Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners - a New Era

On 01 January 2024, the ninth edition of the Guide to Professional Conduct & Ethics for Registered Medical Practitioners (“the Guide”) came into effect.

The Guide updates the 8th edition originally released in 2016 and amended in 2019 to take account of the Health (Regulation of Termination of Pregnancy) Act 2018. The Guide, launched in November 2023, followed a consultation process involving members of the public, doctors and partner organisations and aims to provide guidance in relation to a range of topics and scenarios that are likely to arise over the course of a doctor's professional career.

The updated edition of the Guide, contains new and revised guidance for doctors on areas including:

• Communicating with the public.
• Managing situations with patients including honesty, integrity, putting patients first, treating patients with dignity and respect.
• Responsible use of health resources and advocating for patients and services.
• Acting as expert witnesses.
• Professional conduct and professional ethics.

Below we have included a brief overview of the various chapters of the Guide, highlighting some of the key changes.

Chapter 1: Good Medical Practice and Patient Safety

The Guide introduces a duty to practise and promote a positive culture of patient safety. This duty is absolute. Complying with this includes medical practitioners keeping their knowledge and skills up to date; reflecting on practice and working within competencies; supporting and demonstrating effective communication, partnership and teamwork with patients and colleagues; identifying and reporting concerns about the quality of patient care and services to the appropriate person or authority; encouraging and supporting a culture of disclosure amongst staff; and complying with and supporting safety procedures such as infection control, incident and risk management.

The Guide provides updated guidance in relation to Open Disclosure reiterating the duty to practise, promote and support a culture of open disclosure. An additional obligation to comply with applicable legislation and national polices is also included in the Guide.

In relation to the reporting of alleged historic abuse, the Guide reiterates the obligation to assess the current risk to patients and/or others, refer to the relevant guidance and, where required, report to the appropriate authorities. The Guide extends the previous obligation by explicitly stating that the reporting obligation remains even if the patient does not provide his/her consent.

There is also a new section highlighting the importance of medical practitioners operating in a safe environment and premises. Where a medical practitioner has control over, or responsibility for practice premises, they should take all reasonable steps to ensure that appropriate standards are met. Where a medical practitioner does not have control over, or responsibility for, the practice premises, they should raise any concerns with the appropriate person or authority.

Chapter 2: Consent

This chapter sets out the importance of consent as a fundamental ethical and legal requirement in medical practice, noting that informed consent (or another lawful authority) must be obtained from each patient before initiating any treatment. An adult patient’s rights to decline or withdraw consent, the importance of advanced care planning, involving children in decision-making and consent for specific procedures such as genetic testing, intimate examinations and clinical trials and research are also covered in the new addition of the Guide.

Although the guidance on consent is broadly similar to that of the eighth edition, the Guide has been expanded in some areas. For example, in emergency situations, the guidance remains that treatments should be provided as are immediately necessary to save a patient’s life or prevent serious harm to their health. However, the Guide also now includes a section to the effect that this remains the position unless a medical practitioner is “aware of a valid and applicable advance refusal of such treatment”.

The advent of the Assisted Decision-Making (Capacity) Act 2015 has resulted in updated guidance in situations where a medical practitioner has concerns in relation to a patient’s ability to make an informed decision. These updates include the following: -

• Where a person lacks capacity to make their own decision, the Guide outlines a list of obligations to be considered by a medical practitioner, including giving effect (as far as is practicable) to the patient’s past will and preferences, considering the patient’s beliefs and values, the likelihood of the patient recovering capacity, and considering the views of any person named by the patient to be consulted and any decision-making supporter.
• The recognition that an Advance Healthcare Directive is a legally binding document.
• Where a patient lacks decision-making capacity, a medical practitioner should take all reasonable steps to find out whether the patient has an Advanced Healthcare Directive.

Chapter 3: Confidentiality

The Guide includes updates in relation to the obligation of confidentiality owed by medical practitioners to their patients. With regard to children and young people, the previous edition of the Guide noted that parents and guardians have a legal right to access medical records of their children until they are 18 years of age. However, the revised Guide is more subtle in its approach. It states that where a child or young person does not wish to share information with their parents, a medical practitioner “…should usually try to encourage [the child] to involve a parent". If the child subsequently refuses, a medical practitioner may consider disclosing the information to the parents if they consider it is necessary and it is in the child’s best interests. The Guide sets out that any discussion the medical practitioner has in relation to sharing the child’s records together with the reasons for sharing the information should be recorded.

However, the Guide does acknowledge that parents may be entitled by law to access their child's medical records and, therefore, a medical practitioner should explain to young patients that they cannot give an absolute guarantee of confidentiality when it comes to sharing information with parents.

This chapter also considers issues such as disclosing patient information between the patient’s healthcare team, disclosing patient information outside the patient’s healthcare team as well as disclosing patient information outside the healthcare team without consent.

Guidance is also provided in relation to best practice in relation to photographic, audio and video recordings, including facilitating requests by patients to record all or part of their consultation, unless it is considered this could have a negative impact.

Chapter 4: Continuity of Care

This chapter of the Guide addresses the coordination of care between different medical practitioners across primary, secondary and tertiary healthcare settings, focusing on areas that present risk such as prescribing medication, record keeping, conscientious objection and end of life care.

Chapter 4 contains new guidance relating to a medical practitioner’s obligations and responsibilities when patients are being referred, discharged or transferred to or from their care. This includes a new absolute duty on a medical practitioner to share relevant patient information with colleagues in a prompt and timely manner.

There have also been revisions and additions to the guidance in relation to storage and preparation of medical records. It is notable that the Guide sets out a requirement that medical records must be retained for as long as required by law or for as long as they remain clinically relevant.

In relation to conscientious objection, the Guide now contains obligations that must be adhered to when a medical practitioner refuses to carry out a lawful procedure. Such obligations include the need to inform colleagues and the patient involved as soon as possible of the conscientious objection; arranging for the patient to be treated elsewhere in a timely manner; and provide care, support and follow-up for patients who have undergone the treatment to which the medical practitioner has conscientiously objected.

Chapter 5: Professionalism

As with the eighth edition, the Guide continues to highlight some of the more current challenges facing medical practitioners as a result of social media and other online communication tools and public-facing platforms. The Guide provides that a medical practitioner is legally liable for anything they publish online through their social medial channels whether this relates to posting content or advice. The Guide notes that privacy on social media which a medical practitioner uses in their own personal life cannot be guaranteed and therefore the Guide encourages medical practitioners to consider the impact and the public perception of content that they post on social media. The Guide includes some helpful pointers in relation to the preparation of medical reports and the issuing of certificates and other formal documentation by medical practitioners.

A new addition in the Guide is the inclusion of guidance for medical practitioners who are considering acting as an expert witness in legal proceedings. The Guide specifically references that a medical practitioners first duty in any legal proceedings is to the court or tribunal to whom evidence is being given as opposed to the party who has requested the expert evidence or the party who is paying for the provision of the expert evidence.

Chapter 6: Regulatory Requirements

Chapter 6 sets out some of the Medical Council regulatory requirements for a medical practitioner who wishes to practise in Ireland. The Guide provides information on registration, maintaining professional competence, professional indemnity and proficiency in the English language. This chapter also provides detail in relation to how the Medical Council handle complaints that are made to it about medical practitioners.

Read the Guide here.

If you would like any further information or advice, please contact Ciara Hanratty from our Healthcare team.

*This information is for guidance purposes only and does not constitute, nor should be regarded, as a substitute for taking legal advice.