__________________________________________________________________ Medical Ethics for Physicians
a constitutionally protected liberty interest in determining the time and manner of one’s own death. It then ruled that a Washington state law prohibiting physicians from prescribing life-ending medication for use by terminally ill, competent adults violates this Fourteenth Amendment due process right [24]. The Second Circuit Court of Appeals in Quill v. Vacco, invalidating New York’s similar law on a narrower ground, concluded that the statute violated the equal protection rights of mentally competent, terminally ill persons. Given that those on life support systems are permitted to hasten their deaths by having their doctors take them off life support, the court found no reason to prohibit those in the final stages of their illnesses who are not on life support from making the same choice by requesting lethal medication from their physicians [25]. In opinions authored by former Chief Justice Rehnquist, the Supreme Court rejected the argument that the state statutes outlawing assisted suicide infringed upon any fundamental right, and concluded that, because all competent persons are entitled to refuse lifesaving medical treatment and no one is permitted to assist a suicide, that there was no different treatment of similarly situated persons to trigger the Equal Protection Clause of the Fourteenth Amendment [24]. Although all nine justices agreed with the result, there was observation that this result “permits the debate [about assisted suicide] to continue, as it should in a democratic society” [24]. A majority of the justices made it clear that after public debate and legislative consideration have run a reasonable course, they might rule differently in a different case at a later time [25]. It is interesting that in both of these cases the plaintiffs included physicians and terminally ill patients who desired to overturn state statutes that made it illegal for physicians to assist patients in ending their lives. Some states, most notably Oregon, have used voter initiatives to attempt to change the law. In January 2006, the Supreme Court upheld Oregon’s 1997 Death with Dignity Act (DWDA), a unique initiative that allows physicians to prescribe lethal doses of prescription medicines to patients diagnosed with a terminal illness that will lead to death within six months [26]. As it now stands, a patient may make a written request that medication be prescribed to end his or her own life. There must be two witnesses to attest that the patient is competent, one of which shall not be a family member; the attending physician also may not be a witness. No criminal, civil, or disciplinary action may be brought against any person involved in implementing or witnessing the act. The Act requires the Oregon Health Authority to collect information about patients and physicians who participate in the Act. In 2021, 238 people had died from ingesting the prescribed medications. This number included 20 patients who had received physician prescriptions in previous years [27].
AMA CODE OF ETHICS The American Medical Association (AMA) published its first Code of Medical Ethics in 1847, shortly after establishment of the organization that same year [28]. The AMA Council on Ethical and Judicial Affairs (CEJA)—composed of seven practicing physicians, one fellow or resident, and one medical student—is responsible for developing, maintaining, and updating the AMA’s ethical guidelines to keep pace with the evolution of medicine and healthcare practice [29]. The Code is updated periodically to address the changing conditions of medicine. The current edition, adopted in June 2016, is the culmination of an eight-year project to comprehensively review, update, and reorganize guidance to ensure that the Code remains a timely, easy-to-use resource. The Code is accessible online at the AMA website and may be downloaded or purchased in book form. The “Principles of Medical Ethics” is the first section of the current AMA Code and outlines basic standards of practice [30]. PREAMBLE The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self. The following Principles adopted by the American Medical Association “are not laws, but standards of conduct that define the essentials of honorable behavior for the physician” [30]. Principles of Medical Ethics 1. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights. 2. 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. 3. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements that are contrary to the best interests of the patient. 4. 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. 5. 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.
37
MDTX1625
Powered by FlippingBook