MedJ.Malaysla Vol.XXXV No.!

September, 1980

EDITORIAL
ETHICS IN MEDICAL PRACTICE
DR. G.A. SREENEVASAN

The maintenance of the highest standards of members of the australian Medical Association
ethics in the practice of medicine has been the have to sign an undertaking that they will observe
object of all concerned medical practitioners from the principles of the Declaration of Geneve. Our
time immemorial. Malaysian Medical Association and the Malaysian
Medical Council have so far not required their
Hippocrates more than 2000 years ago formu- doctors to sign any undertaking but one wonders
lated hes well known "Heppocratic Oath" which if this practice should be introduced here so that
he wanted the members of hes profession to when doctors are called up for investigations they
subscribe to and observe. The Hippocratic oath do not plead ignorance of our Ethical Code.
has been the corner stone on which the medical
profession has built its traditions of practice and
codes of conduct. We in the medical profession Every member of the Malaysian Medical
in Malaysia can be justly thankful and proud Association receives the Ethical Code which the
that the standard of medical ethics' has, by large Association has very carefully propared. This
been preserved in the best traditions of the document is quite extensive and well worthy of a
Hippocratic Oath. Whenever there has been detailed study. However, it might require periodic
deviations by a very few, the profession is hurt alterations. The malaysian Medical Council pub-
that its good name is being tarnished. lishes a much smaller pamphlet on Medica
Ethics. This pamphlet could well do with more
Due to advances in medical knowledge and elaborate additions and modifications. As not al
changing patterns of life styles minor modifeca- registered medical practitioners are members of
tons of the Code of Ethics have been made by the malaysian Medical Association, the Malay-
.ach nation. However by and large the basic sian Medical Council should issue a detailed
.rinciples laid down in the Hippocratic Oath Ethical Code as a guide to all doctors.
we been followed. We in Malaysia have
intained the same traditions as that of our The Ethical Committee of the Malaysian
.dical colleagues in the Commonwealth. Medical Association has been the watch dog to
oversee and try to bring to book lapses in ethical
In 1948, the world Medical Association put practice but as it does not have legal powers,
forward a modern version of the Hippocratic cases are referred to the Malaysian Medical
ideals and produced what is called the Declara- Council as and when it deems fit. the President
tion of Geneva, and based on this declaration of the J\A vlaysian Medical Council, who is also
drew up what is known as "The International the Director General of Medical and Health
Code of Medical Ethics". This Code, deals with Services, refers these c ises to a Preliminary
three main obligations of doctors. It first Investigation Committee, whose powers are res-
discusses the ethical obligations of the doctor in tricted, to make the necessary investigations c' nd
gineral and then his obligations towards the sick reporting back to the Council. Whar i~ r.ot
and finally the doctors intraprofessional obliga- generally understood is that this Prelir-in..ry
tions. The International Code of Ethics has been I nvestigation Committee can advise that actior: be
designed so that it can be nracticed the world taken by the Malaysian Medical Council onlu if
over. the :! l1<;gations are' strictly proved by evidence
whi: i I he doctor has the right ot dispute, if
In Australia, '1' .. ;:; with the help of his Counsel. Such
investigations take considerable time and not ledgeable about medical problem and as a result
until recently has legal help been obtainalbe by want to seek a specialist opinion. Whether we
the Preliminary Investigation Committee. It will like it or not specialization in Malaysia has not
save a lot of time if the Ethical Committee of the only come to stay but will continue to develop in
Malaysian Medical Association could also be the Goverment and private sector. Specialization
advised, and represented at investigations, by a has been there among doctors from the Hippo-
legal adviser of some standing. cratic era in the 5th and 4th Century B. C.
Francis Adams who published a book in 1938
With more and more doctors coming into named the "Genuine works of Hippocrates
private practice and a third Medical School in translated from Greek" while quoting his transla-
tha offing we should seriously consider if medical tion from the Hippocratic Oath says "I will not
ethics should not be taught as a subject in our covet persons labouring under the stone, but
medical schools and seminars held on medical leave this to be done by men who are practi-
ethics for graduates working in hospitals during tioners of this work".
their housemanship year. As more specialists are
coming out into private, practice there will be The Malaysian Medical Council has constituted
increasing competition among them. Human a committee to consider the setting up of a
failings being what they are, with increasing specialist register. It is hoped that the work of
competition there may be a tendency for un- this Committee will be finalised so that like in
healthy and unethical practices. Unfortunately we other advanced countries Malaysia could also
are in an era where many are looking for instant have a register of specialists and draw guide lines
success, instant money and instant fame without to determine the qualifications acceptable and
having to go through the arduous training and the period of training required in their respective
practice, in what is essentially a humbling and specialities.
demanding profession. Even if medical ethics is
taught in medical schools the best way to One of the major complaints received by the
incaIculate the rigl: t modes of practice is by Malaysian Medical Council is in regard to
examples set by senior members of the profes- advertisements and publicity. During olden times
sion. Restraining influence by a quick acting there were no newspapers, radios, television
disciplinary Committee of the Malaysian Medical interviews and talks by medical experts to various
Council with enhanced powers will be useful. We clubs and organisations. But today these have
read that in many countries today unnecessary become part and parcel of our everyday life and
operations are being performed without proper some of our medical colleagues without the
indications. We in Malaysia should not slip into approval of their professional organisations rush
those practices. Treatments of different nature to use these to air their view. Unfortunately
are fashionable and tend to change, so do sometimes private medical institutions also tend
indications for surgery. There should however, be to advertise directly and indirectly their facilities.
no hesitation on the part of a doctor to call for a All this is not looked upon kindly by the
second opinion or even suggest it to the patient if profession generally. Arthur Burton in his book
he or she is in any doubt about the need for "Medical Ethics and the Law" writing on the
surgery. One should not hesitate to consult his subject of advertising and publicity introduces his
colleagues if he is in any doubt about how to deal chapter with the following paragraph which I
with a particular problem. This attitude enhances think is well worth quoting in this context. He
the status of the consultant and does not reduce says "It is the hallmark of a responsible
it as people like to think. It is surprising how profession that its members do not advertise, and
another view point can be helpful and construc- so the ethical rules relating to advertisement are
tive. strict. The fundemental principle is that a
medical practitioner should build up his practice
Patients are becoming more and more know- by proficiency in his work and by establishing a

2
sound professional reputation, and not by ma- conduct. it may be necessary for the Malaysian
king use of commercial tricks. The word 'adver- Medical Council to list the type of "therapists" a
tise' is used in its broadest sense and includes all doctor can associate oneself with.
methods by which a practitioner may be made
known to the public either directly or indirectly, There is no doubt that the vast majority of our
with the object of promoting his own professional doctors do their utmost to practice their profes-
advantage" . sion with the highest ethical standards in mind
and thus maintain the stading of our noble
The Malaysian Medical Council regards adver- profession in this country. In order that this good
tisement to be an infamous conduct in a image may continue to be maintained it would be
professional respect and it would be valuable if useful if medical ethics be taught in our medical
the President of the Malaysian Medical Council schools, seminars in medical ethics be held
now and again makes pronouncements on this regularly, andf if every doctor registering with the
matter and so educate the public and the press. alaysian Medical Council be made to sign the
International Code of Ethics.
No ethical code can lay down rules and modes
of conduct for each and every situation. What The Malaysian Medical Council should periodi-
can be set out are only rules of guidance and cally review and make pronouncement on what is
the rest has to be left to the conscience of the and what is not ethical practice and act quickly
doctor. As early as 1894 Lord Justice Lopez without delay to deal with those who deviate from
defined infamous conduct as that "which will be the established practice as stated in the Ethical
reasonably regarded as disgraceful or dishonoura- Code.
ble by his professional brethren of good repute
and competency". REFERENCES
One of the other problems that the Malaysian
Medical Council faces is the association of Arthur W. Burton (1974) - Medical Ethics And The Law
publeshed by Australasian Medical Publishing Co. Ltd.
doctors with unqualified persons. With "speciali-
zation" developing in speech therapy, skin care General Medical Council (January 1979) - Professional
therapy etc. The Council has to make a ruling on Conduct And Discipline.
how it would regard association of doctors with
persons working in these fields. In Victoria, Ethical Code of the Malaysian Medical Association.
australia any association with a person whose Adams. Francis (1938) The Genuine Works of Hippocrates
qualifications are not accepted by the Australian translated from the Greek. Blatimore, Williams and
medical association is regarded as unprofessional Wilkins Co.