CODE OF PROFESSIONAL ETHICS AND DEONTOLOGY OF NURSES, MIDWIVES AND MEDICAL ASSISTANTS IN ROMANIA

CHAPTER I

GENERAL PROVISIONS

Art.1 The Code of professional ethics and deontology of nurses, midwives and medical assistants in Romania includes a set of principles and rules representing the fundamental values under which nurses, midwives and medical assistants in Romania, practice their profession.

Art.2 The Code of professional ethics and deontology of nurses, midwives and medical assistants in Romania has the following main objectives:

a) protecting patient’s rights;

b) compliance of the professional duties by nurses, midwives and medical assistants;

c) protecting the dignity and prestige the profession of nurses, midwives and medical assistants;

d) professional recognition, recognition of responsibility and trust conferred by the society, as well as the domestic duties arising from this trust.

Art.3 The fundamental principles based on which the profession of nurses, midwives and medical assistants is practiced in Romania, are the following:

a) the profession is exercised only in respect for life and human being;

b) patient’s interest and public health prevail in any situation;

c) respecting patient’s right in any situation;

d) collaboration with all the stakeholders in ensuring patient’s health, whenever appropiate;

e) providing the highest quality standard services, based on a high level of competencies, practical skills and professional performance, without discrimination;

f) when exercising their profession, nurses, midwives and medical assistants need to demonstrate loyalty and solidarity to one another, under any circumstances, must provide collegial support and assistance, in order to accomplish their professional tasks;

g) nurses, midwives and medical assistants must act with professional honour and dignity and not bring prejudice to the profession or undermine patient’s trust, in any way.

CHAPTER II

PERSONAL RESPONSIBILITY, PROFESSIONAL INTEGRITY AND INDEPENDENCE OF NURSES, MIDWIVES AND MEDICAL ASSISTANTS

Art.4 In exercising their profession, nurses, midwives and medical assistants must avoid any attitudes that could affect their professional honor, and any aspects incompatible with the professional and individual integrity and morality.

Art.5 Nurses, midwives and medical assistants are required to have a flawless behavior towards patients, always respecting their dignity.

Art.6 In case of public danger, nurses, midwives and medical assistants have no right to abandon their patients, except for a formal order of a competent authority, according to the law.

Art.7 Nurses, midwives and medical assistants are responsible for each of their professional acts.

Art.8 Nurses, midwives and medical assistants within the public or private system must sign a liability insurance for errors in work, regarding the risks arising from their professional activity.

Art.9 Entrusting own duties to unqualified persons constitutes an ethical error.

Art.10 Nurses, midwives and medical assistants must communicate with the patient in an appropriate manner, using a respectful language, minimalizing the specialized terminology.

Art.11 Nurses, midwives and medical assistants must avoid any attempt of asking for reward, other than the legal payment forms.

CHAPTER III

PROFESSIONAL RELATIONSHIP WITH OTHER HEALTH PROFESSIONALS AND INSTITUTIONS

Section I

Professional relationship with other health professionals

Art.12 Based on team spirit, nurses, midwives and medical assistants owe each other mutual support.

Art.13 The following are considered breach of ethical rules:

a) professional offense and slandering;

b) professional blaming and defamation;

c) any other act or event that can affect the professional dignity of  nurses, midwives and medical assistants.

Art.14 (1) In case of conflict regarding the professional quality, in the first instance, the issue should be mediated by the County Council Office, at the county level /Bucharest level and by the Executive Board, at national level.

(2) If the conflict continues, the persons involved can contact The Ethics Comission or to the Court, disturbance of professional activities being forbidden for these reasons.

(3) Where breaches of ethic rules are found, the sanctioning procedure is enforced, according to the provisions set out in the Statute of The Order of Nurses, Midwives and Medical Assistants in Romania.

Art.15 If several nurses, midwives and medical assistants contribute to the examination, treatment or healthcare of the same patient, each practitioner must assume his own responsibility, individually, by applying the professional seal to each of their techniques or maneuvers performed personally.

Art.16, Nurses, midwives and medical assistants will collaborate with other health professions, in the interest of patients, respecting the professional dignity and honor.

Section II

Professional Relationships with the Institutions

Art.17 The employer must ensure optimal practice conditions for nurses, midwives and medical assistants.

Art.18 Nurses, midwives and medical assistants must notify the competent person or authority, of any circumstance that could harm the quality of healthcare or treatment, particularly those regarding the effects on the individual or those limiting the  practice.

Art.19 According to the different levels of responsability, nurses, midwives and medical assistants, must contribute to policy orientation and to the development of the health system.

CHAPTER IV

CONTINUING MEDICAL EDUCATION

Art.20 In order to increase the level of training, nurses, midwives and medical assistants are required to attend courses and  other forms of continuing education, attested by The Order of Nurses, Midwives and Medical Assistants in Romania, as well as other forms of continuing education required by law, in order to meet the minimum number of credits required annualy, for the renewal  their license to practice.

CHAPTER V

ETHICAL AND PROFESSIONAL OBLIGATIONS

Section I

Obligation to provide medical care

Art.21 When practicing their profession, nurses, midwives and medical assistants, will not discriminate patients based on  race, sex, age, ethnicity, national or social origin, religion, political views, personal  antipathy or social conditions.

Art.22 Nurses, midwives and medical assistants  are required to provide first aid.

Art.23 Nurses, midwives and medical assistants are required to provide the necessary medical assistance and healthcare, within the limits of their professional competence.

Art.24 In the event of natural disasters (earthquakes, floods, epidemics, fires) or mass injury (shipwrecks, road accidents, aviation accidents, nuclear accidents, etc.) nurses, midwives and medical assistants are required to answer the calls, to voluntarily provide their care services, as soon as they  learn about the event.

Art.25 (1) Patient’s will of choosing a specific nurse, midwife or medical assistant must always be respected, regardless of its meaning.

(2) If the patients’  physical or mental condition prevent them from lucidly express their will, the legal representatives or their relatives must be warned and properly informed, in order to decide on patient’s behalf, unless it is impossible (identify them, communicate or travel, etc),  or in case of emergency.

Art.26 If nurses, midwives or medical assistants feel that they do not have enough knowledge or experience to provide appropriate care, following the examination or during the procedures, they will consult with colleagues or refer the patient to another specialist.

Art.27 Nurses, midwives and medical assistants will maintain a strictly neutral attitude and will not interfere in the patients’ family issues (moral, material), expressing their opinion  only if the intervention is motivated by the patients’ health interest, with their prior consent.

Art.28 Nurses, midwives and medical assistants may refuse providing care to the patient, only when the refusal is motivated by the patient’s health interest, except in case of emergency.

Section II

Respecting the patient’s right

Art.29 The patient has the following rights: the right to medical information, the right to consent, the right to confidentiality and privacy, reproductive rights, the right to treatment and care.

Section III

Consent

Art.30 A medical intervention can not be  performed unless the patient or their legal representative give their informed consent. The patient has the right to refuse or to stop a medical intervention, assuming the responsibility for their decision, in writing; consequences of their refusal must be explained to the patient.

Art.31 Patient’s consent or, where appropiate, their legal representative’s, is mandatory for:

a) collection, storage and use of all biological products collected from their body, in order to  establish the diagnosis or treatment  that they have agreed with;

b) in case of any medical intervention;

c) participating in clinical medical education and scientific research;

d) photographing or filming them in a medical unit;

e) blood donation as provided by law.

Art.32 Patient’s consent or their legal representative’s, where appropiate, is not mandatory in the following situations:

a) when the patient can not express his will and an emergency medical intervention is required;

b) when healthcare providers consider that the intervention is in the interest of patient and the legal representative refuses to  give consent, nurses, midwives and medical assistants are required to notify the physician/emergency physician (the decision will be taken by a specialized  arbitration commission).

Section IV

Professional Secrecy

Art.33 (1) Professional secrecy is mandatory.

(2) Professional secrecy also must be maintained in case of tutors, colleagues or other persons within the health system, uninterested in the treatment, even after the end of treatment and the patient’s death.

Art.34 The object of secrecy represents everything that nurses, midwives and medical assistants, as professionals, learned directly or indirectly, about the patient’s private life, their families, tutors, as well as about the diagnosis, prognosis, treatment issues, disease-related circumstances and other various facts, including the autopsy results.

Art.35 Nurses, midwives and medical assistants are liable to disciplinary action for disclosing the professional secrecy, except where the patient has given expressed consent for disclosure of such information, in whole or in part.

Art.36 The general interest of the society (preventing and combating epidemics, sexually transmitted diseases, mass expansion diseases and others provided by law) takes precedence over the patient’s personal interest.

Art.37 In scientific communications, the cases will be presented so as the patient’s identity can not be recognized.

Art.38 Confidential information may be provided by nurses, midwives and medical assistants, only if the patient gives explicit consent or where expressly required by law.

CHAPTER VI

SPECIAL SITUATIONS IN PRACTICING WITHIN AN  INSTITUTIONALIZED SYSTEM

Section I

Mentally ill patient condition

Art.39 Individuals with mental disorders benefit from the same quality of medical assistance and healthcare  as those applied  to other categories of patients and adapted to their health needs.

Art.40 Any individual suffering from a mental illness must be protected from any damage  that can be done by the unjustified administration of a drug, the healthcare or treatment techniques and the maltreatment of other patients or individuals, or other acts likely to result in physical or mental suffering.

Art.41 (1) Mentally ill patients must be involved in the decision-making process, as far as their ability to understand allows it. If the mentally ill patients cannot freely express their will, their legal representative  must provide their written consent.

(2) Obtaining the consent is not required  under the conditions set out in paragraph (1) when an emergency intervention is neccessary.

(3) Patients have the right to refuse or to stop a medical intervention, as appropriate, by assuming the responsibility for their decision, in writing; the consequences of refusal or interruption of the medical actions must be explained to the patient and the physician must be informed, if the discontinuation of treatment or healthcare results in endangering patient’s life.

Art.42 Any mentally ill individual must be treated with kindness and respect for  human dignity and must be protected from all forms of economical, sexual exploitation or any other form of abuse, from harmful or degrading treatments. Discrimination based on  mental disorder is not accepted.

Section II

Prescribing, dispensing upon prescription and administration of drugs

Art.43 Prescribing, dispensing upon prescription and administration of drugs under conditions other than the ones provided by law, represents an offence.

Section III

Patients deprived of liberty

Art.44 Nurses, midwives and medical assistants who provide care services  for a patient deprived of liberty,  are forbidden to prejudice their physical and mental integrity and their dignity.

Art.45 If nurses, midwives or medical assistants learn that the patient deprived of liberty suffered from mistreatment, they have the obligation to notify the competent authorities.

Section IV

Patients infected with  HIV/AIDS

Art.46 (1) Patients infected with HIV/AIDS  have the right to undiscriminating medical care and treatment, and nurses, midwives and medical assistants have the obligation to ensure the healthcare and treatment prescribed to these patients.

(2) Keeping the confidentiality of data for the patient infected with HIV/AIDS is mandatory for the nurses, midwives and medical assistants who provide their care, supervision or treatment.

(3) Information regarding the HIV/AIDS status of a patient, must be shared between healthcare professionals.

CHAPTER VII

PRACTICING WITHIN A PRIVATE SYSTEM. HOME CARE

Art.47 Nurses, midwives and medical assistants practice on a salary basis and/or independently.

Art.48 Nurses, midwives and medical assistants who practice as a holder or associate of a medical practice unit, may provide home care, if they are duly authorized, according to the legal provisions on organizing and functioning of home care.

Art.49 Nurses, midwives and medical assistants have the obligation to inform the physician who recommended these services, on the evolution of the patient’s condition.

Art.50 Nurses, midwives and medical assistants called within a family or a community to practice their profession, must respect the rules of hygiene and prophylaxis.

CHAPTER VIII

CHILD CARE ISSUES

Art.51 If nurses, midwives and medical assistants consider that the under age is the victim of an assault or deprivation, they must try to protect them, by using caution and must alert the competent authority.

Art.52 Nurses, midwives and medical assistants must protect the under age patients, if they consider that their health condition is not well understood or not sufficiently protected.

Art.53 In order to perform techniques and/or care maneuvers and/or to provide treatment to an under age, consent must be obtained from their legal representative, except in case of emergency situations.                                                                                                                               

CHAPTER IX

HUMAN EXPERIMENTATION ISSUES

Art.54 (1) It is forbidden to induce artificial disorders to healthy individuals, for experimental reasons.

(2) The provisions of this article are added to other legal provisions regarding this matter.

Art.55 Imposition of an experiment on humans by force or by mislead, represents a serious misconduct for all nurses, midwives and medical assistants who voluntarily and knowingly participate in such acts.

CHAPTER X

SPECIAL PROVISIONS

Art.56 (1) Upon registration with The Order of Nurses, Midwives and Medical Assistants in Romania, nurses, midwives and medical assistants, respectively, will take the following oath:

“In the name of life and honour,

I swear

To practice my profession with dignity,

To respect human beings and their rights

And to keep the professional secrecy.

I swear that I will not let any considerations of nationality, race, religion, political affiliation or social statute  interfere between me and the patient.

I will maintain full respect for human life, even if threatened, and I will not use my medical knowledge contrary to the laws of humanity.

I take this oath solemnly and freely.

Art.57 The Membership certificate issued by OAMGMAMR is the proof of OAMGMAMR membership.

Art.58 Medical and care servics performed by nurses, midwives and medical assistants will bear their seal and signature, for individual accountability and proof of profesional responsibility.

Art.59 The membership certificate and the professional seal are adopted by the National Council of OAMGMAMR, as annexes to the Statute of OAMGMAMR, adopted by the Decision of The National General Assembly  of OAMGMAMR, no.1/2009 and are part of it.

CHAPTER XI

FINAL PROVISIONS

Art.60 Violation of the provisions of this Code represents a misconduct and results in disciplinary action.

Art.61 The disciplinary liability of the members of The Order of Nurses Midwives and Medical Assistants in Romania does not exclude civil, criminal, administrative or material liability.

Art.62 Referral procedure and resolution of cases are provided by the Statute of OAMGMAMR.

Art.63 Nurses, midwives and medical assistants have the obligation to inform the County Council of OAMMGMAMR and the Bucharest Council, respectively, on the changes in their professional situation.

Art.64 The County Council of OAMGMAMR and the Bucharest Council, respectively, will inform the National Council of OAMGMAMR on these changes.

Art.65 The provisions of this Code of Ethics and Deontology of nurses, midwives and medical assistants shall be completed according to the provisions of Law no. 46/2003 on patient rights, the provisions of Government Emergency Ordinance no. 144/2008, on the practice of nurses, midwives and medical assistants and the organization and functioning of The Order of Nurses Midwives and Medical Assistants in Romania, to the provisions of the Statute of OAMGMAMR, adopted by the Decision of The National General Assembly of OAMGMAMR, no.1/2009, to the provisions of the rules for organizing and functioning of OAMGMAMR, adopted by the Decision of The National General Assembly of OAMGMAMR, no.3/2009, as well as with the legal rules on specialties, as amended.

Art.66 Supplementing or amending this Code shall be done by the National General Assembly, at the proposal of The National Council of The Order of Nurses Midwives and Medical Assistants in Romania.

Art.67 Upon entry into force of this Code of Professional Ethics and Deontology of nurses, midwives and medical assistants, The Code of Ethics and  Deontology of nurses and midwives, adopted by the National General Assembly of  OAMGMAMR, is revoked.

Art.68 This Code of Professional Ethics and Deontology of nurses, midwives and medical assistants was adopted by the National General Assembly of OAMGMAMR at  9.07.2009 and shall enter into force on its publication in the Official Gazette of Romania, part.I.

Monitorul Oficial nr. 560/august 2009