Approved by the Decision of the Ukrainian Medical Council
Protocol No. 18 as of January 27, 2006
Ethical Code of Ukrainian Doctor
Based on the principles of humanism and mercy, the Declaration of the World Medical Association and the legislation of Ukraine On the rights of citizens to quality and affordable healthcare, declaring the leading role of the physicians in the healthcare system, following the Oath of Ukrainian Physician, taking into account special intercourse between a physician and a patient and the need to complement the regulatory mechanism of standards of the medical ethic and deontology, as well as moral responsibilities of the physician to the medical community and society for the professional activities, the Ukrainian Medical Council adopts the Ethical Code of Ukrainian Physician.
Human’s life and health are the main fundamental values. Physician’s activities are directed to save it from the moment of impregnation and requires therefrom to humane treatment of the person, respect for his / her personality, empathy and complicity, kindness, charity and compassion, patience, trust, honesty and fairness. The physician should keep in mind that the conscience is the main judge in his / her professional career.
These moral principles are codified to the Ethical Code of Ukrainian Physician (hereinafter ― the Code) including the Regulation of the International Code of Medical Ethics, the Helsinki Declaration, the Universal Declaration on Human Genome and Human Rights and the Convention on the Protection of Humans Rights and Dignity due to the appliance progress of biology and medicine.
This Code is intended for use in the physician’s and scientist’s professional activity, the field of professional activity of which includes prenatal and postnatal human life and health, birth and death.
Provisions of the Code
- The Provisions of the Code shall be performed by physicians, administrative staff and researchers, which are directly related to the treatment and prophylactic, as well as research activities in the field of healthcare.
- The Ethical Boards and Committees at health and research institutions of the health, medical and scientific federations, associations, societies and other public organizations shall support and control the implementation of the Code.
- Recognition of the Code by physicians of health institutions, scientific establishments, higher medical educational or postgraduate educational institutions, medical and scientific education establishments, associations, societies or other public organizations acting in the field of health, shall be confirmed by an official statement to the Committee of Bioethics at the Ministry of Health of Ukraine (hereinafter ― Committee of Bioethics).
In case of breaching of the Code by physicians, doctors of scientific and educational institutions, members of federations, associations, societies or other public organizations that act in the field of health and recognize this Code, they may be sanctioned by the Ethical Board or Committees of these institutions and organizations, and also by the Ethical Committee of the Ukrainian Medical Council.
Elimination of physicians or doctor from the Ukrainian Medical Council is the outer form of public condemnation of breach of professional and ethical principles.
- In each case of non-recognition or breaching the Code by public societies, separate legal entities and individuals acting in the field of health, the relevant Committee of Bioethics is required to investigate the possible negative consequences for individuals and society, and take appropriate measures to prevent and remove them by submitting petition to the relevant organizations and public authorities for disciplinary, administrative and legal sanctions.
- In the case of situations not stipulated by the Code, as well as vague questions and disputes as to interpretation, performance or breach of the regulations of the Code, the Committee of Bioethics shall make the ultimate decision.
- If it necessary, the Committee of Bioethics, ethical boards of health institution, scientific establishments, universities and medical associations, have the right to protect honor and dignity of physician, if his / her professional actions correspond to the Ethical Code of Ukrainian Physician.
Part 2. Physician and Society
2.1. The main aim of physician’s (practitioner and scientist) professional activities is to preserve and protect human life and health in the prenatal and postnatal periods, ensure disease prophylaxis and health recovery, as well as decrease the suffering of incurable diseases at birth and death.
Ethical attitude to the patient’s personality does not stop even after his death.
2.2. The physician performs its obligations with respect for the life, dignity and personality of each patient on the basis of moral and ethical principles of the society based on the Oath of Ukrainian Physician and this Code.
2.3. The physician bears responsibility for his / her own decisions and actions related to lives and health of patients. He / she is obliged to improve systematically the professional level, using in work the most effective early known and the latest medical achievements in the manner prescribe by law.
2.4. Moral aims gives physician a reason to seek legal protection of his / her own ethical positions and principles of personal dignity, financial guarantee, creation of proper conditions for the realizations of professional activities.
2.5. In any case, the physician should not lose the professional independence. During making professional decisions by physician, motives of material and personal benefits, career, satisfactions of personal ambitions should not prevail.
2.6. In state and public health care institutions, the physician provides free medical care to patients, within the funding allocated to this institution. Extortion any gratification from the patient or his relatives by physician, which is not prescribed by laws and regulations deemed criminal and immoral.
Law regulates the rights of physician on private practice.
2.7. The physician has the right to obtain material rewards of his / her work in accordance with the law. The physician shall protect the right to a valid estimate and payment of his labor from the state, to avoid humiliation and financial discrimination when working in private agencies and during private practice.
However, the physician shall not:
- engage in unfair advertising and allow to use his / her name and statements for the purpose of blurb of misleading medical information;
- distribute for profit medicinal products and medical devices, except in certain circumstances defined by legislation;
- participate in collusion with other physicians, pharmacists, agents of medical and pharmaceutical industry and other individuals or legal entities in order to obtain illegal profit;
- accept gratification from manufacturers and distributors of medicinal products for prescription of purposed products, medical, diagnostic and hygienic medical devices, products of diet nutrition, except in certain defined by legislation;
- engage in other activities incompatible with professional honor and reputation;
- use elective, administrative or other official position for the meritless increase the number of patients of own medical practice or health establishment, which is headed by physician;
- create the background for getting illegal gratification and to fail to pay money in taxes.
2.8. The physician may engage in any other activities if it is compatible with professional independence, does not diminish his / her merits and does not make harm to patients and medical practice.
2.9. The physician should provide specialized medical care to patients irrespectively of their age, sex, race, nationality, religion, social status, political opinion, residence place, citizenship or other non-medical backgrounds, including financial situation.
2.10. The physician with his professionalism, moral and ethical beliefs, behavior in all situations, attitude to human and fulfillment of professional obligations shall be worthy example for his / her colleagues and other members of medical society.
2.11. The physician is obliged by his / her behavior and other available means (lectures, media, Internet, etc.) to promote healthy lifestyle and be an example in keeping with its rules and regulations.
2.12. The physician has the right to participate actively in the work of professional unions and associations, simultaneously obtaining their protection and support. Medical unions and associations are obliged to conduce and provide each of members with assistance as to compliance the principles of professionalism, professional independence, morality, ethics and deontology.
2.13. The physician shall be honest with patients and colleagues, principal in own position as to professional lacks of other physicians, recognize own mistakes and prevent cheating and fraud.
2.14. The physician shall not be engaged in political and religion agitation and propaganda at the work time, prompt colleagues to actions and deeds that deemed inconsistent with the title of physician.
2.15. The physician has the right to participate in the form of protest involved by the Ukrainian legislation, but not exempt from the obligation to provide the necessary medical care to patients who are under his supervision.
Part 3. Physician and patient.
3.1. From the moment of adoption of physician decision about assignment of required medical care or attraction to scientific research as a volunteer the physician shall plan his / her action in relation to this person and arrange relationship with him / her on the basis of human ethics and morality proclaimed by the Oath of Ukrainian Physician, medical deontology, Ethical Code of Ukrainian Physician and International Code of medical ethic.
3.2. The physician is responsible for the quality and humanity of medical care provided to patients and other professional actions on intervention to human life and health. The physician is obligated to observe the Constitution and Laws of Ukraine, regulations concerning medical practice, take into account the characteristics of disease, use preventions methods, diagnosis and treatment, which are considered the most effective in each case, taking into account the interest of each patient. If necessary, the physician is obligated to ask for the help of colleagues.
3.3. Physician activities are aimed at attainment of maximum benefits for the lives and health of patients and his / her social protection.
At the time of providing information for patient about his / her condition and medical recommendation, the physician shall take into account personal characteristics of patient during all period of treatment.
The physician shall not:
- poach in patient’s business and his family without sufficient professional reasons;
- expose patient to unnecessary risk, and use own knowledge in inhuman targets. The physician, choosing any treatment mode first of all should go by not only principle of «don’t harm» but also «bring the most benefits».
The physician is obligated to give patient enough time and attention which is necessary to make correct diagnosis, accomplish full extent of medical care, substantiate instructions and recommendations for further treatment and its explanation for patient.
The physician has no right to exaggerate or underscore disease severity that does not correspond to real state of patient’s health, in order to obtain social protection and financial support by patient.
3.4. Except of emergency cases, the physician can refuse to treat a patient, if he / she is sure that between him and patient there is a lack of necessary trust, when he / she feels insufficiently qualified or does not have necessary possibilities for treatment, other cases, if it does not contradict to the Oath Ukrainian Physician. In such situation, the physician should take all measures to inform patient about it and give him / her appropriate recommendations.
In addition, the physician should not prevent for realization patient’s rights to be consulted by another physician.
3.5. The physician shall respect patient’s right to choose another doctor and his / her participation in decision-making process as to the treatment and preventive measures, except cases of compulsory medical treatment in accordance with procedure established by law. The physician shall obtain patient’s voluntary agreement for assessment, treatment and examination with his participation during personal conversation. This consent must be intended, patient should be informed about treatment methods, consequences of its application, particularly about possible complications, as well as other alternative therapies. If patient is not able consciously to express own agreement, his will shall be fulfilled by the legal representative or a permanent guardian.
Conducting medical-diagnostic actions without patient’s agreement is allowed just in cases of threats to his life and health and inability to assess the situation. In such case, the decision must be taken collectively and with the assistance of patient’s relatives.
During treatment a child or a patient who is under the care of a guardian, the physician is required to provide full details of his / her parents or guardians and get their agreement to use of a particular treatment mode.
The physician shall protect the interests of a child or a patient who cannot independently make a decision, if it is obvious that interests of his life and health are indifferent for people.
3.6. The physician shall respect the honor and dignity of patient, his / her right to privacy, treat him / her kindly, perceive with understanding the concerns of patient’s relatives and friends.
Every patient has the right to keep privacy. The physician and other medical staff who take part in medical treatment are obliged to keep medical secret, even after the death of patient, as well as the fact of seeking care, unless otherwise is specified, or if the disease does not threaten to patient’s family and society.
Medical secret extends to all information obtained over the period of patient treatment (including diagnosis, treatments, prognosis, etc.).
Medical information about patient can be disclosed:
- in the case of a written agreement of patient;
- in the case of a reasonable request of bodies of inquiry, investigation, prosecution and trial, Sanitary-Epidemiological Service;
- if keeping secrets appreciably threatens to health and life of patient and / or / other persons (dangerous infectious diseases);
- in the case of attraction to treatment other specialists, for whom this information is required professionally.
All persons who has the right to access medical information are obliged to keep confidentiality about patient and has to be informed by physician about the liability associated with information disclosure.
Student’s study and physician’s training shall abide to medical secret in the process of research. Demonstration of patient is possible just with his personal agreement or consent of his / her parents or guardian.
3.7. The patient has the right for information about state of his health but he can refuse of it or specify a person to whom can report the health state.
The information may be hidden from the patient in some cases, if there are reasonable grounds to suppose that it can bring serious harm for him / her. However, in the case of persistent demands of patient, the physician is obliged to provide detailed information for him / her. In case of unfavorable prognosis for patient, it is necessary to inform him / her in a delicate and gentle way, leaving the hope for continuation of life with possible successful result.
3.8. In case of physician’s mistakes or uprise of contretemps as a result of his actions, he / she is obliged to inform a patient, a senior colleague and a head of department, or if they’re absent, to inform the administration of institution where he / she work, and immediately recover contretemps without waiting for instructions. If necessary, involve other professionals and honestly inform them about mistake or contretemps.
The physician shall carefully analyze the mistakes and discuss them with colleagues and head of department to prevent the occurrence of such cases in further clinical practice.
3.9. The physician shall make practical actions only under own surname, without insertion of non-official titles and degrees.
3.10. The physician shall favor to the implementation of patient’s rights for moral support from a representative of respective religious confession.
3.11. The physician is obliged to stay with dying patient until the last moment of his / her life, to provide conform medical supervision, to keep necessary level of life, as much as possible to facilitate the physical and mental suffering of patient and his / her relatives with all available means.
The question of termination of resuscitation should be resolved collectively and in case when the state of person is defined as definitive death in accordance with the criteria satisfied by the Ministry of Health of Ukraine.
The physician has no right to anticipate death coming, resort to euthanasia or attract other persons for it.
3.12. In case of common danger physician has no right to leave patient.
3.13. The physician cannot ignore any acts of cruelty or humiliation.
3.14. The physician cannot propose patient treatments methods, medicines and medical products that have not been approved for general use by the Ministry of Health of Ukraine in accordance with applicable legislation. The physician can inform patient about using other treatments and methods for the same disease abroad.
3.15. The physician shall have the proper appearance, which should have a positive effect to patient.
Part 4. Medical cooperation
4.1. The physician is obliged to preserve the respect and gratitude to those who teach him to be a good doctor throughout the life.
4.2. The physician is obliged to protect the honor and the honorable traditions of medical society, and to behave with colleagues with respect and kindness.
4.3. The physician has no right to publicly call doubt or discredit the professional qualification of another doctor. Professional remarks about colleagues must be argued in harmless form and expressed in a personal conversation before medical community and the ethics board or committee will discuss this issue.
4.4. In severe medical cases physicians shall advise and assist their colleagues in delicate form. All responsibility for treatment process making just by attending doctor, who can allow or refuse recommendations, is ruled by the interests of patient. The physician shall not create conditions for the transition to his patients from other colleagues.
4.5. Head-MD of health facilities and scientific and educational institutions are obliged to ensure the protection of the moral and ethical positions and principles of personal dignity, as well as sufficient financial security and social protection, the creation of appropriate conditions for execution of professional activities, professional improvement of subordinates.
4.6. The physicians are obliged to respect other medical staff, to ensure consistently improvement of their skills.
Part 5. Scientific researches with participation of patient
5.1. The physician can combine research with medical care just in such cases where the research is justified by prophylactic, diagnostic or therapeutic purposes.
5.2. Before starting of biomedical research, testing of new medicines, diagnostics, treatment methods and medical equipment the MD has to obtain the written consent of relevant ethical board or committee with the approved plan (protocol) of the research, which clearly defined its goals, ethical aspects, course and possible complications.
5.3. After introduction patient (participant) with objectives, methods, potential benefits and possible risks, physician has to obtain in the prescribed manner the consent to participate in a study, which can be stopped on any stage of research.
5.4. Agreement of disabled patients for participation in research shall be obtained in writing from parents or other legal representative (legally responsible person). Such research is conducted only in the interest of saving lives, reversibility or health care activities without causing damage or health deterioration.
5.5. Physicians can carry out scientific activities involving patients only where they meet the following conditions:
- if they are aimed to improve the health of patients participating in the experiment;
- if it makes a significant contribution to medical science and practice;
- if the results of previous studies and existing data do not indicate a risk of complications;
- provided that all necessary measures for the safety of patient were observed.
5.6. Medical research related to involvement patients, should be carried out with conditions ensuring the rights and safety of participants, to protect their dignity; performed by highly qualified MDs and scientists under the supervision of ethical bodies or committees. The research stop in cases of unexplained and unexpected situations and in case of symptoms of danger of life of participant.
5.7. Doctor-researcher is personally liable in case when result of his / her actions (negligence properly conducted experiment etc.) of patient’s health deterioration. The physician should fully contribute to the restoration of normal health of patient.
5.8. All participants of research must be insured in case of causing unintentional harm to their health.
5.9. During testing on animal the doctor-researcher has to adhere to principles of humanity, try to minimize the number of experimental animals and contribute to development of methods that allows using them during the experiments.
Part 6. Modern medical technologies
6.1. Physician’s actions upon using modern medical technologies (transplantation of human organs and tissues, intervention in the human genome, reproduction system, etc.) are defined by the ethical-legal and legislative instruments of Ukraine, the recommendations and requirements of the World Health Organization, UNESCO Bioethics Body and Commission on Bioethics.
6.2. During the selection of patients who need to conduct complex prophylactic, diagnostic and especially therapeutic measures (for instance, organ transplantation), physicians shall to prioritize medical help, and take into account medical indications, make decisions on their own or collectively with participation of members of the Ethics Board (Commission).
Part 7. Information
7.1. MD is obliged to improve his / her skills, to be informed about the latest achievements in professional activity. He / she must actively stand against any false information in scientific publications and media.
7.2. The publication of medical nature, doctor’s speeches at scientific meetings, educational activities through the media should be flawless in ethical way, limited to objective scientific and practical information and do not contain elements of unfair competition, advertising and self-promotion.
7.3. According to legislation, physician is obliged to report about all the unknown and unwanted side effects of medication and medical devices, which were observed by him during research and in practical work.
7.4. In order to ensure the life and health of patients, physician must actively resist the promotion and application of diagnostic and treatment methods and means, which are not provided for by applicable legislation.
7.5. Medicinal reference shall be issued only in accordance with applicable legislation or regulatory and methodological guidance documents.
7.6. Physician shall inform colleagues, first of all, in special editions about the results of research after the registration of copyright for discovery, invention, etc.
7.7. Physicians should adhere to the requirements of copyright in scientific publications. Including yourself or others without sufficient reasons in writing team or default list of names of persons who have been actively involved in research, as well as cribbage is dimmed to be gross violation of professional ethics principles. Unscrupulous attitude and indifference to distortion of scientific truth, concealment of principal errors of scientific research by member of scientific team is not permitted.
Part 8. Respect of doctor’s profession
8.1. The principle of respect for profession shall be maintained in all areas of medical activities: professional, social, journalistic, and the like. Each physician has to refrain from any actions or statements that undermine respect for the medical profession. Through the activities, medical specialist has to help to preserve and enhance the prestige of the profession to which he/she belongs, as well as the effectiveness of the Code.