l^\b"T The University of British Columbia Library THE CHUNG COLLECTION This book is the property of Dr. Address ...„„__^i2^^^ ,&§ Anyone finding it is requested to return it to above address. CONSTITUTION. -BY-LAWS and CODE OF ETHICS •C lltfiiad llssodaiion; zzs& IBZZ TRYTHALL ft SON. PRINTERS. 678 HOMER ST. VANCOUVER. B.C. IT The Constitution and By-Laws OF THE 'British Columbia Medical Association constitution. Article I. NAME. This Association shall be called the British Columbia Medical Association. Article II. OBJECTS. The objects of the Association shall be:— (a) The advancement of medical science in all its branches. (b) The prevention of disease, with vigorous support to all health officers, health boards and others engaged in this work. (c) The maintenance of a high scientific and social status of its members. (d) The protection of the public against those unqualified to treat the sick or injured. (e) The close co-operation of its members in the protection of their rights. (f) The regulation of minimum scale of fees, with such alteration of such scale from time to time as becomes necessary by reason of changes in the cost of living, education, etc. (g) The dealing with all matters for the good and welfare of the Association. .-4— Article Ml. MEMBERSHIP. Any medical practitioner, licensed in British Columbia and in good standing, is eligible for membership in this Association upon fulfilment of the requirements hereinafter set forth. There shall be two classes of members: (a) Active. (b) Honorary. The qualifications of the members shall be as follows:— No medical man shall be eligible for membership in this Association until he has been one year in practice in this province and has the approval of the majority of the members in the branch organization of the district in which he practices. "Good standing" in the Association shall be deemed to entail conduct worthy of a physician and citizen, and due observance of these Articles and By-Laws, together with the code of ethics as laid down by the Association, (a) Active Members shall be members of the profession resident in the Province of British Columbia, who have qualified for membership, and who have been elected to membership at any annual meeting or regular meeting of the Executive Committee. Honorary Members shall be members of the profession, or others, who have distinguished themselves by their attainments in medical or allied sciences or who have rendered signal service to this Society. (b) -o— Recommendations for election to Honorary Membership shall come solely from the Executive Committee. Such recommendations shall be made only at a regular meeting of the Executive Committee, and then only provided the Executive is unanimously in favour of the proposed recommendations. Article IV. BRANCHES. Any Medical Society, at present existing in the Province of British Columbia, or any Society, which may in future, be organized in the province,* may, upon application, become a branch of the British Columbia Medical Association. Article V. MEETINGS. The time and place of the annual meeting shall be determined by the Executive Committee. Special meetings may be called by the President at his discretion, or at the written request of fifteen members in good standing. Twenty members shall form a quorum at any meeting. Article VI. OFFICERS. (a) The title of "Honorary President" may be conferred at any annual meeting upon any member of the profession for merit, by a majority vote of members present. (b) The officers shall be President, President-elect, Immediate Past —6 President, Vice-President, and Secretary-Treasurer, all of whom shall be elected by ballot at the annual meeting. (c) The Executive Committee shall consist of the President, Presidentelect, Immediate Past President, and Vice-President of the Association, and three members at large, elected by the Association, together with a representative from each local Medical Society organized within the province and affiliated with the Association, who shall be appointed by the said local Society. BY-LAWS. Article I. DUTIES OF OFFICERS. (a) President. |§8| The President shall preside at all meetings of the Association, or of the Executive Committee, and perform all other duties that custom, parliamentary practice and usage may require. In his absence the Vice-President shall preside, and in the event of both President and Vice-President being absent, the Immediate Past President shall preside. (b) President-ESect. The President-elect shall take office as President immediately following the annual meeting next succeeding that at which he is elected. He shall be a member of the Executive Committee during the time of his ser- -7- vice as President-elect and as President, and for one year after vacating the office of President. (c) Immediate Past President. After having held the office of President for at least one year and on vacating this office a member of this Association shall be known as "Immediate Past President," and shall be a member of the Executive Committee for one year after the date of his successor's election. (d) Vice-President. .The Vice-President shall assist the President in the discharge of his duties. (e) Secretary-Treasurer. The Secretary-Treasurer shall attend all meetings of the Association and Executive Committee; shall record the minutes of such meetings; conduct the correspondence of the Association; keep a list of members and their addresses; shall present a general report at each annual meeting; and shall perform such duties as the Association and Executive Committee may from time to time require. He shall have no vote at Executive Committee meetings. He shall receive all subscriptions, donations and other moneys payable to the Association. He shall pay all accounts for expenses out of the Association funds, and make such other disbursements as the Association shall decide. He shall keep a detailed record of receipts and expenditures and present a report of the financial condition of the Association at each annual meeting. He shall deposit all moneys received by him on behalf of the Association in a recognized chartered bank, and shall ■ —8— disburse the same by cheque, signed by himself and by the President or Vice-President, or other member of the Association designated by the Executive Committee. He shall receive such remuneration for his services as the Executive Committee shall decide. He shall furnish a bond, which shall be paid for out of the funds of the Association. (f) Auditor. An Auditor shall be appointed each year by the Executive Committee, and he shall examine the vouchers and books of the Secretary-Treasurer within the week prior to the annual general meeting, and | report thereon to that meeting. Article II. COMMITTEES. Standing Committees, consisting of five members each, shall be appointed by the incoming Executive Committee for the current year. The chairmen of Standing Committees are to be ex-officio members of the Executive Committee. These Standing Committees shall be as follows: — (a) The Legislative Committee, whose duty it shall be to watch all Bills affecting the practice of medicine coming before the Legislative Assembly and Municipal Councils, and to take such steps as are necessary to promote legislation favourable to, and to combat legislation adverse to, the interests of the profession and the public. (b) An industrial Service Committee, whose duty it shall be to deal with all matters arising out of the Workmen's Compensation Act, or similar legislation, and also —9— to advise regarding any medical contracts which may from time to time affect the profession or its members. (c) A Publicity and Educational Committee, who shall arrange to conduct a systematic and continuous campaign through the lay press, or through whatever other channels may be deemed advisable, to educate the public with regard to questions of health, sanitation, recognition of early signs of diseased conditions, the progress of medical science, the lack of scientific training of members of various cults which pretend to heal by irregular means, and any other sohjects which from time to time they may deem in the interests of the public and the medical profession should be given publicity. For this purpose they may appoint a staff of control, both lay and medical, to prepare articles along the lines indicated. They shall appoint a Board of Censors (Medical), who shall review all such articles before they are submitted to-the press, so as to eliminate any statements which may not Be orthodox or be recognized as sound in the light of present-day medical knowledge. (d) The Credentials Committee shall examine all applications for membership and shall report thereon, with recommendations, to the Executive Committee. Article III. NOMINATING COMMITTEE. There shall be a Nominating Committee appointed at the annual meeting by the President, who shall nominate the officers — 10— and elective members of the Executive Committee, and report the same to the annual meeting. Article IV. ALTERATION OF CONSTITUTION. No section of Constitution shall be made, altered, or repealed, except at a general meeting, nor unless a written notice, specifying the nature and the object of the proposed amendment shall have been given to the Executive at least one month previously. Article V. ETHICS. This Association shall be governed by the Code of Ethics of the Canadian Medical Association. Article VI. THE RULES OF PROCEDURE. The rules of procedure of this Association shall be those of Canadian parliamentary procedure, except where such conflicts with these Articles and By-Laws. Article VII. FEES. (a) Private Practice. The following scale of fees is recommended for use by members of this Association in private practice. (a) Generally speaking the figures in the first column of the scale following will form the minimum charge for the services to which they are annexed. —11— (b) In cases of PROTRACTED ILLNESS, especially with patients in reduced circumstances, it is the custom to charge a sum for the whole attendance, which may be less than the total would be if a separate fee were charged for each visit. If any material departure is made below that amount, the patient should be informed that such departure is unusual and special in his case. MEDICO-LEGAL FEES. (c) If a physician is called to give "expert" evidence in any case, he should obtain in writing, and beforehand, a specific agreement that his fees will he paid, as otherwise he has no recourse. SPECIALISTS' FEES. (d) If asked what a specialist's charges will be, the general practitioner should refrain from mentioning any definite sum, unless such a sum is specifically mentioned in the following list, or until after communication with the specialist. The minimum fees in subjoined Schedule A are not to be considered as binding upon specialists. (e) It is understood that in case of a consultation, the fee of the consultant should be paid at the time, and if this is not possible, the consultant should be told, and arrangements made for payment. (f) All bills for services rendered by a physician other than the regular attendant shall be sent direct to the patient by such physician. SCHEDULE A. House and Office Practice. 1. Office consultation $ 2.50 upwards (a) Advice over telephone 1.00 —12— 2. Single visit, 8 a.m. to 8 p.m 3.00 f| 3. Ordinary attendance, each visit.. 3.00 4. Single visit, 8 p.m. to 8 a.m., in cluding Sundays 5.00 " If more than one member of the family is seen, an extra consultation fee may be charged. 5. Consultation with another physi cian | 5.00 "■ 6. Visit on vessel at wharf 3.00 '* 7. Visit on vessel in harbor or visit on vessel in roads 5.00 " 8. Visit to country, per mile (one way) in addition to ordinary fee l.OO " 9. When visiting in country, if call ed to see person in neighborhood, or on the road 5.00 " 10. Vaccination 2.50 " 11. Certificate of Health 2.50 | 12. Urinalysis 2.50 1 13. Life Insurance 5.00 | 14. Highly infectious diseases, e. g., smallpox, per visit 5.00 j§ 15. Post-mortem examinations, ex cept in Coroner's cases (apart from microscopical examinations) 25.00 | 16. Blood transfusion 25.00 " 17. Thoracentesis 10.00 | 18. Lumbar puncture 10.00 | VENEREAL DISEASE. 19. For first consultation $ 5.00 upwards ($10.00 to be paid in advance) $0z Salvarsan injections (exclusive of drug) 15.00 | —13— SURGICAL FEES. 20. (a) Assisting at operations 10 (Minimum $5.00)- ANAESTHETICS. (b) Up to half hour $ 6 For every 10 minutes over half hour, $1.00 extra. MINOR OPERATIONS. (c) Wounds requiring stitches....$ 5 Dressings 2, Incision of abscess 5. Peritonsillar abscess 10, Foreign body in eye 3. Removal of small tumors 5 Hydrocele (tapping) 5, Radical cure (Hydrocele) 50. Varicocele 50. Circumcision 15, Haemorrhoids, Fissures 50, Stricture 50, Fistula 50 t Ingrowing toe-nail 10 MAJOR OPERATIONS. (d) It is suggested that in fixing the fee for a critical major surgical or obstetrical operation, a definite percentage (8 to 10 per cent.) of the yearly income of the responsible party be charged. HEAD AND NECK. Trephining skull $100. Harelip 100. Cleft palate 100. Thyroid 1 150, -25% 00 upwards .00 upwards 50 <« 00 << 00 boring colleagues to take charge of the case. Other physicians may be associated in the care of the patients as consultants. Art. IN.—Of the Duties of Physicians in Regard to Consultations. 1. Under no conditions should a physician consult with other than a regularly qualified practitioner. 2. In a consultation the good of the patient is the sole object in view. 3. In consultations, no rivalship or jealousy should be indulged; candor, probity, and all due respect should be exercised toward the physician having charge of the case. 4. Consultants should retire to a private place for deliberation, and the one first in attendance should communicate the directions agreed upon to the patient or his friends, as well as any opinions which it may be thought proper to express. But no statement or discussion of it should take place before the patient or his friends except in the presence of all the consultants attending, and by their common consent, and no opinions or prognostications should be delivered which are not the result of previous deliberation and concurrence. Attending Physician Responsible. 5. The physician in attendance is in charge of the case and is responsible for the treatment of the patient. Consequently he may prescribe for the patient at any time and is privileged to vary the mode of treatment outlined and agreed on at a consultation, whenever, in his opinion, such a 54- change is warranted. However, at the next consultation, he should state his reasons for departing from the course decided upon at the previous conference. When an emergency occurs during the absence of the attending physician, a consultant may provide for the emergency and the subsequent care of the patient until the arrival of the physician in charge, but should not do more than this without the consent of the physician in charge. 6. A physician who is called upon to consult should observe the most honorable and scrupulous regard for the character and standing of the practitioner in attendance. The practice of the latter, if necessary, should be justified as far as it can be consistently with a conscientious regard for truth, and no hint or insinuation should be thrown out which would impair the confidence reposed in him, or affect his reputation. The consulting physician should also carefully refrain from any of those extraordinary attentions or assiduities which are too often practised by the dishonest for the base purpose of gaining applause, or ingratiating themselves into the favor of families and individuals. Consultant and Attendant. 7. When a physician has attended a case as a consultant, he should not become the attendant of the patient during that illness except with the consent of the physician who was in charge at the time of the consultation. i vO 8. When a patient is sent to one especially skilled in the care of the condition from which he is thought to be suffering, and for any reason it is impracticable for the physician in charge of the case to accompany the patient, the physician in charge should send to the consultant by mail, or in care of the patient under seal, a history of the case, together with the physician's opinion, and an outline of the treatment, or as much of this as may possibly be of service to the consultant; and as soon as possible after the case has been seen and studied the consultant should address the physician in charge and advise him of the results of the consultant's investigations of the case. Art. IV.—Duties of Physicians in Case of Interference. 1. A physician, in his intercourse with a patient under the care of another practitioner, should observe the strictest caution and reserve. No meddling inquiries should be made, no disingenuous hints given relative to the nature and treatment of his disorder, nor any course of conduct pursued that may directly or indirectly tend to diminish the trust reposed in the physician employed. 2. The same circumspection and reserve should be observed when, from motives of business or friendship, a physician is prompted to visit an individual who is under the direction of another practitioner. Indeed, such visits should be avoided except under peculiar circumstances, and when they are 36— made no particular inquiries should be instituted relative to the nature of the disease or the remedies employed, but the topics of conversation should be as foreign to the case as circumstances will admit. 3. A physician ought not to take charge of or prescribe for a patient who has recently been under the care of another member of the faculty in the same illness, except in cases of sudden emergency or in consultation with the physician previously in attendance, or when the latter has relinquished the case or been regularly notified that his services are no longer desired. Under such circumstances no unjust, illiberal insinuations should be thrown out in relation to the conduct or practice previously pursued, which should be justified as far as candor and regard for truth and probity will permit. 4. When a physician is called to an urgent case because the family attendant is not at hand, he ought, unless his assistance in consultation be desired, to resign the care of the patient to the latter immediately on his arrival. 5. It often happens in cases of sudden illness or of recent accidents and injuries, owing to the alarm and anxiety of friends, that a number of physicians are simultaneously sent for. Under the circumstances courtesy should assign the patient to the first who arrived, who shall select from those present any additional assistants that he shall deem necessary. In all such cases, however, the practitioner who officiated should request the family physician, if there -^z- be one, to be called, and unless his further attendance be requested, should resign the case to the latter on his arrival. This shall equally apply where a patient is taken to a hospital. 6. When a physician is called to the patient of another practitioner, in consequence of the sickness or absence of the latter, he ought, on the return or recovery of the regular attendant, to relinquish the case. 7. When a physician attends a woman in labor in the absence of another who has been engaged to attend, such physician should resign the patient to the one first engaged upon his arrival; the physician is entitled to compensation for the professional services he may have rendered. Art. V.—Of Differences Between Physicians. 1. Whenever there arises between physicians a grave difference of opinion which cannot be properly adjusted, the dispute should be referred for arbitration to a committee of impartial physicians, preferably the Committee on Ethics of the Local Medical Society. It is desirable that such a committee be appointed and act in each county or local society. Art. VI.—Of Standards of Fees.- 1. General rules and standards regarding fees should be adopted by the profession in every province and district. It should be deemed a point of honor to adhere to these rules with as much uniformity as varying circumstances and conditions will admit. rr -38-- o Cl. The payment of a commission to any" person or persons who may be instrumental in influencing a patient or patients to apply for professional advice, is wrong in principle, and detrimental to the best interests of our profession. 3. When two or more practitioners are engaged in a case, the disposition of the respective fees shall only be made with the knowledge and consent of the patient as varying circumstances and conditions will admit. 4. By the members of no profession are free services given more generally and generously than by medical men; but justice requires that some limits should be placed to the performance of such good offices. Poverty, professional brotherhood, and certain public duties, should always be recognized as presenting valid claims for gratuitous services. But institutions endowed by the public or rich individuals, societies for mutual benefit, for the insurance of lives (the certificates for which should be sent confidentially to the company and paid for), whether furnished by the medical adviser of the company or by the family physician, or for analogous purposes, nor any special profession or occupation can be admitted to possess such privilege. Nor can it be justly expected of physicians to furnish certificates of inability to serve on juries, to perform militia duty or to testify to the state of health of persons wishing to insure their lives, obtain pensions, or the like, without a pecuniary acknowledgment. But to individuals in indigent circumstances such- —39- professicnal services should always be cheerfully and freely given. CHAP. C. OF THE DUTIES OF THE PROFESSION TO THE PUBLIC. Art. I.—Duties of the Profession to the Public. 1. As good citizens it is the duty of physicians to be ever diligent and vigilant for the welfare of the community, and to bear their part in sustaining its institutions and burdens. They should also be ever ready to give counsel to the public in relation to matters especially appertaining to their profession, as on subjects cf medical police, public hygiene and legal medicine. It is their province to enlighten the public in regard to quarantine regulations, the location, arrangement and dietaries of hospitals, asylums, schools, prisons, and similar institutions; in relation to the medical police of towns, as drainage, ventilation, etc., and in regard to measures for the prevention of epidemic and contagious diseases, and when pestilence prevails it is their duty to face the danger and to continue their labors for the alleviation of the suffering, even at the jeopardy of their own lives. 2. It is the duty of physicians, who are frequent witnesses of the enormities committed by quackery, and the injury to health and even destruction of life'caused by the use of quack medicines, to enlighten the —40— public on these subjects, to expose the injuries sustained by the unwary from the devices and pretensions of artful empirics and imposters. Physicians ought to use all the influence which they may possess by exercising their option in regard to the shops to which their prescriptions shall be sent, to discourage druggists and apothecaries vending quack or secret medicines, or from engaging in any way in their manufacture and sale. Principles of Ethics. In conclusion, it may be pointed out that such a Code of Ethics is based upon the Golden Rule, and that the principles enunciated are primarily for the good of the patient and public, and their ©bservance and enforcement should be conducted in such a manner as shall deserve and receive the endorsement of the community. a it ■ uJdO ■*«■» r\*ZU< tqz2s m fe 12#&<^ r* T ■ - 4