Code of Ethical Conduct

The Code of Ethical Conduct was drafted as the Dartmouth-Hitchcock Medical Center Code of Professional Conduct in 1991 by the Hitchcock Clinic, Mary Hitchcock Memorial Hospital (MHMH), and Dartmouth Medical School (DMS), and was endorsed by the Veterans Affairs Medical Center in White River Junction (VAMC). Subsequent revisions of the Code were made and approved by the combined Board of Governors of the Dartmouth-Hitchcock Clinic (DHC) and the MHMH, and were endorsed by DMS and the VAMC. The 2010 revision was made by DHC and MHMH (now jointly called Dartmouth-Hitchcock, or D-H) and renamed the Code of Ethical Conduct-D-H to be applicable more generally.

Code of Ethical Conduct

The mission of Dartmouth-Hitchcock is to advance health through research, education, clinical practice, and community partnerships providing each person the best care, in the right place, at the right time, every time. The following core principles of ethical conduct represent values that support and serve this mission:

• Honesty, trustworthiness, and integrity.
• Respect for the dignity of persons.
• Respect for cultural and religious/spiritual beliefs.
• Respect for property.
• Respect for and adherence to the law.
• Respect for the physical and emotional environment in which we work.
• Personal responsibility and accountability for actions.
• Stewardship of financial, human, and other resources.
• Compassion.
• Commitment to continuous improvement.

The ethical principles inform a Code of Ethical Conduct (“Code”), which specifies behaviors that all individuals who work at, study at, or are affiliated with D-H (including its volunteers, agents, consultants, and vendors) are expected to display. The Code also applies to medical students as well as nursing and other professional allied health students who work or study at D-H.

While the principles that underlie the Code apply to all personnel, certain portions of the Code are more frequently applicable in some disciplines than in others. Certain principles have direct application in clinical settings, while others are applicable to teaching, research, business, or support activities.

All staff members at D-H are essential to our mission and are subject to the Code of Ethical Conduct. All professional staff members at D-H have additional ethical obligations that exceed legal and regulatory requirements by virtue of their professional training and because of their positions of responsibility. Professionals have responsibilities to those whom they serve, their colleagues, and the public.

The Code of Ethical Conduct is a series of principles and their subsidiary rules that govern all interactions. The Code consists of two complementary sections: obligations and ideals. "Obligations" refer to necessary behaviors that are required by the ethical foundation that informs our organizational mission as outlined above. “Ideals" refer to desirable behaviors to which D-H personnel and affiliates, at all levels, should aspire.

Failure to meet the obligations described below represents a violation of the Code. Items marked with an asterisk indicate behaviors that may additionally violate federal or state laws. Alleged infractions of the obligations of the Code will be dealt with by the appropriate D-H disciplinary committees and processes.

For ease of obtaining further detail, the Code is cross-referenced to applicable D-H policies that may change over time.

Obligations

1. Practice Respect for Persons
   • Treat those whom you serve, with whom you work, and the public with the same degree of respect you would wish them to show you.
   • Treat patients and colleagues with kindness, gentleness, and dignity.
   • Include patient preferences for treatment in the plan of care to the fullest extent possible.
   • Respect the privacy and modesty of patients.
   • Do not use discriminatory, harassing, hostile or profane language, verbally or in writing.
   • Do not harass others physically, verbally, psychologically, or sexually.*
   • Do not discriminate on the basis of gender, religion, race, disability, age, sexual orientation, national origin, or marital status.*
2. Maintain Patient Confidentiality
   • Do not share the medical or personal details of a patient with anyone except those health care professionals integral to the well-being of the patient or within the context of an educational endeavor.*
   • Do not seek data on patients unless you have a professional "need to know."*
   • Do not discuss patients or their illnesses in public places where the conversation may be overheard.
   • Do not publicly identify patients, verbally or in writing, without documented permission or adequate justification.
   • Do not invite or permit unauthorized persons into patient care areas.
   • Do not share your confidential computer system passwords with unauthorized persons.
3. Protect Confidential and Proprietary Information
   • Do not share other employees’ personal identifying information acquired as part of your job duties, including information such as Social Security numbers, addresses, and other personally identifying information, unless the employee has authorized such disclosure, or the acquisition and disclosure of personal identifying information is part of your job duties. Do not discuss business negotiations outside of the context of the negotiation itself.
   • Use electronic mail responsibly.
4. Maintain Personal Honesty and Integrity
   • Be truthful in verbal and in written communications.
   • Acknowledge your errors of omission and commission to colleagues.
   • Do not mislead others.
   • Do not cheat, steal, plagiarize, or otherwise act dishonestly.
   • When using information that is not your own in verbal or written communication or in medical records, give proper attribution, including the sources and date.
   • Do not abuse privileges.
   • Be truthful in negotiations and business transactions.
5. Assume Responsibility for Patient Care
   • Do not engage in unsupervised involvement in areas or situations where you are not adequately trained unless in an urgent or emergency situation.
   • Obtain the patient's informed consent for diagnostic tests or therapies.
   • Take responsibility for the patients under your care; when off duty, or on vacation, assure that your patients are adequately cared for by another practitioner.
   • Do not abandon a patient. If you are unable or unwilling to continue care, you have an obligation to arrange for alternative care or, if time permits, assist in making a referral to another competent practitioner willing to care for the patient.
   • Follow up on ordered laboratory tests and complete patient record documentation conscientiously.
   • Charge patients or their insurers only for clinical services provided or supervised.*
   • Provide services to all patients regardless of their ability to pay in accordance with the D-H Financial Assistance policy.
   • Do not abuse alcohol or drugs that could diminish the quality of patient care or academic performance.
   • Do not have romantic or sexual relationships with patients; if such a relationship seems to be developing, seek guidance and terminate the professional relationship.*
   • Cooperate with other members of the health care team in clinical activities.
   • Honestly disclose consequential, unanticipated outcomes to patients or families in accordance with D-H’s Communication of Unanticipated Patient Outcomes policy.
6. Maintain Awareness of Limitations and Opportunities for Improvement and Strive to Improve
   • Act in accordance with your authorized role and level of responsibility.
   • Be aware of your personal limitations and deficiencies in knowledge and abilities and know when and who to ask for supervision, assistance, or consultation.
   • Know when and for whom to provide appropriate supervision.
   • Report system problems that may place patients or others at risk of harm.
   • Assure that students have all patient workups and orders countersigned by the appropriate supervisor.
   • Avoid patient involvement when you are ill, distraught, or overcome with personal problems.
   • Keep abreast of new knowledge and policy changes that may relate to your work.
7. Practice Professional Deportment
   • Identify yourself and your role to patients and staff; wear your name tag.
   • Dress in a neat, clean, manner following local policies that govern accepted attire.
   • Maintain a professional composure despite the stresses of fatigue, professional pressures, or personal problems.
   • Introduce all students accurately and appropriately, for example, not as "doctor" or “nurse.”
   • Do not write offensive or judgmental comments in patients' charts.
   • If medical or professional decisions of colleagues are questionable, discuss with sensitivity in an appropriate place.
   • Avoid the use of first names without permission in addressing adult patients.
   • Conduct yourself in a professional manner whenever you are performing your job duties or representing the organization in a job-related capacity.
   • Resolve professional disagreements through discussion conducted respectfully.
8. Avoid Conflicts of Interest
   • Maintain your objectivity in all decision making and avoid creating any perceptions of impaired objectivity.
   • Follow institutional policies regarding disclosure of real or perceived conflicts of interest in a timely manner.
   • Avoid conflicts of interest, but when conflicts of interest exist, always resolve all of them in favor of the patient.
   • Follow guidance from the current Conflict of Interest and other applicable policies regarding the acceptance of gifts, participation in commercial incentive programs, accepting “kickbacks” for patient referrals, participation in contract negotiations that would benefit you or family members and other activities that are or could be perceived as a conflict of interest.*
9. Assume Responsibility for Self and Peer Behavior
   • Take the initiative to identify and help rehabilitate impaired students, physicians, nurses, and other employees with the assistance of the DMS Student Needs and Assistance Program, the Employee Assistance Program, or the employee's supervisor, and report appropriately.
   • Report breaches of the Code to the appropriate person.
   • Indicate disapproval or seek appropriate intervention if you observe less serious breaches.
   • Seek input and feedback from patients and colleagues on your own professional behavior, and use it to improve.
10. Respect Personal Ethics by Permitting Appropriate Conscientious Refusal
    • You are not required to perform or participate in procedures (e.g., elective abortions, termination of medical treatment) that you believe are unethical, illegal, or may be detrimental to patients.
    • You have an obligation; however, to inform patients and their families of available treatment options that are lawful and consistent with acceptable standards of medical and nursing care.
    • When no other staff member is available to care for the patient, you must continue to render appropriate care until another staff member can assume care of the patient.
11. Respect Property and Laws
    • Protect the property of D-H and its components and the property of patients, research participants, students, employees, contractors, and others who work in or are being served by our facilities.
    • Adhere to the regulations and policies of Dartmouth College and D-H.
    • Adhere to local, state, and federal laws and regulations.
    • Do not use computer and telecommunication resources for personal commercial purposes or financial gain or to distribute content that would violate D-H policy.
    • Report actual or suspected incidents of fraud, waste or abuse in federal health care programs to the appropriate party(ies). Reports can be made anonymously and without fear of retaliation.*
    • Do not misappropriate, destroy, damage, or misuse property of D-H.*
    • Conduct business in accordance with all pertinent laws and regulations and applicable institutional policies.*
12. Practice Ethical Behaviors in Teaching
    • Be knowledgeable about the subject material you are teaching.
    • Create and nurture a collegial environment in which students and trainees are valued and respected.
    • Foster student and trainee professional growth, lifelong learning, and ethical behavior.
    • Encourage intellectual curiosity and rigor.
    • Encourage academic freedom and integrity.
13. Maintain Trust and Integrity in Research
    • Respect the autonomy and promote the dignity of each human research participant; ensure just treatment of and create protections for those whose autonomous decision-making may be diminished or impaired; design research to minimize potential harm and maximize potential benefits for each human participant.
    • Obtain consent for participation in research based on providing adequate information for decision-making to each potential participant.
    • Reduce the potential for pain and suffering of research animals to an extent consistent with humane treatment.
    • Protect the integrity of scientific design, data collection, and conclusions.
    • Report the results of research honestly in scientific and scholarly presentations and publications, and without exaggeration to the public and the media.
    • Attribute proper credit to colleagues and others who contribute to the research when publishing and presenting reports of results. Accept co-authorship attribution only when appropriate.
    • Recognize that intellectual property has value and respect the ownership rights of others.
    • Avoid conflicts of interest in research activities and candidly disclose, on request, sources of income, ownership of equity, and any other relationship that produces or could be perceived to produce a conflict of interest.
    • Encourage the free sharing and collegial exchange of research results; foster cooperation and collaboration among research team members.
14. Practice Financial Responsibility
    • Adhere to laws and institutional policies to protect, spend, and account for money and resources to which we are entrusted.
    • Do not offer or accept bribes, kickbacks, or other inducements that may influence a decision, such as the purchase of products and services or patient referrals.
    • Adhere to all regulations and policies in spending and accounting for grants and contracts.
    • Adhere to accepted regulations governing fair and ethical billing and collection practices; including adhering to D-H’s False Claims Act policy.
    • Adhere to accepted accounting standards for records and reporting.
15. Promote Personal and Environmental Health and Safety
    • Adhere to institutional regulations and accepted practices governing the safe use of chemicals, drugs, equipment, and products in the workplace.
    • Take precautions to safely perform our duties and protect our coworkers.
    • Assure that your physical and mental health render you fit to work.
    • Promote a healthy work environment for us and our patients.
16. Promote Diversity, Equal Opportunity, and Respect in the Workplace
    • Practice the principles of equal opportunity and non-discrimination.
    • Promote an atmosphere in which we can discuss concerns about diversity and equal opportunity without fear of retaliation or retribution.
    • Maintain dignity and respect for all persons.
    • Discuss and resolve disagreement in the workplace in a professional manner consistent with D-H policy.
17. Follow Accepted Business and Legal Standards
    • Conduct all business operations in a manner that complies with applicable laws and regulations and merits the trust and respect of those whom we serve.
    • Fairly and accurately represent our services and responsibilities to the public.
    • Protect privileged information entrusted to D-H from vendors, referral sources, contractors, service providers, and others.
    • Do not disclose or use for your own or other’s personal gain any D-H trade secret and/or private or confidential information that you learn through your job duties.
18. Follow Rules Governing Personal Political Activities in the Workplace and Public Representation
    • Do not use D-H or DMS titles or affiliations to support or oppose candidates on public ballots.
    • You may use D-H or DMS titles or affiliations in public oral or written presentations for purposes of professional identification but not to represent the position of D-H without express permission.
    • Do not pursue personal political activities while in the workplace.
    • Do not use D-H or DMS letterhead or email for personal political activities or for personal commercial purposes.

Ideals

1. Virtues
   • Strive to cultivate and practice virtues, such as caring, empathy, and compassion.
2. Conscientiousness
   • Fulfill your professional and work-related responsibilities conscientiously.
   • Notify the responsible supervisor if something interferes with your ability to perform clinical or support tasks effectively.
   • Learn from experience and knowledge gained from errors in order to avoid repeating them.
   • Dedicate yourself to lifelong learning and self-improvement by implementing a personal program of continuing education and continuous quality improvement.
   • Students and trainees should complete all assignments accurately, thoroughly, legibly, and in a timely manner.
   • Students and trainees should attend scheduled classes, laboratories, seminars, and conferences except for justified absences.
3. Collegiality
   • Teach others at all levels of education and training.
   • Be generous with your time to answer questions from trainees, patients, and patients' family members.
   • Be a good D-H citizen by participating in your fair share of the communal work of the organization.
   • Adopt a spirit of volunteerism and altruism in teaching and patient care tasks.
   • Use communal resources (equipment, supplies, and funds) responsibly and equitably.
4. Personal Health
   • Develop a personal lifestyle of dietary habits, recreation, disease prevention, exercise, and outside interests to optimize physical and emotional health and enhance professional performance.
5. Objectivity
   • Avoid providing professional care to colleagues, family members, and friends or to persons with whom you have a romantic relationship, outside the context of a doctor-patient relationship.
6. Responsibility to Society
   • Avoid unnecessary patient or societal health care monetary expenditures.
7. Advancement of Professionalism
   • Strive to further professionalism.

*Behaviors that also may violate federal or state laws.

D-H Policy ID: 2347