VENEZUELAN CODE OF MEDICAL ETHICS
National Academy of Medicine
The Venezuelan Code, first promulgated by the National Academy of Medicine of Venezuela in 1918, was largely the work of Dr. Luis Razetti and for this reason is sometimes called the "Razetti Code." It served as a model for other codes of medical ethics in Latin America (Colombia, 1919; Peru, 1922). The Sixth Latin American Medical Congress, meeting in Havana in 1922, recommended that the Venezuelan Code (slightly revised in 1922) serve to unify medical ethical concerns in Latin America. The First Brazilian Medical Congress, held in Rio de Janeiro in 1931, was similarly influenced by the Venezuelan Code.
The Venezuelan Code of 1918 includes many elements characteristic of the codes of its day, with heavy emphasis on the protection of the dignity of the profession, the maintenance of high standards of competence and training, duties toward patients (even regarding their health habits), the rendering of professional services to other doctors, obligations regarding substitute physicians and consultants, professional discipline, fees, etc.
There are several interesting features in the Venezuelan Code which deserve comparison with other codes:
1. The Code insists that there are "rules of medical deontology" which apply to the entire "medical guild"—physicians, surgeons, pharmacists, dentists, obstetricians, interns, and nurses.
2. It places emphasis on physicians' virtues and qualities of character— circumspection, honesty, honor, good faith, respect, etc.—which serve as a basis for those practices of etiquette that support the honorable practice of medicine.
3. The Code prohibits abortion and premature childbirth (morally and legally), except "for a therapeutic purpose in cases indicated by medical science"; but it permits embryotomy if the mother's life is in danger and no alternative medical skills are available.
4. In the excerpt below, there is an interesting and detailed set of instructions on "medical confidentiality.'' It combines a strong affirmation of the moral obligation of health professionals to observe confidentiality with many attenuations of that obligation in the interests of the public welfare.
Chapter IX. On Medical Confidentiality
Article 68. Medical confidentiality is a duty inherent in the very nature of the medical profession; the public interest, the personal security of the ill, the honor of families, respect for the physician, and the dignity of the art require confidentiality. Doctors, surgeons, dentists, pharmacists, and midwives as well as interns and nurses are morally obligated to safeguard privacy of information in everything they see, hear, or discover in the practice of their profession or outside of their services and which should not be divulged.
Article 69. Confidential information may be of two forms: that which is explicitly confidential—formal, documentary information confided by the client -and that which is implicitly confidential, which is private due to the nature of things, which nobody imposes, and which governs the relations of clients with medical professionals. Both forms are inviolable, except for legally specified cases.
Article 70. Medical professionals are prohibited from revealing professionally privileged information except in those cases established by medical ethics. A revelation is an act which causes the disclosed fact to change from a private to a publicly known fact. It is not necessary to publish such a fact to make it a revealed one: it suffices to confide it to a single person.
Article 71. Professionally confidential information belongs to the client. Professionals do not incur any responsibility if they reveal the private information received by them when they are authorized to do so by the patient in complete freedom and with a knowledge of the consequences by the person or persons who have confided in them, provided always that such revelation causes no harm to a third party.
Article 72. A medical person incurs no responsibility when he reveals private information in the following cases:
1. When in his capacity as a medical expert he acts as a physician for an insurance company giving it information concerning the health of the applicant sent to him for examination; or when he is commissioned by a proper authority to identify the physical or mental health of a person; or when he has been designated to perform autopsies or give medico-legal expert knowledge of any kind, as in civil or criminal cases; or when he acts as a doctor of public health or for the city; and in general when he performs the functions of a medical expert.
2. When the treating physician declares certain diseases infectious and contagious before a health authority; and when he issues death certificates.
In any of the cases included in (1), the medical professional may be exempt from the charge of ignoring the right of privacy of a person who is the object of his examination if said person is his client at the time or if the declaration has to do with previous conditions for which the same doctor was privately consulted .
Article 73. The physician shall preserve utmost secrecy if he happens to detect a venereal disease in a married woman. Not only should he refrain from informing her of the nature of the disease but he should be very careful not to let suspicion fall on the husband as responsible for the contagion. Consequently, he shall not issue any certification or make any disclosure even if the husband gives his consent.
Article 74. If a physician knows that one of his patients in a contagious period of a venereal disease plans to be married, he shall take pains to dissuade his patient from doing so, availing himself of all possible means. If the patient ignores his advice and insists on going ahead with his plan to marry, the physician is authorized without incurring responsibility not only to give the information the bride's family asks for, but also to prevent the marriage without the bridegroom's prior consultation or authorization.
Article 75. The doctor who knows that a healthy wet-nurse is nursing a syphilitic child should warn the child’s parents that they are obligated to inform the nurse. If they refuse to do so, the doctor without naming the disease will impose on the nurse the necessity of immediately ceasing to nurse the child, and he should arrange to have her remain in the house for the time needed to make sure that she has not caught the disease. If the parents do not give their consent and insist that the wet-nurse continue to nurse the child, the doctor shall offer the necessary arguments, and if they nevertheless persist he shall inform the nurse of the risk she runs of contracting a contagious disease if she continues to nurse the child.
Article 76. The doctor can without failing in his duty denounce crimes of which he may have knowledge in the exercise of his profession, in accord with article 470 of the [Venezuelan] Penal Code.
Article 77. When it is a matter of making an accusation in court in order to avoid a legal violation the doctor is permitted to disclose private information.
Article 78. When a doctor is brought before a court as a witness to testify to certain facts known to him, he may refuse to disclose professionally private facts about which he is being interrogated, but which he considers privileged.
Article 79. When a doctor finds himself obliged to claim his fees legally, he should limit himself to stating the number of visits and consultations, specifying the days and nights, the number of operations he has performed, specifying the major and minor ones, the number of trips made outside the city to attend the patient, indicating the distance and time involved in travel in each visit, etc., but in no case should he reveal the nature of the operations performed, nor the details of the care that was given to the patient. The explanation of these circumstances, if necessary, shall be referred by the doctor to the medical experts so designated by the court.
Article 80. The doctor should not answer questions concerning the nature of his patient's disease; however, he is authorized not only to tell the prognosis of the case to those closest to the patient but also the diagnosis if on occasion he considers it necessary, in view of his professional responsibility or the best treatment of his patient. . . .
["Codigo Venezolano de Moral Medica," in Luis Razetti, Obras Completas: I. Deontologia Medica. Caracas: Ministerio de Sanidad y Asistencia Social, 1963, pp. 111-135. The excerpt translated here is found on pp. 124-127.]