Medical Ethics for Physicians __________________________________________________________________
6. A physician shall, in the provision 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. 7. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health. 8. A physician shall, while caring for a patient, regard responsibility to the patient as paramount. 9. A physician shall support access to medical care for all people. AMA ETHICS OPINIONS Following the Preamble, the AMA Code of Medical Ethics provides guidance (“Opinions”) on ethical practice across 11 domains, or chapters: • Patient-Physician Relationships • Consent, Communication, and Decision Making • Privacy, Confidentiality, and Medical Records
• When a physician provides emergency care or provides care at the request of the patient’s treating physician. In these circumstances, the patient’s (or surrogate’s) agreement to the relationship is implicit. • When a physician provides medically appropriate care for a prisoner under court order, in keeping with ethics guidance on court-initiated treatment. • When a physician examines a patient in the context of an independent medical examination, in keeping with ethics guidance. In such situations, a limited patient- physician relationship exists. Opinion 1.1.3 Patient Rights The health and well-being of patients depends on a collaborative effort between patient and physician in a mutually respectful alliance. Patients contribute to this alliance when they fulfill responsibilities they have, to seek care and to be candid with their physicians, for example. Physicians can best contribute to a mutually respectful alliance with patients by serving as their patients’ advocates and by respecting patients’ rights. These include the right: • To courtesy, respect, dignity, and timely, responsive attention to his or her needs. • To receive information from their physicians and to have opportunity to discuss the benefits, risks, and costs of appropriate treatment alternatives, including the risks, benefits, and costs of forgoing treatment. Patients should be able to expect that their physicians will provide guidance about what they consider the optimal course of action for the patient based on the physician’s objective professional judgment. • To ask questions about their health status or recommended treatment when they do not fully understand what has been described and to have their questions answered. • To make decisions about the care the physician recommends and to have those decisions respected. A patient who has decision-making capacity may accept or refuse any recommended medical intervention. • To have the physician and other staff respect the patient’s privacy and confidentiality. • To obtain copies or summaries of their medical records. • To obtain a second opinion. • To be advised of any conflicts of interest their physician may have in respect to their care.
• Genetics and Reproductive Medicine • Caring for Patients at the End of Life • Organ Procurement and Transplantation • Research and Innovation • Physicians and the Health of the Community • Professional Self-Regulation • Interpersonal Relationships • Financing and Delivery of Health Care
Each chapter addresses a range of clinical and societal issues, situations, and potential conflicts pertaining to current medical practice. By way of example, and to illustrate the tone and applicability of the guidance provided, selected excerpts (subsections) from the AMA Code of Ethics are reproduced below, with permission [30]. Opinion 1.1.1 Patient-Physician Relationships The practice of medicine, and its embodiment in the clinical encounter between a patient and a physician, is fundamentally a moral activity that arises from the imperative to care for patients and to alleviate suffering. The relationship between a patient and a physician is based on trust, which gives rise to physicians’ ethical responsibility to place patients’ welfare above the physician’s own self-interest or obligations to others, to use sound medical judgment on patients’ behalf, and to advocate for their patients’ welfare. A patient-physician relationship exists when a physician serves a patient’s medical needs. Generally, the relationship is entered into by mutual consent between physician and patient (or surrogate). However, in certain circumstances a limited patient-physician relationship may be created without the patient’s (or surrogate’s) explicit agreement. Such circumstances include:
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