CODE OF ETHICS FOR DOCTORS

Norwegian Medical Association

amended 1992, 2000

Adopted in 1961 and most recently amended in 2000, the Norwegian Medical Association's Code of Ethics for Doctors is interesting in its freedom from the governmental intrusions that characterize U.S. codes. Other provisions of interest include the right to withhold information from patients (I, §3) and the admonition that physicians should take care of their own health (II, §3). Excerpts from the Norwegian code follow.

Adopted by the Representative Body in 1961 and subsequently amended, most recently in 2000.

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I. General Provisions

1. A doctor shall protect human health. A doctor shall cure, alleviate and console. A doctor shall help the ill to regain their health and the healthy to preserve theirs. A doctor shall base his practice on respect for fundamental human rights, and on truth and justice in relation to patients and to society.
2. A doctor shall safeguard the interests and integrity of the individual patient. The patient shall be treated with compassion, care and respect. Cooperation with the patient should be based on mutual trust and where possible on informed consent.
3. A patient is entitled to information on his or her condition and treatment and normally to access to the information in the patient's case sheet. The patient shall be informed to the extent he or she wishes. Information which may be thought to be particularly difficult to bear, shall be given with care.
4. A doctor shall maintain confidentiality and exercise discretion in respect of information he or she obtains in his or her medical capacity. The ethical obligation to maintain professional secrecy and discretion may extend further than the statutory obligation. The giving of information must be grounded in the patient's implicit or explicit consent or in a statute.
5. A doctor must when a patient's life is ending show respect for the patient's right of self-determination. Active euthanasia, i.e. measures intended to hasten a patient's death, must not be engaged in. A doctor must not help a patient to commit suicide. To terminate or to refrain from initiating treatment which is of no avail is not considered active euthanasia.
6. When a patient is in urgent need of medical assistance, this shall be provided as soon as possible. The obligation to provide immediate assistance ceases to apply if the doctor has ascertained that another doctor is providing assistance.
   A doctor can refuse to treat a patient provided the patient has reasonable access to treatment by another doctor.
7. A doctor must not exploit a patient sexually, financially, religiously or in any other way. A patient's consent does not absolve the doctor of responsibility. A doctor must not enter into sexual relations with a person whose doctor he or she is.
8. A doctor shall in his or her practice have due regard for his or her patient's financial circumstances and not charge unreasonable fees.
9. In examinations and treatment a doctor shall only employ methods indicated by sound medical practice. Methods which expose the patient to unnecessary risk shall not be employed. If a doctor does not possess the skill a method calls for, he or she shall ensure that the patient receives other competent treatment.
   A doctor must not use or recommend methods which lack foundations in scientific research or sufficient medical experience. A doctor must not allow him- or herself to be pressed into using medical methods which he or she regards as professionally incorrect.
   When new methods are being tried out, regard for the patient on whom they are being tried shall be the primary concern.
10. A doctor shall maintain and constantly seek to renew his or her knowledge.
    A doctor should according to his or her competence contribute to the development and mediation of medical knowledge.
11. A doctor should according to his or her ability contribute to objective information to the public and the authorities on medical matters. A doctor who pronounces on medical matters to the media should ensure that he or she will be able to check the form in which the pronouncements are made public.
12. A doctor shall in his or her practice have due regard for the national economy. Unnecessary or excessively costly methods must not be employed.

A doctor must contribute to the distribution of medical resources in accordance with generally accepted ethical norms. A doctor must in no way seek to provide individual patients or groups with unjustified advantages, whether financial, in respect of priorities, or otherwise. A doctor must give notice of insufficient resources in his or her area of responsibility.

II. Rules Governing the Relations of Doctors with Their Colleagues and Collaborators

1. A doctor must show respect for colleagues and collaborators, and assist, advise and guide them.
2. A doctor who sees signs of professional or ethical failings in a colleague or collaborator should first take the matter up directly with the person concerned. The approach should be tactful, especially towards students or doctors in training.
   If this does not have the desired effect, the doctor should take the matter up with the person's administrative superior, bodies of the Norwegian Medical Association, or the competent health authority.
   A doctor who sees signs of illness or abuse of intoxicants in a colleague or collaborator should offer his/her assistance.
3. A doctor should take care of his own health and seek help if it fails.
4. A doctor should take care not to criticise colleagues and collaborators in the presence of patients and their relatives, but must always keep the patient's interests in view.
5. Public and other debates between colleagues on medical questions and health policy issues must be conducted in an objective manner.
6. The referring and referring back of patients between colleagues must be based on professional medical criteria and the patient's need for continuous health services.
7. Doctors must communicate with one another openly and trustfully. Exchanges of information between doctors concerning patients must take place sufficiently quickly and cover what is professionally necessary.
8. Practice with regard to referrals must not be governed by personal financial interests.

III. Advertisements and Other Information

Concerning Medical Services

• § 1. Advertisements and other information concerning medical services may only state:
• –the location, opening hours, and administration of the business,
• –the type of practice, and the speciality (cf. § 2 below) and title (cf. § 3 below) of the practitioner,
• –the diagnostic and therapeutic methods used, and
• –the fees charged.

The information must reflect generally medically accepted and/or scientifically documented diagnosis of indications and/or methods. The information must contain nothing incorrect or misleading to the public.

Advertisements or other information may make no mention of possible or expected results of specific services, or of the quality of the services. No formulations may be used which could give the public the impression that by failing to avail oneself of the services advertised, one is placing one's own or other persons' somatic, mental or social health at risk.

The overall presentation of the advertisement or other information concerning medical services must accord with the intentions indicated in the above.

Commercial advertisements of medical services must state the name of a or the medically responsible doctor. That doctor is considered responsible for compliance with the provisions in this Chapter.

• § 2. A doctor who is not an approved specialist may only advertise general practice. An approved specialist may advertise his or her specialty on its own or together with "general practice". A specialty in a particular disease may only be advertised with the permission of the Council.
• § 3. A doctor may only use such titles and designations as his or her education and position entitle him to. He or she may not use titles and designations which may give an erroneous impression of his or her qualifications and work.
• § 4. A doctor may not advertise medicines or medical consumer goods. Mention in professional medical contexts in articles, lectures and the like, not made for gain, is not regarded as advertising.

IV. Rules Governing the Issuing by Doctors of Medical Certificates and Other Certified Documents

1. A medical certificate is a declaration by a doctor concerning a person's state of health. Medical certificates comprise such documents as completed forms for the use of the National Insurance authorities, certificates for various purposes, and statements of expert opinion.
2. A doctor shall not issue a medical certificate if he/she is in doubt as to his/her competence. If a doctor does not find objective grounds for issuing a certificate, a certificate shall not be issued.
3. A doctor shall base his/her certificates on the necessary information and on examinations that are sufficiently extensive for the purpose.
4. A medical certificate shall convey sufficient information for its purpose and be objective and neutral in its wording. Relevant information must not be withheld or distorted. A certificate shall not contain more information than necessary for its purpose. When medical documents intended for other purposes are attached to medical certificates, special care must be taken to observe professional secrecy.
5. A medical certificate must clearly show to whom it is addressed, its purpose, the doctor's relation to the person concerned, and what the doctor's knowledge concerning the person is based on. Written certificates must be drawn up as separate documents and dated and signed.
6. The person to whom a medical certificate relates is generally entitled to be informed of the contents of the certificate.

Regulations of the Council for Medical Ethics and the Divisional Medical Ethics Committees

Adopted by the Representative Body in 1997.

1. The Council for Medical Ethics and the Divisional medical ethics committees are the Norwegian Medical Association's special bodies for dealing with ethical questions.
2. The Council for Medical Ethics is the Association's highest competent body in matters concerning medical ethics. The Council's decisions are binding on members of the Association, and decisions in individual cases can not be reviewed by other bodies.
3. The Council's main task is to advise members of the Association, its central bodies, and society on questions of medical ethics. The Council reports on matters of principle relating to questions of medical ethics, and deals with complaints against doctors on the basis of the Code of Ethics for Doctors.
   The Council does not deal with matters relating to professional aspects of medical work or normally with cases undergoing public legal or administrative treatment.
4. The Council consists of a chairperson, a deputy chairperson, and three other members, and is elected by the Representative Body for terms of four calendar years. Two deputy members are also elected, to step in in the event of lasting absence. The Central Board nominates persons for membership of the Council. The chairperson and deputy chairperson are elected separately. Members of the Central Board can not be members of the Council.
   One of the Medical Association's lawyers serves as secretary to the Council.
5. Each Division of the Norwegian Medical Association shall have a medical ethics committee of four members, and a deputy member who shall step in in the event of lasting absence, cf. §11 of the Bylaws of the Medical Association. The committees shall concern themselves with questions of medical ethics in cooperation with the Council, and deal with complaints at divisional level.
6. Matters may be brought before the Council and the committees by individuals, organizations, or Medical Association bodies. The Council and the committees may also themselves bring matters up.
   If a complaint appears to be due to a doctor's health problem, an offer of assistance should be made as mentioned in §12 of the Medical Association's Bylaws.
7. The Council and the committees shall always consider
   first whether or not a matter falls within their scope, and can in that connection consider whether to send it from the committee to the Council or vice versa. Matters which raise important questions of principle are dealt with by the Council.
   Cases of doubt as to which Divisional committee ought to handle a case are decided by the Council.
   Decisions by medical ethics committees can be appealed to the Council within four weeks after receipt of notification of the decision.
   The Council and the committees shall keep minutes of their proceedings. Committees shall send copies of all their minutes to the Council. The Council shall send a copy of its minutes to the committee concerned.
8. When a matter has been brought before the Council or a committee, the person or persons concerned shall be entitled to comment. They can demand to present a verbal account of the matter at a meeting. If the case concerns a complaint, the complainant is entitled to comment on the reply given by the person complained against.
   Members of the Medical Association are obliged to testify before the Council or a medical ethics committee. If no testimony has been received within the time limit, the matter can be decided on the basis of the information available.
   Any person is entitled to assistance by a lawyer and/or a colleague in matters brought before the Council or a medical ethics committee.
9. Parties in cases before the Council or a committee may submit reasoned requests that members whom they consider disqualified shall withdraw during the handling of the case. A Council or committee member may also request permission to step down if he/she believes that he/she is disqualified. Such questions are decided by the Council or by the committee concerned.
10. For a decision by the Council or by a committee to be valid, it must be adopted with at least three votes in favour.
11. A decision by the Council or a committee shall be made known to the persons concerned as soon as possible. The Council can decide to publish a decision, formulated so as to ensure anonymity, in the Journal of the Norwegian Medical Association.
12. If the Council or a committee is of the opinion that a doctor has contravened the Code of Ethics, it can express its disapproval or reprimand the doctor. It may require that the doctor apologise for and/or discontinue the matter complained of.
    If the Council finds that a doctor has committed such a serious contravention of the Code of Ethics for Doctors that he/she should be expelled from the Medical Association, the case and the expulsion proposal shall be sent to the Central Board. The expulsion can also be proposed of a doctor who refuses to comply with a Council decision.