BACKGROUND:

The profession of optometry is privileged to serve the eye care needs of the public and is entrusted by society to do so professionally and ethically. The placement of the patient’s interests above self-interest is referred to as fiduciary duty and is the primary ethical responsibility of all health care professionals. Specifically, optometrists must look after the best interests of their patients concerning the patient’s eye, vision, and general health. Additionally, an ethical optometrist strives to protect and enhance the health and welfare of the public in general.

The Bihar’s Optometry Association (BOA) has adopted a Code of Ethics and Standards of Professional Conduct to guide optometrists in their professional and ethical duties. These documents are supplemented by The Optometric Oath and certain BOA’s (Executive Body) resolutions policy statements. The content of these ethical documents and pronouncements is the result of a continually evolving relationship between the profession of optometry and the society it serves. While the Code of Ethics of the Bihar’s Optometry Association sets forth the basic tenets of ethical behaviour for optometrists, the Standards of Professional Conduct is a more evolving document that amplifies the Code of Ethics and describes appropriate ethical and professional behaviours in greater detail. It is the intent of the Bihar’s Optometry Association that the Code of Ethics and the Standards of Professional Conduct be written expressions of and a continuing commitment to professional and ethical behaviour for all optometrists.

Ethics and the law are two different entities, although many times these may overlap. The law sets minimum standards for societal behaviour that all persons must comply with. Ethics is generally set higher than minimum standards for behaviour that people should strive for as the ideal.

Standards of Professional Conduct:

1. Patient Participation: Optometrists must respect the right of their patients to be active participants in decisions affecting their health care. This duty should be reinforced and supported through patient education and effective communication.
2. Confidentiality: Optometrists and their staff should hold in confidence all protected health and other personal information. This is an essential element of the doctor-patient relationship that is necessary to build and maintain trust. The optometrist may reveal protected health and other personal information only with the written consent of the patient. However, exceptions to confidentiality do exist that are ethically justified. These exceptions occur either when it is necessary to protect the welfare of the patient or others when faced with a significant threat, or when the release of information is required by law. It should be noted that an ethical imperative of an optometrist to release information to protect the welfare of the patient or others without the patient’s consent may have legal considerations.
3. Truthfulness: Telling the truth is a necessary component of a trusting optometrist- patient relationship. From an ethical standpoint, there are two levels of truthfulness, veracity, and candor. Simply put, veracity is “telling the truth” and candor is “telling the whole truth.” Optometrists should always practice veracity and strive to tell the truth. While candor is usually required from an ethical standpoint, exceptions are only justifiable out of kindness to the patient or to protect the overall best interests of the patient. Since breaching candor would be a violation of the basic principle of patient autonomy, it should only be considered after careful reflection and weighing the alternatives.
4. Informed Consent: Optometrists must inform patients or their legal guardians about the patient’s health care and health care options. The process of informed consent requires the optometrist to make a reasonable determination of the patient’s ability to reason and make informed decisions free of external coercion. Additionally, optometrists should explain to the patient or their legal guardian the patient’s health care status, what appropriate procedures are available, and the risks and benefits of each procedure. Finally, optometrists should make the effort to ensure that the patient or guardian has a reasonable understanding of the information presented.
5. Patient Records: The optometrist is responsible for maintaining appropriate and accurate records on every patient encounter. Upon written request and following applicable federal and state laws, patients or their legal guardians have a right to obtain or have sent copies or summaries of their medical records.
6. Conflict of Interest: The care of a patient should never be influenced by the self- interests of the provider. Optometrists should avoid and/or remove themselves from any situation that presents the potential for a conflict of interest where the optometrist’s self-interests are in conflict with the best interests of the patient. Disclosure of all existing or potential conflicts of interest is the responsibility of the optometrist and should be appropriately communicated to the patient.
7. Referral: An optometrist should refer a patient whenever the optometrist believes this may benefit the patient. The provider and/or facility to which the patient is referred should be based primarily on what is in the best interest of the patient. When a patient is referred to another health care provider, the referring optometrist should remain involved in co-managing the patient’s overall care. An optometrist should not offer or accept payment of any kind, in any form, from any source, for referring a patient.
8. Respect for the Law: Optometrists should comply with all applicable state and Indian laws and should remove themselves from any situation which prevents them from fulfilling their legal and professional responsibilities. It should also be noted that ethical duties may sometimes exceed legal obligations.
9. Patient Abandonment: Once the optometrist has undertaken a course of treatment, the optometrist should not discontinue treatment without giving the patient adequate notice and the opportunity to obtain the services of another eye care provider. Optometrists are responsible for ensuring appropriate follow-up care when not available to render such care.
10. Advertising: Advertising by optometrists should be truthful and under prevailing Indian and state laws and regulations. Optometrists who advertise should identify their professional degree and/or their profession in all forms of advertising and should never mislead the public regarding their expertise or competency. Optometrists should not hold themselves as having superior knowledge or credentials other than their earned degrees, certifications, or license types.