Professional Self-Regulation

Romantic or sexual interactions between physicians and patients that occur concurrently with the patient-physician relationship are unethical. A physician must terminate the patient-physician relationship before initiating a dating, romantic, or sexual relationship with a patient. Sexual or romantic relationships with former patients are unethical if the physician uses or exploits trust, knowledge, emotions, or influence derived from the previous professional relationship, or if a romantic relationship would foreseeably harm the individual.

Physicians should avoid sexual or romantic relations with any individual whose decisions directly affect the health and welfare of the patient. Physicians should refrain from sexual or romantic interactions with key third parties when the interaction would exploit trust, knowledge, influence, or emotions derived from a professional relationship with the third party or could compromise the patient’s care.

Sexual harassment can be defined as unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature. Sexual harassment exploits inequalities in status and power and abuses the rights and trust of those who are subjected to such conduct. Sexual harassment in the practice of medicine is unethical.

Having contact with patients is essential for training medical students, and both patients and the public benefit from the integrated care that is provided by health care teams that include medical students. All physicians share an obligation to ensure that patients are aware that medical students may participate in their care and have the opportunity to decline care from students.

Residents and fellows have dual roles as trainees and caregivers; however, residents and fellows are physicians first and foremost and should always regard the interests of patients as paramount.

Medical training sometimes involves practicing procedures on newly deceased patients, including critical medical skills for which adequate educational alternatives are not available. Such training must balance protecting the interests of newly deceased patients, their families, society, and the profession with the need to educate health care providers.

When conflicts arise between medical students, resident physicians or fellows, and/or their supervisors, it is essential to ensure that disputes are resolved fairly. Retaliatory or punitive actions against those who raise complaints are unethical and are a legitimate cause for filing a grievance with the appropriate institutional committee.

Medical students who volunteer to act as “patients” are not seeking to benefit medically from the procedures being performed on them; their goal is to benefit from educational instruction, yet their right to make decisions about their own bodies remains. In the context of practicing clinical skills on fellow students, instructors should ensure that medical students’ privacy, autonomy, and sense of propriety are protected.

Physicians should strive to further their medical education throughout their careers, to ensure that they serve patients to the best of their abilities and live up to professional standards of excellence. Participating in certified continuing medical education (CME) activities is critical to fulfilling this professional commitment to lifelong learning.

Financial or in-kind support from pharmaceutical, biotechnology, or medical device companies that have a direct interest in physicians’ recommendations creates conditions in which external interests could influence the availability or content of continuing medical education (CME). When possible, CME should be provided without such support or the participation of individuals who have financial interests in the educational subject matter.

When physician health or wellness is compromised, so may be the safety and effectiveness of the medical care provided. To preserve the quality of their performance, physicians have a responsibility to maintain their health and wellness, broadly construed as preventing or treating acute or chronic diseases, including mental illness, disabilities, and occupational stress.

Physicians should strive to distinguish conditions that are permanently incompatible with the safe practice of medicine from those that are not and respond accordingly. Physicians should intervene with respect and compassion when a colleague is not able to practice safely. Physicians should also encourage the development of inclusive training standards that enable individuals with disabilities to enter the profession and have safe, successful careers as well as work to eliminate stigma within the profession regarding illness and disability.

Peer review is recognized and accepted as a means of promoting professionalism and maintaining trust. The peer review process is intended to balance physicians’ right to exercise medical judgment freely with the obligation to do so wisely and temperately.

The obligation to report incompetent or unethical conduct that may put patients at risk is recognized in both the ethical standards of the profession and in law, and physicians should be able to report such conduct without fear or loss of favor. Reporting a colleague who is incompetent or who engages in unethical behavior is intended not only to protect patients, but also to help ensure that colleagues receive appropriate assistance. Physicians must not submit false or malicious reports.

The obligation to address misconduct falls on both individual physicians and the profession as a whole. The goal of disciplinary review is both to protect patients and to help ensure that colleagues receive appropriate assistance from a physician health program or other service to enable them to practice safely and ethically. Disciplinary review must not be undertaken falsely or maliciously.

Physicians have a responsibility to address situations in which individual physicians behave disruptively, i.e., speak or act in ways that may negatively affect patient care, including conduct that interferes with the individual’s ability to work with other members of the health care team, or that of others to work with the physician.

The organized medical staff performs essential hospital functions even though it may often consist primarily of independent practicing physicians who are not hospital employees. The core responsibilities of the organized medical staff are the promotion of patient safety and the quality of care.

The purpose of medical staff privileging is to improve the quality and efficiency of patient care in the hospital. Physicians who are involved in granting, denying, or terminating hospital privileges have an ethical responsibility to be guided by concern for the welfare and best interests of patients.

Physicians who engage in activities that involve the accreditation, approval, or certification of institutions, facilities, and programs that provide patient care or medical education or certify the attainment of specialized professional competence have the ethical responsibility to develop and apply standards that are relevant, fair, reasonable, nondiscriminatory, and patient-centered.

Opportunities must not be denied to any physician or medical trainee because of race, color, religion, creed, ethnic affiliation, national origin, gender or gender identity, sexual orientation, age, family status, or disability or for any other reason unrelated to character, competence, ethics, professional status, or professional activities.

Inequality of professional status in medicine among individuals based on gender can compromise patient care, undermine trust, and damage the working environment. Physician leaders in medical schools and medical institutions should advocate for increased leadership in medicine among individuals of underrepresented genders and equitable compensation for all physicians.

There are no restrictions on advertising by physicians except those that can be specifically justified to protect the public from deceptive practices.

Gifts to physicians from industry create conditions that carry the risk of subtly biasing—or being perceived to bias—professional judgment in the care of patients. To preserve the trust that is fundamental to the patient-physician relationship and public confidence in the profession, physicians should decline any gifts for which reciprocity is expected or implied.

To be ethically appropriate, word-of-mouth referrals must be voluntary on the part of current patients and should reflect honestly on the practice. Physicians must not offer financial incentives or other valuable incentives to current patients in exchange for recruitment of other patients.

Physician sale of health-related products raises ethical concerns about financial conflict of interest, risks placing undue pressure on the patient, threatens to erode patient trust, undermine the primary obligation of physicians to serve the interests of their patients before their own, and demean the profession of medicine.

With limited exceptions, the sale of non-health-related goods by physicians presents a conflict of interest and threatens to erode the primary obligation of physicians to serve the interests of their patients before their own.

Physicians should prescribe drugs, devices, and other treatments based solely on medical considerations, patient need, and reasonable expectations of effectiveness for the particular patient.

Direct-to-consumer advertising may raise awareness about diseases and treatment and may help inform patients about the availability of new diagnostic tests, drugs, treatments, and devices. However, direct-to-consumer advertising also carries the risk of creating unrealistic expectations for patients and conflicts of interest for physicians.

Diagnostic imaging tests are sometimes marketed directly to consumers before they have been scientifically validated. Physicians should advocate for the conduct of appropriate trials aimed at determining the predictive power of diagnostic imaging tests and their sensitivity and specificity for target populations.

Physicians should not refer patients to a health care facility that is outside their office practice and at which they do not directly provide care or services when they have a financial interest in that facility.

Physicians have an obligation to assist in the administration of justice. Physicians who testify as fact witnesses in legal claims involving a patient they have treated must hold the patient’s medical interests paramount.

Physicians have civic duties, but medical ethics do not require a physician to carry out civic duties that contradict fundamental principles of medical ethics, such as the duty to avoid doing harm. In limited circumstances, physicians can ethically participate in court-initiated medical treatments.

As a member of a profession dedicated to preserving life when there is hope of doing so, a physician must not participate in a legally authorized execution.

Questions about the propriety of physician participation in interrogations and in the development of interrogation strategies may be addressed by balancing obligations to individuals with obligations to protect third parties and the public. The further removed the physician is from direct involvement with a detainee, the more justifiable is a role serving the public interest. When physicians have reason to believe that interrogations are coercive, they must report their observations to the appropriate authorities.

Torture refers to the deliberate, systematic, or wanton administration of cruel, inhumane, and degrading treatments or punishments during imprisonment or detainment. Physicians must oppose and must not participate in torture for any reason.