CMA CODE OF ETHICS AND PROFESSIONALISM

The CMA Code of Ethics and Professionalism articulates the ethical and
professional commitments and responsibilities of the medical profession. The
Code provides standards of ethical practice to guide physicians in fulfilling their
obligation to provide the highest standard of care and to foster patient and public
trust in physicians and the profession. The Code is founded on and affirms the
core values and commitments of the profession and outlines responsibilities
related to contemporary medical practice.

In this Code, ethical practice is understood as a process of active inquir y,

reflection, and decision -making concerning what a physician’s actions should be
and the reasons for these actions. The Code informs ethical decision -making,
especially in situations where existing guidelines are insufficient or where values
and principles are in tension. The Code is not exhaustive; it is intended to provide
standards of ethical practice that can be interpreted and applied in particular
situations. The Code and other CMA policies constitute guidelines that provide a
common ethical framework for physicians in Canada.

In this Code, medical ethics concerns the virtues, values , and principles that
should guide the medical profession, while p rofessionalism is the embodiment or
enactment of responsibilities arising from those norms through sta ndards,
competencies, and behaviours. Together, the virtues and commitments outlined in
the Code are fundamental to the ethical practice of medicine.

Physicians should aspire to uphold the virtues and commitments in the Code, and
they are expected to enact the professional responsibilities outlined in it.

Physicians should be aware of the legal and regulatory requirements that govern
medical practice in their jurisdictions.

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unlimited copies of CMA Policy Statements provided that credit is given to Canadian Medical Association.
A. VIRTUES EXEMPLIFIED BY THE ETHICAL PHYSICIAN

Trust is the cornerstone of the patient–physician relationship and of medical professionalism.

Trust is therefore central to providing the highest standard of care and to the ethical practice of
medicine. Physicians enhance trustworthiness in the profession by striving to uphold the
following interdependent virtues:

C O MP A SSI O N . A compassionate physician recognizes suffering and vulnerability, seeks to

understand the unique circumstances of each patient and to alleviate the patient’s suffering,
and accompanies the suffering and vulnerable patient.
H O NE STY . An honest physician is forthright, respects the truth, and does their best to seek,
preserve, and communicate that truth sensitively and respectfully.
H U MI L I TY . A humble physician acknowledges and is cautious not to overstep the limits of their
knowledge and skills or the limits of medicine, seeks advice and support from colleagues in
challenging circumstances, and recognizes the patient’s knowledge of their own
circumstances.
I NTE GR I TY . A physician who acts with integrity demonstrates consistency in their intentions and
actions and acts in a truthful manner in accordance with professional expectations, even in the
face of adversity.
P R U D E NC E . A prudent physician uses clinical and moral reasoning and judgement, considers
all relevant knowledge and circumstances, and makes decisions carefully, in good conscience,
and with due regard for principles of exemplary medical care.

B. FUNDAMENTAL COMMITMENTS OF THE MEDICAL PROFESSION

Commitment to the well-being of the patient

Consider first the well-being of the patient; always act to benefit the patient and promote the
good of the patient.
Provide appropriate care and management across the care continuum.
Take all reasonable steps to prevent or minimize harm to the patient; disclose to the patient if
there is a risk of harm or if harm has occurred.
Recognize the balance of potential benefits and harms associated with any medical act; act to
bring about a positive balance of benefits over harms.

Commitment to respect for persons

Always treat the patient with dignity and respect the equal and intrinsic worth of all persons.
Always respect the autonomy of the patient.
Never exploit the patient for personal advantage.
Never participate in or support practices that violate basic human rights.

Commitment to justice
Promote the well-being of communities and populations by striving to improve health outcomes
and access to care, reduce health inequities and disparities in care, and promote social
accountability.

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Commitment to professional integrity and competence
Practise medicine competently, safely, and with integrity; avoid any influence that could
undermine your professional integrity.
Develop and advance your professional knowledge, skills, and competencies through lifelong
learning.

Commitment to professional excellence

Contribute to the development and innovation in medicine through clinical practice, research,
teaching, mentorship, leadership, quality improvement, administration, or advocacy on behalf
of the profession or the public.
Participate in establishing and maintaining professional standards and engage in processes
that support the institutions involved in the regulation of the profession.
Cultivate collaborative and respectful relationships with physicians and learners in all areas of
medicine and with other colleagues and partners in health care.

Commitment to self-care and peer support

Value personal health and wellness and strive to model self-care; take steps to optimize
meaningful co-existence of professional and personal life.
Value and promote a training and practice culture that supports and responds effectively to
colleagues in need and empowers them to seek help to improve their physical, mental, and
social well-being.
Recognize and act on the understanding that physician health and wellness needs to be
addressed at individual and systemic levels, in a model of shared responsibility.

Commitment to inquiry and reflection

Value and foster individual and collective inquiry and reflection to further medical science and
to facilitate ethical decision-making.
Foster curiosity and exploration to further your personal and professional development and
insight; be open to new knowledge, technologies, ways of practising, and learning from others.

C. PROFESSIONAL RESPONSIBILITI ES

PHYSICIANS AND PATIENTS

Patient–physician relationship

The patient–physician relationship is at the heart of the practice of medicine. It is a relationship

of trust that recognizes the inherent vulnerability of the patient even as the patient is an active
participant in their own care. The physician owes a duty of loyalty to protect and further the
patient’s best interests and goals of care by using the physician’s expertise, knowledge, and
prudent clinical judgment.

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In the context of the patient–physician relationship:

1. Accept the patient without discrimination (such as on the basis of age, disability, gender
identity or expression, genetic characteristics, language, marital and family status, medical
condition, national or ethnic origin, political affiliation, race, religion, sex, sexual orientation,
or socioeconomic status). This does not abrogate the right of the physician to refuse to
accept a patient for legitimate reasons.
2. Having accepted professional responsibility for the patient, continue to provide services until
these services are no longer required or wanted, or until another suitable physician has
assumed responsibility for the patient, or until after the patient has been given reasonable
notice that you intend to terminate the relationship.
3. Act according to your conscience and respect differences of conscience among your
colleagues; however, meet your duty of non-abandonment to the patient by always
acknowledging and responding to the patient’s medical concerns and requests whatever
your moral commitments may be.
4. Inform the patient when your moral commitments may influence your recommendation
concerning provision of, or practice of any medical procedure or intervention as it pertains
to the patient’s needs or requests.
5. Communicate information accurately and honestly with the patient in a manner that the
patient understands and can apply, and confirm the patient’s understanding.
6. Recommend evidence-informed treatment options; recognize that inappropriate use or
overuse of treatments or resources can lead to ineffective, and at times harmful, patient
care and seek to avoid or mitigate this.
7. Limit treatment of yourself, your immediate family, or anyone with whom you have a
similarly close relationship to minor or emergency interventions and only when another
physician is not readily available; there should be no fee for such treatment.
8. Provide whatever appropriate assistance you can to any person who needs emergency
medical care.
9. Ensure that any research to which you contribute is evaluated both scientifically and
ethically and is approved by a research ethics board that adheres to current standards of
practice. When involved in research, obtain the informed consent of the research
participant and advise prospective participants that they have the right to decline to
participate or withdraw from the study at any time, without negatively affecting their
ongoing care.
10. Never participate in or condone the practice of torture or any form of cruel, inhuman, or
degrading procedure.

Decision-making

Medical decision-making is ideally a deliberative process that engages the patient in shared
decision-making and is informed by the patient’s experience and values and the physician’s
clinical judgment. This deliberation involves discussion with the patient and, with consent,
others central to the patient’s care (families, caregivers, other health professionals) to support
patient-centred care.

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In the process of shared decision-making:

11. Empower the patient to make informed decisions regarding their health by communicating
with and helping the patient (or, where appropriate, their substitute decision-maker)
navigate reasonable therapeutic options to determine the best course of action consistent
with their goals of care; communicate with and help the patient assess material risks and
benefits before consenting to any treatment or intervention.
12. Respect the decisions of the competent patient to accept or reject any recommended
assessment, treatment, or plan of care.
13. Recognize the need to balance the developing competency of minors and the role of
families and caregivers in medical decision-making for minors, while respecting a mature
minor’s right to consent to treatment and manage their personal health information.
14. Accommodate a patient with cognitive impairments to participate, as much as possible, in
decisions that affect them; in such cases, acknowledge and support the positive roles of
families and caregivers in medical decision-making and collaborate with them, where
authorized by the patient’s substitute decision-maker, in discerning and making decisions
about the patient's goals of care and best interests.
15. Respect the values and intentions of a patient deemed incompetent as they were expressed
previously through advance care planning discussions when competent, or via a substitute
decision-maker.
16. When the specific intentions of an incompetent patient are unknown and in the absence of
a formal mechanism for making treatment decisions, act consistently with the patient's
discernable values and goals of care or, if these are unknown, act in the patient's best
interests.
17. Respect the patient's reasonable request for a second opinion from a recognized medical
expert.

PHYSICIANS AND THE P RACTICE OF MEDICINE

Patient privacy and the duty of confidentiality

18. Fulfill your duty of confidentiality to the patient by keeping identifiable patient information
confidential; collecting, using, and disclosing only as much health information as necessary
to benefit the patient; and sharing information only to benefit the patient and within the
patient’s circle of care. Exceptions include situations where the informed consent of the
patient has been obtained for disclosure or as provided for by law.
19. Provide the patient or a third party with a copy of their medical record upon the patient’s
request, unless there is a compelling reason to believe that information contained in the
record will result in substantial harm to the patient or others.
20. Recognize and manage privacy requirements within training and practice environments and
quality improvement initiatives, in the context of secondary uses of data for health system
management, and when using new technologies in clinical settings.

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21. Avoid health care discussions, including in personal, public, or virtual conversations, that
could reasonably be seen as revealing confidential or identifying information or as being
disrespectful to patients, their families, or caregivers.

Managing and minimizing conflicts of interest

22. Recognize that conflicts of interest may arise as a result of competing roles (such as
financial, clinical, research, organizational, administrative, or leadership).
23. Enter into associations, contracts, and agreements that maintain your professional integrity,
consistent with evidence-informed decision-making, and safeguard the interests of the
patient or public.
24. Avoid, minimize, or manage and always disclose conflicts of interest that arise, or are
perceived to arise, as a result of any professional relationships or transactions in practice,
education, and research; avoid using your role as a physician to promote services (except
your own) or products to the patient or public for commercial gain outside of your
treatment role.
25. Take reasonable steps to ensure that the patient understands the nature and extent of your
responsibility to a third party when acting on behalf of a third party.
26. Discuss professional fees for non-insured services with the patient and consider their ability
to pay in determining fees.
27. When conducting research, inform potential research participants about anything that may
give rise to a conflict of interest, especially the source of funding and any compensation or
benefits.

PHYSICIANS AND SELF

28. Be aware of and promote health and wellness services, and other resources, available to
you and colleagues in need.
29. Seek help from colleagues and appropriate medical care from qualified professionals for
personal and professional problems that might adversely affect your health and your
services to patients.
30. Cultivate training and practice environments that provide physical and psychological safety
and encourage help-seeking behaviours.

PHYSICIANS AND COLLEAGUES

31. Treat your colleagues with dignity and as persons worthy of respect. Colleagues include all
learners, health care partners, and members of the health care team.
32. Engage in respectful communications in all media.
33. Take responsibility for promoting civility, and confronting incivility, within and beyond the
profession. Avoid impugning the reputation of colleagues for personal motives; however,
report to the appropriate authority any unprofessional conduct by colleagues.
34. Assume responsibility for your personal actions and behaviours and espouse behaviours
that contribute to a positive training and practice culture.

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35. Promote and enable formal and informal mentorship and leadership opportunities across
all levels of training, practice, and health system delivery.
36. Support interdisciplinary team-based practices; foster team collaboration and a shared
accountability for patient care.

PHYSICIANS AND SOCIE TY

37. Commit to ensuring the quality of medical services offered to patients and society through
the establishment and maintenance of professional standards.
38. Recognize that social determinants of health, the environment, and other fundamental
considerations that extend beyond medical practice and health systems are important
factors that affect the health of the patient and of populations.
39. Support the profession’s responsibility to act in matters relating to public and population
health, health education, environmental determinants of health, legislation affecting public
and population health, and judicial testimony.
40. Support the profession’s responsibility to promote equitable access to health care resources
and to promote resource stewardship.
41. Provide opinions consistent with the current and widely accepted views of the profession
when interpreting scientific knowledge to the public; clearly indicate when you present an
opinion that is contrary to the accepted views of the profession.
42. Contribute, where appropriate, to the development of a more cohesive and integrated
health system through inter-professional collaboration and, when possible, collaborative
models of care.
43. Commit to collaborative and respectful relationships with Indigenous patients and
communities through efforts to understand and implement the recommendations relevant
to health care made in the report of the Truth and Reconciliation Commission of Canada.
44. Contribute, individually and in collaboration with others, to improving health care services
and delivery to address systemic issues that affect the health of the patient and of
populations, with particular attention to disadvantaged, vulnerable, or underserved
communities.

Approved by the CMA Board of Directors Dec 2018