Ethics and deontology

Ethics Charter 2011
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In 2010, CEOM updated the European Principles of Medical Ethics of 1987 and 1995, distinguishing between Ethics, the moral thought underlying action, and Deontology, the codified concrete action inspired by moral thought..
In June 2011, the European Charter of Medical Ethics was adopted by CEOM, and for the past two years, the participants have been working on drafting the Ethical Recommendations.

Adopted in Kos, 10 June 2011.

Download the European Charter of Medical Ethics in PDF.
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The expansion and developments of the European Community provides the opportunity for physicians to extend their influence, not only on a joint ethical basis but also relative to the principles of behaviour to be respected in the practice of their profession.

The European Charter of Medical Ethics includes the principles on which physicians' behaviour in the practice of their profession is based, no matter what type of practice they have.
The Charter shall inspire deontological principles taken by the Doctors Chambers and by the Regulatory Authorities habilitated to adopt such rules.

The Charter finds its legitimacy in the work carried out since many years by the European Council of Medical Orders.

The European medical community agrees to respect the European Charter of Medical Ethics.
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Principle 1
The physician defends human physical and mental health.
He relieves suffering while respecting the life and dignity of the person concerned with no discrimination, of any kind, in peace and in war.

Principle 2
The physician agrees to give priority to the interest of the patient's health.

Principle 3
The physician gives the patient the most essential and appropriate care, without any discrimination.

Principle 4
The physician will take the environment in which the patient lives and works as decisive elements relative to his/her health.

Principle 5
The physician is the patient's essential confidant. He betrays this confidence on revealing what he has learned from the patient.

Principle 6
The physician uses his professional knowledge to improve or maintain the health of those confiding in him, at their request; he may not act to their detriment under any circumstances.

Principle 7
The physician calls on all the resources of medical science to apply them appropriately to his patient.

Principle 8
While respecting personal autonomy, the physician will act in accordance with the principle of treatment efficacy, taking into consideration the equitable use of resources.

Principle 9
Health protection goes with constant striving to maintain the person's integrity.

Principle 10
The physician must never accept acts of torture or any other form of cruel, inhuman or degrading treatment, no matter what the arguments may be, under any circumstances, including those of civil or military conflict. He must never be present and must never take part.

Principle 11
The physician acting as a simple practitioner towards a patient, or as an expert or member of an institution, must ensure the greatest transparency in what might appear to be a conflict of interest and act in full moral and technical independence.

Principle 12
If the moral and technical conditions are such as to prevent the physician from acting in full independence, he must inform the patient of this. The patient's right to treatment must be guaranteed.

Principle 13
When a physician decides to take part in a joint organized refusal to provide care, he is not released from his ethical obligations towards the patients to whom he guarantees emergency treatment and care needed for patients in treatment.

Principle 14
The physician is not required to satisfy requests for treatment which he does not approve. However, medical practice involves respect of the life, moral autonomy and freedom of choice of the patient.

Principle 15
The physician exercises his profession with conscience, dignity towards himself and the others and in independence.
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Download the Charter on Regulation of the European Medical Profession in PDF Version - Madrid, November 2018
Principles of 1987-1995
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Principles Of European Medical Ethics adopted on 6 January 1987
Appendix of the Principles adopted on 6 February 1995
In 2010, the CEOM has decided to update the Principles of European Medical Ethics of 1987 by distinguishing what is of Ethics, the moral thought which subtends action of what constitutes the Deontology, which is a codified concrete action inspired by moral thought.
In June 2011, the European Charter of Medical Ethics has been adopted and since then, the CEOM participants are drafting Deontological Guidelines.

International Conference of Medical Professional Associations and Bodies with similar remits, 6 January 1987

Principles of European Medical Ethics

This text contains the most important principles aimed at inspiring the professional conduct of doctors, in whatever branch of practice, their contacts with patients, with society and between themselves. It also refers to the specific situation of doctors, upon which good medical practice depends. The conference recommends that the medical professional associations in each member state of the European Community take such measures as may be necessary to ensure that their national requirements relating to the duties and rights of doctors regarding their patients and society, and in their professional relationships, conform with the principles set out in this text, and to take all useful measures to ensure that the legislation in their country allows the efficient implementation of these principles.

Article 1

The vocation of a doctor consists in protecting man’s physical and mental health and relieving suffering while respecting life and human dignity, without discrimination based on age, race, religion, nationality, social situation or political ideology, or any other reason, both in times of war and peace.
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Article 2

In the practice of his or her profession, the doctor commits to giving priority to the patient’s healthcare interests. The doctor must only use his or her professional knowledge to improve or maintain the health of those who entrust themselves to his or her care, at their request; the doctor may not, in any case, act to their detriment.

Article 3

The doctor is forbidden from imposing personal, philosophical, moral or political opinions on the patient in the practice of his or her profession.
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Article 4

Unless in an emergency, the doctor must clearly inform the patient of the expected effects and consequences of the treatment. He or she must obtain the patient’s consent, especially when the proposed treatment presents a serious risk.

The doctor must not substitute his or her own concept of the quality of life for that of his or her patient.
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Article 5

In order to advise and act, the doctor must have full professional freedom and the technical and moral conditions allowing him or her to act with complete independence.

The patient must be informed if these conditions have not been fulfilled.

Article 6

When a doctor acts on behalf of a private or public authority, and when the intervention is ordered by a third party or an institution, he or she must also inform the patient.
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Article 7

The doctor is the patient’s necessary confidant. He or she must guarantee the complete secrecy of all the information he or she has collected and the findings made during his or her contact with the patient.

The patient’s death does not exempt the doctor from medical confidentiality.

The doctor must respect the patient’s privacy and take all necessary measures to render impossible the disclosure of all the information he or she has acquired while exercising his or her profession.

If exceptions to medical confidentiality are provided for by national law, the doctor may ask for the prior opinion of his association or the professional body of similar competence.

Article 8

Doctors must not collaborate in the creation of electronic medical databases that may jeopardise or weaken the patient’s right to privacy, safety and the protection of his or her private life. To comply with medical ethics, any electronic medical database must be placed under the responsibility of a specifically designated doctor.

Medical databases may not be linked in any way to other databases.
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Article 9

The doctor must refer to all medical resources and apply them appropriately to the patient.

Article 10

A doctor must not claim proficiency for a competence that he or she does not have.

Article 11

He or she must call upon a more qualified colleague if any test or treatment is beyond his or her knowledge.
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Article 12

In all circumstances, medicine implies constant respect for life, moral autonomy and the patient’s free choice. However, in the case of incurable and terminal conditions, the doctor may limit himself or herself to relieving the physical and moral suffering of the patient by giving appropriate treatment and by maintaining, as far as is possible, the quality of a life nearing its end. It is essential to assist a dying person until the end and to act in such a way as to maintain that person’s dignity.
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Article 13

When it is impossible to reverse the terminal process of artificially-maintained vital function failure, doctors must take into account the latest scientific data when certifying the death of a patient.

At least two doctors must be responsible for separately establishing a document concerning this situation. They must be independent from the team responsible for the transplant.

Article 14

The doctors responsible for removing an organ intended for transplant may use special treatment aimed at keeping the donor organs alive.

Article 15

The doctors harvesting the organs must ensure by all possible means that the donor has not expressed an opinion while alive, either in writing or through his or her kin.
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Article 16

The doctor must provide the patient with, and upon their request, any useful information concerning reproduction and contraception.

Article 17

In compliance with the code of ethics, a doctor may, owing to his or her own convictions, refuse to intervene in the reproduction process or in pregnancy terminations or abortions and ask the interested parties to seek advice from other doctors.
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Article 18

Medical progress is based on research that cannot be undertaken without experiments carried out on human beings.

Article 19

The protocol of any planned experiment on a human being must be submitted beforehand to an ethics committee, independent of the researcher, for advice and opinion.

Article 20

The subject of the experiment must give his or her clear and free consent after having been suitably informed of the objectives, methods and anticipated benefits as well as the risks and potential undesirable side effects, of his or her right to refuse to participate in the experiment and to withdraw at any moment.

Article 21

A doctor may only associate biomedical research with medical care, with a view to acquiring new medical knowledge, insofar as this biomedical research is justified by a potential diagnostic or therapeutic benefit for the patient.
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Article 22

A doctor must never assist, participate in or accept acts of torture or other forms of cruel, inhuman or degrading treatment, whatever the reasons (crime committed, accusation, beliefs) or whatever the situation, including cases of civil or armed conflict.

Article 23

A doctor must never use his or her knowledge, competence or skill with a view to facilitating the use of torture or any other cruel, inhuman or degrading process, for any purpose whatsoever.
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Article 24

To accomplish his or her humanitarian mission, a doctor has the right to the legal protection of his professional independence, both in times of war and peace.

Article 25

A doctor acting alone or through a professional organisation is duty bound to draw the community’s attention to shortcomings in the areas of healthcare and the professional independence of practitioners.

Article 26

Doctors are duty bound to participate in the elaboration and execution of all collective measures aimed at improving prevention, diagnosis and treatment among patients. In particular, they are required to collaborate, from a medical point of view, in the organisation of aid, especially in disaster situations.

Article 27

Within the limits of their skills and the possibilities available, they must participate in the continuous progress of healthcare quality through research and continuous improvement in order to offer patients care that complies with scientific data.
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Article 28

The rules of fraternity have been established in the interest of patients. They aim to prevent patients from being the victims of unfair competition between doctors. However, doctors may legitimately cite professional qualities recognised by their peers.

Article 29

A doctor called upon to care for a patient already in the care of one of his or her colleagues, must strive to make contact with the latter in the interests of the patient, unless the patient opposes this.

Article 30

It is not a breach of fiduciary duty if a doctor informs the competent professional body of breaches of medical ethical rules and professional competence of which he or she may be aware.
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Article 31

Doctors are duty bound to make known in the professional press, first and foremost, any discoveries they have made or the conclusions of scientific studies concerning diagnosis or therapy. They must submit them for critical study by their colleagues according to the appropriate channels before revealing anything to the non-medical public.

Article 32

Any advertising of a medical success for the benefit of a person or a group or a school is contrary to the medical code of ethics.
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Article 33

Regardless of the doctor’s speciality, he or she must consider it a duty to provide urgent care to a person in immediate danger unless he or she is certain that another doctor can and is capable of providing this care.

Article 34

Any doctor who accepts to care for a patient commits to guaranteeing continuity as needed with the help of assisting doctors, locums or associates with the appropriate skills.
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Article 35

The patient’s free choice of doctor constitutes a fundamental principle of the patient/doctor relationship. The doctor must respect and ensure respect for this freedom of choice. As for the doctor, he or she may refuse to provide care, except when a patient is in danger.
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Article 36

When a doctor decides to participate in an organised collective refusal to provide care, he or she is not exempt from his or her ethical obligation towards patients; healthcare must be guaranteed to patients needing urgent medical attention and those already under treatment.
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Article 37

When establishing fees, and in the absence of a contract or individual or collective agreement establishing fees, the doctor must take into account the scope of the service provided, possible special circumstances, his or her own skills and the patient’s financial situation.
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This text was unanimously adopted on 6 January 1987

The following participated in the work for the International Conference of Medical Professional Associations and Bodies with similar remits

Grand Duchy of Luxembourg: COLLEGE MEDICAL
The Republic of Ireland: MEDICAL COUNCIL
Federal Republic of Germany: BUNDESARZTEKAMMER

International Conference of Medical Professional Associations and Bodies with similar remits, 6 February 1995
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A. Preamble

The preceding principles of medical ethics contain the deontological principles on which the European medical corps agree.

The evolutions noted in the European Community (for instance, concerning the basic conditions of free movement in the market or community law regarding publicity or companies) reveal an opportunity for doctors to agree not only on the “ethical basis” of exercising their profession, but also on the principles of conduct to be observed in the exercising of their profession (for instance, on the manner in which they announce their activity or exercise it in companies or associations).

The principles of behaviour adopted in the interest of the patient form an appendix to the ethical principles adopted in 1987. They constitute recommendations aimed at all orders of doctors as well as similar bodies authorised to adopt rules in this domain and doctors themselves.

B. Presentation of a medical activity

1. The practice of a medical profession is neither a trade nor a business activity. Whatever sort of medicine a doctor practices, either as an employee or in a private practice, he or she may make known his or her titles and qualifications as well as any other indications necessary for the patient’s information, in accordance with the provisions of the Medical Professional Associations and Bodies with similar remits and within the framework of the law.

Such information must be clearly distinguishable from any advertising or any information likely to mislead patients and which could be considered as anti-deontological by doctors from all European countries. In addition, doctors must not have such advertising done on their behalf or allow such advertising to be made about them.

2. A doctor practicing in a hospital or within other medical establishments or within the framework of companies or associations must not allow the manager of the establishment or company to specifically advertise his or her knowledge, abilities or services compared with those of other practitioners.

3. The ways to advertise the opening of a surgery and its consulting times, as well as the size and wording of brass plates and insertions in telephone directories, address books and specialised media are governed by the deontological rules applicable within the medical association or any similar bodies to which the doctor belongs.

4. A doctor may objectively inform other doctors about the medical services he or she is offering. This is particularly applicable to information supplied to generalists by specialists. However, it is unacceptable among colleagues for a doctor to specifically highlight his or her services in relation to those of other doctors.

5. A doctor may neither contribute to nor tolerate the publication of reports of an advertising nature concerning him or her in the press, on the radio or on the television or by any other means. He or she must prevent the publicity of such report by all possible means. In addition, the doctor must not allow the public or private bodies in which he or she practices or in which he or she assists to use his or her name or professional activity for advertising purposes.

6. A doctor can participate in public documentaries and reports in the press, on the radio or television insofar as it serves to inform the public about health issues.
If a doctor participates in an educational or health-related public information action, whatever the means of distribution, he or she must only deal with confirmed data, behave prudently and be attentive to the repercussions his or her words may have on the public. The doctor must not use this opportunity to advertise his or her own activity. The doctor must also be careful to avoid any attitude of self-promotion or promotion of an institution. The doctor must abstain from speaking about methods that have not yet been proven in publications aimed at the public.

7. Doctors are duty bound to publish any research results in the specialized press while refraining from advertising their own activity or personal services.

8. Doctors must not participate in any advertising pertaining to pharmaceutical products aimed at the general public.

9. A doctor exercising a medical activity as a supplier of services in a member state of the European Community other than the one in which he or she is domiciled or exercises his or her professional activity, and in which he or she belongs to a medical association (or the competent professional organisation), is required to respect the professional rules of the member state where he or she is practicing. The same applies if the doctor simply wishes to make his or her activity known in another member state; the doctor is only allowed to advertise his or her medical activity according to the deontological and legal rules applicable to practitioners in the member state in which he or she is advertising his or her medical activity.

C. Practicing a medical profession in a company or association

1. If a doctor practices a medical activity outside a hospital or other authorised establishments, he or she must practice in a surgery.

2. A doctor may choose to practice in a company or association in a form legally approved by the law of the country in which he or she practices medicine. The choice of structure is left to the doctors, in accordance with the deontological rules.

3. A doctor may only co-operate with the members of other healthcare professions if they perform their activities under the doctor’s control or they hold under medical orders a well-defined field of responsibility corresponding to their qualifications. Every doctor must remain responsible for his or her medical acts and prescriptions.

4. If the law of a member state authorises the practice of a medical activity in a company or association, the contract that the doctor is required to sign must preserve his or her independence concerning the practice of medicine. In particular the doctor must not be subject to the orders of non-medical persons in the practice of his or her profession. The remuneration or the length of the doctor’s contract with the company must never depend on criteria of profit or profitability, which are likely to affect his or her free choice by limiting his or her independence, decisions or the quality of care provided. The same is true for any contract agreed between a healthcare establishment and a practitioner called upon to work there.

5. In all forms of common medical practice or within the framework of practicing within a company, it is essential to be watchful that the patient’s free choice of doctor and the doctor’s freedom concerning treatment are maintained.

This text was unanimously adopted on 6 February 1995

The following participated in this work for the International Conference of Medical Professional Associations and Bodies with similar remits
Grand Duchy of Luxembourg: COLLEGE MEDICAL
Republic of Ireland: MEDICAL COUNCIL



Deontological Guidelines

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In 2010, the CEOM decided to update the Principles of European Medical Ethics of 1987 by distinguishing what is of Ethics, the moral thought which subtends action of what constitutes the Deontology, which is a codified concrete action inspired by moral thought.

In June 2011, the European Charter of Medical Ethics was adopted. Since then, the CEOM participants draft Deontological Guidelines.

In June 2013, the CEOM adopted its first Deontological Guidelines. These Guidelines have been updated during CEOM Plenary meeting in Madrid in November 2018.
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Given the European Charter of Medical Ethics (Kos, 2011), principles 8, 9, 14, 15,

Adults and conscious patients
The consent of the examined or treated patient must be sought in all cases, including in the context of the telemedicine.

It must be free and informed by a fair and understandable information.

It may be withdrawn by the person at any time. Refusal to consent to a medical procedure does not remove the patient's right to receive quality care.

It must be written and recorded in the patient's medical record, especially for situations according to National Laws.

Minors or incapacitated patients
The physician must strive to contact patient’s parents or legal representative to obtain their consent in the same cases as those required for an adult and conscious patient.

The minor or incapacitated patient should always be involved in decision-making regarding a medical procedure to be used to treat him/her. The communication should be commensurate with the patient’s receptive skills.

Emergency Situations
In emergency situations and if there is uncertainty about the willingness of the patient, the doctor makes any necessary intervention in the interest of the patient.
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Given the European Charter of Medical Ethics (Kos, 2011), principle 5,

The physician must ensure the patient absolute secrecy on all the information he has collected.

Confidentiality covers everything that physicians have learned in the exercise of their profession, that is to say not only what they were told in trust, but also what they may have observed, heard or understood.

Medical confidentiality is not abolished by the death of patients.

The physician informs people assisting him about their obligations as regards secrecy, asking, whenever possible to give a written undertaking.

Derogations*, when they exist, are strictly provided for in national legislations.

*Derogations will be analysed specifically.
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The physician should not advise, prescribe or administer pharmacological treatments or substances, or of a different nature, directly or indirectly modifying the natural psychophysical balance of the subject in order to modify the performances related to the sporting activity.

For the same reason, the physician should protect athletes against any external pressure encouraging them to use such methods, by informing them about the serious health consequences.
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Given the European Charter of Medical Ethics (Kos, 2011), principles 2 and 15,

Fraternity rules are laid down in the interest of patients.

The physician must ensure that his behaviour is characterised by respect and discretion towards his colleagues and by dignity towards himself, keen on defending the honour of the medical profession.

The physician should avoid situations leading to direct or indirect customer poaching.

The physician who experiences a disagreement with a colleague should, first and discreetly, seek conciliation. Any public conflict should be prevented.

The physician who notices serious breaches of ethics, deontology or medical practice from a colleague, likely to endanger the patient, should inform the fraternal competent authority.

Physicians should mutually assist and aid each other.
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Given the European Charter of Medical Ethics (Kos, 2011), principle 4,

The physician should take into account the environment in which the human being lives and works, and should participate in preventive initiatives in order to safeguard citizens’ live outside or on the workplaces.

The physician commits himself to favor individual and collective health through an adequate communication on environmental risks, by suggesting an appropriate usage of natural resources. This should ensure the ecosystem balance and make it leavable, also for future generations.
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Given the Convention for the Protection of Human Rights and Fundamental Freedoms, art. 14,

Given the European Charter of Medical Ethics, principles 1, 2, and 3, 13, 14,

Ceom members recommend:

Except in emergency cases and when he/she fails to fulfill his/her duties of humanity, a physician may refuse his care for professional or personal reasons.

A refusal of medical treatment has to be grounded on regulatory or deontological texts.

A refusal of medical treatment, either explicit or implicit, may under certain circumstances be considered as discriminatory conduct by the physician.

The physician who finds himself/herself obliged to licitly refuse to treat a patient has to explain the reasons of the refusal to the patient, and seek the most appropriate solutions to the situation of the person, especially concerning the continuity of care.
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Given the European Charter of Medical Ethics (Kos, 2011), principles 6, 11, and 15,

"Advertising" refers to any form of communication made by a physician or by a third person for the physician's profit, in order to promote his/her services or to increase the value of his/her image.

Comparative advertising is forbidden.

The information given by the physician must only concern objective data; it should be careful, precise, clear and in accordance with actual scientific data.

Advertising cannot encourage the use of tests and treatments for commercial ends.

The physician should not participate in medicine or health product promotion.

Patient's dignity and private life should not be harmed in any way.

This guideline applies to all media.
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Given the Oviedo Convention, article 2,

Given the WMA Helsinki Declaration,

Given the European Charter of Medical Ethics (Kos, 2011), principles 6, 9 and 11,

The physician involved in medical research must, in compliance with the laws of his/her country, ensure that:

There is no conflict of interest with the project initiator,
Research has been the subject of a protocol duly examined by an independent ethics committee,
There is no other alternative technique to bring into play than research on the Human Being,
Expected benefits outweigh the risks incurred by the person undergoing research.
Free and informed consent was obtained in the manner of the European Deontological Recommendation on informed consent.
Medical research involving persons physically or mentally incapable of giving consent can only be conducted in the manner of the Helsinki Declaration.
The consent of an incapable person must always be obtained in addition to the consent of his/her legal representative.
The physician agrees to publish exhaustively the research results and to make them publicly available.
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Given the European Charter of Medical Ethics (Kos, 2011), principles 11 and 15,

The obligation to practice with independence, the need of public trust in the medical profession, and the art of caring for one's health as a mission of public interest require doctors to let not personal interest influence their medical judgment.

Doctors spontaneously and seamlessly make public any interest link likely to generate doubt as to their independence, especially regarding research and training.
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Given the European Charter of Medical Ethics (Kos, 2011), principles 3 and 7,

When prescribing examinations and treatment, the physician must take into account the latest tested scientific knowledge, make optimal use of resources, while respecting the principles of clinical efficacy, safety, suitability and humanization.

The physician has the duty to always inform the patient, who must be able to give consent to the tratment, and to adjust the prescription to his/her specific needs.
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Given the European Charter of Medical Ethics (Kos, 2011), principles 6, 7 and 8,

The professional updating and the continuing medical education are a duty for all physicians during their professional life.

The physician must keep herself/himself constantly updated on the evolutions of science within the socio-economic context so as to maintain and develop knowledge and new skills in order to ensure the best quality of care, in respect of the trust relationship with citizens.
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1) The physician who believes he can treat a patient with non-conventional practices in the medical field should fairly inform the patient about the scientifically validated treatments.

2) The physician cannot exclude the patient from scientifically validated treatments if this is harmful to his health.

3) The physician who uses non-conventional practices in the medical field must have acquired a special training and be able to present the documentation certifying his training program.
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Concerned about the protection of the child against all forms of violence, physical or mental, the physician acts with caution, objectivity and kindness. The relationship of trust with the child is essential.

He or she demonstrates availability, listening skills and welcomes the child in an adapted environment that guarantees confidentiality.

The physician informs the child's relatives, or even the competent public authority, only in his or her interest.

When caring for frail elderly people or those in psycho-physical, social or civil vulnerable conditions, the physician adopts an empathetic attitude, attentive to possible injustices to which the patient may be subjected and concerned to improve his living conditions.

He provides conscientious diagnostic and therapeutic care.
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When the doctor performs non-therapeutic acts intended to strengthen a patient's physical and cognitive capacities, he or she shall act with respect for the dignity, identity, integrity and genetic characteristics of the individual, guided by the principles of specificity and proportionality.

The physician must obtain the written consent of the patient who has been informed about the risks inherent in the acts performed.

The physician must refuse any disproportionate or excessively risky request.

In this assessment, it takes into account the invasive degree and potential irreversibility of the treatment, in the face of non-therapeutic but supposedly improving benefits.