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Council On Ethical And Judicial Affairs Open Forum

In conformity with Resolution 14 (I-94), which requires the Council on Ethical and Judicial Affairs (CEJA) to "conduct an Open Forum at all future meetings for the purpose of discussing pending ethical opinion issues," the 2015 Interim Meeting Open Forum will be held:

Monday, June 13, 2016
9:30 a.m. to 11 a.m.
Hyatt Regency Chicago
Chicago, IL

The Open Forum is open to all AMA members, interested non-members, other guests, and the press.

New Proposed Issues

Open Forum attendees are invited to introduce emerging ethical issues that may warrant attention from CEJA and inclusion in the AMA "Code of Medical Ethics."

Dual Loyalties

The subject of dual loyalties presents in various medical professions: sports medicine, independent medical examiners, public health, military and prison doctors. The article cited below discusses the dual loyalties in military medicine in particular. While the Presidential Commission for the Study of Bioethical Issues unequivocally stated that medical ethics are not different for military physicians “except in the most extreme contingences”, military physicians frequently face extreme ethical dilemmas when they are called upon to supervise interrogations that include torture tactics, force feeding prisoners on hunger strikes, and certifying soldiers who are mentally wounded to return to dangerous war zones and combat duty.

Relevant Literature:
Annas GJ. “Military Medical Ethics-Physician First, Last, Always.” New England J Med. 2008;359(11):1087-1089.

Issues in Medical Tourism

There are several salient ethical issues surrounding medical tourism. One example of the potential risks of seeking surgery abroad is related to the differing microbiomes of the host nation and destination when compared to the individual’s home. This can be particularly concerning when a patient is receiving care in a developing nation or country that has a dramatically different climate. Some of the other concerns with medical tourism that are outlined in the articles cited below are compromised pre-surgical evaluation, post-surgical management, patient safety, and “the oversight, accountability and record keeping to support those tenets of surgery commonly seen in developed nations.” Further, when complications develop once the patient has returned home, it is often difficult to reach the surgeon abroad for information or records to aid in their care. In a survey of Canadian physicians, 41% of the physicians who had encountered such patients responded that patients presented with insufficient information about their treatment abroad. A survey of US medical tourism companies found that 91% of the companies gathered patient satisfaction data, while only 50% collected patient outcome data. In developed nations, this data is routinely collected and complications are commonly taken back to the operating surgeon responsible.

Relevant Literature:
Boyd JB, McGrath MH, Maa J. “Emerging trends in the outsourcing of medical and surgical care.” Arch Surgery. 2011;146(1):107-112.

Procedural Guidelines

A member of the Council on Ethical and Judicial Affairs will briefly present each topic on the agenda. After an issue has been introduced, the audience will be invited to discuss, with the Council, the ethical and professional considerations most relevant to the development of ethical guidelines on the topic at hand. In addition, the Council will collect written testimony for consideration at the time of the Open Forum or prior to it. Advance written testimony can be submitted to the Council staff, by e-mail at danielle.hahn@ama-assn.org or by fax at (312) 464-4799. Written testimony submitted to the Council will be given the same consideration as if it had been delivered orally.

Any member of the Association is privileged to speak on agenda items. Members should be mindful to disclose any conflict of interest that may influence their testimony. All other individuals should request from the Chair the privilege to provide oral testimony, indicating their identity and affiliation. Such a request will be honored upon approval of the Chair. Due to time constraints or other considerations, however, the Chair may not approve such requests.

All commentary should directly relate to the AMA Principles of Medical Ethics:

I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements, which are contrary to the best interests of the patient.

IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

IX. A physician shall support access to medical care for all people.

The Chair may establish rules on the presentation of testimony with respect to time constraints, repetitive statements, etc. The Chair also has the authority to prohibit photography, filming, and audio or video recording if the Chair feels that such factors would be undesirable for the orderly conduct of the meeting. Adherence to these guidelines will ensure that the forum runs smoothly and that the results are satisfactory to all.

Disclosure. The content of this activity does not relate to any product of a commercial interest as defined by the ACCME; therefore, there are no relevant financial relationships to disclose.

Learning Objectives

  • Identify several professions where physicians may face ethical issues with dual loyalties.
  • Describe typical ethical challenges when dealing with dual loyalties.
  • Describe why medical tourism is a potential concern to be aware of, regardless of specialty.
  • Identify the various ethical challenges with medical tourism.
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.