The AMA Code of Medical Ethics and health care spending

Kevin B. O'Reilly , Senior News Editor

A recent study published in JAMA comparing health care spending in the U.S. with other developed countries is sparking new discussion about the money expended to deliver medical care to Americans. The AMA Code of Medical Ethics has guidance that focuses on the physician’s role as a steward of health care resources.

In Opinion 11.1.2, “Physician Stewardship of Health Care Resources,” the Code explains:

Physicians’ primary ethical obligation is to promote the well-being of individual patients. Physicians also have a long-recognized obligation to patients in general to promote public health and access to care. This obligation requires physicians to be prudent stewards of the shared societal resources with which they are entrusted. Managing health care resources responsibly for the benefit of all patients is compatible with physicians’ primary obligation to serve the interests of individual patients.

To fulfill their obligation to be prudent stewards of health care resources, physicians should:

(a) Base recommendations and decisions on patients’ medical needs.

(b) Use scientifically grounded evidence to inform professional decisions when available.

(c) Help patients articulate their health care goals and help patients and their families form realistic expectations about whether a particular intervention is likely to achieve those goals.

(d) Endorse recommendations that offer reasonable likelihood of achieving the patient’s health care goals.

(e) Choose the course of action that requires fewer resources when alternative courses of action offer similar likelihood and degree of anticipated benefit compared to anticipated harm for the individual patient but require different levels of resources.

(f) Be transparent about alternatives, including disclosing when resource constraints play a role in decision making.

(g) Participate in efforts to resolve persistent disagreement about whether a costly intervention is worthwhile, which may include consulting other physicians, an ethics committee, or other appropriate resource.

Physicians are in a unique position to affect health care spending. But individual physicians alone cannot and should not be expected to address the systemic challenges of wisely managing health care resources. Medicine as a profession must create conditions for practice that make it feasible for individual physicians to be prudent stewards by:

(h) Encouraging health care administrators and organizations to make cost data transparent (including cost-accounting methodologies) so that physicians can exercise well-informed stewardship.

(i) Ensuring that physicians have the training they need to be informed about health care costs and how their decisions affect overall health care spending.

(j) Advocating for policy changes, such as medical liability reform, that promote professional judgment and address systemic barriers that impede responsible stewardship.

AMA Principles of Medical Ethics: I, V, VII, VIII, IX

Explore other AMA Code of Medical Ethics opinions on the financing and delivery of health care. The Code also offers guidance in areas such as patient and physician interactions, treatments and use of technologies, and professional relationships and self-regulation.

You can earn continuing medical education for modules drawn from the Code on informed consent and decision-making; physician well-being and professional conduct; ethical issues in organ donation; and boundaries for physicians.

The Code of Medical Ethics is updated periodically to address the changing conditions of medicine. The new edition is the culmination of an eight-year project to comprehensively review, update and reorganize guidance to ensure that the Code remains timely and easy to use for physicians in teaching and in practice.