AMA ethics code helps solve day-to-day issues

The American Medical Association's Code of Medical Ethics addresses deep abstract concepts, but a panel of experts assembled for an observation of the first global Medical Ethics Day agreed that the book's greatest strength is its usefulness in solving day-to-day practice dilemmas.

The panel met in Chicago, one day before Sept. 18, the date established by the World Medical Assn. as Medical Ethics Day. The AMA recently released the latest version of the code. It contains 185 ethical opinions including 12 new and 14 amended items.

Panelist and former AMA Director of Ethics Standards Steven R. Latham, PhD, noted that the code was written by doctors for doctors. Over time, that has led some to criticize it as a document used to protect doctors. But, he said, the code sends a message from the AMA to the public and "embodies a promise" from physicians to their patients that they will maintain a practice within the ethical boundaries found in the code. For physicians, Dr. Latham said the code's greatest strength is how doctors can "pull it off the shelf" and get answers to questions that are addressed nowhere else.

A useful tool

Panel moderator and member of the AMA Council on Ethical and Judicial Affairs, Regina M. Benjamin, MD, said -- as a physician in solo practice -- it was reassuring to open the code and find answers to her questions. She added that, during her 13 years on the Alabama Board of Medical Examiners, the AMA Code of Medical Ethics was used extensively.

Dr. Latham agreed that much of the code's usefulness is symbolized in answering questions like "Who owns the medical files of physicians who leave a group practice?" (According to opinion E-7.03, when a physician leaves a practice or retires, the practice should hold patients' records until authorized by patients to forward the files to the doctors of their choice.)

Arthur R. Derse, MD, director of medical and legal affairs at the Center for the Study of Bioethics at the Medical College of Wisconsin in Milwaukee, highlighted the usefulness of the code as an educational and judicial tool. He noted that the code does not have legal force, but it does have "ethical persuasive force" and that it has been cited in court decisions.

Dr. Derse added that he uses 16 of the code's ethical opinions in his medical ethics class, and said surveys indicated that 86% of his students agreed that using the AMA code was helpful in understanding medical ethics. "It's helpful for students to see in black and white what the largest and most influential medical organization has to say," he said.

Dr. Latham, however, argued that when the AMA gets "too ambitious" and addresses issues like cloning in its code, it strays from the area of its biggest strength, which is providing useful advice on the correct way to run an ethical practice.

Panelist Clarence H. Braddock III, MD, associate professor of medicine at Stanford Medical School in Palo Alto, Calif., mentioned an example of how the code can be misused. He cited its opinions on patient responsibility and warned that they could be used by "weak physicians" to blame patients for the failure of their treatment.

While patients have some responsibility for the success of treatment, Dr. Derse said it doesn't pay to dwell on that. "With some patients, you have to go the extra mile, and they still don't keep up their end of the bargain," he said. "We really can't concentrate on patient responsibilities; we can only concentrate on our own."

Dr. Braddock noted the significance of patient perception and cited that as a reason for making limits on gifts from industry even stricter.

The drug industry spends about $60,000 on marketing its products to individual physicians, Dr. Braddock said. The public is aware that a lot of money is being spent, so he said a stricter code may alleviate patients' fears that their prescription "is some form of kickback."