AMA Code of Medical Ethics PDF

Chapter 5 AMA Code AMA Code of Medical Ethics The American Medical Association (AMA) Code of Medical Ethics provides a set of professional guidelines that govern physicians' responsibilities and conduct in medical practice. It ensures that doctors uphold h...

Chapter 5 AMA Code AMA Code of Medical Ethics The American Medical Association (AMA) Code of Medical Ethics provides a set of professional guidelines that govern physicians' responsibilities and conduct in medical practice. It ensures that doctors uphold high moral standards, prioritize patient welfare, and maintain trust in the healthcare profession. Importance of the AMA Code of Ethics Protects patient rights and enhances trust in the medical profession. Ensures physicians uphold moral and professional responsibilities. Guides doctors in ethical dilemmas and complex medical decisions. Promotes fair and equitable healthcare practices. Foundational Principles of the AMA Code of Medical Ethics The AMA Code of Medical Ethics is built on several core ethical principles: Respect for Autonomy – Physicians should respect patients' rights to make informed decisions about their own health. Beneficence – Physicians must act in the best interest of their patients. Nonmaleficence – Physicians should avoid causing harm to patients. Justice – Physicians must provide fair and equal treatment to all patients. These principles ensure that doctors maintain professionalism while delivering quality care. Key Sections of the AMA Code of Medical Ethics The AMA Code is divided into several sections, each addressing different aspects of medical practice. 1) Patient-Physician Relationship 41 | P a g e  Physicians must treat patients with compassion, honesty, and respect. Confidentiality must be maintained, except when disclosure is necessary for public safety (e.g., in cases of infectious diseases). Informed consent is a priority—patients must understand treatment options and risks before making decisions. 2) Honesty, Integrity, and Professionalism Physicians should provide accurate medical information and avoid misleading patients. Conflicts of interest, such as financial incentives influencing treatment decisions, should be avoided. Medical professionals must adhere to ethical standards in billing, advertising, and patient interactions. 3) Competence and Lifelong Learning Doctors must stay updated with medical advancements through continuous education. Physicians should recognize their limitations and refer patients to specialists when needed. They must only perform procedures and provide treatments within their scope of expertise. 4) Fairness and Justice in Healthcare Physicians should provide care without discrimination based on race, gender, socioeconomic status, or disability. They must advocate for equitable healthcare policies to ensure all patients have access to treatment. Physicians should report any unethical or illegal medical practices. 5) Public Health Responsibilities Doctors play a role in preventing disease outbreaks by promoting vaccinations and public health measures. They should contribute to medical research, following ethical standards in clinical trials. Physicians must help manage public health crises, such as pandemics and environmental health concerns. 42 | P a g e 6) End-of-Life Care and Decision-Making Physicians should respect patients’ wishes regarding life-sustaining treatments. They must provide palliative care and pain management to ensure dignity in dying. Advance directives, living wills, and do-not-resuscitate (DNR) orders should be honored. 7) Medical Research and Innovation Ethics Physicians must follow ethical guidelines when conducting clinical trials and medical research. Patients should be informed about potential risks and benefits before participating in research. The use of new medical technologies and experimental treatments must be carefully evaluated for safety and efficacy. Importance of the AMA Code of Medical Ethics Protects Patients’ Rights: Ensures that physicians prioritize patient well- being and autonomy. Guides Medical Decision-Making: Helps doctors navigate ethical dilemmas in medical practice. Maintains Trust in Healthcare: Establishes ethical standards to uphold the integrity of the medical profession. Promotes Fair and Equitable Treatment: Advocates for just healthcare practices and non-discriminatory care. Ensures Accountability: Encourages physicians to report and prevent unethical conduct. Consequences of Not Following the AMA Code of Medical Ethics Failing to adhere to the American Medical Association (AMA) Code of Medical Ethics can lead to serious legal, professional, and personal consequences for physicians. Ethical violations not only compromise patient safety but also undermine public trust in the healthcare system. Below are some major consequences of non-compliance: 43 | P a g e 1. Legal Consequences Violating medical ethics can result in legal actions, lawsuits, and criminal charges, depending on the severity of the misconduct. Malpractice Lawsuits: Patients or families can sue for negligence, misdiagnosis, or improper treatment. Loss of Medical License: State medical boards may revoke or suspend a physician’s license for ethical violations. Criminal Charges: Fraud, patient abuse, or prescribing medication irresponsibly can lead to imprisonment. 2. Professional Consequences Physicians who disregard ethical guidelines may face disciplinary actions, damaged reputations, and loss of professional credibility. Medical Board Disciplinary Actions: Physicians can be censured, fined, or required to undergo retraining. Loss of Hospital Privileges: Doctors may be banned from practicing at certain healthcare institutions. Job Termination: Healthcare facilities may fire employees for repeated ethical breaches. 3. Patient Harm and Safety Risks Ethical violations can lead to serious medical errors and harm to patients. Misdiagnosis and Incorrect Treatment: Not following ethical standards in diagnosis can lead to unnecessary suffering or death. Breach of Patient Confidentiality: Leaking or mishandling patient records can cause psychological and social harm. Lack of Informed Consent: Performing procedures without patient knowledge can lead to emotional distress and legal action. 44 | P a g e 4. Loss of Public Trust and Damage to the Medical Profession Physicians who violate ethical standards contribute to distrust in the healthcare system. Erosion of Doctor-Patient Relationships: Patients may avoid seeking care due to fear of unethical treatment. Negative Public Perception: Scandals involving unethical doctors can damage the reputation of entire hospitals or medical fields. 5. Ethical and Moral Consequences Ignoring ethical guidelines can lead to personal guilt, moral distress, and professional burnout. Moral Injury: Physicians may struggle with guilt if they knowingly act unethically. Burnout and Stress: Constant ethical conflicts can contribute to mental and emotional exhaustion. The term medical ethics first dates back to 1803, when English author and physician Thomas Percival published a document describing the requirements and expectations of medical professionals within medical facilities. The Code of Ethics was then adapted in 1847, relying heavily on Percival's words. Over the years in 1903, 1912, and 1947, revisions have been made to the original document. The practice of Medical Ethics is widely accepted and practiced throughout the world. Historically, Western medical ethics may be traced to guidelines on the duty of physicians in antiquity, such as the Hippocratic Oath, and early Christian teachings. The first code of medical ethics, Formula Comitis Archiatrorum, was published in the 5th century, during the reign of the Ostrogothic king Theodoric the Great. In the medieval and early modern period, the field is indebted to Islamic scholarship such as Ishaq ibn Ali al-Ruhawi (who wrote the Conduct of a Physician, the first book dedicated to medical ethics), Avicenna's Canon of Medicine and 45 | P a g e Muhammad ibn Zakariya al-Razi (known as Rhazes in the West), Jewish thinkers such as Maimonides, Roman Catholic scholastic thinkers such as Thomas Aquinas, and the case-oriented analysis (casuistry) of Catholic moral theology. These intellectual traditions continue in Catholic, Islamic and Jewish medical ethics. By the 18th and 19th centuries, medical ethics emerged as a more self- conscious discourse. In England, Thomas Percival, a physician and author, crafted the first modern code of medical ethics. He drew up a pamphlet with the code in 1794 and wrote an expanded version in 1803, in which he coined the expressions "medical ethics" and "medical jurisprudence". However, there are some who see Percival's guidelines that relate to physician consultations as being excessively protective of the home physician's reputation. Jeffrey Berlant is one such critic who considers Percival's codes of physician consultations as being an early example of the anti-competitive, "guild"-like nature of the physician community. In addition, since the mid-19th century up to the 20th century, physician-patient relationships that once were more familiar became less prominent andless intimate, sometimes leading to malpractice, which resulted in less public trust and ashift in decision making power from the paternalistic physician model to today's emphasis on patient autonomy and self-determination. In 1815, the Apothecaries Act was passed by the Parliament of the United Kingdom. It introduced compulsory apprenticeship and formal qualifications for the apothecaries of the day under the license of the Society of Apothecaries. This was the beginning of regulation of the medical profession in the UK. In 1847, the American Medical Association adopted its first code of ethics, with this being based in large part upon Percival's work. While the secularized field borrowed largely from Catholic medical ethics, in the 20th century a distinctively liberal Protestant approach was articulated by thinkers such as Joseph Fletcher. In the 1960s and 1970s, building upon liberal theory and procedural justice, much of the discourse of medical ethics went through a dramatic shift and largely reconfigured itself into bioethics. Values A common framework used when analysing medical ethics is the "four principles" approach postulated by Tom Beauchamp and James Childress in their textbook 46 | P a g e Principles of Biomedical Ethics. It recognizes four basic moral principles, which are to be judged and weighed against each other, with attention given to the scope of their application. The four principles are: Respect for autonomy – the patient has the right to refuse or choose their treatment. Beneficence – a practitioner should act in the best interest of the patient. Non-maleficence – to not be the cause of harm. Also, "Utility" – to promote better than harm. Justice – concerns the distribution of scarce health resources, and the decision of who gets what treatment. Important TERMS: Autonomy The principle of autonomy is rooted in society's respect for individuals' ability to make informed decisions about personal matters with freedom. Autonomy has become more important as social values have shifted to define medical quality in terms of outcomes that are important to the patient and their family rather than medical professionals. The increasing importance of autonomy can be seen as a social reaction against the "paternalistic" tradition within healthcare. The definition of autonomy is the ability of an individual to make a rational, uninfluenced decision. Therefore, it can be said that autonomy is a general indicator of a healthy mind and body. Beneficence The term beneficence refers to actions that promote the wellbeing of others. In the medical context, this means taking actions that serve the best interests of patients and their families. However, uncertainty surrounds the precise definition of which practices do in fact help patients. James Childress and Tom Beauchamp in “Principles of Biomedical Ethics” identify beneficence as one of the core values of healthcare ethics. Non-maleficence The concept of non-maleficence is embodied by the phrase, "first, do no harm," it is more important not to harm your patient, than to do them good, which is part of the Hippocratic oath that doctors take. This is partly because enthusiastic practitioners 47 | P a g e are prone to using treatments that they believe will do good, without first having evaluated them adequately to ensure they do no harm to the patient. In practice, however, many treatments carry some risk of harm. In some circumstances, e.g., in desperate situations where the outcome without treatment will be grave, risky treatments that stand a high chance of harming the patient will be justified. Double effect Double effect refers to two types of consequences that may be produced by a single action, and in medical ethics it is usually regarded as the combined effect of beneficence and non-maleficence. Respect for human rights The human rights era started with the formation of the United Nations in 1945, which was charged with the promotion of human rights. The Universal Declaration of Human Rights (1948) was the first major document to define human rights. Medical doctors have an ethical duty to protect the human rights and human dignity of the patient so the advent of a document that defines human rights has had its effect on medical ethics. Most codes of medical ethics now require respect for the human rights of the patient. It provides special protection of physical integrity for those who are unable to consent, which includes children. Solidarity Individualistic standards of autonomy and personal human rights as they relate to social justice, clash with and can also supplement the concept of solidarity, which stands closer to a European healthcare perspective focused on community, universal welfare, and the unselfish wish to provide healthcare equally for all. In the United States individualistic and self-interested healthcare norms are upheld, whereas in other countries, including European countries, a sense of respect for the community and personal support is more greatly upheld in relation to free healthcare. Acceptance of ambiguity in medicine The concept of normality, that there is a human physiological standard contrasting with conditions of illness, abnormality and pain, leads to assumptions 48 | P a g e and bias that negatively affects health care practice. It is important to realize that normality is ambiguous and that ambiguity in healthcare and the acceptance of such ambiguity is necessary in order to practice humbler medicine and understand complex, sometimes unusual usual medical cases. Euthanasia There is disagreement among American physicians as to whether the nonmaleficence principle excludes the practice of euthanasia. Around the world, there are different organizations that campaign to change legislation about the issue of physician-assisted death. Examples of such organizations are the Hemlock Society of the United States and the Dignity in Dying campaign in the United Kingdom. These groups believe that doctors should be given the right to end a patient's life only if the patient is conscious enough to decide for themselves, is knowledgeable about the possibility of alternative care, and has willingly asked to end their life or requested access to the means to do so. This argument is disputed in other parts of the world. For example, in the state of Louisiana, giving advice or supplying the means to end a person's life is considered a criminal act and can be charged as a felony. In state courts, this crime is comparable to manslaughter. The same laws apply in the states of Mississippi and Nebraska. Informed consent Informed consent refers to a patient’s right to receive information relevant to a recommended treatment, in order to be able to make a well-considered, voluntary decision about their care. To give informed consent, a patient must be competent to decide regarding their treatment and be presented with relevant information regarding a treatment recommendation, including its nature and purpose, and the burdens, risks and potential benefits of all options and alternatives. After receiving and understanding this information, the patient can then make a fully informed decision to either consent or refuse treatment. Confidentiality Confidentiality is commonly applied to conversations between doctors and patients. This concept is commonly known as patient-physician privilege. Legal protections prevent physicians from revealing their discussions with patients, even under oath in court. 49 | P a g e  Privacy and the Internet In increasing frequency, medical researchers are researching activities in online environments such as discussion boards, and there is concern that the requirements of informed consent and privacy are not applied, although some guidelines do exist. Control, resolution, and enforcement In the UK, medical ethics forms part of the training of physicians and surgeons and disregard for ethical principles can result in doctors barred from medical practice after a decision by the Medical Practitioners Tribunal Service. To ensure that appropriate ethical values are being applied within hospitals, effective hospital accreditation requires that ethical considerations are taken into account, for example with respect to physician integrity, conflict of interest, research ethics and organ transplantation ethics. Culture and language As more people from different cultural and religious backgrounds move to other countries, among these, the United States, it is becoming increasingly important to be culturally sensitive to all communities in order to provide the best health care for all people. Lack of cultural knowledge can lead to misunderstandings and even inadequate care, which can lead to ethical problems. Healthcare reform and lifestyle Leading causes of death in the United States and around the world are highly related to behavioral consequences over genetic or environmental factors. This leads some to believe true healthcare reform begins with cultural reform, habit and overall lifestyle. Lifestyle, then, becomes the cause of many illnesses and the illnesses themselves are the result or side-effect of a larger problem. Some people believe this to be true and think that cultural change is needed in order for developing societies to cope and dodge the negative effects of drugs, food and conventional modes of transportation available to them. Conflicts of interest Physicians should not allow a conflict of interest to influence medical judgment. In some cases, conflicts are hard to avoid, and doctors have a responsibility to avoid entering such situations. Research has shown that conflicts of interests are very common among both academic physicians and physicians in 50 | P a g e practice. Treatment of family members The American Medical Association (AMA) states that "Physicians generally should not treat themselves or members of their immediate family". This code seeks to protect patients and physicians because professional objectivity can be compromised when the physician is treating a loved one. Studies from multiple health organizations have illustrated that physician- family member relationships may cause an increase in diagnostic testing and costs. Many doctors still treat their family members. Doctors who do so must be vigilant not to create conflicts of interest or treat inappropriately. Conflicts Between autonomy and beneficence/non-maleficence Autonomy can come into conflict with beneficence when patients disagree with recommendations that healthcare professionals believe are in the patient's best interest. When the patient's interests conflict with the patient's welfare, different societies settle the conflict in a wide range of manners. In general, Western medicine defers to the wishes of a mentally competent patient to make their own decisions, even in cases where the medical team believes that they are not acting in their own best interests. However, many other societies prioritize beneficence over autonomy. People deemed to not be mentally competent or suffering from a mental disorder may be treated involuntarily. Examples include when a patient does not want a treatment because of, for example, religious or cultural views. In the case of euthanasia, the patient, or relatives of a patient, may want to end the life of the patient. Also, the patient may want an unnecessary treatment, as can be the case in hypochondria or with cosmetic surgery; here, the practitioner may be required to balance the desires of the patient for medically unnecessary potential risks against the patient's informed autonomy in the issue. A doctor may want to prefer autonomy because refusal to respect the patient's self-determination would harm the doctor-patient relationship. 51 | P a g e