Genetic testing, gifts among CEJA topics

Controversy and consensus are both expected to be generated during deliberations of Council on Ethical and Judicial Affairs reports at the upcoming AMA Annual Meeting.

By Andis Robeznieks, amednews staff. June 2/9, 2003.

The AMA Council on Ethical and Judicial Affairs will be exploring matters both esoteric and scientific at the 2003 AMA Annual Meeting, but -- eventually -- the discussion always seems to come back to the doctor-patient relationship.

Items on the CEJA agenda include reports on accepting gifts from patients, self-regulation, disclosure of familial risks uncovered by genetic testing, and the ethical responsibility to study and prevent medical errors.

Links
See related content

The unifying thread of caring for patients runs through just about all 12 reports on the agenda -- even in a report supporting cloning for biomedical research.

The doctor-patient relationship is not a one-way street, however, and CEJA acknowledges this in its revised report on disclosing familial risks uncovered by genetic testing.

The report was approved last June without much discussion, but concerns were raised at the Association's December 2002 Interim Meeting, and delegates sent it back to CEJA for revision.

"There wasn't much controversy at all the first time," said CEJA Chair Leonard J. Morse, MD, a New Bedford, Mass.-based internist. "But after it was approved, there was six months of reflecting on it, and the American Society of Clinical Oncology and other genetics interest groups brought it to our attention that they felt it was putting a tremendous burden on physicians. The way it was written before, every time they did a genetic test, the doctor would have to call all the patient's biological relatives and tell them about the information" in the test.

The report's recommendations were revised, he said, to put responsibility for telling relatives about any family risks uncovered by genetic tests squarely on the shoulders of the patient who was tested.

The report's first recommendation explains that physicians have a professional duty to protect the confidentially of their patient's information, and that even includes genetic data that might be of concern to the patient's relatives.

But the report also states that, before testing, doctors should discuss with their patients circumstances under which they would expect them to notify their relatives about test results, and that the physician should be available to help the patient with family communications.

Medical errors back on agenda

Another report making its third appearance on the agenda involves doctors' ethical responsibility to study and prevent medical errors.

"I think this is the most important report we're bringing forward," Dr. Morse said. "I think the greatest disappointment is the failure to learn from an error."

The report calls for responding to errors with compassion and continued treatment for the patients, along with providing an explanation for the error and the steps being taken so similar errors won't reoccur. It also calls for developing confidential and protected error-reporting mechanisms and for physicians to seek changes in legal systems that open error reporting to legal liability.

"The medical liability issue is the only thing stifling this report, which is unfortunate," Dr. Morse said, adding that the report is "a strong message to our patients that we recognize the situation" on medical errors.

Dr. Morse said he expected little controversy about the report on accepting gifts from patients, which states that accepting a gift as a token of appreciation doesn't fall outside ethical boundaries. But it is unethical to accept gifts in exchange for preferential treatment.

Also, if a gift is believed to be disproportionate to the care delivered or if it might create a hardship for the patient's family, Dr. Morse said the gift should be respectfully declined. "That's when you say, 'I appreciate your thoughtfulness, but I don't think I can accept this,' " he said.

While the report on accepting gifts may not create much of a controversy, Dr. Morse said he anticipates that a report on cloning for biomedical research "will generate a lot of discussion." The report sidesteps the reproductive cloning controversy by acknowledging scientific evidence that this may never happen.

"At this time, cloning to produce children appears impossible," the report states. "Therefore, it is inaccurate to claim that cloned human embryos have the potentiality for human life. Fears related to cloning to produce children … do not justify the prohibition of all cloning."

Dr. Morse said CEJA also would hold an open forum focusing on expert testimony and problems with disparities and access to care. "The open forum is going to be very exciting," he said, adding that attendees are also eligible for continuing medical education credits.