Code of Ethics of the Medical College of Honduras

The Code of Ethics of the Medical College of Honduras is the set of ethical and moral principles that, within its professional function, guides all physicians who, as such, exercise their profession and who are under the inescapable duty to adjust their conduct to what is referred to in this Code: Respect for human dignity, life, and human rights.

This Code of Ethics of the Medical College of Honduras must be respected by all physicians who exercise the profession temporarily or permanently in the national territory, in accordance with its laws and regulations.

The physician, in the activity proper to his profession, must safeguard the rights and duties of those who require his services, always maintaining as a quality, with others and with himself, honor and dignity.

The physician has the primary duty to serve humanity, with loyalty to his country and to the people, through the personal, family, and/or community care of those who need his services. Consequently, he shall not engage in discrimination on grounds of religion, race, age, gender, nationality or origin, social class, political affiliation, economic condition, health status, legal status, or any other nature.

It shall be a preferential concern of the physician to provide his collaboration to the advancement of science, through scientific methodology, and his actions shall be directed at raising the health level of the country, with respect for life and human dignity.

Under no pretext or circumstance may the medical professional associate or link himself, not even temporarily, with those who illegally practice medicine.

It is the duty of the physician that his relations with his colleagues be based on respect, tolerance, and consideration for the functions of their professional practice, whatever the hierarchical relationship or level of specialization that may exist between them.

The physician has the duty to show solidarity with his colleagues in adverse circumstances.

The physician who is called upon to issue an opinion or to replace another physician in the care of a patient shall refrain from treating him if he ascertains or has knowledge that the treating physician has not been properly informed of the fact by the patient.

Research in the field of health must comply with the agreements, conventions, treaties, codes, and declarations of ethics, both national and international, that serve as a framework of reference for outlining the ethical principles of all research in human beings.

Every research study must be based on the principles of beneficence, justice, and respect for the person, as a guide to addressing the ethical problems that arise during its implementation in the individual and in the community.

Every research study in health must comply with the following requirements: a. Comply with accepted scientific and methodological principles. b. Have a research protocol that must be approved by a duly recognized local Ethics Committee. c. Research in human beings must be conducted only by persons trained scientifically and technically in the area to be investigated and under the supervision of a competent professional. d. The benefits of the research for the individuals participating must outweigh the risks involved in participation. e. It must guarantee respect for the conscience and integrity of the human being, both as a subject of the research and as an executor thereof. f. The results must be disclosed with accuracy and in accordance with the findings of the project. g. Obtain the consent of the individual who will participate in the research, or of his legal representative in case he cannot make the decision by himself due to being a minor or having alterations of consciousness.

When publishing scientific works, the researcher must adhere to the ethical principles of authorship, publishing in his name exclusively those works in which he has actively participated in the design and development thereof, including as co-authors the other professionals who have participated directly under his guidance. The publication of data from other studies must be done while preserving the rights of its author through reference to the source.

Medical confidentiality is understood as the act of safeguarding information that, by reason of the exercise of his profession, comes to the knowledge of the physician in the physician-patient relationship and its context, whether because it was confided to him, or because he observed it or intuited it. This information must not be shared except with prior consent of the patient, or for harm to the patient or to third parties.

The physician may disclose information about patients who are under his responsibility when these patients do not have the capacity to evaluate their problem and solve it by their own means, or when silence may cause harm to the patient, to third parties, or to society.

The physician has the duty to require from his work team absolute discretion and scrupulous observance of medical secrecy.

The physician is obligated to maintain medical secrecy even in the event of a claim for judicial or extrajudicial collection of his fees.

When medical computer systems are used, these must not compromise the patient's right to privacy without his consent. CHAPTER VII ETHICS IN HEALTH CARE INSTITUTIONS

The physician is free to choose the provision of his professional services in public or private institutions, as long as ethical and legal principles are not violated.

In the exercise of his profession, the physician shall fulfill his duties and ensure the observance of his institutional rights, those of the patients, or of others involved in his professional work. The institution shall provide the appropriate resources for the proper performance of his functions.

The physician who holds a managerial or confidential position in any institution is obligated to act in accordance with professional ethics and ensure compliance with what is established in the laws; he shall likewise avoid obtaining professional advantages from the authority that emanates from his rank.

The physician who works in a public or charitable health institution shall not take advantage of such status, nor utilize the resources and procedures thereof to attract or treat patients in his private practice.

Every physician shall strengthen the scientific-technical, ethical, and social prestige of the institution where he works.

The physician who is owner, co-owner, or administrator of an enterprise, or partner in a partnership or entity engaged in the provision of any health service or linked in some form with the health sector, such as insurance companies, maintenance companies, and others, shall not take advantage directly or indirectly to obtain undue benefits.

When integrating an institutional ethics and bioethics committee, the physician shall act, in the knowledge of the matters submitted to his study and consideration, based on ethical principles and norms. CHAPTER VIII PHYSICIAN-PATIENT RELATIONSHIP

The physician-patient relationship shall be understood as fluid, sincere, and honest communication in order to satisfy a need, both of one who seeks to cure another's ailment and of one who seeks the service for his illness, with the understanding that such communication shall extend to the patient's environment and relatives with the sole objective that the latter may assist in the restoration of his health.

The physician-patient relationship is based on mutual respect for the dignity of the persons who establish it, whose moral value is invaluable and which is increased by the physician's conduct of service, to whom one has consulted for the satisfaction of a need. No one can obligate the other to violate his own convictions.

The physician-patient relationship is established in an atmosphere of trust with kind personal treatment, a high degree of technical quality and human warmth in medical care, which optimize its effectiveness.

The physician shall respect the ideas, beliefs, and convictions of the patient or his relatives, without these being a cause of discrimination, nor influencing negatively the quality of medical care.

Patients have the right to participate in the decisions regarding their therapy, for which the physician shall propose to them the different therapeutic options, in order to provide him with the greatest possible benefit.

The physician must provide the patient with the care that his professional knowledge and conscience dictate, communicating to him in understandable words and in a measured manner about his health status, the different diagnostic methods and techniques and therapeutic options, as well as the risks and benefits thereof, so that he may exercise his right to choose, give his consent or refuse the proposed treatment. In cases where the patient is not capable of understanding and/or deciding, the physician shall communicate this to the family members or to the legally responsible persons.

When the patient is not in a condition to give his consent to medical action and it proves impossible to obtain it from his family or legally responsible persons, the physician must act with diligence in the search for the protection of human life.

The physician's action shall be complemented by providing information and education to the patient, encouraging him, through warm accompaniment, to commit to adopting healthy behavior.

The physician must exercise the profession with broad autonomy, except in the cases that current regulations expressly provide for.

The physician must respect the personal privacy, intimacy and modesty of the patient.

Teamwork in health care does not exempt individual professional responsibility from each member of the team regarding their personal actions. In turn, it does not exclude the patient's right to know who is the person assuming responsibility for his care.

The physician shall not abandon his patient for being a carrier of an incurable and/or contagious disease, but rather shall treat him by applying basic biosafety standards to prevent contagion that could endanger his health, that of his family or that of other patients.

The physician shall issue his opinions with objectivity, impartiality and truthfulness while observing ethical-moral standards.

The Physician has the right to receive remuneration for his work, which constitutes his normal means of subsistence. It is understood that the work or service of the physician shall only benefit him and the person who receives it and never third parties who intend to exploit it commercially or politically.

The professional practice of medicine shall be remunerated in accordance with the circumstances of each case, such as the importance and quality of the service rendered, nature of the disease, economic and social situation of the patient and the time dedicated to his care.

The physician shall set his fees in accordance with his professional competence in relation to the importance and circumstances of each of the acts he is required to perform, subject to prior agreement with the patient, his guardians or his legal representative.

Fees for medical service and assistance shall be set by free contracting or by mutual agreement between the physician, the patient or the institution responsible for payment thereof.

The physician has the commitment to offer his professional services free of charge to the active or retired colleague and his economic dependents (spouse, children and parents). The decision to charge in those cases covered by medical insurance shall be at the physician's discretion.

It constitutes a violation of professional ethics the perception of percentages and/or commissions derived from the referral of patients among colleagues, prescription of medications, indications of laboratory examinations, orthopedic devices, lenses, prosthetics or similar items. Likewise, it constitutes a breach the economic remuneration to intermediaries of any kind between physicians and patients.

When several physicians have participated in the care of the patient, the fees must be presented separately. Medical reports, the presence of the treating physician at a surgical intervention, whether by request of the surgeon, the patient or his family members, etc., also generate professional fees.

In case of emergency, medical assistance shall not be conditioned upon advance payment of professional fees.

The physician who works in a public entity shall not take advantage of his or her affiliation with such institution to induce the patient to use his or her services in the private practice of the profession, nor may he or she receive professional fees related to this particular case.

In the case of professional fees for consulting, expert assessments on public health issues and preparation of opinions at the request of governmental and non-governmental entities, they shall be governed by the ethical principles set forth in this Code. CHAPTER X ETHICS IN ACADEMIC ACTIVITY

The physician dedicated to academic activity shall teach ethical norms in both theoretical and practical manner in his or her daily work, transmitting knowledge through the exercise of the profession, with the aim of preserving the health of individuals and the community, emphasizing that love and respect for the human being are the foundation of good medical practice.

The physician shall teach and practice by example the principle of doing good to others, respecting the legacy of Hippocrates: "First do no harm" (Primum non nocere).

The physician shall teach and practice respect for the Constitution of the Republic, the Health Code, Code of Ethics, Laws and Regulations of the Medical College of Honduras and of the institution where he or she works.

When the physician dedicates himself or herself to the teaching of medicine, he or she shall submit to the moral norms on the subject, as well as to the dictates of science and to pedagogical principles based on professional ethics.

The physician teacher shall respect the principle of autonomy of each student and shall show them the consideration, appreciation and respect that they deserve, giving them fair, humanized and dignified treatment, without prejudice to the fulfillment of his or her duties.

The physician teacher shall under no circumstance take advantage of students contrary to moral, ethical and scientific principles.

The physician teacher shall not show preference for or discrimination against his or her students, knowing that all have the same rights, regardless of their abilities, social, political, economic or religious status, race and gender.

The physician teacher shall teach his or her students respect for the patient in all aspects of medical care. Likewise, he or she shall show consideration in the process of death and the respect for those who, even in death, serve for learning purposes.

The physician teacher shall transmit his or her knowledge free of professional selfishness, with full command of the subject matter he or she teaches, keeping himself or herself updated on ethical, scientific and technological aspects regarding the new advances that emerge in his or her field in order to prepare the student for honorable practice of medicine.

Every physician, even if he or she does not receive a salary as a teacher, has the moral duty to transmit and enrich the health personnel and students with his or her knowledge, skills and experiences. CHAPTER XI THE PHYSICIAN AND HUMAN RIGHTS

With respect to the protection of prisoners and detainees against torture and other cruel, inhuman or degrading treatment or punishment, it is stipulated that it is a grave violation of medical ethics for physicians and health personnel under their charge to take active or passive part in acts that constitute participation, complicity, incitement, attempts at torture or other cruel, inhuman or degrading treatment.

The physician shall report or denounce cases of torture or cruel, inhuman or degrading treatment of which he or she has knowledge and depending on the circumstances, the report or denunciation shall be directed to medical, legal, national or international authorities, to non-governmental organizations or to the International Criminal Court. Likewise, physicians must be prudent in this matter and take into account international reporting protocols.

In those cases in which there exist ethical obligations that conflict with one another, the physician shall adhere to the Istanbul Protocol, which provides for recourse to international codes and ethical principles that require notification to a responsible body of all information relative to torture or ill-treatment, with the fundamental principle thereof being the avoidance of harm. Likewise, the health professional shall seek solutions that promote justice without violating the right to confidentiality that belongs to the individual.

Every person deprived of liberty is recognized the right to medical care, to privacy without any discrimination or prejudice, provided that such care is requested by the competent authorities and safety norms and adequate conditions for care are complied with, guaranteeing the physical integrity of both the physician and the patient.

The physician who provides care to a person and suspects or detects any violation of their rights in their different physical, sexual, and psychological aspects, shall by mutual agreement with the patient make the respective report to the competent body and shall seek comprehensive care offering emotional, mental, and physical well-being.

The physician who provides care to a child under eighteen years of age and suspects or detects any violation of their rights in their different physical, sexual, and psychological aspects, shall make the respective report to the competent body and shall seek comprehensive care offering emotional, mental, and physical well-being to both the patient and their family.

The physician shall guide their patients through genetic counseling regarding the different genetic diseases and their transmission risks respecting their dignity and rights of free choice. ARTICLE 66. The physician may participate in genetic investigations provided that they are aimed at alleviating suffering and improving the health of the individual and all of humanity, respecting the dignity of human life.

The physician shall not consent to nor develop practices that are contrary to the dignity of the person, such as human cloning. The physician shall also promote before the State, health institutions, and competent national and international organizations, cooperation to identify these practices and the adoption at the national or international level of appropriate measures to ensure their prevention.

The physician shall promote and prescribe healthy nutrition and nourishment free from toxic infectious contamination and genetic manipulation that place human health and dignity at risk.

The physician shall provide care and promote careful and compassionate treatment of patients with disabling, terminal, or infectious-contagious illnesses such as HIV/AIDS.

The physician shall monitor and promote compliance with universal biosafety norms regarding any type of waste generated in their medical practice.

The physician shall monitor and promote actions for the proper preservation of the environment that contribute to preventing diseases derived from contamination. CHAPTER XII THE PHYSICIAN BEFORE THE CRITICAL PATIENT AND THE PATIENT IN TERMINAL STATE

It is not ethical to admit the existence of a period in which human life lacks value, for which reason every physician must dedicate their best efforts to protecting life and must never arrogate to themselves the right to dispose of it.

The physician shall never intentionally cause the death of a patient by their own decision, nor when the patient and/or their relatives request it or for any other requirement, because euthanasia is contrary to medical ethics.

The physician may declare objection of conscience when required to perform actions or omissions that are contrary to their principles related to life.

In case of incurable illness and terminal state, the physician shall continue to provide comprehensive care until the end, to alleviate the physical and moral suffering of the patient, respecting the human dignity of a life that is fading; however, they shall avoid undertaking or continuing therapeutic actions without expectation of recovery.

The decision to terminate artificial survival in case of brain death shall be the responsibility of the medical team managing the case, of the institution, of the family, and of the local bioethics committee, who shall analyze each case based on the most rigorous scientific and ethical criteria and with the guarantees required by law.

In no case shall the physician discriminate against or refuse to provide care to a patient due to attempted suicide, hunger strike, rejection of treatment, or requested discharge. CHAPTER XIII ON THE DONATION AND TRANSPLANTATION OF ORGANS

The medical profession recognizes that the donation and transplantation of organs represents a significant advance in scientific knowledge in favor of the health and well-being of humanity.

It is the moral and ethical obligation of the Medical College of Honduras to ensure that all practices related to the donation and transplantation of human organs are carried out within the fundamental principles of respect and dignity of the human person.

The physician who participates in organ donation and transplantation interventions must take extreme measures to protect the rights of the donor and the recipient. Likewise, he or she must adopt the necessary measures to minimize the possibility of disease transmission or other risks in order to ensure maximum success in the process.

The extraction of organs from deceased persons may only be performed after prior verification and certification of the donor's death. The extraction shall be performed by qualified professionals taking into account ethical principles, scientific advances in the matter, and generally accepted medical practice. The aforementioned professionals must be physicians different from those who will participate in the extraction or transplantation and shall not be subject to the instructions of these.

The donation and transplantation of organs must not be mandatory either morally or legally under any circumstance.

In the case of organ donation from a living person, the transplant team directed by a physician must provide all necessary information to the donor and his or her family members, clearly establishing that the donation is voluntary and that he or she has been informed of the implicit risks and expected benefits.

The physician commits a serious violation of professional ethics by facilitating and executing trafficking in organs or tissues of human origin for profit, without prejudice to the civil and criminal liability that may correspond to him or her.

It is the obligation of the physician to take into account that in this process, voluntariness, altruism, gratuitousness, and absence of profit motive must be respected, so that it is not possible to obtain economic compensation or any other type of compensation for the donation of any part of the human body.