UH Clinical Update - August 2016
By Cliff Megerian, MD, President, University Hospitals Physician Services
Since the days of Hippocrates in ancient Greece, medicine has been considered a profession, and a singular one at that. No other profession has the immense responsibility for so many people’s lives and health – and on a daily basis.
First, though, let’s consider what it means to be a ‘profession.’ The word’s root in Latin means to “declare openly.” In Old French (circa 1200), another layer of meaning was added – that of “vows taken upon entering a religious order.” And of course, in the Hippocratic Oath, we do, in a manner, take vows – the best known being, “First, do no harm,” traced to Hippocrates’ “Of the Epidemics.”
Professions require social contracts. In our case, the contract is between us as physicians and our patients. Our obligations under these social contracts are typically expressed in codes of ethics. Because the medical profession must continually meet the needs of the individuals and communities it serves, the ‘social contracts’ in our code of ethics must, too, evolve with changes in the clinical and social environment.
The American Medical Association (AMA) first created a national code of ethics for physicians in 1847. It was the first of its kind for any profession in the world, and it is still regularly cited as the professional authoritative voice in legal opinion and scholarly journals. We look to it as the way we define ethics for our field – it is our bedrock.
However, as medicine and the cultural and social environment around it have changed over the years, our code has also had to evolve and expand. Over time, additions to the code came to encompass 220 separate opinions on ethics guidance for physicians, making the code lengthy, fragmented and unwieldy.
In 2008, the AMA decided to do a systematic review and revision of the code, to modernize its ethical guidance “for relevance, clarity and consistency.” However, in the years since, the health care system in the U.S. has undergone substantial shifts. Factors include the Affordable Care Act, increasingly complex and expensive treatment options and cost pressures, as well as the increased velocity of information flow, an increasing number of patients with chronic conditions and the trend toward collaboration of care for patients by a group of providers. In addition, the code has to keep pace with new technologies, including telemedicine, changing patient expectations and shifting health care priorities.
This summer, the AMA announced that after eight years of work, it has issued a ‘modernized’ AMA code – addressing many issues which likely did not even exist 10 years ago.
Among the areas addressed are such broad topics as patient privacy, the ethical management of medical records and respect for patient autonomy. There are also changes in terms, ensuring preferred definitions and consistent terminology, such as replacing the term ‘health care proxy’ with ‘surrogate,’ in cases where patients do not have decision-making capacity. There is an emphasis, too, on the importance of physicians consulting with colleagues who may have greater expertise certain areas, to the benefit of the patient.
To fully appreciate the changes, I recommend that you read this summary below of the AMA Principles of Medical Ethics. Better yet, read more about the complete code at the AMA site.
The new AMA code reflects how much the world we live and work in has changed. But it also reminds us that some things in the medical profession have not changed and never will – namely, the compassion and respect for human dignity we must embrace and demonstrate in the way we treat our patients, each and every day.
AMA Principles of Medical Ethics
- A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
- A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
- A physician shall respect the law and also recognize a responsibly to seek changes in those requirements which are contrary to the best interests of the patient.
- A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
- A physician shall continue to study, apply and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues and the public, obtain consultation and use the talents of other health professionals when indicated.
- A physician shall, in the providing of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
- A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
- A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
- A physician shall support access to medical care for all people.