MEDICAL COUNCIL OF TANGANYIKA

CODE OF ETHICS AND PROFESSIONAL CONDUCT FOR

MEDICAL AND DENTAL PRACTITIONERS IN TANZANIA, 2005
 PREAMBLE

The medical and dental professions hold a special position of trust in the
society. Consequently the society accords these professions certain
privileges that are not available to other professions. In return, persons who
profess medical and dental professions (hereinafter referred to as
practitioners) make a commitment to the society to observe, adhere to and
attain high ethical standards of conduct. The standards, known as the
Principles of Ethics and Code of Professional Conduct, carry obligations
arising from the inherent implied contract between the practitioners and the
society.

The Principles of Ethics and Code of Professional Conduct, as known today

are not new phenomenon in Tanzania and the World in General. They have
their roots in Greece, way back in 500 B.C and traceable to the emergence of
Hippocrates (460 B.C.) and his philosophy in scientific approaches in
medicine and principles on moral and ethical requirement of an ideal
physician. The principles, which were then summarized in the form of
“Hippocratic oath”, were the fundamental governance of the medical and
dental professions. Ever since, the principles have existed throughout history
until when they were officially modified by the Geneva Convention in 1948,
which then formed the basis for diverse ethical approaches.

The principles of ethics are inspirational goals and attributes of the

professions. They provide guidance and other justification for the
professional conduct. The Principles can overlap each other as well as
compete with each other for priority as one principle can justify a given
element of the code of professional conduct and may, at times, need to be

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balanced against each other. Otherwise the principles are the profession’s
firm guideposts.

Moreover the principles express specific types of conduct that are either
required or prohibited resulting from resolutions that are adopted by the
professionals. The principles are binding to members of the medical and
dental professions and violations may result in disciplinary action.

Notably, ethics attained in the principles closely relate to the law but are not
the same and often do exceed legal duties. For that matter, in resolving any
ethical problem not explicitly covered by the code, both practitioners and
clients shall consider the ethical principles, client’s need and interests with
respect to the applicable law.

The Principles of Ethics and Code of Professional Conduct for medical and
dental practitioners in Tanzania are therefore epitomised and herein
presented into five cardinal principles namely:
 Beneficence that requires practitioners to do good,
 Non maleficence that requires practitioners not to do harm to their
clients,
 Autonomy that emphasises respect for the client’s informed choices
and consent,
 Justice which puts obligation on practitioners to act fairly, and
 Veracity and Fidelity which demands truthfulness and royalty in the
practitioner’s actions.

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In addition, a number of important ethical areas and issues that pose
dilemma and challenges in the day to day practice have been given due
weight and considered separately by this Code.

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 1.0 BENEFICENCE (DO GOOD)

The principle of beneficence refers to positive acts that lead to the welfare of
others and a client in particular. It implores that a practitioner has to do all
he can to promote good, kindness or generosity, and it implies acts of
humanity, mercy or charity. It is a moral obligation required from the
practitioner to act for the benefit of others, thus,

The practitioner shall:-

1.1. devote time and life to the service of humanity;
1.2. maintain by all means the honour and noble traditions of the
profession;
1.3. practice the profession with conscience and dignity, and the health of
the client shall be his first consideration;
1.4. maintain the utmost respect and preservation for human life even
when subjected under threat;
1.5. act only in the client’s interest when providing medical and dental
care which might have the effect of weakening the physical and
mental condition of the client;
1.6. have the duty to give emergency care until thepractitioner is sure that
others are willing and able to give such care;
1.7. give advice and treatment as shall be necessary to reduce the suffering
of the client;
1.8. represent, recommended or perform treatment or diagnostic
techniques that are evidence based best practice.

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 2.0 NON-MALEFICENCE (DO NO HARM)

This principle is based on the concept that a practitioner is under moral

obligation to refrain from any act or omission that may result into
undesirable or uncomfortable consequences inflicted upon a client.

The practitioner shall:-

2.1. refrain from taking part in any activity or experiment which does not
conform to ethical requirements and which is likely to cause harm or
endanger the health and well-being of a client: including but not
limited to taking part in strikes in circumstances which endangers or
causes harm to a patient, or compromises the Hippocratic Oath;
2.2. strive to have adequate standard equipment and necessary supplies for
practice;
2.3. be obliged, whenever an examination or treatment is beyond his/her
skills, capacity, knowledge and experience, to seek an advice or refer
a client to a practitioner who has the necessary special skills,
knowledge, ability and experience;
2.4. upon completion of the care, where dealing with a referral case, return
the patient back to a referring practitioner, unless a client expressly
indicates different preference;
2.5. not permit oneself to be exploited in a manner which is undesirable to
the public or professional interest;
2.6. be obliged at all times to protect health of a client by assigning to
qualified auxiliaries only those duties which can be professionally
delegated;

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2.7. be obliged to supervise the client care provided by auxilliary
personnel working under his direction;
2.8. once instituted a course of treatment to a client he should not
discontinue that treatment without giving the client adequate notice
and the opportunity to obtain services of another practitioner;
2.9. not select a health facility on the basis of financial gains when
referring his or her client.

3.0 AUTONOMY (SELF DETERMINATION)

This principle is based on the concept that a client has inherent right to make
decisions in accordance with his values, as opposed to the values of others
who do not suffer the consequences of the decisions. The principle
mandates the client to make informed decisions unrestricted by values of the
practitioner.

The practitioner shall:-

3.1. offer treatment and other forms of health intervention to client
only after getting informed consent from the client;
3.2. always give the client sufficient information to enable him to decide
whether or not to accept treatment, including the relevant risks,
expected benefits and available alternatives;

3.3. ensure that consent is given free from undue influence such as force,
pretence, promise and deception. Any decision to withdraw the
consent must be respected;

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 3.3.1. consent can be implied or express, oral or written. But,
consent for major surgery and test for sensitive diseases such
as HIV/AIDS must be express,
3.3.2. consent from a client who lacks capacity such as a child or
unconscious person, shall be obtained from the next of kin or
any other person or authority for the best interest of the client
and only for the necessary intervention,
3.3.3. when seeking client’s consent as to the disclosure of
confidential information, the practitioner shall ensure that the
client clearly understands the reasons for such disclosure and its
possible consequences,
3.3.4. the client has the right to choose a practitioner, who will attend
the client,
3.3.5. the client’s last wishes while still in sound mind and his right
to die in dignity must be respected,
3.3.6. the client’s right to receive or decline spiritual and moral
comfort must be respected.

4.0 PRIVACY

This principle is based on the concept that records, interests and affairs
relating to the client’s health condition are confided to the practitioner only.

The practitioner shall:-

4.1 respect the privacy of a client in a course of providing treatment and
any other forms of interaction, and shall avoid acts that are degrading,
insulting, interfering with or injuring the self value of the client.

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4.2 The practitioner shall take into account that touching a client without
consent may be construed as trespass to the person, battery or assault,
and that the body (corpus) of the client or information of the client
is private property.

5.0 VERACITY (TRUTHFULNESS) AND FIDELITY

(FAITHFULLNESS / LOYALTY)

Veracity is the principle that imposes a duty upon the practitioner to be

honest and truthful in the course of interaction with clients. The practitioner
is obliged to respect the inherent trust that exists in the practitioner – client
relationship. It requires a practitioner to communicate with a client truthfully
and without deception, and thus maintain professional integrity.

On the other hand fidelity is the principle based on the concept that a
practitioner shall keep promises made to the client, and requires the
practitioner not to represent in a false or misleading manner any care or
service rendered by him to the client.
The practitioner shall;
5.1. not charge fees for providing care in a false or misleading
manner;
5.2. not increase fee to a client on reason that a client is covered under
insurance scheme;
5.3. not recommend or perform unnecessary procedures for purposes of
financial gain;

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5.4. while presenting educational or scientific information in an article,
seminar or other programmes, disclose to the reader or participants
stakeholders as the case may be, any monetary or other special interest
he may have with a company whose products are being promoted or
endorsed in the presentation;
5.5. disclose any monetary or other special interests he may have with the
company whose products are being promoted or endorsed in
educational, scientific information in an article, seminar or other
programmes. Disclosure shall be made in any promotional material
and in the presentation itself;
5.6. In the event of adverse reaction to a drug or device, the practitioner
shall communicate that information to members of the profession and
relevant authorities;
5.7. not misrepresent his training or competence in any way which is false
or misleading in any material respect.

6.0 JUSTICE (FAIRNESS)

This principle is based on the concept of fairness, equitable and appropriate

treatment in light of what is due or owed to a person. Health needs are
limited, and every health care system faces some form of scarcity. Given
the circumstances, the practitioner is expected to use wisdom to ensure that
the limited resources are distributed fairly.
The practitioner shall:-
6.1. treat all clients fairly and equitably by providing services to clients
based on their needs regardless of factors such as economic status,
faith, race, gender, tribe, age or physical attributes.

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 7.0 CONFIDENTIALITY
The principle refers to limitation to access to client’s private information. It
is a foundation on which a practitioner - client relationship is built. The
principle underlines the trust and willingness that allow practitioner to
access client’s private information.

The practitioner shall:

7.1. maintain secrecy and security of client’s private information;
7.2. use professional judgment and responsibility in sharing the client’s
confidential information among colleagues;
7.3 . ensure that subordinate and any other member of staff observe
confidentiality;
7.4. disclose confidential information only if:
7.4.1 consent of a client is duly obtained,
7.4.2 the disclosure is in compliance with the requirement of law,
7.4.3 the disclosure is in the interest of the public or community.

8.0 RELATIONSHIPS

Good relationship resulting from effective teamwork and interaction

between the community, practitioners and other health workers is one of the
factors influencing the provision of quality health care.
In this regard, in order to properly serve the public the practitioners shall
represent themselves in a manner that contributes to the esteem of the
profession.

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 8.1 Doctor – Doctor Relationship

Every practitioner has the responsibility to co-operate fully with colleagues

in the interests of provision of the best care to the society.

The practitioner shall:

8.1.1 consider that colleagues are brothers and sisters and have to respect
each other;
8.1.2 share knowledge with colleagues and do all one can to promote
medical and dental education and research;
8.1.3 avoid any action, which may be regarded as self-laudatory,
condemning colleagues or using derogatory language about them;
8.1.4 in view of the bond of fellowship that exists amongst all members of
the profession, not to charge fees for attention to another practitioner
or to immediate dependants of the practitioner i.e. wife, husband,
children or father and mother. In this case fellow practitioners include
all members of health care team;
8.1.5 not stop, intervene, vary or withdraw management of a client ordered
by a colleague without consultation with the colleague whose
management plan is to be altered, except where interests of the client
demand otherwise. In all case common sense shall prevail.

8.2 Doctor – Client Relationship

The relationship between a practitioner and the client is based on trust and
the assumption that the practitioner will act in the best interests of the client.

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The practitioner shall refrain from acts of dishonesty or abuse of the
professional relationship.

The practitioner shall:-

8.2.1 have an obligation to preserve health of a client and human life in
general, and therefore has a duty, while making treatment decisions,
to assess how a client can be managed optimally;
8.2.2 in the event an accident is occasioned to a client in the course of
management, inform the client of the accident and restorative
measures taken or to be undertaken;
8.2.3 handle the client and any person accompanying or visiting a client
with due courtesy and respect;
8.2.4 avoid interpersonal relationship that can impair professional
judgement or proper assessment of risks or abusing inherent trust
between the practitioner and the client;
8.2.5 observe client’s right to respect in all facets of client’s personality
including physical, psychological, spiritual, financial and social;
8.2.6 taking into consideration that patients can easily be embarrassed,
ashamed or fearful, the practitioner shall:
8.2.6.1 show humanity, kindness and understanding towards client,
8.2.6.2 do the best to relieve them of hidden fears and
apprehension,
8.2.6.3 encourage and restore confidence in the client,
8.2.6.4 ensure that whenever death becomes unavoidable, the
patient dies with dignity.

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 8.3 Doctor - Other Health Workers Relationship

Practitioners shall recognize and respect the expertise and contribution of

other health workers, and collaborate with them to provide the best care.

8.4 Doctor – Community Relationship

Practitioners shall promote the provision of effective health services and

notify relevant authorities of conditions, which could be hazardous to the
health of the community.

8.5 Doctor – Employer Relationship

Relationship between the practitioner and employer may be undermined by

grievances, differences and disputes. Efforts must be made to resolve
disputes amicably through mediation, arbitration or collective bargaining.

The practitioner shall:-

8.5.1 in the process of resolving dispute always bear in mind that care of the
client is of paramount importance, and never should emergencies be
left unattended;
8.5.2 cooperate with the employer or employee as the case may be and use
reasonable degree of wisdom and any available means to avoid
situations that may lead to frustration, tension and hatred to the
detriment of client.
.

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 9.0 Accountability and Responsibility

9.1 The principle is based on the concept that practitioners shall be ready
to account for any action taken and express readiness to accept fault
resulting from such action;
9.2 The practitioner shall observe professional responsibilities and adhere
to standards of practice.

10. Competence to Practice

The principle underscores that in order to qualify for medical or dental

practice, a minimum level of competence has to be attained and maintained.

The practitioner shall:-

10.1. display high degree of skills embodied in the profession;
10.2. practice ethically by striving to achieve the best care in the
circumstances;
10.3. maintain competence at all times and refrain from exposing clients to
unnecessary risks or costs;
10.4. strive to advance their knowledge in the medical and dental profession
and take steps to ensure that they keep up to date with relevant
developments in their field of practice;
10.5. refrain from abusing controlled substances, alcohol or other chemical
agents likely to impair his ability and competence to practice;
10.6. request a second opinion or expert advice where necessary, and in the
client’s interest, to a suitably qualified colleague in respect of any case
which requires advice or specialized management.

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 11. SPECIAL SITUATIONS

11.1 Research

Advancement of medical and dental science depends on doing research

which ultimately involves experimentation on human subjects. In the
circumstances, the practitioner shall:
11.1.1 protect the welfare and rights of subjects in research;
11.1.2 ensure that the research is conducted by qualified persons after
getting approval from an approved Ethical Review Committee;
11.1.3 ensure that dignity and privacy of research subjects is
preserved;
11.1.4 ensure that rights of research subject to consent or withdraw of
consent are respected;
11.1.5 keep abreast with current researches including stem–cell
research and cloning.

In this regard, the Medical Council of Tanganyika adopts the declaration

of Helsinki proclaimed by the World Medical Association, 1964 as
revised in Tokyo in 1975, which provides guidance in Medical Research.

11.2. Torture

It is the obligation of the practitioner in the service of humanity, to preserve

and restore physical and mental health of the client.
The practitioner shall:-
11.2.1 not participate in any way in the practice of torture of human being
or other forms of cruel, inhuman or any form of degrading

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 procedures no matter whether such practice or procedure is ordered
after due process of law;
11.2.2 not provide any premises, instrument, substance or knowledge to
facilitate the practice of torture or other forms of cruel, inhuman or
degrading treatment, or to diminish the ability of the victim to resist
such treatment.

11.3 Capital Punishment

Capital punishment is not a domain of medical or dental profession. Since

the fundamental goal of a practitioner is to preserve life, he shall only
participate in a due process prescribed by law including certification of
death.

11.4 Prisoners
The practitioner while attending a client held in prison or detention is urged
to provide professional services to the best interest of the health of the
prisoner or detainee and the general community of that prisoner.

The practitioner shall:-

11.4.1 draw to the attention of the responsible authority of an existing or
impending unhealthy environment or condition.
11.4.2 take all necessary steps to preserve the dignity of the prisoner or
detainee.

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 11.5 Disaster and Emergency Situations

Practitioner shall practice the profession with conscience and dignity, and
the health of the clients shall be the first consideration.

The practitioner shall:-

11.5.1 have an obligation during life threatening emergencies to take
immediate steps to ensure that necessary treatment is given to the
victim without discrimination and undue delay.

11.6 HIV/AIDS AND OTHER INFETIOUS DISEASES

In the management of HIV/AIDS and other infectious diseases, the

practitioner may encounter ethical problems embodied in the special nature
of the disease, its fatality, absence of cure, public stigma and imminent
danger to the society.

The practitioner shall:-

11.6.1 balance the need to observe confidentiality and save human life
against deliberate acts likely to infect potential victims.
11.6.2 acquire adequate knowledge and skills on counselling related to the
special aspects of HIV/AIDS other infectious diseases including
prevention of transmission.
11.6.3 ensure that individuals infected with HIV or suffering from AIDS
and other infectious diseases are informed of available supportive
measures.

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11.6.4 ensure that Individuals infected with HIV/AIDS are afforded
opportunity to agree or decline from being research subjects and to
the method applied for scientific research, teaching, and taking of
photographs, video or film.

11.7 Medical Examinations Requested by Employer

Practitioners shall ensure that an employee is fully aware and consent

to medical or dental examination requested by the employer.

11.8 Publicity, Advertisement and Canvassing

Sound relationship between a practitioner and colleagues is essential for

fostering the esteem and truthfulness of the medical and dental profession.
Practitioners shall be aware that matters of general interest are sacred and
practitioners shall refrain from adopting methods aimed at advertising a
particular person, institution, remedy or technique.

The practitioner shall not:

11.8.1 use any professional premises to display the name of a commercial
product;
11.8.2 by way of publication of any article or personal photograph or
otherwise indulge in any form of self advertisement or publicity;
11.8.3 encourage any practice which is of a nature that invites attention to
professional position, skill, qualification or achievements;
11.8.4 publish or cause to be published in a lay media articles likely to
publicise, advertise and canvass;

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11.8.5 give to journalists of the lay media interviews likely to lead to
publicise, advertise and canvass;
11.8.6 encourage the publication in the lay media, of cases, operations,
treatments, cures or remedies.
11.8.7 communicate or address to the lay public, use or permit the use of
personal professional qualification as an advertisement for the
organization or the company or be personally involved in
advertising organization’s or company’s services.
11.8.8 talk in a derogatory manner about the professional skills,
knowledge, qualification or services of another practitioner.
11.8.9 canvass for purposes of obtaining clients, whether done directly or
through an agent associated with or employed by an organization
or company, which canvass.

11.9 Organ Donation and Transplantation

Potential live donors are at risk from financial and other inducements to
donate their organs. Cadaver organs from executed prisoners may prompt
judicial decisions and timing of the executions to take place concurrently
with the most convenient time for the transplantations.

The practitioner shall:

11.9.1 safeguard the rights and interests of potential donors and recipients
by observing the internationally accepted rules for transplantations;
11.9.2 have an obligation to explain fully to potential donors the risks
associated with removal of organs or tissues;
11.9.3 . ensure that the decision to donate has been made entirely
voluntarily;

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 11.9.4 ensure that the selection of recipients is made solely on the basis of
their medical suitability for the procedure;
11.9.5 ensure that in cases where an organ is to be removed after death,
death has been confirmed by a practitioner who is not directly
involved with the team carrying out the transplantation.

11.10. Diagnosis of Death

A situation may arise whereby the human body is controlled by a brain
which is damaged to an uncertain degree and poses ethical dilemma for
termination of life. In such a situation a patient shall be considered dead
when there is irrevocable establishment of brain stem death. Death shall be
clinically ascertained by not less than two physicians and one of them shall
be the doctor in charge of the care and another one should be an experienced
and clinically independent of the first. In any case the examination must be
done over twenty four hours at eight hourly intervals.

11.11 Health Management Organisations

Health Management Organisations (HMO) have at their basis, profit making

by ‘managing’ health funds. This, at times, leads to unreasonable exclusion
from key investigations, drugs therapy, surgical procedures etc. and
interference in the confidentiality of the clients. Practitioners must have
interest of their clients at heart and should not barge to HMO’s pressures. In
every aspect of practice the patient’s welfare remains the practitioner’s
responsibility irrespective of the influences of health agents.

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 11.12 Practitioners Appropriate Presentation and Attire

A practitioner shall, at all times in and outside the place of work, appear in
smart, proper and decent dress and behave in a manner becoming of the
profession. At a place of work, a practitioner shall present himself and
appear in official attire that shall include proper uniform and identification
name tag.

________________________________________
__________________

Adopted by the Medical Council of Tanganyika

On this 22nd day of September, 2005

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