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 2009 Interim Meeting Open Forum will be held:
Monday, Nov. 9th, 2009
9:30 a.m. to 11:00 a.m.
Convention Center Room 320 A-E
Houston, TX.
The Open Forum will be 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.
Never Events
"Never events" are defined by the National Quality Forum (NQF) as errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients. These adverse events include surgery performed on the wrong body part or wrong patient, patient death or serious disability associated with the use of contaminated or wrong drugs, devices, or biologics provided by the healthcare facility, and an infant discharged to the wrong person. There are no known precise figures regarding deaths and increased costs associated with never events, however it is estimated that never events lead to tens of thousands of deaths per year and billions in excess costs. Some states have instituted mandatory reporting of the events on the NQF list. Physicians have an ethical obligation to study error and prevent harm, however the practical implementation for physicians and facilities of these mandatory reports raises ethical questions. Concerns have also been raised regarding the clarity and appropriateness of how never events are defined.
Relevant Principles of Medical Ethics:
Principles I, II, III, VII.
Relevant Opinion in the Code of Medical Ethics:
E-8.121, "Ethical Responsibility to Study Error and Prevent Harm"
E-9.025, "Advocacy for Change in Law and Policy"
E-9.032, "Reporting Adverse Drug or Device Events"
Relevant Literature:
Serious Reportable Events in Healthcare: 2005-2006 Update. National Quality Forum.
Farley DO, Haviland A, Champagne A, Jain AK, Battles JB, Munier WB, Loeb JM. Adverse-event reporting practices by US hospitals: results of a national survey. Quality and Safety in Health Care. 2008:17;416-423.
Limiting Serious, Preventable, and Costly Medical Errors- Never Events. Centers for Medicare and Medicaid Services. May 18, 2006.
Michaels RK, Makary MA, Dahab Y, et al. Achieving the National Quality Forum's "Never Events": prevention of wrong site, wrong procedure, and wrong patient operations. Ann Surg. 2007;245:526-532.
Stewardship and Management of Finite Resources
Many studies have been published that demonstrate that health care spending levels in the United States are unsustainable. Another body of research has shown that many physicians appear to be over utilizing health care resources. Regional and other variations in health care utilization by physicians do not correlate with difference in health outcomes. High levels of health care utilization have been linked to fee-for-Service payment systems, technological innovation, and defensive medicine. Currently, efforts are being made (some successfully) to control utilization by physicians at a policy and health system level. On the other hand, the effort to control utilization on the level of individual physicians making decisions for individual patients has been a struggle and garnered intense debate. The ethical obligation of a physician to the patient is paramount, however societal interests, stewardship, cost-conscious decisions, and justice must all play some role in ethical decision-making. However, how big of a role and whether that amount should be decided by an individual physician or by policy-makers further complicates this topic.
Relevant Principles of Medical Ethics:
Principles VII, VIII and IX.
Relevant Literature:
Gawande A. The cost conundrum: What a Texas town can teach us about health care. The New Yorker. June 1, 2009, 2009
Fisher ES, Bynum JP, Skinner JS. Slowing the growth of health care costs--lessons from regional variation. N Engl J Med. Feb 26 2009;360(9):849-852.
Hall MA, Berenson RA. Ethical practice in managed care: a dose of realism. Ann Intern Med. Mar 1 1998;128(5):395-402.
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 rebecca.shore@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.
Individuals involved with planning and presenting this activity have no relevant financial relationships to disclose
Learning Objectives
- Identify emerging and currently relevant issues in medical ethics.
- Apply ethical obligations related to "never events," (to report such events, to study error and prevent harm and advocate for changes in law and policy) to medical practice.
- Apply principles of medical ethics to the management of finite resources in medical practice including decisions to order diagnostic tests, procedures and prescriptions.
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 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
