Editorial
New code of medical ethics and the necessary knowledge for the ophthalmologist
Nuevo código de Deontología Médica y su necesario conocimiento por el oftalmólogo
J. Jiménez Benito
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Doctor en Medicina. Médico oftalmólogo
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"apellidos" => "Duch-Samper" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669123001429" "doi" => "10.1016/j.oftal.2023.07.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669123001429?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423001287?idApp=UINPBA00004N" "url" => "/21735794/0000009800000011/v3_202311101354/S2173579423001287/v3_202311101354/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "New code of medical ethics and the necessary knowledge for the ophthalmologist" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "611" "paginaFinal" => "613" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Jiménez Benito" "autores" => array:1 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Jiménez Benito" "email" => array:1 [ 0 => "jjimenez@saludcastillayleon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Doctor en Medicina. Médico oftalmólogo" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Nuevo código de Deontología Médica y su necesario conocimiento por el oftalmólogo" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Hippocratic medicine is considered to be the beginning of medicine in Western culture, and it is noteworthy that the <span class="elsevierStyleItalic">Hippocratic Oath was</span> already written in the <span class="elsevierStyleItalic">Corpus hippocraticum</span> (4th century B.C.),<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which are rules of conduct that doctors must comply with in order to achieve excellence in their professional practice. It is in this tradition that we can understand the existence of the Code of Medical Ethics (CDM), which began in Spain in 1945, but which has had successive updates, until the current one in December 2022.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Updates of the CDM are necessary, both because of scientific advances and because of the evolution in the morals of society. I believe that there is a widespread perception, both in society and in the medical profession, of the importance of the CDM to help us in the correct and difficult professional practice.</p><p id="par0015" class="elsevierStylePara elsevierViewall">As stated in the current preamble,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> the CDM is an essential element in the exercise of professional self-regulation that seeks to maintain social trust through transparency, acceptance and correction of errors and inappropriate conduct as well as proper management of conflicts. In this new CDM, new chapters have been introduced such as those on patient safety, telemedicine and information and communication technologies, or artificial intelligence and large healthcare databases.</p><p id="par0020" class="elsevierStylePara elsevierViewall">As these are mandatory rules, the general principles on which they were always drafted have been maintained: to establish ethical and deontological precepts inspired by the universal principles of medicine, and to codify only those behaviours and situations that are accepted by the majority of the medical profession, without going against anyone's conscience or violating the ethical foundations that guarantee the coexistence of a broad collective, which necessarily has to have and maintain different opinions on certain issues, which are increasingly complex in the practice of medicine.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The essential principles of today’s medical profession are translated into basic attitudes, responsibilities and commitments:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">•</span><p id="par0030" class="elsevierStylePara elsevierViewall">The promotion of altruism, integrity, honesty, truthfulness and empathy, which are essential for a trusting care relationship.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">•</span><p id="par0035" class="elsevierStylePara elsevierViewall">Continuous improvement in professional practice and quality of care, based on scientific knowledge and self-assessment.</p></li></ul></p><p id="par0040" class="elsevierStylePara elsevierViewall">The CDM is not there to defend the corporate interests of the medical profession, but to seek professional excellence in our health care work. Although I consider it necessary to read the entire CDM, it is perhaps appropriate to present some articles that may be of particular relevance to our professional activity.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Article 1.1</span><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The duties imposed by this code, as sanctioned by a Corporation under Public Law, oblige all physicians in the practice of their profession, regardless of the modality in which they practise, to be aware of them and to comply with them.</span></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Article 5.2</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">A physician must not abandon any patient in need of his or her care, even in situations of disaster or epidemic, unless compelled to do so by competent authority or in the presence of an imminent and unavoidable life-threatening risk to him or herself.</span></p><p id="par0055" class="elsevierStylePara elsevierViewall">The sentence that was in this article in the previous CDM in 2011 has been deleted: <span class="elsevierStyleItalic">"Will volunteer to assist in medical aid tasks</span>".<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Article 18.3</span><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The time required for each medical act should be set by the physician's professional judgement, taking into account the individual needs of each patient and the duty to strive for maximum effectiveness and efficiency in his or her work.</span></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Article 24.4</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In order to be able to repair any damage he may cause in the exercise of his profession, a doctor must have professional liability insurance.</span></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Article 44</span><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In order to limit transmission to patients, and unless there are reasons not to do so, physicians should be vaccinated, and it is their responsibility to use the necessary preventive measures against those transmissible diseases of higher prevalence and incidence.</span></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Article 51.1</span><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Physicians in managerial positions must avoid conduct that amounts to abuse of power.</span></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Article 79.3</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">As far as publications are concerned, it is contrary to medical ethics:</span><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">•</span><p id="par0085" class="elsevierStylePara elsevierViewall">To prematurely or sensationally publicise or exaggerate procedures of unproven efficacy.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">•</span><p id="par0090" class="elsevierStylePara elsevierViewall">To falsify or fabricate data.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">•</span><p id="par0095" class="elsevierStylePara elsevierViewall">Plagiarising in whole or in part what has been published by other authors.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">•</span><p id="par0100" class="elsevierStylePara elsevierViewall">To allow oneself to be included as an author without having made a substantial contribution to the design, development or writing of the work.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">•</span><p id="par0105" class="elsevierStylePara elsevierViewall">To refrain from disclosing the sources of funding for the work that motivates the publication or other sources that may involve conflicts of interest, current or future.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">•</span><p id="par0110" class="elsevierStylePara elsevierViewall">To carry out repetitive publications.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">•</span><p id="par0115" class="elsevierStylePara elsevierViewall">To take part in covert misleading advertising or promotion of a product.</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Article 80.1</span><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The use of telematic means or other non-presential communication systems to assist in professional decision-making is in accordance with Medical Ethics, provided that the identification of those involved is unequivocal, confidentiality is ensured and communication channels that guarantee the maximum available security are used.</span></p><p id="par0125" class="elsevierStylePara elsevierViewall">Article 26.3, which was in the previous 2011 CDM, has been deleted: <span class="elsevierStyleItalic">"The clinical practice of medicine by means of consultations exclusively by letter, telephone, radio, press or Internet is contrary to the rules of ethics. Correct practice inevitably involves personal and direct contact between doctor and patient</span>.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Article 83.2</span><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Physicians should not disseminate information that creates false expectations, social alarm, or generates confusion or doubt regarding health care, maintenance or prevention.</span></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Article 92.4</span><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The physician must not sell pharmaceuticals or any other product that has a therapeutic purpose to the patient.</span></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Article 92.1</span><p id="par0140" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The medical act should not be exclusively for financial gain.</span></p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Article 92.2</span><p id="par0145" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Medical fees must be dignified, proportionate and non-abusive. It is contrary to Medical Ethics to charge commissions for the indication of tests or treatments, to charge fees for acts not performed and to refer patients, for profit, between professionals, individually or between institutions or centres.</span></p><p id="par0150" class="elsevierStylePara elsevierViewall">Regrettably, Article 66.5, which was in the previous 2011 MOC, has been deleted: "<span class="elsevierStyleItalic">A doctor who, in his or her capacity as a manager, official, administrator or consultant, intervenes in the determination or regulation of the fees of other doctors and decides or contributes to the fact that these fees are not worthy of or commensurate with his or her qualifications, is a breach of ethics".</span></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Article 88.2</span><p id="par0155" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Medical advertising should be objective, prudent and truthful so as not to raise false hopes or propagate unfounded concepts.</span></p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Article 89.3</span><p id="par0160" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Medical advertising should not use public figures or real patients as a means of inducing health consumption.</span></p><p id="par0165" class="elsevierStylePara elsevierViewall">We end with 2 articles of the CDM that exceed our professional competence, but it is worth remembering that we ophthalmologists are doctors and live in a society with certain moral values that can generate conflicts with Medical Ethics:</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Article 38.4</span><p id="par0170" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">The physician must not intentionally cause or assist in the patient's death.</span></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Article 66</span><p id="par0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Genital mutilation is contrary to human dignity and deontologically reprehensible.</span></p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">No funding or grants were received for writing this manuscript.</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">No conflicts of interest were declared by the author.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:19 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Article 1.1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Article 5.2" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Article 18.3" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Article 24.4" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Article 44" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Article 51.1" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Article 79.3" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Article 80.1" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Article 83.2" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Article 92.4" ] 10 => array:2 [ "identificador" => "sec0055" "titulo" => "Article 92.1" ] 11 => array:2 [ "identificador" => "sec0060" "titulo" => "Article 92.2" ] 12 => array:2 [ "identificador" => "sec0065" "titulo" => "Article 88.2" ] 13 => array:2 [ "identificador" => "sec0070" "titulo" => "Article 89.3" ] 14 => array:2 [ "identificador" => "sec0075" "titulo" => "Article 38.4" ] 15 => array:2 [ "identificador" => "sec0080" "titulo" => "Article 66" ] 16 => array:2 [ "identificador" => "sec0085" "titulo" => "Funding" ] 17 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflict of interest" ] 18 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Como arqueros al blanco" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Gracia Guillén" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "fecha" => "2004" "paginaInicial" => "245" "editorial" => "Estudios de bioética" "editorialLocalizacion" => "Madrid: Triacastela" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Consejo General de Colegios Oficiales de Médicos. Código de Deontología Médica. Guía de ética médica. Julio 2011 [Accessed 20 June 2023]. Available from: <a target="_blank" href="https://www.cgcom.es/sites/main/files/files/2022-03/codigo_deontologia_medica.pdf">https://www.cgcom.es/sites/main/files/files/2022-03/codigo_deontologia_medica.pdf</a>." ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Consejo General de Colegios Oficiales de Médicos. Código de Deontología Médica. Guía de ética médica. Julio 2011 [Accessed 20 June 2023]. Available from: <a target="_blank" href="https://www.cgcom.es/sites/main/files/minisite/static/828cd1f8-2109-4fe3-acba-1a778abd89b7/codigo_deontologia/index.html">https://www.cgcom.es/sites/main/files/minisite/static/828cd1f8-2109-4fe3-acba-1a778abd89b7/codigo_deontologia/index.html</a>." ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009800000011/v3_202311101354/S2173579423001366/v3_202311101354/en/main.assets" "Apartado" => array:4 [ "identificador" => "5814" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009800000011/v3_202311101354/S2173579423001366/v3_202311101354/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579423001366?idApp=UINPBA00004N" ]
