Ethics in the medical profession

You might have noticed in the general news portion of this newsletter an item about National Healthcare Decisions Day, which is being observed April 16, and the role that physicians play in discussing end-of-life issues with patients. This news piece is part of Ethics in Brief, a monthly report that highlights AMA policy on various ethics topics. Recent issues have covered financial incentives and generic drugs, lethal injection, and physician self-referral.

Ethics in Brief is one of many ways the AMA helps ensure that physicians and the medical community subscribe to strict principles and standards of professionalism. These principles and standards—the backbone of what we do every day—are documented in the AMA Code of Medical Ethics, the most comprehensive ethical guide for physicians.

Did you know that the AMA Code was the first ever national code of ethics for any profession? In fact, it dates back 161 years and the original manuscript (PDF, 88KB), written in 1847 (the same year the AMA was founded), began with these words: “A physician should not only be ever ready to obey the calls of the sick, but his mind ought also to be imbued with the greatness of his mission, and of the responsibility he habitually incurs in its discharge.” Taking out the (unfortunately) gender-specific nature of these words, it’s remarkable how pertinent the principles and values of the original code are to medicine today.

At the same time, medicine certainly has come a long way since then. The code now applies the timeless values of medicine to issues that its original writers could hardly have imagined—from multiplex genetic testing to xenotransplantation, and from do-not-resuscitate orders to managed care contracting. The code is the most practical and up-to-date ethical guide available to physicians anywhere, and it is used as a standard not only nationally but worldwide. The full text of the code can be downloaded to a PDA, and a pocket-sized version summarizing key issues also is available.

The AMA’s Council on Ethical and Judicial Affairs (CEJA) maintains and updates the code. Comprising seven practicing physicians, a resident or fellow, and a medical student, CEJA completed the most recent update in 2006. Opinions issued since then can be found online, including ethics policy approved at the 2007 Interim Meeting of the AMA House of Delegates.

CEJA reports and opinions analyze and address timely issues that affect physicians and the medical profession. These opinions become official AMA policy after the House of Delegates deliberates and approves them.

But CEJA doesn’t work alone—it receives input from AMA members and nonmembers alike. And the rest of the AMA’s Ethics Group performs critical research on ethical issues and teaches the subject to medical students, residents, and physicians. In other words, the AMA doesn’t just make policies on ethics; our policies are buttressed by research and educational outreach. Excellence in research, teaching, and policy-making on ethics makes the AMA, in my judgment, the nation’s premier resource on ethical issues in medicine.

A distinctive part of the AMA’s Ethics Group is the Institute for Ethics, an academic research and training center that surveys physicians and publishes articles in peer-reviewed journals on emerging issues such as professionalism and accountability, public health preparedness, health care communication, and health information privacy. Institute researchers work with other units in the AMA and with independent researchers from around the world to carry out cutting-edge research, which has served as the foundation for CEJA’s policy work and for policy-making throughout the AMA, in areas such as disaster preparedness, health disparities, and health information technology.

In 2006, the Ethics Group launched a new research program: Innovative Strategies for Transforming the Education of Physicians (ISTEP), an impressive research partnership of 27 medical schools in 15 states that studies how physicians learn so we can better shape medical education. ISTEP investigators and educators are working together on two research projects: one studying the influence that pharmaceutical industry marketing and promotion have on physician prescribing, and another on the development of educational materials for students and residents to promote substance abuse prevention.

One unique offshoot of the Institute for Ethics is the Ethical Force program, a collaborative effort to develop organizational performance measures for ethics quality. With so many different parties involved in health care (often influencing physicians’ ability to practice ethically), it’s important that all participants have reasonable and integrated expectations for each other’s ethical behavior. The Ethical Force program works to ensure that managed care organizations, employers, investors, patients, the government, and clinicians are accountable to one another for setting and then living up to these ethical expectations.

The Ethical Force program is governed by a 23-member oversight body, representing organizations from across the health care continuum, that selects topics for performance measure development. Unlike many performance measures, Ethical Force measures are geared to assess the ethical culture of organizations, not individual doctors. These measures undergo rigorous field testing to ensure validity, reliability, and feasibility. A recently released toolkit allows organizations to assess their communication climate, with a special focus on the needs of patients with low health literacy, language barriers, or cross-cultural communication gaps.

The Ethics Group also produces educational and outreach programs for medical students and residents through the Ethics Resource Center (ERC). The ERC’s Ethics-in Action program is designed to strengthen AMA medical student chapters by encouraging and funding selected ethics education and service projects proposed by the students. In the projects funded for this year, medical students are teaching school-aged children in neighborhoods near their campuses about nutrition and healthy lifestyles.

A major outreach program of the ERC is Virtual Mentor, the AMA’s online journal for ethics, which focuses on ethical and professional issues that medical students, residents, and young physicians are likely to confront during their training or daily practice. This month’s issue explores the relationship between the mind, body, and brain and how the connections across them affect illness and medical care. One of my favorite issues included several articles addressing ethical matters in medical shows on television. A great feature of the journal is that it’s student- and resident-driven; theme issue editors are selected each year through a competitive process from among medical students and resident physicians.

The AMA offers fellowships and internships in ethics (research-oriented and policy-oriented), which are great opportunities for medical students, residents, and practicing physicians. These fellowships and internships are unpaid, but participants may receive course credit for their work in accordance with the requirements of their academic program.

Good technical skill and customer service are essential elements of high-quality health care. But it is equally important that every part of the health care system uphold the highest standards of ethics and professionalism. Helping physicians and medical students live up to those standards has always been, and will continue to be, a core objective of the AMA.

Please send comments, questions, and replies to amaprez@ama-assn.org.