AMA meeting: CEJA to study doctors' duty to guarantee access

The ethics body also tackled conflicts of interest in sports medicine.

By Kevin B. O'Reilly, amednews staff. Dec. 3, 2007.

Interim Meeting 2007

Meeting Notes

Resources

Honolulu -- Is access to health care a right? How could such a right be enforced, and what exactly does it entail?

These were some of questions surrounding access to health care that delegates considered at the Council on Ethical and Judicial Affairs' open forum held during the AMA's Interim Meeting last month.

Meeting notes: Medical ethics
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Topic: The uninsured

"There's a phenomenon in the nursing ethics world known as moral distress, which is knowing what the right thing to do is, but not being able to do it," said Susan Goold, MD, a CEJA member who introduced the topic for discussion. She said doctors experience moral distress when they know what treatment a patient needs but cannot provide it due to financial barriers.

Several delegates urged CEJA to avoid rights language when formulating ethical policy on access. "Once we say something is a right, it gives the government the opportunity to confiscate our services and the revenues of other people in order to provide that service," said Michael R. Redmond, MD, a Pensacola, Fla., ophthalmologist.

Some delegates said CEJA should put medical care in context as a market service for which physicians should be paid appropriately and be wary of overrun emergency departments or underfunded clinics that offer access in name only. Yet others said it's long overdue for health care to be viewed as a basic service to which everyone is entitled.

"We have established certain areas as being in the public good and that everyone has access to, such as public schools, fire protection, 911," said Leon Reinstein, MD, a Baltimore rehabilitation specialist. "When you call 911, they don't ask you what insurance you have."

Shifting gears, delegates also discussed what they believe should happen when physicians or health systems pay for the exclusive right to provide care for sports teams in exchange for promotion as the official health care choice of the hometown heroes.

It's a question that goes further than an existing Code of Medical Ethics opinion that says doctors should put the best interests of their athlete-patients before those of the teams they play for or the fans who root them on.

Many delegates said CEJA should declare the practice unethical because it might lead physicians to put a team's interests ahead of the athletes under their care.

AMA Secretary William A. Hazel Jr., MD, is an orthopedic surgeon who cares for the D.C. United professional soccer club but is concerned that new ownership may sell the right to care for the team's players to the highest bidder.

"The relationship I need to have with the players is that I'm the best doctor for the job, and if I'm paying to have that relationship, it undermines the trust I have with the players," he said.

ADDITIONAL INFORMATION:

Meeting notes: Medical ethics

Issue: Disagreements about treatment sometimes arise among doctors, parents and child patients. Resolving these disputes ethically and in the pediatric patient's best interest can be an awesome challenge for physicians.

Proposed action: A new ethical opinion that says pediatric patients should participate in medical decision-making in a way that is appropriate to their mental development; institutional policies should address how to resolve disagreements; and physical force and courts should be last resorts. [ Adopted ]

Issue: Doctors with financial ties to commercial umbilical cord blood banks have recommended the facilities to patients even though there is a 1 in 20,000 chance that low-risk children would develop a condition requiring them to use stem cells from their own cord blood.

Proposed action: A new ethical policy calling for doctors to obtain informed consent before cord blood is banked. Also, it calls on physicians to disclose any financial ties and recommend public, rather than private, banking to patients unless there is a family predisposition to a condition for which cord blood stem cells are therapeutically indicated. [ Adopted ]

Issue: Doctors may be missing cases of domestic violence and abuse by only questioning supposedly high-risk patient populations.

Proposed action: Revise AMA ethical guidelines to state that physicians should routinely inquire about violence and abuse, consider the possibility during differential diagnosis, note cultural variations when treating abused patients, and report abuse where legally required by supplying minimal information to respect patients' privacy. [ Adopted ]

Issue: Some physicians have skirted their ethical duty by limiting access to procedures that could benefit patients through the use of trade secrets, confidentiality agreements and other means, but existing AMA policy addresses only the unethical use of patents.

Proposed action: Amend the Code of Medical Ethics to make clear that the use of any legal tool to impede the sharing of medical knowledge is unethical. [ Adopted ]