Cardiovascular professionalism and ethics in the modern era

Abstract

The health care professions have always enjoyed special trust and position in our society. Patients trust health care professionals (HCPs) to guard their health, inform them, and put a patient's interests above any other consideration. This is one definition of “professionalism.” When HCPs deal with human subjects in research there are basic ethical principles, articulated in the classic Belmont Report of 1979, that have been accepted by all (1). We believe from our experience that the members and staff of the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) strive to do “good” for society in general and for patients specifically. They put patients' interests first, above their own, in an overwhelming majority of situations. There are virtually hundreds of thousands of patient-HCP encounters daily in the U.S. It is assumed that HCPs are trying their utmost to benefit their patients even when the outcome is not optimal or when disease progression cannot be effectively treated. Complications of therapy occur despite the best of intentions. Clinician-scientists and the medical industry develop new therapies to improve the lives of patients living with cardiovascular disease, and society has seen the benefits of this effort over the past several years. Everything in this system works well until or unless a conflict between the HCP's interests and those of the patient results in actions that harm the patient. Then it is assumed that there has been a breach of that respected patient-HCP trust. Many modern situations exist in which the personal interest of the HCP may not be aligned with that of the patient. Ethical choices must be made by the HCP in these situations. Examples include: