Key changes to the Medical Council’s guidance to Medical Practitioners following launch of 2024 Guide

Introduction

The Medical Council has launched the 9^th Edition of the Guide to Professional Conduct and Ethics for Registered Medical Practitioners (the 2024 Guide).   This sets out the general principles that doctors are expected to adhere to and observe as well as more specific guidance in relation to certain aspects of practice.

The 2024 Guide came into effect on 1 January 2024, and updates the 8^th edition released in 2016, amended in 2019.

There were several changes in the guidelines from the previous editions, updated based on research and exploration of emerging issues affecting both medical practitioners and patients. Grace Toher provides an overview of the pertinent changes.

Key Changes

1. Change in the use of word “must” and the word “should”

There has been a marked change in the wording of the guidelines – particularly with the phrases “you [the medical practitioner] must” and “you [the medical practitioner] should”.

The term “you must” is used where there is an absolute duty on medical practitioners to comply with the guidance.  The term “you should” is used to describe best practice in most circumstances, accepting that it may not always be practical to follow guidance or that another approach may be appropriate in particular circumstances, and medical practitioners are expected to exercise judgement in such cases.

In comparison with the 8th edition, the word “must” has risen from being used approximately 120 times previously to now being used approximately 150 times. This, combined with the fact the use of the word “should” has fallen from being used approximately 275 times in the last edition to only approximately 182 times in the 9^th edition, indicates the Medical Council’s desire to, through these guidelines, be more assertive on the behaviour and actions it expects from its members.

2. Conscientious Objections

There has been a change in the care the Medical Council expects doctors who conscientiously object to a procedure, such as, for example, termination of pregnancy.

In the 2024 Guide, it is stated that doctors “must provide care, support and follow-up for patients who have had a lawful procedure, treatment or form of care” to which the doctor has a conscientious objection. This contrasts with the previous guidelines which allowed doctors to “refuse to provide or to take part in the provision of lawful treatments or forms of care which conflict with your sincerely held ethical or moral values.”

Furthermore, previous guidelines dealt with conscientious objections by saying a doctor “should” follow certain steps when faced with a patient who wishes to access a procedure that the doctor has a conscientious objection to – such as inform their patients and employer of the objection, inform the patient that they have a right to seek the procedure lawfully, give the patient information to enable them transfer to another doctor for the procedure and not mislead the patient or obstruct access to the procedure.  The wording “you should” has now been replaced with the phrase “you must”, placing more positive clearer obligations on practitioners.

3. Use of social media

Due to the significant increase in medical practitioners providing advice on social media during the pandemic, in addition to controversy surrounding the provision of false or misleading medical advice online, medical practitioners are reminded that they should always identify themselves by name as they are legally liable for anything they publish on their own social media accounts. It is also recommended that practitioners, if they do decide to provide medical information or advice on social media, to do so using a separate account from their own personal accounts.

4. Medical Practitioners acting as expert witnesses

While previous editions of the Medical Council Guidelines provided general guidance to practitioners when providing medical reports, the 2024 Guide provides expanded guidance to practitioners specifically regarding their duties when acting as expert witnesses.  It reminds practitioners that their first duty is to be of assistance to the relevant court or tribunal in providing independent expert opinion and states “you must be honest and objective in all your spoken and written statements”, and that this obligation overrides any instruction from the person paying for the expert opinion.

5. Self-Prescription

The 2024 Guide echoes the previous editions of the guidelines to say that a doctor should not treat or prescribe for themselves, and it introduces a clear absolute prohibition on self-prescribing controlled drugs.

6. End of Life Care

The wording in the 2024 Guide concerning treatment which should be provided to individuals in end-of-life care has been amended from the wording in previous editions.  Previously, doctors were advised that there is no obligation to start treatment if it is unlikely to be effective.

This has been updated to say that doctors “should not” start or continue treatment, including resuscitation, or provide nutrition and hydration by medical intervention, if they consider the treatment is unlikely to be effective or will cause more harm to the patient than good and extend their suffering.

7. Photographic, video and audio recording

For the first time, the 2024 Guide provides guidance to doctors when faced with a patient who wishes to record a consultation.  It is stated that a doctor should facilitate this request, but if a doctor considers that it would have a negative impact on the consultation, this should be explained to a patient and, if possible, come to an agreement with the patient.

8. Open Disclosure

The 2024 Guide reiterates doctors’ duties of practising and promoting a culture of open disclosure.  There is a clear definition of the term “open disclosure” as honest, open, compassionate, consistent, and timely approach to communicating with patients, and, where appropriate, their family, carers and/or supporters, following patient safety incidents.  The 2024 Guide confirms a doctor’s obligations on compliance with new legislation on the area to include the Patient Safety (Notifiable Incidents and Open Disclosure) Act 2023[1]

Conclusion

The 2024 Guide provides welcomed clarifications and practical information for doctors on how to deal with emerging and challenging issues which arise frequently in practice.  It is a helpful outline of the principles of good medical practice which are in the interests of patients and the broader population.

For more information on these updated guidelines, please contact our Healthcare Litigation Team.

[1] See our previous articles on this legislation: Patient Safety (Notifiable Patient Safety Incidents) Bill 2019 (ckt.ie)  ;  The Patient Safety (Notifiable Incidents and Open Disclosure) Act 2019 is awaiting a Commencement Order. – CKT