IN REPLY: The debate about the proposed national code of conduct (“the Code”) has raised a number of important issues, including those highlighted by Myers. The original draft aroused serious concern in the community about the potential role of a centralised bureaucracy with the power to enforce a set of precepts derived from a narrow, largely discredited, philosophical perspective. Although the revised draft now circulated for public comment is admittedly less objectionable than its predecessor, significant concerns remain relating to both its form and its conten

Komesaroff, P

Kerridge, I

English

Sydney eScholarship

190 MJA • Volume 191 Number 3 • 3 August 2009LETTERSThe Australian Medical Council draft code of professional conduct: good practice or creeping authoritarianism?John B MyersTO THE EDITOR: The expert working partythat developed the Australian Medical Council(AMC) draft code of professional conductreferred to by Komesaroff and Kerridge1 waschaired by Joanna Flynn, past President of theVictorian Medical Practitioners Board (MPB[Vic]). Herein lies the crunch. The AMC issurely meant to be an independent and objec-tive body — yet if it is aligned with the MPB(Vic), how can this be the case?Komesaroff and Kerridge state that the appen-dices to the AMC’s draft code “quote extensively(without attribution) the conclusions of guide-lines developed by the Royal Australasian Col-lege of Physicians” and that “in the AMC’sversion, the evidence, context and argumenta-tion are omitted and the recommendations arepresented as legally binding”.1 If this is the case,there is cause to question the integrity of thedrafters of the code, to fear the code’s implica-tions, and to request “that the whole processthat gave rise to it be rigorously reconsidered”.1MJA • Volume 191 Number 3 • 3 August 2009 191LETTERSPlagiarism cannot be condoned. To attributehonestly and give credit where credit is due iscentral to ethical practice, scientific discovery,education, accountability and learning. Simi-larly, context matters. In my opinion, integrity,the basis of ethics and morality, is measured bythe extent to which context is valued andconceded. Ethical conduct demands bothhonesty and integrity.Doctors and the public, and governmentsurely, place their trust in the AMC to objec-tively evaluate governing practices, laws andregulations, such as the Health Professions Reg-istration Act 2005 (Vic) (“the HPR Act”), underwhich the MPB (Vic) operates, as well asprofessional conduct. Yet the authors of theAMC draft code fail to address the issue of theaccountability of regulatory bodies and the factthat the HPR Act contains no benchmark forexcellence: because context is omitted fromthe Act, “unprofessional conduct” cannot bedefined and becomes relative. This leaves itopen for any third party, including members ofthe regulatory authority itself, to abuse doctorsand patients by being dismissive of thepatient’s view (and thus, context), while claim-ing to protect patients and guide doctors.By contrast, the Medical Treatment Act 1988(Vic), which is not mentioned in the AMCdraft code, provides a benchmark for excel-lence in clinical practice with reference to bothdoctors and patients. This Act specifies (a) thatthe wishes of the patient to refuse treatment berespected, and (b) that medical practitionerswho act in good faith in accordance with thepatient’s expressed wishes be protected fromany civil or criminal liability or disciplinaryaction by the regulatory board.2As doctors, we are the naturally appointedadvocates of our patients’ health preferencesand wellbeing. Ensuring that choices are madefor the patient’s benefit requires honesty andintegrity at all levels of government.1,3,4 Whena failure occurs in the system, it is imperativeto have avenues of awareness, transparency,protection and evaluation available throughpublic action and professional debate.1,3,5John B Myers, Physician and GeriatricianLorne Street Medical Centre, Melbourne, VIC.PO Box 246, Balaclava VIC 3183.1 Komesaroff PA, Kerridge IH. The Australian MedicalCouncil draft code of professional conduct: good prac-tice or creeping authoritarianism? Med J Aust 2009; 190:204-205. 2 Biegler P, Stewart C, Savulescu J, Skene L. Determiningthe validity of advance directives. Med J Aust 2000; 172:545-548. 3 Myers J. Ethics and professional medical opinion andguardianship and administration legislation. Intern MedJ 2006; 36: 540-541.4 Justice Buchanan and Justice Nettle. Supreme Court ofAppeal. Leave application. Myers v Medical Practition-ers Board of Victoria [2007] VSCA 163.5 Sweet MA, Chapman S, Moynihan RN, Green JH.CHAMP: a novel collaboration between public healthand the media. Med J Aust 2009; 190: 206-207. ❏Paul A Komesaroff and Ian H KerridgeIN REPLY: The debate about the proposednational code of conduct (“the Code”) hasraised a number of important issues, includingthose highlighted by Myers. The original draftaroused serious concern in the communityabout the potential role of a centralisedbureaucracy with the power to enforce a set ofprecepts derived from a narrow, largely dis-credited, philosophical perspective. Althoughthe revised draft now circulated for publiccomment is admittedly less objectionable thanits predecessor, significant concerns remainrelating to both its form and its content.The main issues are still the purpose androle of the Code and the confusion betweenethical and legal discourses on which it isbased. In a multicultural society in whichpluralism and diversity are themselvesregarded as inherently valuable, the very con-cept of a unitary set of criteria that define goodpractice is questionable. In this setting, theproper roles of codes of conduct and of ethicsare not to enforce particular kinds of out-comes, but rather to inform and enrich prac-tice. If the Code were devised as aneducational process to stimulate clinicians toreflect critically on their existing practices andunderlying values, it would be much morelikely to change behaviour and increase com-munity wellbeing.Paul A Komesaroff, Professor of Medicine and Director1Ian H Kerridge, Associate Professor of Bioethics and Director21 Centre for Ethics in Medicine and Society, Monash University, Melbourne, VIC.2 Centre for Values, Ethics and the Law in Medicine, University of Sydney, Sydney, NSW.paul.komesaroff@med.monash.edu.au ❏

The Australian Medical Council draft code of professional conduct: good practice or creeping authoritarianism? In reply

Dissertação de mestrado em Cuidados Continuados e Paliativos, apresentada à Faculdade de Medicina da Universidade de CoimbraO enquadramento do estudo assenta na compreensão e proposta de algumas medidas para fazer face ao alheamento dos médicos de família e ao ostracismo a que são votados nos cuidados paliativos pediátricos.
Como objectivo nuclear pretendemos dimensionar a integração dos cuidados paliativos pediátricos num contexto de rede alargada, focalizando a articulação do médico de família com o pediatra e vice-versa.
Quanto à metodologia, o trabalho consta de duas partes. A primeira reporta a uma revisão teórica sobre o médico de família face à doença de mau prognóstico na criança e a família como sistema de suporte. A segunda parte refere-se a um estudo de investigação de natureza observacional, transversal e exploratório/descritivo, com aplicação de um questionário sobre uma amostra de vinte médicos de família e outra de vinte pediatras. O questionário, validado, assenta em quatro dimensões (comunicação com as crianças doentes e familiares, organização e coordenação de cuidados, conhecimento e perícia dos profissionais e integração de cuidados). Destacamos estes resultados: - Médicos de família com 46% das respostas em relação aos pediatras (33%), quanto às dificuldades na comunicação com os doentes e familiares; - Pediatras com 65% para 50% das respostas dos médicos de família, no reconhecimento de dificuldades na organização dos cuidados;- Clara afirmação da necessidade de mais conhecimentos e aptidões por parte dos médicos de família (51%) para 40% das respostas dos pediatras; - Médicos de família com 57% das respostas em relação aos pediatras (46%) no que respeita à inadequação da integração dos cuidados.
Como conclusão há que destacar a insuficiente formação teórica e prática dos médicos de família e pediatras, o que justifica o investimento na educação, treino, conhecimento e competências para uma melhor prestação de cuidados paliativos.The study framework is based on understanding and proposing a number of measures to address the alienation of family doctors and the ostracism that is voted in pediatric palliative care.
As a core objective we intend to scale the integration of pediatric palliative care in a WAN environment, focusing on the joint family doctor with the pediatrician and vice versa.
As regards the method, the work consists in two parts. The first relates to a theoretical review of the family doctor due to the poor prognosis of disease on the child and family as a support system. The second part relates to a study of observational research nature, transverse and exploratory / descriptive, with application of a questionnaire on a sample of twenty family doctors and other twenty pediatric. The questionnaire, validated, based on four dimensions (communication with sick children and family, organization and coordination of care, knowledge and expertise of professionals and integration of care). We highlight these results: - Family physicians with 46% of responses to the pediatricians (33%), and the difficulties in communicating with patients and family ; - Pediatricians 65% to 50% of the responses of family doctors in recognition of difficulties in the organization of care ; - Clear affirmation of the need for more knowledge and skills on the part of family physicians (51%) to 40% of the responses of pediatricians ; - Family physicians with 57% of responses to the pediatricians (46%) regarding the inadequacy of integration of care.
As a conclusion it is necessary to highlight the insufficient theoretical and practical training of family doctors and pediatricians, hence the investment in education, training, knowledge and skills for better provision of palliative car

Romão, António José Foz

Estudo Geral

O médico de família e os cuidados paliativos na criança

https://ses.library.usyd.edu.au/bitstream/2123/11539/2/MJA-AMCdraft-code-of-prof-conduct-2009.pdf

The Australian Medical Council draft code of professional conduct: good practice or creeping authoritarianism? In reply

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