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A-08 Open Forum
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 2008 Annual Meeting Open Forum will be held on Monday, June 16 th , 2008, from 8:00 a.m. to 9:30 a.m., in Regency Ballroom C of the Hyatt Regency Chicago.
The Open Forum will be open to all AMA members, interested non-members, other guests, and the press.
1. 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.
2. Professional obligation to take call
Recently, CEJA has received several inquiries regarding physicians' duty to take call and payment for being on call. Health care institutions and hospitals along with physicians share an ethical obligation to provide emergency care to patients. This obligation, to some extent is legally mandated under the Emergency Medical Treatment and Labor Act (EMTALA) which requires hospitals to provide on call specialists to the appropriate level of an individual institution's medical staff. However whether a physician is compensated for taking call can be based on their specialty or whether they are employed by a hospital or private practice. Is taking call a part of a physician's obligation to patients? Is it ethical for hospitals to mandate that staff participate in on call panels? Is it fair that some specialties are compensated for taking call and others are not?
Relevant Principles of Medical Ethics: Principles VI, VII, and IX
Relevant Opinion in the Code of Medical Ethics:
E-4.06 Physician-Hospital Contractual Relations
Relevant literature
American College of Emergency Physicians. Problems with on-call coverage contribute to treatment delays and rising hospital costs. American College of Emergency Physicians. http://www.acep.org/PrintFriendly.aspx?id=29884. Accessed April 3, 2008.
Fromer, M. Pay4Call: Economic, Ethical, and Quality Issues of Payment for Taking Call: Physicians Angry at Lack of Payment. ENToday. 2007;2(12):1,18. http://www.entoday.com/
pt/re/entoday/pdfhandler.01265117-200712000-00002.pdf;jsessionid=H1pPgsf1PLj331hHylp92q4
QR3NpXB9LLPlkzpVJWQ2GlJL63L92!132671813!181195628!8091!-1?index=1&database=ppvovft&results=
1&count=10&searchid=1&nav=search Accessed April 3, 2008.O'Malley AS, Draper DA, Felland LE. Hospital Emergency On-Call Coverage: Is There a Doctor in the House?, Issue Brief No. 115. Center for Studying Health System Change. http://www.hschange.com/CONTENT/956/. Published November 2007. Accessed April 3, 2008.
3. Genetic testing and “recreational genomics”
There is a range of ethical issues that continue to emerge with the growth in number of genetic tests. Though the Code of Medical Ethics contains a number of ethical Opinions on physicians' obligations to their patients regarding genetic testing, there are many more questions that are yet to be answered.
Relevant Principles of Medical Ethics: Principles I, IV, V, and VIII.
Relevant Opinions in the AMA Code of Medical Ethics:
E-2.12 Genetic Counseling
E-2.131 Disclosure of Familial Risk in Genetic Testing
E-2.132 Genetic Testing by Employers
E-2.135 Insurance Companies and Genetic Information
E-2.136 Genetic Information and the Criminal Justice System
E-2.137 Ethical Issues in Carrier Screening of Genetic Disorders
E-2.138 Genetic Testing of Children
E-2.139 Multiplex Genetic TestingRelevant literature
Phil B. Fontanarosa PB, Pasche B, DeAngelis CD. Genetics and Genomics for Clinicians. JAMA. 2008;299(11)1364-1365.
van Ommen DG, Cornel MC. Recreational genomics? Dreams and fears on genetic susceptibility screening. Euro J Human Genetics. 2008;16:403–404.
Colliver V. Home DNA tests create medical, ethical quandaries. San Francisco Chronicle. August 21, 2007:C1. http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/08/21/BUKGRJ32F.DTL. Accessed April 3, 2008.
Prenatal testing questioned for mild disease. MSNBC. http://www.msnbc.msn.com/id/20841358/. Updated Sept 18, 2007. Accessed September 17, 2007.
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.The American Medical Association 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.
Learning objectives:
- Identify emerging and currently relevant issues in medical ethics and suggest topics to be addressed in future reports and opinions.
- Debate the ethical obligations of physicians as related to taking call.
- Debate the ethical issues surrounding genetic testing and “recreational genomics.”
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Content provided by: CEJA