Adopted March 1, 2001

Preamble

The Code of Ethics of the American College of Rheumatology, Inc. (the "College") applies to the entire College, including its Fellows and Members, and is enforceable solely by the College.

The primary purpose of this Code of Ethics is to support the College's mission, which is to advance rheumatology through programs of education, research, and advocacy that foster excellence in the care of people with arthritis and rheumatic and musculoskeletal diseases.

The College can succeed in this mission only if it maintains its reputation in the scientific and medical communities and with the general public as a credible, objective and unbiased force whose statements, activities and relationships are beyond reproach.

It is the purpose of this code to provide guidelines which will ensure this reputation be maintained. The College has not attempted in this Code to set forth a position regarding all ethical issues which its members may face in their day-to-day professional activities. A primary purpose of this Code is to emphasize those ethical matters which bear directly on the College's scientific and educational mission and to those activities which relate to that mission.

As used in this Code of Ethics, the term "Member" means any Fellow or Member of the College in any class of membership, except as otherwise noted.

I. General principles of medical ethics

These General Principles of Ethics form the first part of this Code of Ethics. These general principles represent generally accepted standards of professional conduct which members should strive to attain. The following Principles of Professional Conduct have been adopted by the American College of Rheumatology as standards of honorable behavior which each member of the College is expected to follow in his or her relationship with patients, colleagues and the public.

1. Members shall be dedicated to providing competent medical care with compassion and respect for human dignity.
2. Members shall uphold the dignity and honor of the profession by dealing honestly with their patients and colleagues; they should expose, without hesitation, colleagues engaged in fraud or deception or other illegal or unethical conduct.
3. Members 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.
4. Members shall respect the rights of their patients and shall, within the constraints of the law, safeguard the confidentiality of the physician/patient relationship.
5. Members shall continue to study, apply and advance scientific knowledge and should make useful information available to their patients, colleagues and the public. Physicians have an affirmative obligation to disclose new medical advances to patients and colleagues.
6. Members may choose whom they will serve. In an emergency, however, members should render service to the best of their ability. Having undertaken the care of a patient, a member may not neglect the patient unless the patient has been discharged and may discontinue medical service only after giving adequate notice to the patient.
7. A member's responsibility extends to community and society, and members should participate in civic and community activities contributing to an improved society.
8. Members shall provide their patients a reasonable explanation of the etiology, treatment and prognosis of their disease.
9. In the practice of medicine, members shall limit the source of their professional income to services actually rendered by them or to the patients under their supervision when they are personally and identifiably responsible for the service. Fees should be commensurate with services rendered, and members shall neither pay nor receive commissions for the referral of patients.
10. Members shall not dispense or supply drugs, remedies or appliances unless it is in the best interest of their patients.
11. Members should seek consultation upon request, in doubtful or difficult cases, or whenever it appears that the quality of medical service may be enhanced thereby.
12. Members should provide the general public information necessary to select a qualified health care provider. Members shall not engage in advertising which is false, fraudulent, deceptive or misleading.
13. Members shall provide services under terms and conditions which permit the free and complete exercise of sound medical judgment and skill.
14. Members' clinical judgment should not be affected by an economic interest.

II. Specific principles.

The Rules and Policies of Ethics set forth below form the second part of this Code of Ethics. They are mandatory and specific standards of conduct for all Fellows or Members of the College in any class of membership.

A. Rules and policies pertaining to the individual

1. Members shall comply with all ACR policies including but not limited to ACR bylaws, ACR Code of Ethics, as well as all laws, government regulations and requirements of other bodies governing the member on account of his/her professional status (e.g., health care entities, boards of medical examiners, self-regulatory bodies). Self-dealing must be avoided.
2. Members shall ensure that public statements and statements to the press should preserve patient confidentiality and be truthful and not deceptive or misleading.
3. Members shall not use the imprimatur of the College or its name or logo as to create the impression that the members speak for College or that the College has endorsed any product, service, person or idea without the College's consent.

B. Rules and policies pertaining to volunteers and staff

1. Members and staff should act in the best interests of the College in carrying out responsibilities in good faith, with reasonable care, honesty, and due diligence.
2. Members and staff shall give individual allegiance to the College when making decisions affecting the College.
3. Members and staff should avoid self dealing including transactions with the organization where they have a personal or business interest beyond their interest as a representative of the College.
4. Members and staff shall not use their position within the College for individual advantage or advantage of another person or entity to which they are related or obligated.
5. Members and staff shall not engage in unauthorized activities, i.e. those activities that are not in accordance with College bylaws, policies, and other documents addressing their responsibilities.
6. Members and staff shall maintain the confidences of the College.
7. Members and staff shall discharge responsibilities with fidelity to the College and make decisions that are in the best interests of the organization.
8. Members and staff shall disclose any relationships that pose or could be construed to pose potential conflict of interest such as relationships which may affect or appear to affect College activities and decisions.
9. Members and staff should endeavor to avoid conflicts of interest and the appearance of conflicts of interest.

C. Disclosure policy

The purpose of ACR's Disclosure Policy is identification of relationships which may pose actual or potential conflicts. These actual or potential conflicts can then be evaluated by the College so that adjustments can be made which will avoid any undue influence. In this regard, the Policy provides for comprehensive procedures and forms for making such disclosure. This procedure includes:

1. Annual submission of Disclosure Statement by officers, board members, Journal editors, committee chairs, committee and task force members and senior staff in order to disclose relationships which may pose actual or potential conflicts.
2. A procedure for giving notice of an actual or potential conflict and to abstain from participating in any item of business which comes before a board, committee or other meeting.
3. A procedure for participants in Board meetings, Committee meetings and similar meetings where ACR business is being conducted to inform members of any significant relationships which may actually or potentially influence the participant's views.
4. A procedure for speakers at scientific meetings, symposia or other conferences conducted under ACR auspices to inform members of any relationships which may actually or potentially have an influence on the speaker.
5. A procedure for authors and reviewers of manuscripts submitted to the College for publication to alert editors of any financial support received by the author or any other interest that the author and/or reviewer may have which might affect the author's work.

Copies of all disclosure forms can be obtained through the ACR office or at the ACR Web site.

D. Policy regarding gifts to members from industry

Members should be aware that accepting gifts, grants, hospitality or the like may influence clinical judgment. The College recognizes that some gifts given to Members by companies in the pharmaceutical, device and medical equipment industries are educationally and socially beneficial. The College also recognizes that certain gifts from industry to physicians and other health professionals, while reflecting customary practices of industry, may not be consistent with accepted principles of medical ethics. In order to avoid the acceptance of inappropriate gifts, the College supports the following Guidelines:

1. Any gifts accepted by Members individually should primarily entail a benefit to patients and should not be of substantial value. Accordingly, textbooks, modest meals and other gifts may be appropriate if they serve a genuine educational function. Cash payments should not be accepted.
2. Individual gifts of minimal value are permissible as long as the gifts are related to the member's work (e.g., token items such as pens and notepads).
3. Subsidies to underwrite the costs of continuing medical education conferences or professional meetings can contribute to the improvement of patient care and therefore are permissible. Since the giving of a subsidy directly to a Member by a company's sales representative may create a relationship which could influence the use of the company's products, any subsidy should be accepted by the conference's sponsor who in turn can use the money to reduce the conference's registration fee. Payments to defray the costs of a conference should not be accepted directly from the company by the Members attending the conference.
4. Subsidies from industry should not be accepted to pay for the costs incurred by a member of travel, lodging or other personal expenses of attending conferences or meetings, nor should subsidies be accepted to compensate for the Member's time. Subsidies for hospitality should not be accepted outside of modest meals or social events held as a part of a conference or meeting. It is appropriate for a member who serves as faculty at conferences or meetings to accept reasonable honoraria and to accept reimbursement for reasonable travel, lodging and meal expenses. Token consulting or advisory arrangements cannot be used to justify compensating Members for their time and their travel, lodging and other out-of-pocket expenses.
5. Scholarship or other special funds to permit medical students, residents and fellows to attend carefully selected educational conferences may be permissible as long as the selection of students, residents or fellows who will receive the funds is made by the academic or training institution.
6. No gifts should be accepted if there are strings attached. For example, Members should not accept gifts if they are given in relation to the Member's prescribing practices. In addition, when companies underwrite medical conferences or lectures other than their own, responsibility for and control over the selection of content, faculty, educational methods and materials should belong to the organizers of the conferences or lectures.

III. Administrative procedures

The third part of the Code of Ethics sets forth the structure and operation of ACR's Ethics Committee and the procedure for the Ethics Committee and the Board of Directors to handle the challenges raised under the Rules of Ethics.

The ethics subcommittee

Member misconduct

Special judiciary committee

The Special Judiciary Committee shall consist of five (5) voting members of the ACR, excluding members of the Board of Directors, appointed by the President.

The Special Judiciary Committee shall not make a recommendation for disciplinary action with respect to a member unless written notice shall have been sent by registered or certified mail to the member not less than thirty (30) days prior to a meeting of the Special Judiciary Committee

1. stating the time and place of such meeting,
2. informing the member of the alleged misconduct and that disciplinary action against him or her will be considered at such meeting, and
3. that he or she may appear in person with his or her counsel, if he or she so elects, and submit such evidence as he or she deems proper to show that disciplinary action should not be taken. A recommendation of any disciplinary action, including, but not limited to, censure, probation, suspension, or expulsion, shall require an affirmative vote of a majority of the members of the Special Judiciary Committee.
   

Board action

Before final action is taken by the Board of Directors upon a recommendation of the Special Judiciary Committee for disciplinary action against a member, written notice shall be sent by registered or certified mail to such member not less than thirty (30) days prior to a meeting of the Board of Directors (a) advising the member of the recommendation of the Special Judiciary Committee and (b) informing him or her that he or she may, if he or she so elects, submit a written statement to the Board stating his or her objections to the recommendation of the Special Judiciary Committee.

A copy of the recommendation of the Special Judiciary Committee shall be included with such notice. The Board shall review the recommendation and the written statement, if any, submitted by the member, and determine whether to uphold, modify or reject the recommendation of the Special Judiciary Committee. The decision of the Board of Directors shall be final. The Board of Directors may adopt procedural rules more specifically governing the conduct of the foregoing investigations and hearings.

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