वैद्य सद्वत्त

ृ
Ethical regimen/Conduct
ETHICS IN CLASSICAL TEXT
• Charak oath
• Chikitsa Chatushpada
• Types of vaidya
• Pranabhisara vaidya
• Rogabhisara vaidya
• Raj vaidya
Charak oath / चरक शपथ
❑"During the period of study, I shall live a disciplined life with my teachers and peers. My
action shall be guarded, service oriented and free from indiscipline and envy. In my
dealings I shall be patient, obedient, humble, constantly contemplative and calm. I shall
aim my full efforts and ability towards the desired goal of my profession.

❑As a Physician, I shall always use my knowledge for welfare of mankind.

❑I shall always be ready to serve patients, even if I am extremely busy and tired. I shall
not harm any patient for the sake of monetary or selfish gains, nor shall I entertain a
desire for lust, greed or wealth. immorality shall not emerge even in my thoughts.
Charak oath / चरक शपथ
❑My dressing shall be decent yet impressive and inspiring confidence. My conduct shall
always be appropriate, pleasant, truthful, beneficial and polite. I shall use my
experience in actions appropriate for that time and place.

❑I shall constantly endeavor to accomplish/ keep updated with the latest developments
in the field and widen my knowledge.

❑I shall treat patient of gender other than mine in presence of relatives or attendants.

❑When examining a patient, my discretion, attention and senses shall be concentrated

on the cure of the disease. I shall not divulge the confidentiality related to the patient or
family inappropriately.

❑Although an authority (in my subject), I shall not display my knowledge and skill with
arrogance.
ETHICS IN CLASSICAL TEXT
• In Ayurveda , the success of treatment depends totally upon four factors/pillars which
are known as chikitsa chatushpada.

• These chatushpada includes Bhishag, Dravya, Upasthata and Rogi and they are
responsible for the cure of any kind of diseases.

• Acharya Charak gives clear picture of different types of physician such as Raja vaidya,
Pranabhisara, Bhishak chadhamchar, siddhisadhita vaidya, vaidyagunayukta and
Murkha vaidya.
वैद्य गण
ु -4
• श्रत
ु े पययवदातत्वं बहुशो दृष्टकर्यता|
दाक्ष्यं शौचमर्तत ज्ञेयं वैद्ये गण
ु चतष्ु टयर् ्|| (च. सत्र
ू .९/६)

• A vaidya should possess the qualities such as proficiency in theoretical

knowledge (that is learnt), extensive practical experience, dexterity and purity
(of body and mind).

1) श्रत
ु े पययवदातत्वं – Excellent medical knowledge
2) बहुशो दृष्टकर्यता – Practical experience, hands-on training
3) दाक्ष्यं - Skill
4) शौच - Cleanliness
प्राणामिसर वैद्य
• तस्र्ाच्छास्त्रेऽथयववज्ञाने प्रवत्त
ृ ौ कर्यदशयने|
• मिषक् चतष्
ु टये यक्
ु तः प्राणामिसर उच्यते|| (च. सत्र
ू .९/१८)

• A physician possessing four qualities - indulgence in scientific knowledge,

clear understanding, right application, and practical experience - is known as
the one who promotes life i.e. pranabhisara.

• य इर्े कुलीनाः पययवदातश्रुताः पररदृष्टकर्ायणो दक्ाः शुचयो जितहस्ता जितात्र्ानः

सवोपकरणवन्तः सवेजन्ियोपपन्नाः प्रकृततज्ञाः प्रततपवत्तज्ञाश्च ते ज्ञेयाः प्राणानार्मिसरा
हन्तारो रोगाणां;(च. सत्र
ू .29/7)
प्राणामिसर वैद्य
• कुलीनाः- from a respectful background
• पययवदातश्रुताः- reputed for skills in science and art of medicine
• पररदृष्टकर्ायणो- hands-on training
• दक्ाः- intelligent, expert, thinking generously
• शुचयो - clean
• जितहस्ता- who is in full control of his hands and able to perform therapeutic maneuvers,
extremely skilled with his hands and ability to act as the situations demand
• जितात्र्ानः- having control over himself and the senses
• सवोपकरणवन्तः- possessing all necessary tools
• सवेजन्ियोपपन्नाः possessing all sense organs
• प्रकृततज्ञाः – knowledge of rog & rogi prakruti
• प्रततपवत्तज्ञाश्च - having adequate knowledge about all the normal functions of the human body.
and the ability to act as the situation demands
रोगामिसर वैद्य
• अतो ववपरीता रोगाणार्मिसरा हन्तारः प्राणानां, मिषक्छद्र्प्रततच्छन्नाः कण्टकित ू ा लोकस्य
प्रततरूपकसधर्ायणो राज्ञांप्रर्ादाच्चरजन्त राष्राणण|
• Contrary to this are the companions of disease, the killers of the life process, wearing the
mask of a physician like a charlatan roams the country owing to the oversight of the King.

1. Pranabhisara Viparita - they will have qualities opposite to those of life savior physicians
2. Roganaam abhisaro - make diseases complicated
3. Hantaarah prananam - they take away life of patients
4. Chadma pratichanna – quacks,
5. Kantaka bhuto lokasya - they are like thorns for entire world,
6. Pratirupaka - in spite of not being physicians, they take form of physicians and behave like
one
7. Raajnaam pramaadaat charanti rashtrani - with a fright of being caught and punished by
king, these people keep strolling from one place to other in entire country and never stay at
one place
मिषक्छद्र्

• मिषक्छद्र् प्रववश्यैवं व्याधधतांस्तकययजन्त ये | वीतंसमर्व संधश्रत्य वने शाकुजन्तका

द्वविान ्||१०||
• श्रुतदृष्टक्रियाकालर्ात्राज्ञानबहहष्कृताः| वियनीया हह ते र्त्ृ योश्चरन्त्यनुचरा िवु व||११||
• ववृ त्तहे तोमियषङ्र्ानपण
ू ायन ् र्र्
ू वय वशारदान ्| विययेदातरु ो ववद्वान ् सपायस्ते पीतर्ारुताः||१२||
 Consumer Protection Act 2019 (CPA)
ग्राहक संरक्षण कायदा
उपभोक्ता संरक्षण अधिनियम
The Consumer Protection Act, 2019 has been enacted for the
purpose of
1) Protection of the interests of consumers
2) To establish authorities providing timely and effective
administration and settlement of consumer disputes and related
matters.

It is a legal force available to customer to enforce their right as

consumer.
 Consumer Protection Act 2019
✓The Consumer Protection Act was initially enacted in 1986 and
implemented from April 15, 1987.
✓Amendment on Dec 17, 2002, and implemented w.e.f. March15,
2003 (World Consumers’ Rights Day).
✓Further, it was amended in 2019 as ‘The Consumer Protection
(Amendment) Bill, 2019’. 2019 Act was passed by the Indian
Parliament and received the assent of the President on 9th
August 2019. It came into force on 20th July 2020
✓This new act replaced the old Consumer Protection Act, 1986.
 Consumer
Consumer means any individual who-
1) Buys any goods for a consideration which has been paid or
promised or partly paid and partly promised; or
2) Hires or avail of any services for a consideration which has
been paid or promised or partly paid and partly promised
3) Includes any user of such goods other than the person who
buys such goods or hires of any services for consideration paid;
 Not Consumer
1. Person buying goods for resale.
2. Person buying goods for any commercial purpose.
3. Person receiving goods/services free or gifts.
4. Person enjoying personal service under a contract (i.e.-
service by employees/maid servants) etc.
 Addition
1. Online buyer
2. Advertisement / endorsement
3. Food
4. Telecom

A significant addition to the 2019 Act is the introduction of “product

liability” whereby manufacturers and sellers of products or services
have been made responsible to compensate for any harm caused
to a consumer by defective products or for deficiency in services.
 Consumer rights
1) Right to be protected against the marketing of goods, products or services
which are hazardous to life and property;
2) Right to be informed about the quality, quantity, potency, purity, standard
and price of goods, products or services, as the case may be, so as to
protect the consumer against unfair trade practices;
3) Right to be assured, wherever possible, access to a variety of goods,
products or services at competitive prices;
4) Right to be heard and to be assured that consumer's interests will receive
due consideration at appropriate fora;
5) Right to seek redressal against unfair trade practice or restrictive trade
practices or unscrupulous exploitation of consumers; and
6) Right to consumer awareness;
 Confusion
✓The Doctor-patient relationship, which forms the foundation of healthcare.

✓The Consumer Protection Act (CPA) was first passed in India in1986.

✓For several years it was not clear whether the medical profession came under
the ambit of the Act.
 Arguments
1. No mention in legislation - Healthcare word

2. In initial draft healthcare was mentioned under the definition of Services.

3. Later it was removed as per request of healthcare lobby. (To prevent

adverse use of law)
 Counter Arguments
1. Service - means service of any description made available to potential
users but not limited to

2. Excluded services from CPA

Rendered free of charge
Under a contract – Personal service

3. Not included in CPA 1986 also but…..

 The medical profession as service provider under
CPA 2019
✓In 1995 the matter was settled when the Honorable Supreme Court held, in
the case of Indian Medical Association v VP Shantha, that medical services
would be treated as services under the CPA 1986.

✓This landmark decision declared the doctor patient relationship to be

“contractual” in nature and comes under the ambit of the Act.
 The medical profession as service provider under
CPA 2019
✓Telemedicine services also come under the ambit of CPA 2019.

✓ Moreover, all doctors are mandated to provide a receipt or bill for payment
received for their services (consultation).

✓This is required for both in-person and tele-medicine consultations, and if a bill
or receipt is not provided, it shall be deemed to be an unfair trade practice.
 Counter Arguments
4. Deficiency

any sort of imperfection, or defect in the feature, quality, amount, worth,

authenticity, its capacity or potential, and standard which is obligatory to be
maintained and regulated as per the laws and statutes in function or any
agreement/contract claimed by the seller, with respect to the products and
goods, is known as deficiency.

Willful and deliberate concealment of important information, omission or

negligence of acts by seller which may lead to injury or loss to the
consumer(s), also comes under the ambit of deficiency of service.

Any act(s), which a prudent seller is supposed to do or is supposed to omit, but

deliberately does the contrast, such actions amount to 'deficiency of service'.
 Scope and implications of CPA 2019
in the health sector
1) Pecuniary jurisdiction - The word “pecuniary” means “relating to or consisting of
money” and “jurisdiction” means “the official power to make legal decisions and
judgments”. All courts in the judicial hierarchy have pecuniary limits. There are
several changes made in the pecuniary jurisdiction in CPA 2019.
2) First, litigation up to Rs 1 crore, between Rs 1 crore and 10 crore, and more than
Rs 10 crore would be filed in the District, State, and National Commissions,
respectively. Second, the pecuniary jurisdiction would depend on the consideration
paid and not the compensation claimed.
3) “Consideration” refers to the amount of money paid by the patient to obtain the
services provided by the doctor.

The National Consumer Disputes Redressal Commission (NCDRC)

Maharashtra State Consumer Disputes Redressal Commission - 35
Pune District Consumer Disputes Redressal Commission
 Scope and implications of CPA 2019
in the health sector
✓A patient pays a doctor/hospital Rs 2 lakh for an operation, sustains an injury
during the operation due to alleged medical negligence, and makes a claim of
Rs 2 crore as compensation.
✓Under the previous legislation, this case would have gone to the National
Commission as the claim is over Rs 1 crore.
✓Under the current Act, it would come to the District Commission as the
consideration is less than Rs 1 crore.
✓Therefore, with the new provision, cases which were filed in either National or
State Commission, are now likely to come to the District Commission.
 Scope and implications of CPA 2019
in the health sector
✓The second major change is about the place where the complaint can be
lodged.
✓Take the case of a doctor who resides in Bengaluru and provides specialist
urology care to a patient from Bihar. The patient develops complications and
decides to file a complaint against the doctor.
✓ Under CPA 1986, the patient was required to file the complaint in Bengaluru.
✓Under CPA 2019, the patient has the choice of filing the complaint either at
the place where s/he resides or works, or at the place where the service
provider resides.
✓Third, the provision for tele-hearing allows doctors to participate in hearings
from any part of the country.
 Scope and implications of CPA 2019
in the health sector
✓Medical negligence that resulted in grievous hurt or death, are excluded
from the scope of mediation.

✓Therefore, it is imperative for doctors to know that cases relating to medical

negligence involving grievous hurt or death, cannot be taken to mediation.
 Litigation
✓The CPA 2019 includes new provisions for grounds for litigation and their processes.
✓First, grounds for litigation include failure to issue a receipt or bill to the patient;
failure to take informed consent (in the ambit of unfair trade practice); failure to
maintain confidentiality; false endorsement of services or a misleading
advertisement, product service liability and “deficiency” in services.
✓This last encompasses “any act of negligence or omission or commission by
such person which causes loss or injury to the consumer and deliberate withholding
of relevant information by such person to the consumer”.
✓Second, there is no requirement for payment of a fee for filing litigation for services
up to Rs 5 lakh. For filing litigation for services that cost more than Rs 5 lakh, a
nominal fee needs to be paid.
✓The CPA 2019 permits electronic filing of complaints, and tele-hearings.
 Compensation
✓On October 24, 2013, the Supreme Court awarded a record-breaking
compensation of Rs 6,08,00,550 — with 6% interest per annum from the date
of the complaint to the date of the payment — amounting to about Rs 11
crore, to the claimant in Balram Prasad v Kunal Saha, for the death of a
patient from medical negligence by doctors and a private hospital.
✓This judgment sparked debate about how medical negligence compensation
should be calculated.
 NCISM
✓ The Aims and objectives of the National Commission for Indian System of Medicine are to -

1. Improve access to quality and affordable Ayurveda, Unani, Siddha and Sowa-Rigpa
(AUS&SR) medical education
2. Ensure availability of adequate and high-quality AUS&SR medical professionals in all parts
of the country;
3. Promote equitable and universal healthcare that encourages community health perspective
and makes services of AUS&SR medical professionals accessible to all the citizens;
4. Encourage medical professionals to adopt latest medical research in their work and to
contribute to research;
5. Objectively assess and rate medical institutions periodically in a transparent manner;
6. Maintain a National AUS&SR medical register for India;
7. Enforce high ethical standards in all aspects of AUS&SR medical services;
8. Have an effective grievance redressal mechanism.
 The oath of Hippocrates
• I swear by Apollo the physician, by Asklepios and health, by
Panacea (all remedies)and by all the gods and goddesses, making
them witnesses, that I will carry out, according to my ability and
judgement, this oath and this indenture(formal list of binding).

• To regard my teacher in this art as equal to my own parents; to

make him partner in my livelihood; when he is in need of money to
share mine with him; to consider his offspring as my own brother;
to teach them this art if they require to learn it, without fee or
indenture.
• To impart precept ,oral instruction, and all other learning to my sons, to
the sons of my teacher, and to pupils who have signed the indenture
and sworn obedience to the physicians’ law, but to none other.

• I will use treatment to help the sick according to my ability and

judgement , but I will never use it to injure or wrong them.

• I will not give poison to anyone though asked to do, nor will I suggest
such a plan.

•
• I will not give a pessary to a woman to cause abortion, but with
purity and holiness I will gourd my life and my art.

• I will not use the knife on suffers as stone but as a craftsman

therein.

• Into whatso ever houses I enter , I will do so to help the sick,

keeping myself free from all intentional wrong –doing and harm
especially from fornication with woman or man, bond or free.
• Whatso ever in the course of practice I see or hear that
ought never to be published abroad, I will not divulge, but
consider such things to be holy secrets.

• Now, if I keep this oath and break it not, may I enjoy

honour in my life and art, among all men for all time ; but if
I transgress and forswear myself, may the opposite befall
me.
 The declaration of Geneva 1948
• The world medical association at its third general assembly at
Geneva in September , 1948 adapted certain code of ethics , in the
form of oath to be taken by all members of the profession, at the
time of entering into medical profession.
• It was amended in 1968, 1984, 1994 and 2006.

• It builds on the principles of the Hippocratic oath, and is now

known as its modern version.
 The original declaration of Geneva 1948
• I solemnly pledge myself to consecrate my life to the
service of humanity.
• I will give to my teachers, the respect and gratitude which
is their due.
• I will practise my profession with conscience and dignity.
• The health and life of my patient will be my first
consideration.
• I will respect the secrets which are confided to me.
• I will maintain by all the means in my power , the honour and the
noble traditions of the medical profession.
• My colleagues will be my brothers.
• I will not permit consideration of religion, nationality , race , party,
politics or social standing to intervene between my duty and my
patient.
• I will maintain the utmost respect for human life from the time of
conceptions, even under threat, I will not use my medical
knowledge contrary to the laws of humanity.
• I make these promises solemnly , freely and upon my honour.
The declaration of Geneva last amended in 2006
• I solemnly pledge myself to consecrate my life to the service of
humanity.
• I will give to my teachers, the respect and gratitude which is 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 to me.
• I will maintain by all the means in my power , the honour and the
noble traditions of the medical profession.
• My colleagues will be my brothers and sisters.
• I will not permit consideration of age, disease or disability,
creed, ethnic origin gender,religion, nationality , political
affiliation, race , sexual orientation, social standing or any
other factor to intervene between my duty and my patient.
• I will maintain the utmost respect for human life.
• I will not use my medical knowledge to violate human
rights and civil liberties even under threat.
• I will make these promises solemnly , freely and upon my
honour.
The International Code of Medical Ethics, 1949
• World medical association in its general assembly in
London in October, 1949
• Code of medical ethics are as follow-
The International Code of Medical Ethics, 1949
❖Doctors duty to the sick
❖Doctors duty to another doctor
❖Duties of a doctor in general
❖Doctors duty to the sick :
1) Preserving human life from the day of conception
until death.
2) Summon another doctor
3) Absolute secrecy
4) Emergency circumstances
❖Doctors duty to another doctor :
1) Behave towards his colleagues
2) Must not entice
3) Declaration of Geneva
❖Duties of a doctor in general :
1) Professional conduct
2) Motives of profit
3) Unethical practices – self-advertisement
professional independence
receiving money/ without the knowledge of
the patient
4) Therapeutic or prophylactic indication
5) Publishing
6) Certificate
 Rights & Privileges of RMP
• Right to choose his patients
• Right to use title and description of the qualification
• Appointment in public and local hospitals
• Right to prescribe and dispense medicine to his
patient
• Right to realize fee and other expenses
• Right to issue medical certificates and medicolegal
reports
• Right to give evidence in a court of law, as an expert
witness.
• Right to be exempted from acting as a juror in course of
holding an inquest.
• Removal of organs from a dead body for transplantation
purposes.
• Right to perform medical termination of pregnancy.
• Right to use the red cross emblem.
 Code of Medical Ethics
1) Declaration :
2) Duties & responsibilities of the Physician in general :
✓Character of physician –
• Uphold the dignity & honour of his profession
• Serve to humanity
• Not allowed to practice modern medicine without having proper
qualifications
• Maintaining good medical practice
• Maintenance of medical records
• Display of registration number
• Use of generic names of drugs
• Highest quality assurance in patient care
• Exposure of unethical conduct
• Payment of professional services
• Evasion of legal restrictions
3) Duties of physician to their patients
• Obligations to the sick
• Patience, delicacy and secrecy
• Prognosis
• The patient must not be neglected
4) Duties of physician in consultation
• Unnecessary consultations should be avoided
• Consultation for patient’s benefit
• Punctuality in Consultation
• Statement of patient after Consultation
• Treatment after Consultation
• Patients referred to specialist
• Fees and other charges
5) Responsibility of physician to each other
• Dependence of physician to each other
• Conduct in consultation
• Consultant not to take charge of the case
• Appointment of substitute
• Visiting another physician case
 6) Duties of physician to the public and to the public and
to the paramedical profession
• Physician as citizen
• Public and community health
• Pharmacist / nurses Physician should recognize and
promote the practice of different paramedical
services
7) Unethical Acts
• Advertising
• Patient and copyrights
• Running an open shop
• Secret remedies
• Human rights
• Euthanasia
 Misconduct
• Professional misconduct / infamous misconduct
• The act of the medical man done in the pursuit of his profession, with regards
to which it would be reasonably regarded as disgraceful or dishonourable by
his professional brethren of good repute and competence.

• Following acts :
• Violation of regulation
• If he/she does not maintain the medical records
• If he/she does not display the registration
• Adultery or improper conduct
• Conviction by court of law
• Sex determination test
• Signing professional certificate , reports and other documents
• Shall not contravene the provision of the Drugs and Cosmetics act
• Enabling unqualified person to perform an abortion or any illegal operation
• Shall noit issue certificates of efficiency in modern medicine to unqualified or
non- medical person
• Should not contribute to the lay press articles and give interviews regarding
diseases and treatments (soliciting practices)
THANK YOU