In cases of emergency, the patient’s life is endangered, and he can’t express the will and relatives or legal representatives may be contacted, consent is implied and the doctor will do everything possible to save the patient, that his information will be made later.
ART. 63
Grave prognosis will be shared of the patient with caution and tact, in view of his mental condition. Prognosis will be revealed and the family unless the patient consents. Where it is considered that disclosure will harm the patient’s prognosis infaust or when he does not wish to know, the prognosis may be disclosed family.

SECTION D
Issues of child care

ART. 64
The doctor should be the defender of a sick child’s medical interests when assessing the health of children is not well understood or is not sufficiently protected by the entourage.
ART. 65
If the doctor considers that a minor is the victim of aggression and deprivation, has a duty to protect uzand of caution and announcing the competent authority.

SECTION E
Issuance of documents

ART. 66
It is prohibited issuance of certificates for sick complacency or tendentious reports. Any medical act will reflect objective reality.
ART. 67
A doctor can issue certificates, testimonies and documents permitted by law, on its own findings or examinations required for this purpose. It is prohibited for medical information to be presented distorted or hidden. Medical documents will comply as required by law. Medical documents should not contain more data than necessary for the purpose for which they are prepared and issued.
ART. 68
he person referred to medical documents issued is entitled to be informed of the content.

CHAP. IV
Duties to the public

ART. 69
The doctor called in a family or community must take care to follow rules of hygiene and prevention. He will signal the patient and the surroundings the responsibilities of their entourage toward themselves, but also to the community and the collectivity.
ART. 70
The doctor has a moral obligation to inform the competent bodies any situation that was and is a threat to public health.

CHAP. V
Doctor’s relationships with colleagues and collaborators, medical advice, rules of behavior with other professionals in the health sphere, obligations to the College of Physicians in Romania 

SECTION A
A physician relationships with colleagues and collaborators. Fraternity

ART. 71
The doctor will have to treat their counterparts as he would like to be treated by them. In the spirit of the body, doctors owe their moral assistance.
ART. 72
Exchange of information between physicians on patients should be objective and timely manner, in a way that nurse to patient is optimal.
ART. 73
If a physician has a misunderstanding with a colleague, that reconciliation should prevail Staff College of Physicians of Romania.
ART. 74
It is prohibited the dissemination of reviews is likely to damage the professional reputation of a colleague. Physicians should take the defense of a colleague wrongly attacked.
ART. 75
Breach of ethical rules Blaming and colleagues defamation (criticism of their training or medical) in front of patients, medical personnel, etc. And any expression or act able to shake confidence in doctors and authority.
ART. 76
Where a physician has knowledge of ethical or professional misconduct prejudicial to the image of the profession, committed by a colleague, must take action with diplomacy, trying to discuss the matter with the colleague. If this fails, the doctor is obliged to discuss the case at the Medical College of Romania, before addressing the relevant authorities.

SECTION B
Accredited Health

ART. 77
Whenever the doctor considers it necessary to ask the opinion of a colleague to elucidate the diagnosis, treatment plan formulation or indication of an intervention, it will propose, in agreement with the patient or his family and listening his preferences, a consultation with other colleagues.
ART. 78
Consult is organized by the treating physician and it is advisable to consult doctors called to examine a patient in this family doctor. Then doctors retire to discuss the case. Once agreed, notify the treating physician or patient outcome family consultants. If there are differences of opinions, it will, if necessary, to supplement examinations, hospitalization, widening the consultation by inviting other experts, etc.
ART. 79
The medical advice will have an atmosphere of mutual esteem and respect, will not show superiority to their doctors. Case discussion and critical comments will not be in front of patient or other foreign persons, even if it is subordinate to doctors.
ART. 80
A doctor who was called for a consultation after the patient should not review the patient from their own initiative and without the approval of the treating physician.
ART. 81
Where the collaboration of several doctors to examine or treat the same patient, each practitioner should assume personal responsibility. It is prohibited the transfer of tasks and responsibilities for indications of investigations, prescription of medicines or medical leave to other doctors who have not attended medical advice.
ART. 82
If after a consultation the opinion of the call differs fundamentally from that of the treating physician, the patient should be informed. The doctor is free to withdraw if called doctor to consult medical opinion prevailing in the opinion of the patient or his entourage.
ART. 83
The patient who was in treatment of a colleague may be assisted by any colleague for urgent incidents problems with informing or later the doctor.
ART. 84
If a proposal for medical advice comes from the patient or his entourage, the doctor must organize the consultation. If the treating physician disagrees, he may withdraw without explanation. Following consultation will produce a document signed by participants. If the document is drafted, it is believed that the participants in consultation supports the view of the treating physician.

SECTION C
Relations with other health professionals

ART. 85
Doctors will have good relations in the interest of patients, with other healthcare professionals.

SECTION D
Obligations to the College of Physicians in Romania

ART. 86
Members of the College of Physicians Doctors in Romania should support the organization in all respects.
ART. 87
The doctor who is professional investigation is required to work with persons designated by the college and to provide all data required to conclude the investigation no later than 14 days of the request.

CHAP. VI
Special situations

SECTION A
Rules on medical research on human subjects

ART. 88
Medical research on human subjects are subject to the provisions of international conventions and declarations to which Romania is signatory.
ART. 89
Doctors involved in biomedical research have a duty to promote and protect life, health, privacy and dignity of human subjects in research.
ART. 90
In carrying out medical research on human subjects should be given special protection to vulnerable populations, such as:
a) persons from economically disadvantaged and medically;
b) persons who are unable to give consent for participation in medical research (minors, incompetent persons, persons who because of their condition can not express their will);
c) persons who are likely to give consent under pressure (eg, persons in detention, military);
d) persons who do not benefit from the research staff;
e) persons for which medical research is combined with medical care.
ART. 91
In research on human subjects, good prevails over individual good of society in general and science.
ART. 92
Medical research to medical progress must ultimately be made only in humans. It must be in compliance with existing scientific data, other relevant sources of information and data from experiments on animals, where this is possible.
ART. 93
The main purpose of medical research on human subjects is to improve prevention methods, diagnosis and treatment, understanding the etiology and pathogenesis of disease.
ART. 94
It cannot carry out any research on a person unless the following conditions are met:
a) there is no alternative method to research on humans, comparable efficacy;
b) risks that may expose the person are not disproportionate to the potential benefits of research;
c) research project was approved by the competent court having been subject to independent review on its scientific relevance, including an assessment of the importance objective research and multidisciplinary examination of the level of its ethical acceptability;
d) the person of the research is informed about his/her rights and the guarantees for his/her protection;
e) no consent of participants.
ART. 95
Protocol of research should be evaluated by an ethics committee, made up of people independent of researchers or sponsors. Ethics Commission carrying out project evaluation should be informed of conducting research and has the right to monitor ongoing research.
ART. 96
Medical research on human subjects should be conducted only by qualified persons in this regard. This person has the responsibility of the subjects involved in research, even if they have expressed their informed consent to participate.
ART. 97
Clinical trials (non-therapeutic research) is ethically permissible if it behaves any foreseeable serious risk. Researchers conducting clinical trials are obliged to interrupt if appear risk injury to health or if it requires interrupting the subject of the experiment. Medical research on human subjects can be run only if the potential benefit outweighs the risk.
ART. 98
The imposition by force or by misleading conducts man is a serious violation of principles of medical ethics. The participation of human subjects in research can only voluntarily and only after they have been properly informed about: goals, research methods, risks and anticipated benefits. Also, subjects should be informed that research may be withdrawn at any time, without prejudicial him in any way. Informed consent of participants must be taken with legal provisions.
ART. 99
Refusal of a patient to participate in research should not influence the quality of doctor-patient relationship.
ART. 100
In case of minors, consent will be obtained from or belonging to the legal representative. It is necessary prudency in minor consent to participate in research. Is required to use maximum caution in children in medical experiments, and only if the risks are minimal.
ART. 101
In case of incompetent or incapable of expressing the will, consent will be obtained from or belonging to legal representatives.
ART. 102
The inclusion of subjects in medical research incompetent or who cannot express the will shall be done only when the research can be carried out using competent persons (physical or mental condition that prevents obtaining informed consent is a necessary feature of the population included the study) and if the risks are minor.
ART. 103
The physician should take all necessary measures to protect the privacy of subjects participating in research, for maintaining the confidentiality of information about subjects, and be as much as possible to minimize the impact of research on physical, mental and their personality.
ART. 104
Investigations made in therapy are first human application of medical or surgical procedures and will only curative intent. In such research must be a fair proportionality, for the patient, the risks and seriousness of the case new process, potential hazards of new process will not emulate the seriousness of the likely evolution of the disease or treatment known and applied so far.
ART. 105
Using a placebo in medical research combined with patient care is permitted only when no prevention, diagnosis or treatment subjects demonstrated when participants or patients receiving placebo are not exposed to additional risks.
ART. 106
Participants in medical research should have access to the benefits thereof, after the research.
ART. 107
Publication of results of medical research on human subjects will be subject to the accuracy only in terms of compliance with national and international ethical rules governing medical research on human subjects.
ART. 108
It is prohibited the artificial illness to healthy people, for the sake of experimentation.
ART. 109
In all cases of clinical research to verify the effectiveness of methods on human diagnostic or treatment provided will respect strictly the subject’s voluntary consent.
ART. 110
Human experimentation must respect a number of rules:
a) to be preceded by a series on animal experimentation;
b) subject to accept voluntarily, to be increased, at large and fully informed about risks;
c) if of incurable diseases, the subjects in terminal stage, the remedy should not cause additional suffering and there a reasonable chance of being useful;
d) cannot be tested remedies that would impair mental or moral conscience.
ART. 111
It is prohibited any therapeutic or experimental activity on man of simple reasons of professional pride or scientific, whose result cannot benefit most individuals or injuring cultural, moral principles of the community.
ART. 112
Experiments on human cloning are prohibited.

SECTION B
Year legal medicine expertise

ART. 113
The individual will be informed in advance about the purpose of examination by the expert who has never had any relationship at any one gender expertise, which could influence reasoning. In the latter case the expert is required to refuse, informing the competent bodies of the reasons for objection.
ART. 114
Expertise can challenge the expert, it must obey expertise’s desire.
ART. 115
The final report will contain only items made in response to questions in the decision to appoint the expert. Otherwise, the expert is subject to professional secrecy.

SECTION C
Exercise of private medicine

ART. 116
It is forbidden to a doctor to entrust their own firm to a colleague for being thrifty. The exception is when the assigned doctor is out of town because of good grounds (annual leave, sickness, postnatal, trainee ships in other cities or abroad), when the replacement license granted by College of Physicians in Romania.
ART. 117
Offices group, their professional staff remain, in order to ensure, on the one hand, professional independence, and on the other hand, individual professional liability list. Freedom of choice for a doctor to be ensured and respected.
ART. 118
Any association between physicians must be a written contract you have to respect the professional independence of each. Press Council Act to be mandatory territorial college, for giving its opinion in all respects.
ART. 119
Of the doctor’s professional commitment not exceeding professional competence, technical ability and equipment to the cabinet or the affected material, including strong collaboration with other conventions or sanitary facilities.

SECTION D
The attempting to life and physical integrity of the patient. Euthanasia

ART. 120
The doctor should try to reduce suffering incurable patient, ensuring the dignity of dying.
ART. 121
Is completely prohibited euthanasia, or the use of substances or means in order to cause the death of a patient, regardless of severity and prognosis, even though it was urged by a fully conscious patient.
ART. 122
Doctor will not assist or urge to suicide or auto mischief through tips, advice, lending instruments, and empowering. Your refuse any explanation or help in this regard.
ART. 123
No mutilation cannot be practiced without medical justification evidence, documented serious and without the patient’s informed consent, except in life-threatening emergency.
ART. 124
The professional acts, investigation or treatment, your patient should not undergo any undue risk, even if no specific request of the latter.
ART. 125
Can be practiced abortion in cases and under conditions prescribed by law. Any physician is free to refuse the request without explanation of voluntary interruption of pregnancy.

CHAP. VII
Miscellaneous Provisions

ART. 126
In specific areas of medical specialties, the proposal specialist committees, the National Council of the College of Physicians of Romania may adopt rules of detail to be published as annexes, which form part of this code.
ART. 127
When disciplinary action against him, the doctor must be honest in all statements you make. Invoking secrecy not prevent disciplinary training course. Inaccurate statements made intentionally will be regarded as serious misconduct.
ART. 128
Any doctor who has terminated his professional career is obligated to bring this fact to the knowledge of the College of Physicians in Romania.
ART. 129
This code was approved by the national General Assembly meeting on March 25, 2005 and entered into force following its publication in the Official Gazette of Romania, Part I. Division.