CODE OF MEDICAL ETHICS, BRAZIL

Federal Council of Medicine

1988

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Brazil's Federal Council of Medicine approved the current Code of Medical Ethics in January 1988, rescinding the 1965 Code of Medical Ethics and the 1984 Brazilian Code of Medical Deontology. The preamble states that the code "contains the ethical standards governing physicians"; that "organizations delivering medical services are subject to the standards in this code"; and, interestingly, that "those who violate this code are subject to disciplinary action as stated by law." Other interesting features of the code include: (1) statements regarding occupational health and the natural environment (articles 12, 13); (2) the right of physicians to strike (article 24); and (3) the requirement that protocols for medical research be submitted to an independent committee for approval and monitoring (article 127).

Chapter I

Basic Principles

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ART. 6 –The physician shall have utmost respect for human life, always acting in the interest of the patient. He/she will never use his/her knowledge to inflict physical or moral suffering, to end the life of an individual, or to allow coverups against his dignity and integrity.

ART. 7 –The physician shall practice his/her profession with ample autonomy and is not forced to provide professional services to an individual against his/her will, except in the absence of another physician, in emergency cases, or when his refusal could cause irreversible damage to the patient.

ART. 8 –The physician may not, under any circumstance or pretext, renounce his professional freedom and shall disallow any restriction or imposition that could harm the efficacy and appropriateness of his/her work.

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ART. 11 –The physician shall keep information, obtained during the practice of his profession, confidential. The same applies to his/her work with businesses, except in cases when such information damages or poses a risk to the health of an employee, or the community.

ART. 12 –The physician shall promote an appropriate working environment for the individual, and the elimination, or control, of risks inherent in his/her work.

ART. 13 –The physician shall inform competent authorities of any forms of pollution and deterioration of the environment, that pose a risk to health and life.

ART. 14 –The physician shall promote the improvement of health conditions and medical service standards, and take part in responsibilities in relation to public health, health education, and health legislation.

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Chapter II

Rights of the Physician

The physician has the right to:

ART. 20 –Practice Medicine without being discriminated against in terms of religion, race, sex, nationality, color, sexual choice, social status, political opinion, or for any other reason.

ART. 21 –Recommend adequate procedures to the patient, observing regularly accepted practice and respecting legal standards in force in the country.

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ART. 24 –Suspend his/her activities, individually or collectively, when the public or private institution for which he/she works, does not offer minimal conditions for the practice of his/her profession, or does not pay accordingly, except in conditions of urgency and emergency. This decision shall be communicated immediately to the Regional Council of Medicine.

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ART. 27 –When employed, dedicate the time and professional experience recommended for the performance of his/her duties, to the patient, avoiding excessive workloads or consultations that could harm the patient.

ART. 28 –Refuse to perform medical practices, although allowed by law, that are contrary to his/her conscience.

Chapter III

Professional Responsibility

The physician is forbidden:

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ART. 40 –Not to inform the individual about working conditions that could pose a risk to his/her health. These facts must be communicated to those in charge, the authorities, and the Regional Council of Medicine.

ART. 41 –Not to inform the patient about social, environmental, or professional implications of his/her illness.

ART. 42 –To practice or recommend medical procedures, not necessary or forbidden by local law.

ART. 43 –Not to abide by specific legislation on organ or tissue transplants, sterilization, artificial insemination, and abortion.

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Chapter IV

Human Rights

The physician is forbidden:

ART. 46 –To perform any medical procedure without previous explanation and consent of the patient or his/her legal representative, except in cases of imminent threat to life.

ART. 47 –To discriminate against a human being in any way or under any pretext.

ART. 48 –To exercise his/her authority in such a way that it limits the right of the patient to decide freely for him/herself or on his/her well-being.

ART. 49 –To participate in the practice of torture, or any other degrading procedures, that are inhuman or cruel; to be an accomplice in these kinds of practices, and not to denounce them when they come to his/her knowledge.

ART. 50 –To provide means, instruments, substances, or knowledge that facilitate the practice of torture or other kinds of degrading, inhuman, and cruel procedures, in relation to the individual.

ART. 51 –To force-feed any person on a hunger strike, who is considered capable, physically and mentally, of making perfect judgement of possible complications from this attitude. In these cases, the physician shall inform the individual of possible complications from prolonged lack of nutrition and treat him/her if there is imminent danger to life.

ART. 52 –To use any process that might change the personality or conscience of an individual, to decrease his/her physical or mental resistance during a police investigation or of any other kind.

ART. 53 –Not to respect the interest and integrity of an individual, by treating him/her in any institution where the person is being kept against his/her will.

Any procedures damaging the personality or physical or mental health of an individual, while under the care of a physician, shall compel the physician in charge to denounce this fact to the competent authorities and to the Regional Council of Medicine.

ART. 54 –To provide means, instruments, substances, knowledge, or to participate in any way, in the execution of a death penalty.

ART. 55 –To use the profession to corrupt customs or to commit or favor crime.

Chapter V

Relation with Patients and Family Members

The physician is forbidden:

ART. 56 –To disregard the right of the patient to decide freely about the performance of diagnostic or therapeutic practices, except in cases of imminent loss of life.

ART. 57 –Not to use all available diagnostic and treatment means within his/her reach in favor of the patient.

ART. 58 –Not to treat a patient, looking for his/her professional care, in an emergency, when there are no other physicians or medical services available.

ART. 59 –Not to inform the patient of the diagnosis, prognosis, risks and objectives of treatment, except when direct communication may be harmful to the patient. In this case, communication shall take place with the legal representative of the patient.

ART. 60 –To exaggerate the seriousness of a diagnosis or prognosis, to complicate treatment, or to exceed the number of visits, consultations, or any other medical procedures.

ART. 61 –To abandon a patient under his/her care.

1. –Under circumstances, that in his/her view are harmful to the doctor–patient relationship or that interfere with full professional performance, a physician has the right to renounce treatment, as long as this fact is previously communicated to the patient or his/her legal representative, with the assurance of continuity of care and supplying all necessary information to the substituting physician.
2. –Except in cases of just cause, communicated to the patient or his/her family members, the physician may not abandon the patient for having a chronic or incurable disease. The physician shall continue to treat him/her, even if only to alleviate physical or psychological suffering.

ART. 62 –To prescribe treatment or other procedures without examining the patient directly, except in emergency cases or the impossibility of performing such an examination. In this case, the examination shall be performed as soon as possible.

ART. 63 –Not to respect the modesty of any individual in his/her professional care.

ART. 64 –To oppose the realization of a medical inquiry requested by the patient or his legal representative.

ART. 65 –To take advantage of the doctor–patient relationship to obtain physical, emotional, financial, or political advantages.

ART. 66 –To use, in any case, means to shorten the life of a patient, even if requested to do so, by the patient or his legal representative.

ART. 67 –Not to respect the right of the patient to decide freely on a contraceptive or conceptive method. The physician shall always explain indication, reliability, and reversibility, as well as the risk of each method.

ART. 68 –To practice artificial insemination, without total consent by the participants, with the procedure duly explained.

ART. 69 –Not to maintain medical records for each patient.

ART. 70 –To deny the patient access to his/her medical records, clinical or similar records, as well as not to provide explanations necessary for their understanding, except when this incurs risks for the patient or third parties.

ART. 71 –Not to provide a medical opinion to the patient, upon referral or transfer for the continuity of care, or upon release, if requested to do so.

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Chapter IX

Medical Confidentiality

The physician is forbidden:

ART. 102 –To reveal the fact that he is aware of information received during the practice of his/her profession, except for just cause, legal duty, or express authorization by the patient.

This is maintained:

1. Even if the fact is public knowledge or if the patient is deceased.
2. When testifying. In this instance, the physician shall present him/herself and declare his/her constraint.

ART. 103 –To reveal a professional secret relating to a minor, including to his/her parents or legal representatives, as long as the minor is capable of resolving his/her problem by his/her own means, except when the lack of revelation could imply damage to the patient.

ART. 104 –To make reference to identifiable clinical cases, exhibit patients or their photographs in professional announcements or during medical programs on radio, television or movies, as well as in articles, interviews or newspaper reports, magazines or other publications not specific to Medicine.

ART. 105 –To reveal confidential information obtained during the medical exam of workers, including upon demand by directors of businesses or institutions, except if silence poses a risk to the health of workers or the community.

ART. 106 –To provide insurance companies with any information about the circumstances of the death of his/her patient, beyond that contained in the death certificate, except by express authorization of the legal representative or heir.

ART. 107 –Not to inform his/her assistants and not to promote the respect of professional secrecy, as required by law.

ART. 108 –To facilitate the handling and knowledge of medical records, forms, and other kinds of medical observations, subject to professional secrecy, by persons not obligated by this commitment.

ART. 109 –Not to maintain professional secrecy when recovering professional fees by judicial or extra-judicial means.

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Chapter XII

Medical Research

The physician is forbidden:

ART. 122 –To participate in any type of experiment with human beings with warlike, political, racial, or eugenic reasons.

ART. 123 –To perform research on an individual, without his/her express consent in writing, after having had the nature and consequence of research duly explained.

If the patient is not in condition to give his/her consent, research shall only be performed, in his/her own benefit, after express authorization by his/her legal representative.

ART. 124 –To use any type of experimental treatment, not approved for use in the country, without due authorization by competent authorities and without the consent of the patient or his legal representative, duly informed of the situation and possible consequences.

ART. 125 –To promote medical research in the community without knowledge by the community and with a purpose not directed at public health, in consideration of local characteristics.

ART. 126 –To obtain personal advantages or have any commercial interest or to renounce his/her professional independence in relation to medical research financing entities in which he/she participates.

ART. 127 –To perform medical research on individuals without having submitted the protocol for approval and monitoring of a commission not subject to any entity related to the researcher.

ART. 128 –To perform medical research on volunteers, healthy or not, who have a direct or indirect relation of dependency or subordination with the researcher.

ART. 129 –To perform or participate in medical research in which there is a need to suspend or to stop using recognized treatment, thereby harming the patient.

ART. 130 –To perform experiments with new clinical or surgical treatment on incurable or terminal patients, without reasonable hope for positive effects, imposing additional suffering.

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