Ethical Duties of Doctors in India

Key Takeaways

• Doctors in India are legally and professionally expected to maintain high standards of professional conduct, medical ethics, competence, confidentiality and integrity while treating patients.
• At present, the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 remain the operative ethical framework. The National Medical Commission’s 2023 Professional Conduct Regulations were placed in abeyance in August 2023.
• A doctor’s primary ethical responsibility is towards the health, safety and interests of the patient. Personal financial interests should not interfere with medical judgment.
• Important ethical duties include obtaining valid consent, maintaining confidentiality, providing emergency care, keeping medical records, prescribing medicines rationally and maintaining professional competence.
• Doctors must avoid unethical practices such as fee-splitting, receiving commissions for referrals, improper advertising, misleading claims and prohibited financial relationships with pharmaceutical companies.
• Medical confidentiality is important but is not absolute. Disclosure may be permitted or required in limited circumstances, including court orders, certain public-health obligations and situations involving serious risks to identifiable persons.
• Violation of professional ethics may amount to professional misconduct and can result in disciplinary proceedings before the competent medical regulatory authority.

What Are the Ethical Duties of Doctors?

The duties of a doctor are the professional responsibilities that govern how medical practitioners should behave towards patients, colleagues, the medical profession and society.

Medical practice involves much more than diagnosing an illness or prescribing treatment. A patient places considerable trust in a doctor and may disclose highly personal information, undergo invasive procedures or depend upon medical advice while making major decisions concerning health and life.

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Medical ethics therefore requires doctors to exercise their professional powers responsibly.

In India, these duties cover matters such as patient welfare, informed consent, confidentiality, emergency treatment, medical records, rational prescribing, professional competence, financial integrity, relationships with other doctors and conduct towards pharmaceutical companies.

Ethical duties may overlap with legal duties. A particular act can therefore result in professional disciplinary action and may, depending upon the circumstances, also give rise to civil, consumer, statutory or criminal consequences.

What Law Governs Medical Ethics in India?

The principal professional ethics framework presently applicable to doctors is the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002.

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These Regulations were originally framed by the Medical Council of India and contain detailed provisions relating to professional conduct, etiquette and ethics.

The regulatory structure later changed with the establishment of the National Medical Commission (NMC) under the National Medical Commission Act, 2019.

The NMC notified the National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023 on 2 August 2023. However, on 23 August 2023, the NMC formally placed those Regulations in abeyance.

The same notification stated that the 2023 Regulations would not become operative until a further Gazette notification and made the 2002 Regulations effective again with immediate effect.

Therefore, discussions on the current ethical obligations of doctors must primarily proceed on the basis of the 2002 Regulations, together with applicable statutes, judicial decisions and other regulatory requirements.

What are the Ethical Duties of Doctors in India?

Duty to Put the Patient’s Interests First

One of the most important principles of medical ethics is that the interests of the patient should receive priority.

Regulation 1.8 of the 2002 Regulations specifically recognises that a physician’s personal financial interests should not conflict with the medical interests of patients.

This principle affects several areas of medical practice. A doctor should not recommend unnecessary investigations, procedures, medicines or referrals merely because they provide a financial advantage.

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Clinical decisions should instead be based on factors such as:

• the patient’s medical condition;
• accepted medical knowledge;
• available treatment alternatives;
• likely risks and benefits;
• urgency of treatment; and
• the professional judgment required in the circumstances.

The ethical relationship between a doctor and patient is therefore based upon trust rather than ordinary commercial considerations.

Duty to Maintain Professional Competence

Medical knowledge changes continuously. New diagnostic techniques, medicines, treatment protocols and scientific evidence develop over time.

A doctor therefore has an ethical responsibility to maintain adequate professional knowledge and skills.

The Code expects physicians to practise medicine on scientific principles and to continue improving their professional knowledge.

Professional competence also requires doctors to recognise the limits of their expertise. A medical practitioner should not represent himself or herself as a specialist without possessing the recognised qualification required for that field.

Where a patient’s condition requires expertise beyond the treating doctor’s competence, consultation or referral to an appropriate specialist may become necessary. Failure to exercise reasonable professional skill and care may, depending on the circumstances, raise questions of medical negligence.

Duty to Provide Emergency Medical Care

Doctors have a particularly important responsibility where immediate treatment is required to preserve life.

The Supreme Court emphasised this principle in Pt. Parmanand Katara v Union of India. The Court held that every doctor, whether working in a government hospital or otherwise, has a professional obligation to provide medical assistance necessary for protecting life.

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The priority in such circumstances is saving the injured person’s life rather than delaying treatment because of procedural or medico-legal formalities.

The ethical code similarly recognises that although doctors generally have discretion regarding acceptance of patients, assistance should not be refused arbitrarily in emergencies.

Emergency care therefore represents both an ethical and an important legal responsibility in medical practice. Similar principles become relevant when considering whether a doctor can treat a patient without consent in an emergency.

Duty to Obtain Valid Consent

Consent is a fundamental part of ethical medical treatment.

Before carrying out a significant diagnostic, therapeutic or surgical procedure, the doctor must ensure that legally valid consent has been obtained wherever required.

Consent is meaningful only when the patient understands the nature of the proposed treatment sufficiently to make a genuine decision.

What Should a Patient Know Before Giving Consent?

Depending upon the nature of the procedure, appropriate information may include:

• the nature and purpose of the treatment or procedure;
• important risks associated with it;
• reasonable alternatives that may be available;
• likely consequences of refusing treatment; and
• other information necessary for a meaningful decision.

The Supreme Court examined medical consent extensively in Samira Kohli v Dr Prabha Manchanda.

The Court explained that consent in the doctor-patient relationship means permission granted by a patient for a diagnostic, surgical or therapeutic procedure. It also distinguished consent for examination from consent for substantial therapeutic or surgical intervention.

Importantly, consent for one procedure cannot ordinarily be treated as unrestricted permission to perform a substantially different procedure.

The Supreme Court held that consent for diagnostic surgery cannot automatically be regarded as authorisation for an additional therapeutic procedure, except where an immediate life-threatening or emergent situation justifies intervention.

Consent should therefore be voluntary, competent, adequately informed and specific to the proposed medical intervention. Failure to provide sufficient information about material risks may also raise questions concerning informed consent and medical negligence.

Duty to Maintain Patient Confidentiality

Doctors regularly receive sensitive information concerning a patient’s health, personal relationships, family circumstances and medical history.

Maintaining patient confidentiality is a fundamental ethical obligation.

The 2002 Regulations prohibit disclosure of secrets learnt by a physician while exercising professional duties except in specified circumstances.

Confidentiality strengthens trust between doctors and patients. A patient is more likely to disclose complete and accurate information when there is confidence that personal medical details will not be disclosed unnecessarily.

Is Medical Confidentiality Absolute?

No. Medical confidentiality is important but not absolute.

Disclosure may be justified in limited situations, including where:

• disclosure is required pursuant to a lawful court order;
• a legal obligation requires reporting;
• a notifiable disease must be reported to the appropriate authority; or
• there exists a serious and identifiable risk to another person or the community falling within recognised legal or ethical exceptions.

The Supreme Court considered confidentiality and privacy in Mr X v Hospital Z. The case recognised the confidential character of the doctor-patient relationship while also acknowledging that confidentiality may give way in limited circumstances involving protection of another identifiable person’s health.

Confidential information should therefore never be disclosed casually or merely because another person requests it.

Medical information is also closely connected with the broader constitutional right to privacy, particularly where identifiable health information is stored, processed or disclosed.

Duty to Maintain Proper Medical Records

Accurate medical records are important for continuity of treatment, patient safety and accountability.

The 2002 Regulations require doctors to maintain medical records concerning indoor patients for three years from the commencement of treatment.

Where a patient, authorised attendant or legal authority requests such records, the Regulations require them to be supplied within 72 hours. The legal position concerning access to these documents is also relevant to the question of who owns medical records.

Medical records may include relevant documents concerning diagnosis, investigations, treatment, prescriptions, procedures and clinical progress.

Records should be accurate and should not be falsified, retrospectively manipulated or improperly withheld. A hospital’s refusal to provide medical records may also have consequences under professional and consumer law, depending upon the circumstances.

Duty to Prescribe Medicines Rationally

Doctors are ethically expected to prescribe medicines responsibly.

Regulation 1.5 states that physicians should, as far as possible, prescribe medicines by their generic names and ensure rational prescription and use of drugs.

Rational prescribing means that medical judgment rather than commercial considerations should determine the choice of medication.

Doctors should avoid:

• unnecessary medicines;
• irrational combinations;
• prescriptions influenced primarily by commercial incentives;
• treatment unsupported by reasonable medical justification; and
• remedies whose composition is not known to the prescribing practitioner.

Responsible prescribing is important because inappropriate medication may increase treatment costs, create avoidable side effects and contribute to wider public-health problems.

Duty to Avoid Referral Commissions and Fee-Splitting

Medical referrals must be based upon the patient’s clinical requirements rather than financial arrangements between healthcare professionals.

The ethical regulations prohibit doctors from giving, soliciting or receiving commissions, bonuses or other consideration in return for referring, recommending or procuring patients.

The principle also applies to arrangements relating to diagnostic examinations, specimens and other professional medical services.

For example, referring a patient to a particular diagnostic laboratory merely because the doctor receives a percentage of the testing fee would conflict with the ethical principle governing referral commissions.

Such arrangements create a conflict between the patient’s medical interests and the doctor’s financial interests.

Ethical Duties Regarding Pharmaceutical Companies

Relationships between medical practitioners and pharmaceutical or allied healthcare companies require particular care because financial incentives can influence, or appear to influence, clinical decision-making.

The ethical framework restricts doctors from accepting prohibited benefits from pharmaceutical and allied healthcare industries.

Relevant restrictions include matters such as:

• gifts;
• certain forms of hospitality;
• sponsored travel facilities;
• monetary grants for personal benefit; and
• improper endorsements of pharmaceutical products.

Professional collaboration or medical research involving industry may be permissible where applicable legal and ethical requirements are satisfied, but professional independence and patient welfare must remain protected.

The purpose of these restrictions is not to prevent legitimate scientific interaction. It is to prevent commercial influence from interfering with independent medical judgment.

Duty to Avoid Unethical Advertising

Medical practice is treated as a profession rather than an ordinary commercial business.

The 2002 Regulations therefore restrict doctors from directly or indirectly soliciting patients through advertisements or self-promotional practices that amount to professional solicitation.

Certain factual professional announcements are permissible, including specified announcements relating to commencement or change of practice.

However, doctors should avoid misleading claims such as exaggerated promises of treatment success, false claims regarding qualifications or publicity designed primarily to attract patients through improper professional promotion.

Advertising therefore remains an important area where medical ethics and modern digital communication can intersect.

Duty to Be Honest About Qualifications

A medical practitioner should accurately represent professional qualifications, experience and recognised areas of specialisation.

The ethical code requires the registration number of the medical practitioner to be displayed in the clinic and included on prescriptions and relevant certificates.

Failure to properly display the registration number can constitute professional misconduct.

Doctors should also avoid using qualifications or professional descriptions that could mislead patients regarding their expertise.

A practitioner without a recognised specialist qualification should not falsely claim specialist status.

Duty Not to Abandon a Patient Improperly

Once a doctor accepts responsibility for treating a patient, the professional relationship should not ordinarily be terminated without appropriate reasons and reasonable arrangements.

A doctor should not abandon a patient in the middle of necessary treatment merely because continuing treatment becomes inconvenient.

Where withdrawal from treatment becomes appropriate, sufficient notice should ordinarily be provided so that alternative medical care can be arranged.

The obligation becomes particularly significant where sudden discontinuation could place the patient’s health at serious risk.

Duty to Communicate Honestly With Patients

Doctors should communicate medical information responsibly and honestly.

This does not mean alarming patients unnecessarily. It means providing sufficient, accurate and clinically appropriate information regarding diagnosis, treatment and prognosis.

A doctor should neither deliberately exaggerate a medical condition nor intentionally minimise serious risks.

Clear communication is particularly important when treatment involves:

• significant risks;
• surgery;
• irreversible procedures;
• multiple treatment options;
• long-term consequences; or
• a decision to refuse treatment.

Effective communication also supports valid consent and strengthens trust in the doctor-patient relationship.

Duties Towards Other Doctors

Medical ethics also regulates relationships between members of the profession.

Doctors are expected to treat professional colleagues with dignity and fairness.

Professional consultations should not become opportunities for rivalry, personal criticism or improper attempts to take over another practitioner’s patient.

Where one doctor refers a patient to another, communication of relevant clinical information may be necessary for continuity of treatment.

Professional disagreements can occur because medicine frequently involves legitimate differences of clinical opinion. Such disagreements should be handled on medical grounds and in a manner that protects the patient’s interests.

A genuine difference in professional judgment should also not automatically be treated as negligence. The distinction becomes important when determining whether a doctor’s decision amounts to an error of judgment or medical negligence.

Duty to Expose Unethical Professional Conduct

Ethical responsibility is not limited to a doctor’s personal behaviour.

The Regulations state that a physician should expose, without fear or favour, incompetent, corrupt, dishonest or unethical conduct by members of the profession.

This responsibility supports professional accountability.

However, allegations of misconduct should be made responsibly and on a proper factual basis rather than through malicious or competitive accusations.

Where conduct amounts to professional or ethical misconduct, proceedings may be initiated by complaining against the medical professional before the appropriate regulatory authority.

Ethical Duties Towards Society and Public Health

Doctors also have responsibilities towards society.

Medical professionals occupy an important position in preventing disease, controlling epidemics and promoting public health.

Ethical responsibilities may therefore include:

• cooperating with lawful public-health measures;
• reporting diseases where reporting is legally required;
• supporting prevention and control of communicable diseases;
• providing appropriate health education;
• assisting during public-health emergencies; and
• avoiding conduct that places the wider community at unnecessary risk.

The ethical regulations also recognise that physicians should not abandon professional duties during an epidemic merely because of fear of contracting the disease.

Ethical Duty to Respect Human Rights

Medical knowledge must never be used to facilitate torture, cruelty or other serious violations of human dignity.

The professional ethics framework prohibits doctors from participating in or assisting torture and similar forms of inhuman treatment.

Medical professionals must therefore maintain respect for bodily integrity, dignity and fundamental human rights even when working in prisons, detention facilities, institutional settings or other environments where vulnerable persons may depend heavily upon medical personnel.

Ethical Duties in Medical Research

Doctors involved in medical research have additional ethical responsibilities.

Research involving human participants must comply with applicable ethical, scientific and regulatory standards.

Important principles generally include:

• voluntary and informed participation;
• protection of participants from unnecessary harm;
• scientific validity of research;
• appropriate ethical review;
• confidentiality of participant information;
• transparency regarding conflicts of interest; and
• protection of vulnerable participants.

The 2002 Regulations recognise violation of applicable ethical requirements governing medical research as capable of attracting professional consequences.

Industry involvement in research should also not compromise the independence of medical judgment or the welfare of research participants.

What Amounts to Professional Misconduct by a Doctor?

Professional misconduct includes conduct that violates the ethical standards prescribed for registered medical practitioners.

Chapter 7 of the 2002 Regulations identifies several acts and omissions that may constitute professional misconduct.

Depending upon the circumstances, examples may include:

• violating the professional ethics regulations;
• failure to maintain required medical records;
• refusal to provide records within the prescribed period;
• failure to display the registration number as required;
• improper conduct with patients;
• violation of patient confidentiality;
• prohibited advertising or solicitation;
• receiving commissions for patient referrals; and
• other conduct specifically prohibited by the ethical framework.

Not every unsuccessful medical treatment amounts to professional misconduct or medical negligence. Medicine inherently involves uncertainty, and an adverse outcome alone does not establish unethical conduct or negligence.

Similarly, an unsuccessful surgery is not automatically medical negligence. The particular facts, applicable professional standard and nature of the alleged conduct must be examined.

What Happens if a Doctor Violates Medical Ethics?

Violation of professional ethics can lead to disciplinary proceedings before the competent medical regulatory authority.

A complaint concerning professional or ethical misconduct by a registered doctor may ordinarily be taken before the appropriate State Medical Council in accordance with the applicable regulatory process. The available forums differ depending on where a complaint about medical negligence or misconduct is being made.

Depending upon the applicable statutory and regulatory framework and seriousness of the misconduct, disciplinary consequences may affect the practitioner’s registration or ability to practise medicine.

The same conduct may sometimes create other forms of legal liability.

For example, depending upon the circumstances, unethical medical conduct may also lead to:

• civil liability for damages;
• proceedings concerning deficiency in medical services and consumer rights;
• statutory liability;
• criminal proceedings where the ingredients of an offence are independently established; or
• proceedings concerning violation of privacy, confidentiality or other legal rights.

Professional misconduct and medical negligence should nevertheless not automatically be treated as identical concepts. An act may violate professional ethics without necessarily satisfying every legal requirement for negligence, while negligent conduct may also involve ethical violations.

For medical negligence, the complainant ordinarily has to establish the required legal elements rather than relying merely on an adverse outcome. The question of who has to prove medical negligence therefore depends on the applicable principles concerning duty, breach, causation and evidence.

In exceptional cases, the doctrine of res ipsa loquitur may assist where the circumstances themselves strongly indicate negligence, although the doctrine does not make every unsuccessful treatment proof of negligence.

Criminal liability requires separate consideration and generally involves a higher threshold than ordinary civil negligence. The principles governing medical negligence under the Bharatiya Nyaya Sanhita therefore need to be distinguished from professional disciplinary proceedings.

Conclusion

Ethical duties of doctors in India form the foundation of the doctor-patient relationship. Medical ethics requires much more than technical competence. It requires respect for patient autonomy, confidentiality, dignity, safety and informed decision-making.

The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 presently remain the operative professional ethics framework, because the NMC’s 2023 Professional Conduct Regulations were placed in abeyance through the notification dated 23 August 2023.

The major ethical duties of doctors include putting patient welfare first, maintaining professional competence, providing emergency assistance, obtaining valid consent, protecting confidentiality, maintaining medical records, prescribing rationally and avoiding financial conflicts of interest.

Doctors must also maintain integrity in relationships with pharmaceutical companies, other healthcare professionals and society. Practices such as referral commissions, misleading advertising, improper disclosure of patient information and falsification or withholding of medical records can undermine both patient welfare and public confidence in the profession.

Ultimately, medical ethics seeks to ensure that the considerable knowledge, authority and trust placed in doctors are exercised primarily for the protection of human health, dignity and life.