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(RULES OF PROFESSIONAL CONDUCT FOR MEDICAL & DENTAL PRACTITIONERSCODE ON MEDICAL ETHICS IN NIGERIACODE OF MEDICAL ETHICS IN NIGERIAINTRODUCTIONOne of the statutory functions of the Medical and Dental Council of Nigeria, ascontained in Section 1; Sub-section 2(c), of the Medical and Dental PractitionersAct [CAP 221], Laws of the Federal Republic of Nigeria 1990 (Decree No. 23 of1988), is:Considering the paucity of books on Medical Ethics here in Nigeria, this Code ofMedical Ethics could also serve as information booklet for Medical Students,Medical Teachers, legal practitioners who are engaged in MedicalJurisprudence, and even lay persons and patients who may be obliged to seekinformation on these aspects of Medical and Dental Professions in Nigeria."Reviewing and preparing from time to time a statement as to the code ofConduct which the Council considers desirable for the practice of theprofessions in Nigeria."Since that law came into effect, and the Medical and Dental Council of Nigeriawas constituted in accordance with the provisions of the law, 'Statement as to thecode of Conduct which the Council considers desirable for the practice of theprofessions in Nigeria' has been 'prepared and reviewed from time to time'. Thelast revision in January, 1995, was titled "Rules of Professional Conduct forMedical and Dental Practitioners in Nigeria."This particular edition has undergone some major modifications, informed by theexperience of Council in the course of Preliminary Investigations by the Medicaland Dental Practitioners Investigating Panel, sittings of Medical and DentalPractitioners Disciplinary Tribunal, and rulings of the Court of Appeal, in theprofessional disciplinary matters that have been to the Council. This revisededition of the "Rules of Professional Conduct" has been appropriately re-titled a"CODE" in consonance with its legal status.Council's desire is that every medical and dental practitioner should familiarizehimself or herself with the provisions of this Code, so that he or she wouldpractise the profession with conscience and dignity, within the limits of theprovisions of the Code, thus bringing the incidence of ethical violations - to thebearest minimum, as "ignorance of law" will not be an excuse for any ethicalviolation. The Code will enhance the image of the profession, increase theconfidence of the public in the practitioners and offer protection to theconscientious practitioner.12
(RULES OF PROFESSIONAL CONDUCT FOR MEDICAL & DENTAL PRACTITIONERSCODE ON MEDICAL ETHICS IN NIGERIATABLE OF CONTENTSITEMPAGESIntroduction.Table of Contents.Order of the Rules.35-89PARTSA. Preamble and general guidelines.B. Professional conduct.C. Malpractice .D. Improper relationship with colleagues or patients.E. Aspects of private medical or dental practice.F. Self-advertisement and related offences.G. Conviction for criminal offences.H. -75ORDER OF THE RULESPART A:PREAMBLE AND GENERAL GUIDELINES1. Objectives of the Rules.2. Induction of a newly qualified medical practitioneror dental surgeon into profession .(a) Declaration to be made by a prospective Medical or dentalpractitioner before provisional registration.3.4.5.6.PAGE9910(b) The Physicians' Oath .10Allegiance to the professions .Respect to Colleagues.Regulation of Medical and Dental Practices in Nigeria .Legal basis for Medical and Dental Practices.( a) 3272727282828283233333435PART B: PROFESSIONAL CONDUCT25.26.27.28.29.3(i) Provisional Registration ------------------------------(ii) Full Registration -----------------------------------------(iii) Limited or temporary Registration(iv) Registration as a Specialist --------------------------(B) Practicing Fees and Annual Licensing ------------------Guidelines for non-indigenousMedical and Dental Practitioners ------------------------------The International Code of Medical Ethics -------------------General Principles of the Ethics of Medical and DentalPractise in Nigeria ights and responsibilities of members of the Medical andDental Professions nic etiquette ---Classification and nomenclature of health care institutions,Environment of practice g as a Specialist tion by registered practitioners -----------------Professional service to colleagues ---------------------------Notice to practitioners in the locality --------------------------Mutual regard among registered practitioners -------------Discovery of --Informed consent Termination of service by patient ------------------------------New frontiers of knowledge and practice --------------------Telemedicine -----Assisted conception and related practices ------------------Management of HIV/AIDS and other socially dreadedInfectious DiseasesProfessional Brethren of Good Repute and competencyFailure to comply with the General Guideline --------------Attitude towards members of the disciplinary organs ofth e profess ------Profession ----Recurrent professional negligence ---------------------------43738384041
(RULES OF PROFESSIONAL CONDUCT FOR MEDICAL & DENTAL PRACTITIONERS3031.Gross professional negligence --------------------------------Rules guiding physicians in biomedical researchinvolving Human subjects ----------------------------------------CODE ON MEDICAL ETHICS IN NIGERIAPAGEPAGE42PART E:4249.PART C: MALPRACTICE32.Malpractice in a general respect -------------------------------33.Professional certificates, reports and other documents -34.Deceit of patient to extort fees and service charges -------35.Aiding the unprofessional practice of medicine -----------------------36.Association with chemist, opticians, optometrist, dentaltechnologists, other para-professionals andinsurance agent -------------37.Association with midwives or nurses operatingmaternities or nursing homes ----------------------------------38. Association with unqualified or unregistered personspractising medicine dentistry, or midwifery (includingrelationship with persons performing functionsrelevant to medicine, surgery or dentistry)-------------------39.Clinical management of religious adherents ----------------PART ER RELATIONSHIP WITH COLLEAGUESOR PATIENTSInstigation of litigation --------------------------------------------Case referrals to colleagues ------------------------------------Movement of patients among practitioners ----------------------Responsible medical officer entiality ---Right to withdraw service ----------------------------------------Minimum professional fees and service charges ----------Adultery or other improper conduct or associationwith patients ----550.545454555557595952.53.ASPECTS OF PRIVATE MEDICAL OR DENTALPRACTICE.Private practice by registered practitioners who are infull employment as consultants in the public service-----Private practice by Non-consultant registeredpractitioners who are in full employment in the ------------------------Ethical control by practitioners in managementappointments in public hospitals------------------------------New clients and unpaid bill to colleagues-------------------Decency and decorum in professional transactions ------PART F: SELF-ADVERTISEMENT AND RELATED OFFENCES54.Registered medical and dental practitioners and ----------------------55.Self-advertisement or procurement of advertisement---56.Media publication of pending treatment and --------------------57.Media publicity and advertisement --------------------------58.Touting and canvassing rds and T G: CONVICTION FOR CRIMINAL OFFENCES60.Abortion ----------61.Conviction of a registered practitioner in a court of law---62.Aiding criminals in clinics or hospital premises------------PART H: MISCELLANEOUS63.Retainerships, capitation rates and pre-fixec fees forprofessional --64.Alcohol and ---65.Improper financial oper purchase of ----------68.Euthanasia -----69.Fitness to ------70.Enforcement of 616161626363646567676868687070717172737475
(RULES OF PROFESSIONAL CONDUCT FOR MEDICAL & DENTAL PRACTITIONERS(A)Declaration by a prospective medical or dental practitionerCODE ON MEDICAL ETHICS IN NIGERIASignature of the Doctor orDentist who has taken the OathSignature of the Provost or Deanof the College or Faculty ofMedical or Health Sciences (Thesignature of the Head of thetraining institution would not berequired on the Attestation Formsof graduates whose traininginstitutions are outside Nigeria)Da -------------------------------------------I, Doctor. (The doctor being inducted publicly announceshis name here) do sincerely and solemnly declare that as a RegisteredMedical/Dental Practitioner of Nigeria, I shall exercise the several partsof my profession to the best of my knowledge and ability for the good,safety and welfare of all persons committing themselves to my care andattention, and that I will faithfully obey the rules and regulations of theMedical and Dental Council of Nigeria and all other laws that are madefor the control of the medical and dental professions in Nigeria.(B)Furthermore, I hereby subscribe to the PHYSICIANS' OATH as follows: ISOLEMNLY PLEDGE to consecrate my life to the service of humanity; IWILL GIVE to my teachers the respect and gratitude which are their due;I WILL PRACTISE my profession with conscience and dignity;THE HEALTH OF MY PATIENT WILL BE my first consideration;I WILL RESPECT the secrets which are confided in me, even after thepatient has died;I WILL MAINTAIN by all means in my power the honour and the nobletraditions of the medical (dental) profession;MY COLLEAGUES will be my brothers and sisters;I WILL NOT PERMIT consideratiQns of religion, nationality, race, partypolitics or social standing to intervene between my duty and my patient; IWILL MAINTAIN the utmost respect for human life from the time ofconception;Even under threat, I WILL NOT USE my medical knowledge contrary tothe laws of humanity; .I MAKE THESE PROMISES solemnly, freely and upon my honour. TheDeclaration of Geneva (Physicians' Oath Declaration) adopted by theGeneral Assemble of the World Medical Association at Geneva,Switzerland, in September 1948 and amended by the 22nd World MedicalAssembly at Sydney, Australia in August 1994.7Signature of the Registrar of theCouncil3. -------ALLEGIANCE TO THE PROFESSIONS---------Every member of the medical or dental profession must endeavour to---------abide by the dictates of the Physicians' Oath, the modern version of the---------Oath of Hypocrates, which is the foundation of the code of Ethics of the---------profession. Embodied in this oath are the guidelines for behavioral---------interaction between practitioners and their patients, practitioners and---------their colleagues, practitioners and their teachers as well as practitioners---------and the public as represented by the law and the government.-----------------Fundamental to these ethical guidelines is an allegiance which every---------doctor or dentist mandatorily owes to the corporate body of the---------profession. This corporate body of the profession by tradition or---------convention through the ages has assumed the responsibility for---------maintaining and constantly enhancing the standard of service provided---------to the public by the profession as well as protecting the profession from---------unwarranted encroachment by charlatans and quacks. There are two---------arms to this corporate body, namely, a statutory arm represented by the---------Medical and Dental Council of Nigeria, the regulatory body set up by law---------and the Nigerian Medical Association, a quasi-voluntary association of---------all medical doctors and dentists. Both bodies consist of medical doctors---------and dentists. They share the same objectives as stated in these---------Codes and command the allegiance of all doctors and8
(RULES OF PROFESSIONAL CONDUCT FOR MEDICAL & DENTAL PRACTITIONERSCODE ON MEDICAL ETHICS IN NIGERIAdentists in the land. The authority of the Council over all medical doctorsand dental surgeons in Nigeria is statutory and backed by Law.disciplinary process, by a registered practitioner who has been dulynotified but who decides to practise medicine or dentistry in anothercountry. The purpose of such communication will be to compel theregistered practitioner to assist the disciplinary organs in treating such amatter before them, in which he is involved.All medical doctors and dentists are duty-bound therefore to familiarizethemselves with:(A)(B)(C)The laws setting up the Council and which spell out its functions andmodus operandi (Medical and Dental Practitioners Act, Cap 221 Laws ofthe Federation of Nigeria 1990).The Code of Medical Ethics, Le., rules of professional conduct formedical and dental practitioners in Nigeria prepared by the Council. .The constitution of the Nigerian Medical Association, all its bye-laws andstanding orders at national and relevant state levels.All medical doctors and dentists who have paid their annual Practisingfees become, automatically, financial members of the Nigeria MedicalAssociation and for the purpose of the Medical and Dental PractitionersAct are entitled to all rights and privileges appertaining to members. Allregistered practitioners are therefore encouraged to participate activelyin the affairs of the Association.In the exercise of this .allegiance to, and the protection of the good nameof the profession, every doctor or dentist must be his brother's keeperwith regard to the observance and indeed the enforcement of the rulesand regulations, which -guide the professions.Duty to Expose Professional MisconductMedical practitioners and dental surgeons should expose without fear orfavour, before the Medical and Dental Council of Nigeria, either directlyor through the Nigerian Medical Association, any corrupt, dishonest,unprofessional or criminal act or omission on the part of any doctor ordentist. Such exposure must be motivated by the greater good of theentire profession and should be without malice.The Council may, on the recommendation of either of its disciplinaryorgans, communicate to a foreign Medical Council when appropriate,relevant information on a registered practitioner when it is obvious thatthe Medical and Dental Council of Nigeria is being ignored on a matter for94.RESPECT TO COLLEAGUESMedical practitioners and dental surgeons should always endeavor toaccord the senior members of the professions their due respectwhenever junior interact or interrelate with them, either professionally orsocially. Older members of the profession should also consider the juniorones as their brothers and strive to set good examples and giveguidance at all times. This duty should manifest itself in all health careinstitutions in the context of continuing medical education such as duringward rounds, clinical conferences and medical care audit sessions, withboth the senior and junior colleagues interacting to achieve and maintaina high standard of patient care.5.REGULATION OF MEDICAL AND DENTAL PRACTICES IN NIGERIAThe Medical and Dental Professions in Nigeria are regulated by theMedical and Dental Practitioners Act Cap 221 Laws of the Federation ofNigeria, 1990 (as amended), which set up the Medical and DentalCouncil of Nigeria and with the following responsibilities:A.determining the standard of knowledge and skill to be attained bypersons seeking to become members of the medical or dentalprofession and reviewing those standards from time to time ascircumstances may permit.B.Securing in accordance with provisions of the Act theestablishment and maintenance of. register of persons entitledto practise as members of the medical or dental profession andthe publication from time to time of lists of those persons;C.Reviewing and preparing from time to time, a statement as to thecode of conduct which the Council considers desirable for thepractice of the professions in Nigeria, andD.Performing the other functions conferred on the Council by theAct.10
(RULES OF PROFESSIONAL CONDUCT FOR MEDICAL & DENTAL PRACTITIONERSBy provision [c] above, the Council is empowered to make rules forprofessional conduct and is also empowered to establish the Medicaland Dental Practitioners Investigating Panel and the Medical and DentalPractitioners Disciplinary Tribunal for the enforcement of these rules ofconduct.These rules of conduct serve as guiding standards. in the relationship ofmedical and dental practitioners on the one hand with the profession,their colleagues, their patients, members of allied professions and thepublic on the other.6.a)LEGAL BASIS FOR MEDICAL AND DENTAL PRACTICESRegistrationAny person who practises medicine or dentistry anywhere in Nigeriawithout being appropriately registered with the council contravenes thelaw, andso does his employer. 'The categories under which a practitioner may be registered are asfollows:i.Provisional RegistrationThis registration entitles a qualified medical practitioner or dentalsurgeon to undertake internship under the supervision ofregistered consultants or specialists in a hospital approved by theCouncil for internship training. This registration lapsesautomatically when the registered practitioner is signed off fromthe internship. While it subsists, it does not entitled the practitionerto set up and run an independent practice on his own. Every newmedical or dental graduate 'is required to complete his internshipwithin two (2) years of his graduation, or he may unless he gives asatisfactory reason, be subjected to an assessment examinationby the Council.ii.Full RegistrationA practitioner should obtain this registration after a satisfactorycompletion of his internship and this confers on him the legal right topractise on his own. However, the practitioner is expected to be able torecognize his limitations in the management of certain types of cases.11CODE ON MEDICAL ETHICS IN NIGERIAiii-------Limited or Temporary Registration---------This is the type of registration issued to expatriate practitioners. Unlike---------the Full registration, it has a specific period of validity after which it must---------be renewed or the practitioner must leave the country. It is also tied to a---------specific employment. Any change of employment invalidates the---------registration and the practitioner must then process a new registration for---------the new job. A practitioner on Limited Registration cannot set up or run a---------clinic or hospital on his own. A practitioner on the Limited or Temporary---------Register is not allowed to work privately on his own. He must work with---------Nigerian practitioners in the clinic or .hospital.iv.-------Registration as a Specialist---------Every practitioner who has acquired specialist qualification after---------undergoing the requisite training as prescribed by the National---------postgraduate Medical College, or any other training deemed to be the---------equivalent, is required by law to be registered with the Council as a---------specialist before he can practise and be recognized as such. A---------practitioner who is not registered with the Council as a specialist cannot---------validly sign off interns and his opinion, as a specialist will not be backed---------up by the Council upon enquiry.(b) Practising Fees and Annual Licensing----All practitioners must bear in mind at all times that by law, as stipulated inSections 14 and 18 of the Medical and Dental Practitioners Act cap 221,Laws of the Federation of Nigeria 1990 (as amended).----A person shall not hold an appointment or practise as a medical practitioneror dental surgeon, in Nigeria, unless he is registered with the Council.----No registered medical practitioner or dental surgeon shall practise as amedical practitioner or dental surgeon, as the case may be in any year unlesshe has paid to the Council in respect of that year the appropriate practisingfee.----Any medical practitioner or dental surgeon who in respect of any year andwithout paying the prescribed fee practises as such shall be guilty of anoffence and shall be liable on conviction,12
(RULES OF PROFESSIONAL CONDUCT FOR MEDICAL & DENTAL PRACTITIONERSi.in the case of first offence, to a fine of twice the prescribedpractising fee, andii.in the case of a second or subsequent offence, to a fine of notless than ten times the prescribed practising fees;iii.also late payment shall attract a surcharge as may bedetermined by the council from time to time, without prejudice toany other penal provisions in the statuteAll doctors are advised to meet this commitment promptly, as convictionunder this section will be viewed seriously by the Council. By theRegulations of the Council, practitioners are expected to pay theirpractising fees for the ensuing year before the 31 st December of thepreceding year in order to be currently licensed on the first day of the newyear.CODE ON MEDICAL ETHICS IN NIGERIA(A) RegistrationAll foreign qualified doctors wishing to practise in Nigeria must sit andpass the Assessment (Proficiency) Examination before seekingregistration with the Medical and Dental Council of Nigeria.(B) Limited RegistrationA success in the proficiency examination qualifies foreign-trained doctorsto proceed to provisional Registration for Nigerian citizens and a LimitedRegistration for Non-Nigerian Citizens. The laws governing doctors withlimited registration are well spelt out. It is advisable tha t such a doctorfamiliarizes himself with the rules before taking up any job. A practitioner onthe Limited Register shall not own or run any facility in Nigeria. He can onlytake up employment in the institution for which he is registered.On application for registration, the doctor will submit, among otherdocuments" a sworn affidavit that he neither owns, fully or in part, norintends to own or operate a private clinic or medical outfit in Nigeria duringthe period of his limited registration.The law further stipulates as follows:Where a practitioner who is in employment has defaulted from paymentof the practising fee; And if the medical practitioner or dental surgeon is in the employment ofany person, that person shall also be guilty of an offence and punished inlike manner as the medical practitioner or dental surgeon unless heproves that the failure to pay the practising fee was without hisknowledge, consent or connivance.All members of the medical and dental professions who employ medicaldoctors or dental surgeons or who are professional heads of medicalinstitutions, either public or private, are to take due noticed of this aspectof law.7.GUIDELINES FOR NON-INDIGENOUS MEDICAL AND DENTALPRACTITIONERS .For the purpose of clarity, Non-indigenous Medical and DentalPractitioners shall be defined as all Medical and Dental Practitioners bethey Nigerians or not, who are trained in Nigeria shall be regarded asindigenes of the professions and shall be accorded all benefits due themas to their Nigerian counterparts:13(C)Humanitarian DoctorsAll medical and dental practitioners wishing to render health services tothe public are very welcome. However short or long the period of suchservice may be, it is mandatory in the case of expatriate doctors that alimited registration and current practising licence as the case may beshould be obtained before undertaking such exercises. It shall be theresponsibility of the organization or individual responsible for bringing insuch doctors to ensure that they are duly registered and licensed prior toarrival in Nigeria.(D)Exchange Programs DoctorForeign doctors coming in as experts or general duty doctors onexchange programme basis shall be given Limited Registration to coverthe period. They shall be exempted from sitting the proficiencyexamination. Should they wish to remain to practise after theprogramme's expiration, the Medical and Dental Council of Nigeria shallassess them further for retention on the Limited Register or request themto sit the proficiency examination. It shall be the responsibility of theMedical Director of the host institution to ensure that appropriateregistration provisions are complied with.14
(RULES OF PROFESSIONAL CONDUCT FOR MEDICAL & DENTAL PRACTITIONERS8.CODE ON MEDICAL ETHICS IN NIGERIATHE INTERNATIONAL CODE OF MEDICAL ETHICS (DECLARATIONOF VENICE 1983)is beyond the physician's capacity he should summon anotherphysician who has the necessary ability.(A)A physician shall preserve absolute confidentiality on all heknows about his patient even after the patient has died.Duties of Physicians in GeneralA physician shall always maintain the highest standards ofprofessional conduct.A physician shall give emergency care as a humanitarian dutyunless he is assured that others are willing and able to give suchcare.A physician shall not permit motives of profit to influence the freeand independent exercise of professional judgement on behalf ofpatients. A physician shall deal honestly with patients andcolleagues, and strive to expose those physicians deficient incharacter or competence or who engage in fraud or deception.(C)The following are deemed to be unethical conduct:i. Self-advertising by physician, unless permitted by the law ofthe country and the Code of Ethics of the National MedicalAssociation.Ii.Paying or receiving any fee or any other consideration solelyto procure the referral of a patient or for prescribing orreferring a patient to any source.A physician shall observe the principles of the 'Declaration ofGeneva' approved by the World Medical Association.9.A physician shall certify only that which he has personallyverified.(B)Duties of Physicians to the SickA physician shall always bear in mind the obligation of preservinghuman life.A physician shall owe his patients complete loyalty and all theresources of his science. Whenever an examination or treatment15GENERAL PRINCIPLES OF THE ETHICS OF MEDICAL ANDDENTAL PRACTICES IN NIGERIA(a)The principal objective of the medical or dental practitioner shall be thepromotion of the health of the patient. In doing so, the practitioner shallalso be concerned for the common good while at the same timeaccording full respect to the human dignity of the individual.(B)Practitioners have a responsibility in promoting not only individual healthbut also the general health of the community and in pressing for anequitable allocation of health resources.Practitioners must strive at all times not only to uphold the honour and tomaintain the dignity of the profession, but also to improve it. Practitionersshall deal honestly with colleagues and patients at all times.A physician shall act only in the patient's interest when providingmedical care, which might have the effect of weakening thephysical and mental state of the patient.A physician shall use great caution in divulging discoveries ornew techniques or treatment through non-professional channels.Duties of physician to each otherA physician shall behave towards his colleagues, as he wouldhave them behave towards him.A physician shall not entice patients from his colleagues.(c)(d)Practitioners shall always strive to observe the laws of the land but mayparticipate, individually or collectively, in accordance with citizenshiprights to bringing pressure to bear on governments or authorities, tochange or modify laws or actions considered inequitable or inimical to theinterest of the profession or the socie
PART E: ASPECTS OF PRIVATE MEDICAL OR DENTAL PRACTICE. 49. Private practice by registered practitioners who are in full employment as consultants in the public service----- 50. Private practice by Non-consultant registered practitioners who are in full employment in the public Service-----51.
