PREAMBLE

I - This Code of Medical Ethics contains rules that must be followed by doctors in the practice of his profession, including the practice of activities related to teaching, research and administration of health services, as well as the exercise of any other activities in which they use knowledge gained from the study of medicine.

II - organizations providing medical services are subject to the provisions of this Code.

III - Practice of Medicine, requires registration with the Regional Council of the respective state, territory or federal district.

IV - To ensure the observance and full implementation of this Code, the physician shall inform the Regional Council of Medicine, with discretion and plea, the facts of which he is aware that characterize possible violation of this Code and other rules governing the exercise of Medicine.

V - Monitoring compliance with the standards established in this Code is the responsibility of the Board of Medicine, and the ethics committees of doctors in general.

VI - The Code of Medical Ethics consists of 25 fundamental principles of medical practice, 10 rules, 118 ethical standards and five general provisions. The transgression of ethical standards will subject violators to disciplinary penalties provided by law.

Chapter I
FUNDAMENTAL PRINCIPLES

I - Medicine is a profession in the service of human health and the community and will be exercised without discrimination of any kind.

II - The object of all the attention of the physician is the health of human beings, the benefit of which should act with the utmost care and to the best of his professional ability.

III - To practice medicine with honor and dignity, the doctor needs to have good working conditions and be paid fairly.

IV - The physician must be responsible at work and ensure optimal performance of medical ethics, as well as the prestige and good reputation within his profession.

V - The doctor should continually enhance their knowledge and use the best scientific progress for the benefit of the patient.

VI - The doctor will keep absolute respect for human beings and will always act for their benefit. They will never use their knowledge to cause physical or moral suffering, for the extermination of human beings or to enable and cover up attempts against their dignity and integrity.

VII - The physician will exercise their profession independently and is not obliged to provide services contrary to the dictates of their conscience or who does not wish, except for the situations of absence of another doctor in case of emergency, or when his refusal to cause damage to patient health.

VIII - The doctor cannot, under any circumstances or under any circumstances, give up their professional freedom, or permit any levies or restrictions that would impair the efficiency and correctness of their work.

IX - Medicine cannot, under any circumstance or event be exercised as trade.

X - Others cannot exploit the doctor’s work for profit objectives, political or religious purpose.

XI - The doctor will keep the information that holds knowledge in the performance of their duties confidential, except in cases provided by law.

XII - The doctor will strive for better adaptation for human labor, the elimination and control of health hazards inherent in work activities.

XIII - The doctor notify the proper authorities of any forms of ecosystem degradation, harmful to health or life.

XIV - The doctor will strive to improve the standards of medical services and to assume their responsibility in relation to public health, health education and legislation relating to health.

XV - The doctor will be in solidarity with the movement for the defense of professional dignity, whether remuneration is fair and decent working conditions for the practice compatible with ethical and professional medicine and its scientific-technical improvement.

XVI - No statutory provision or regimental hospital or institution, public or private, will limit the choice by the doctor, the means scientifically recognized to be performed for the diagnosis and implementation of treatment unless for the benefit of the patient.

XVII - The relationship between doctor and other professionals should be based on mutual respect, freedom and independence, always seeking the interest and welfare of the patient.

XVIII - The doctor treat colleagues with respect, consideration and sympathy, without excuse to denounce acts contrary to the ethical postulates.

XIX - The doctor is liable in a personal capacity and never presumed, by their professional actions, resulting from particular relationship of trust and executed with diligence, competence and prudence.

XX – Because of the very personal nature of professional practice, the physician will not characterize consumer relationship.

XXI - In the process of decision-making professionals, according to its dictates and conscience of the legal provisions, the doctor will accept the choices of their patients regarding diagnostic and therapeutic procedures expressed by them, provided that it is appropriate to the case and scientifically recognized.

XXII - In clinical situations irreversible and terminal, the doctor will avoid performing unnecessary diagnostic and therapeutic procedures and provide the patients under his care appropriate palliative care.

XXIII - When involved in the production of scientific knowledge, the physician will act impartially and independent, for the greater benefit of his patients and society.

XXIV - Whenever participating in research involving humans or any animal, the physician shall respect the national ethical standards, as well as protect the vulnerability of research subjects.

XXV - In application of knowledge created by new technologies, considering its impact on both present and future generations, the doctor will ensure that people are not discriminated against for any reason linked to genetic inheritance, protecting their dignity, identity and integrity.

Chapter II
DOCTORS RIGHTS

It is the physician’s right to:

I - Practice Medicine without being discriminated against because of religion, ethnicity, gender, national origin, color, sexual orientation, age, social status, political opinion or any other nature.

II - Apply the appropriate procedure to the patient, observing the practices scientifically recognized and respected by law.

III – Point out gaps in standards, contracts and internal practices of institutions that when working they judge unworthy of the profession or harmful to himself, to the patient or others, and should address in such cases the competent bodies and mandatorily, the ethics committee and the Regional Council of Medicine of jurisdiction.

IV - Refuse to practice their profession in a public or private institution where working conditions are not worthy or might harm their own health or that of the patient, as well as other professionals. In this case, immediately notify the ethics committee and the Regional Council of Medicine.

V - Suspend activities, individually or collectively, as a public or private institution for which the work does not offer suitable conditions for professional practice or is not worthy and justly remunerated, except in urgent and emergency situations, and should immediately communicate its decision to the Regional Council of Medicine.

VI - Admit and assist patients in private and public hospitals with philanthropic care or without, even if not part of its clinical staff, respecting technical standards adopted by the Regional Council of Medicine of the relevant jurisdiction.

VII - Require public grievance to the Regional Medical Council when struck in the performance of their profession.

VIII - Decide, under any circumstances, to take into account their experience and professional capacity, time to be dedicated to the patient, preventing the accumulation of charges or consultation that will harm you.

IX - Refusing to perform medical acts, which, although permitted by law, are contrary to the dictates of his conscience.

X-Set their fees fairly and with dignity.

Chapter III
PROFESSIONAL RESPONSIBILITY

The physician shall not:

Article 1 cause harm to the patient, by act or omission, characterized as clumsiness, imprudence or negligence.

Single paragraph. The medical responsibility is always personal and cannot be presumed.

Article 2 Delegate acts or other professional assignments unique to the medical profession.

Article 3 Fail to take responsibility for a medical procedure indicated or attended, even when several doctors have assisted the patient.

Article 4 Fail to take responsibility for any professional act done or indicated, even when requested or consented to by the patient or his legal representative.

Article 5 Assume responsibility for a medical act they have not practiced or participated.

Article 6 Assign their failures and occasional circumstances to third parties, except in cases where this can be substantiated.

Article 7 Fail to attend sectors of urgency and emergency, when it is their obligation to do so, risking the lives of patients, even when backed by majority decision category.

Article 8 Divert his professional activities, even temporarily, while another doctor is in charge of the care of their hospitalized patients or critically ill.

Article 9 Fail to attend duty at set time or leave without the presence of substitute, except for just cause.

Single paragraph. In the absence of a substitute physician on duty, the technical direction of the health facility should provide the replacement.

Article 10. Work with those who practice medicine unlawfully or in institutions where they practice illicit acts.

Article 11. Prescribe, issue reports or testify in secret or illegible without the proper identification of your registration number in the Regional Council of Medicine of jurisdiction as well as sign blank receipts, certificates, reports or any other medical documents.

Article 12. Fail to clarify to the employee about working conditions that endanger their health, they should report it to the responsible employers.

Single paragraph. If the fact remains, it is the duty of the physician to communicate the incident to the relevant authorities and the Regional Council of Medicine.

Article 13. Fail to make clear to the patient, the social determinants of their environmental or occupational disease.

Article 14. Practice or indicate unnecessary medical acts or prohibited by law in the country

Article 15. Waive specific legislation in cases of organ transplant or tissue, sterilization, artificial insemination, abortion, genetic manipulation or therapy.

§ 1 In the case of assisted reproduction, fertilization should not systematically lead to the occurrence of supernumerary embryos.

§ 2 The doctor should not perform medically assisted procreation with the following objectives:

I - create genetically modified human beings;

II - create embryos for research;

III - create embryos for purposes of sex selection, eugenics or to give hybrids or chimeras.

§ 3 Practice medically assisted procreation procedures without the participants full agreement and properly informed about the same.

Article 16. Intervene on the human genome with a view of modification, except in gene therapy, excluding any action that results in germ cells in the genetic modification of the seed.

Article 17. Fail to comply with, except for just cause, the rules issued by the Federal and Regional Councils of Medicine and to meet their administrative requests, subpoenas or notices within a certain term

Article 18. Disobey or disrespect judgments and resolutions of the Federal and Regional Councils of Medicine.

Article 19. Fail when investing in position or function of direction, to ensure the rights of doctors and other conditions suitable for the performance of ethical and professional medicine.

Article 20. Allow pecuniary interests, political, religious or any other orders, your employer or supervisor or the public or private funder of healthcare interfere in the choice of the best means of prevention, diagnosis or treatment available and scientifically recognized in the interests of health the patient or society.

Article 21. Fail to cooperate with the health authorities or infringe relevant legislation.

Chapter IV
HUMAN RIGHTS

The physician shall not:

Article 22. Fail to obtain consent from the patient or his legal representative after enlightening you on the procedure to be performed, except in cases of imminent risk of death.

Article 23. Treat humans without civility or consideration, disregarding their dignity or discriminate against you in any form or under any pretext.

Article 24. Fail to ensure the patient the right to freely decide on their person or their welfare as well as exercise their authority to limit it.

Article 25. Fail to report torture or degrading procedures, inhuman or cruel, practice them and be complicit with those who perform or provide the means, instruments, substances or knowledge to facilitate.

Article 26. Fail to respect the will of anyone deemed physically and mentally capable, fasting, or on compulsorily nutrition, but should consider the probable complications of prolonged fasting and in the event of imminent risk of death, treating it.

Article 27. Disregard the physical and mental integrity of the patient or make use of means that could change his personality or his conscience in a police investigation or of any other nature.

Article 28. Disregard the interest and integrity of the patient in any institution in which it is collected, regardless of their own wishes.

Single paragraph. If there are any acts detrimental to the character and the physical or mental health of the patients entrusted to the doctor, it will be required to report the matter to the competent authority and the Regional Council of Medicine.

Article 29. Participate, directly or indirectly, the execution of the death penalty.

Article 30. Use of the profession to corrupt morals, to commit or facilitate crimes.

Chapter V

RELATIONSHIPS WITH PATIENTS AND FAMILIES

The physician shall not:

Article 31. Disregard the right of the patient or his legal representative to freely decide about performing diagnostic or therapeutic practices, except in cases of imminent risk of death.

Article 32. Fail to use all available means of diagnosis and treatment, and scientifically recognized their power, in favor of the patient.

Article 33. Fail to meet your patient seeking professional care in cases of emergency, when no other doctor or medical service able to do so.

Article 34. Fail to inform the patient of the diagnosis, prognosis, risks and treatment goals unless direct communication can cause them harm, in which case, the communication to his legal representative.

Article 35. Exaggerate the severity of the diagnosis or prognosis, complicate therapy or exceed on the number of visits, consultations or other medical procedures.

Article 36. Abandon the patient under their care.

§ 1 Occurring facts which, at its discretion, affect the good relationship with the patient or the full professional performance, the doctor has the right to waive the service provided first to notify the patient or his legal representative, ensuring the continuity of care and providing all necessary information to the doctor that you succeed.

§ 2 Except for cause, communicated to the patient or their family, the doctor will not abandon the patient with this chronic or incurable disease and will continue to watch it even for palliative care.

Article 37. Prescribe treatment or other procedures without direct examination of the patient, except in cases of urgency or emergency and proven impossibility of realizing it, in which case, do it immediately after the impediment cease.

Single paragraph. Distance medical care, along the lines of telemedicine or other methods, will be given under regulations of the Federal Council of Medicine.

Article 38. Disrespect the modesty of any person under his professional care.

Article 39 Oppose performing medical board or second opinion requested by the patient or his legal representative.

Article 40. Take advantage of situations arising from the doctor-patient relationship to gain physical, emotional, financial advantage or any other kind.

Article 41. Shorten the patient's life, even if requested by the patient or his legal representative.

Single paragraph. In cases of incurable and terminal disease, the physician must provide palliative care available, and all actions must be taken without being unnecessarily diagnostic or therapeutic or stubborn, always taking into consideration the wishes of the patient or, in their absence, of their legal representative.

Article 42. Disrespect the patient's right to freely decide about contraception and must always enlighten them on indication, safety, reversibility and the risk of each method.

Chapter VI
DONATION AND TRANSPLANTATION OF ORGANS AND TISSUES

The physician shall not:

Article 43. Participate in the process of diagnosis to death or the decision to withhold artificial means to prolong the life of the potential donor, when belonging to the transplant team.

Article 44. Fail to clarify to the donor, recipient or their legal representatives about the risks of tests, surgeries and other procedures in cases of organ transplants.

Article 45. Remove a living donor organ when it is legally incompetent, even if authorized by their legal representative, except as permitted and regulated by law.

Article 46. Participate directly or indirectly in the sale of organs or tissue.

Chapter VII
RELATIONSHIP BETWEEN PHYSICIANS

The physician shall not:

Article 47. Use their hierarchical position to prevent, by reason of religious belief, philosophical conviction, political, economic interest or any other, technical-scientific or ethical, that facilities and other resources of the institution under his direction, are used by other doctors in the profession, particularly if they are the only ones in the place.

Article 48. Assume employment, office or position to succeed a dismissed doctor or removed in reprisal for defensiveness movements, legitimate category or application of this Code.

Article 49. Assume conduct contrary to legitimate movements of the medical profession in order to obtain benefits.

Article 50. Cover up errors or unethical doctors.

Article 51. Participate in unfair competition practice with another doctor.

Article 52. Disrespect the prescription or treatment of patients, determined by another doctor, even with a function of leadership or audit, except in situations of unquestionable benefit to the patient, and should immediately report the matter to the responsible physician.

Article 53. Fail to refer a patient who was sent for specialized procedure back to the doctor and, on occasion, provide the patient with the necessary information about what happened in the period in which he was responsible.

-Article 54. Fail to provide other medical information on the clinical status of the patient, once authorized by them or by their legal representative.

Article 55. Fail to report to substitute the clinical features of patients under their responsibility to be replaced at the end of your work shift.

Article 56. Make use of their hierarchical position to prevent subordinates from acting within ethical principles.

Article 57. Fail to report acts contrary to the ethical principles of the ethics committee of the institution where he performs his professional work and, if necessary, the Regional Council of Medicine.

Chapter VIII
PROFESSIONAL FEES

The physician shall not:

Article 58. Exercise mercantilist Medicine.

Article 59. Offer or accept compensation or benefits received or sent per patient, as well as calls not provided.

Article 60. Allow the inclusion of names of professionals not involved in the medical act, for the purpose of charging fees.

Article 61. Fail to set in advance with the patient the estimated cost of the procedures.

Article 62. Subordinate the fees to the result of treatment or cure the patient.

Article 63. Explore the work of another doctor, alone or in teams, under condition of the owner, a partner, officer or manager of companies or institutions providing medical services.

Article 64. Broker, solicit or divert, by any means, to a private practice or institutions of any kind, a patient seen by the public health system or use it themselves to perform medical procedures in his private practice as a way to gain personal advantage.

Article 65. Charge fees of patient treated in an institution intended to provide public services, or receive remuneration from patient to supplement salary or fees.

Article 66. Practicing double recovery by medical procedure.

Single paragraph. The supplementary fees in private service may be charged when stated in the contract.

Article 67. Fail to keep the full payment and allow discounts or retention fees, except those provided by law, when there is a function of direction or leadership.

Article 68. Interact with the occupation or reliance pharmacy, pharmaceutical, optical or any organization dedicated to manufacturing, handling, promoting or marketing of prescription drugs, whatever its nature.

Article 69. Exercise both Medicine and Pharmacy or take advantage by routing procedures for marketing the drugs, orthotics, prosthetics or implants of any kind, which arises from buying direct influence by virtue of their professional activity.

Article 70. Fail to submit their fees separately when other professionals are involved in patient care.

Article 71. Offer their services as professional award, whatever its nature.

Article 72. Establish connection whatsoever with companies that advertise or market financing plans, discount cards or consortia for medical procedures.

Chapter IX
PROFESSIONAL SECRECY

The physician shall not:

Article 73. Reveal the fact that they have knowledge in the exercise of his profession, except for cause, statutory duty or written consent of the patient.

Single paragraph. These prohibitions stand: a) the fact that it is public knowledge the patient has died or b) when his testimony as a witness. In that case, the physician shall appear before the authority and declare his disqualification, c) in the investigation of a suspected crime, the physician is forbidden to reveal secrets that could expose the patient to criminal proceedings.

Article 74. Reveal secrets related to underage patients, including to their parents or legal representatives, provided that the minor has capacity of discernment, unless the non-disclosure may cause harm to the patient.

Article 75. Make reference to identifiable clinical cases, patients or their display pictures in professional ads, or disclose medical affairs in the media in general, even with the consent of the patient.

Article 76. Reveal confidential information obtained during the medical examination of workers, including the requirement for heads of companies or institutions, unless the silence would endanger the health of employees or the community.

Article 77. Provide information to insurers about the circumstances of the death of the patient in their care, in addition to those contained in death certificates, except by express consent of their legal representative.

Article 78. Fail to guide his assistants and students to professional confidentiality and ensure that it is maintained.

Article 79. Fail to guard secrets in collecting fees through judicial or extrajudicial.

Chapter X
MEDICAL DOCUMENTS

The physician shall not:

Article 80. Expedite medical documents without having committed a professional act that warrants that is biased or does not correspond to the truth.

Article 81. Attest as a way to gain an advantage.

Article 82. Use forms of public institutions to prescribe or certify facts verified in private practice.

Article 83. Attest death when it has not been personally verified, or when they have not provided patient care, except in the latter case, if you do as duty, or substitute physician in case of autopsy and forensic examination.

Article 84. Fail to certify death of the patient to which they have been providing assistance, except when there is evidence of violent death.

Article 85. Allow handling and knowledge of records by persons not bound by professional secrecy when under their responsibility.

Article 86. Fail to provide the medical report to the patient or their legal representative when forwarded or transferred for further treatment or in case of high request.

Article 87. Fail to produce legible medical records for each patient.

§ 1 The medical record must contain the clinical data necessary for the smooth conduct of the case, being filled in each review, in chronological order by date, time, with the signature and registration number of the physician at the Regional Council of Medicine.

§ 2 The record should stay in the custody of the institution or physician treating the patient.

Article 88. Deny the patient access to their medical records, fail to provide them with a copy when requested or fail to give explanations for its understanding, unless causing risk to self or to others.

Article 89. Release copies of records under their custody, except as authorized in writing by the patient, or to attend court order for its own defense.

§ 1 When requested, the court records will be made available to the medical expert appointed by the court.

§ 2 When the chart is displayed in its own defense, the physician should request that the secrecy observed.

Article 90. Fail to provide a copy of the medical records of their patients when requested by the Medical Board.

Article 91. Fail to attest acts performed in the exercise professional, when requested by the patient or his legal representative.

Chapter XI
AUDIT AND MEDICAL EXPERTISE

The physician shall not:

Article 92. Subscribe expert reports, or check auditorials when not personally performing the examination.

Article 93. Be an auditor of the patient, the person in your family or other relationships with which he has able to influence your work or company who acts or has acted.

Article 94. Intervene when in the role of auditor, assistant or expert in the acts of other medical professionals, or make any judgment on the presence examined, reserving their comments to the report.

Article 95. Complete corpus delicti forensic medical exams in humans within a building or premises of police stations, military units, detention centers and prisons.

Article 96. Receive remuneration or gratuity for values bound to disallowance or the success of the cause, when in the role of expert or auditor.

Article 97. Authorize, veto, or modify, when in the role of auditor or expert, or imposed therapeutic procedures propaedeutic, unless, in the latter case, in emergency situations, emergency or imminent danger of death of the patient, communicating, in writing, by right of the attending physician.

Article 98. Fail to act with absolute exemption when appointed to serve as an expert or as an auditor, as well as beyond the limits of its powers and jurisdiction.

Single paragraph. The doctor has the right to fair remuneration for conducting the forensic examination.

Chapter XII
MEDICAL EDUCATION AND RESEARCH

The physician shall not:

Article 99. Participate in any kind of activity involving humans for war purposes, political, ethnic, or other eugenic, which offends against human dignity.

Article 100. Fail to obtain approval protocol for conducting research on human subjects in accordance with current legislation.

Article 101. Fail to obtain the patient or his legal representative's consent for conducting research involving human subjects, to appropriate explanations about the nature and consequences of the research.

Single paragraph. In the case of the research subject as a minor, in addition to the consent of their legal representative, it is necessary to have their free and informed consent to the extent of their understanding.

Article 102. Fail to use the correct therapy when their use is released in Brazil

Single paragraph. The use of experimental therapy is allowed if accepted by the relevant authorities and with the consent of the patient or his legal representative, adequately informed of the situation and the possible consequences.

Article 103. Conduct research in a community without first informing and enlighten it about the nature of the research and fail to meet the goal of protecting public health, respecting local characteristics and the relevant legislation.

Article 104. Fail to maintain professional and scientific independence regarding medical research funders, satisfying commercial interest or obtaining personal advantage.

Article 105. Conduct research on medical subjects that are directly or indirectly dependent or subordinate to the researcher.

Article 106. Maintain ties of any kind with medical research involving human subjects, which use placebo in their experiments, when there is effective and efficient treatment for the disease studied.

Article 107. Publish their name with scientific work in which they have not participated; attribute exclusive authorship of the work done by their subordinates or other professionals, even when run under his guidance, as well as omit the name of him who has participated in the scientific article.

Article 108. Use data, information or reviews still unpublished, without reference to its author or without their written authorization.

Article 109. Fail to ensure, when a teacher or author of scientific publications, accuracy, clarity and fairness of the information presented, as well as fail to declare relationships with the drug industry, orthotics, prosthetics, devices, implants and any other nature that may constitute conflicts of interest.

Article 110. Practice Medicine in the teaching profession, without the consent of the patient or his legal representative, without their dignity and ensuring privacy or discriminating against those who deny the requested consent.

Chapter XIII
MEDICAL ADVERTISING

The physician shall not:

Article 111. Participate in the dissemination of medical affairs, in any medium of mass communication, or fail to have character exclusively for clarification in the education of society.

Article 112. Disseminate information about medical matters that are questionable, untrue or promotional content.

Article 113. Disclose, outside scientific circles, a treatment process or discovery whose value is not yet scientifically and expressly recognized by the competent body.

Article 114. Look, diagnose or prescribe through any means of mass communication.

Article 115. Advertise scientific evidence that cannot substantiate the specialty or area of expertise for which there are qualified and registered with the Regional Council of Medicine.

Article 116. Participate with business ads whatever its nature, drawing on his profession.

Article 117. Present any original ideas, discoveries or graphics that actually are not their own.

Article 118. Fail to include in professionals ads in any order, their registration number in the Regional Council of Medicine.

Single paragraph. The advertisements of health facilities shall contain the name and registration number, the Regional Council of Medicine, and Technical director.

Chapter XIV
GENERAL PROVISIONS

I - A doctor that has a crippling disease that affects their professional work, determined by the Regional Council of Medicine in administrative procedure with medical expertise, will have their registration suspended pending the outcome of his disability.

II - Doctors who commit misconduct under this Code and whose continuing professional practice constitutes risk of irreparable harm to the patient or society may be suspended by way of specific administrative procedure.

III - The Federal Medical Council, in consultation with the Medical Board and the medical profession, promote the review and update of this Code when necessary.

IV - The omission of this Code shall be remedied by the Federal Council of Medicine.

Text written by Juliane Pitella

Lawyer and partner of ELP Eugenio de Lima and Pitella Lawyers - Legal and Business Consultancy Specializing in the area of Health


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