AMPS submission: Review of Good medical practice, a code of conduct for doctors in Australia

Medicine already has a clear ethical framework. It rests on four principles: beneficence (act for the patient’s good), nonmaleficence (do no harm), respect for autonomy, and justice. Every doctor learns them. They are the test any code of conduct should meet.

Good medical practice does not name any of them. The words “beneficence”, “nonmaleficence”, “autonomy” and “justice” do not appear, and neither does “do no harm”. The code says it is consistent with the Declaration of Geneva, a pledge of about 200 words. The code itself runs to about 11,000 words and more than 200 numbered clauses, and it reaches into doctors’ public comment, their “actions outside work” and “the reputation of the profession”.

AMPS put AHPRA’s own scoping questions, word for word, to our members, along with the issues we have raised with AHPRA for years. This submission answers each AHPRA question with what our members told us.

What our members told us

• 91% want the code grounded in core medical ethics: “first, do no harm” and respect for patient autonomy.
• 86% say acting in the patient’s best interests matters most in good care.
• 85% have held back a professional opinion for fear of a complaint or regulatory action, and 47% do so often.
• Only 22% feel safe raising a clinical concern or evidence-based disagreement. 69% do not.
• Only 12% are confident the guidelines they follow are free from undue commercial or political influence.
• 84% want regulatory action limited to clinical practice and patient safety. 91% say the code should not regulate public comment outside clinical practice at all.

What we asked for

We ask AHPRA and the Medical Board to rebuild the code on the four principles of medical ethics, to protect the doctor-patient relationship from political and commercial interference, and to apply justice to doctors as well as patients. Our eleven recommendations are below.

Our eleven recommendations

1. Build the code on the four principles.
2. A shorter, clinical code.
3. Remove reputation, confidence and consensus tests.
4. Regulation limited to clinical practice.
5. Protect speaking up.
6. Strengthen informed consent.
7. Clinical judgement.
8. Guideline integrity.
9. Justice for doctors.
10. Equal care.
11. Consultation.

Further details of these recommendations are in the letter below.