American Medical Association Code Research Articles

Graduate Medical Education’s Role in the Battle for Evidence-Based Care

Graduate Medical Education’s Role in the Battle for Evidence-Based Care

Healing Words

Healing Words

Humanizing the Physician-Patient Relationship

Humanizing the Physician-Patient Relationship

Looking back at the lawsuit that transformed the chiropractic profession part 2: Rise of the American Medical Association.

This paper is the second in a series that explores the historical events surrounding the Wilk v American Medical Association (AMA) lawsuit in which the plaintiffs argued that the AMA, the American Hospital Association, and other medical specialty societies violated anti-trust law by restraining chiropractors' business practices. The purpose of this paper is to provide a brief review of the history of how the AMA rose to dominate health care in the United States, and within this social context, how the chiropractic profession fought to survive in the first half of the 20th century. This historical research study used a phenomenological approach to qualitative inquiry into the conflict between regular medicine and chiropractic and the events before, during, and after a legal dispute at the time of modernization of the chiropractic profession. Our methods included obtaining primary and secondary data sources. The final narrative recount was developed into 8 papers following a successive timeline. This paper is the second of the series that explores the growth of medicine and the chiropractic profession. The AMA's code of ethics established in 1847 continued to direct organized medicine's actions to exclude other health professions. During the early 1900s, the AMA established itself as "regular medicine." They labeled other types of medicine and health care professions, such as chiropractic, as "irregulars" claiming that they were cultists and quacks. In addition to the rise in power of the AMA, a report written by Abraham Flexner helped to solidify the AMA's control over health care. Chiropractic as a profession was emerging and developing in practice, education, and science. The few resources available to chiropractors were used to defend their profession against attacks from organized medicine and to secure legislation to legalize the practice of chiropractic. After years of struggle, the last state in the US legalized chiropractic 79 years after the birth of the profession. In the first part of the 20th century, the AMA was amassing power as chiropractic was just emerging as a profession. Events such as publication of Flexner's report and development of the medical basic science laws helped to entrench the AMA's monopoly on health care. The health care environment shaped how chiropractic grew as a profession. Chiropractic practice, education, and science were challenged by trying to develop outside of the medical establishment. These events added to the tensions between the professions that ultimately resulted in the Wilk v AMA lawsuit.

Current COVID-19 vaccine trials in high-income countries: are placebo-controlled trials ethical?

Current COVID-19 vaccine trials in high-income countries: are placebo-controlled trials ethical?

Doctors Strike During COVID-19 Pandemic in Malaysia

Doctors Strike During COVID-19 Pandemic in Malaysia

Cross-sectional analysis of dermatologists and sponsored content on Instagram

Cross-sectional analysis of dermatologists and sponsored content on Instagram

Letter to the Editor RE: Reasons to Accept Vaccine Refusers in Primary Care

I read with interest the Pediatrics Perspective from Drs. Navin, Wasserman, and Opel regarding refusal to accept vaccine refusers in primary care.1 I myself am a general pediatrician and have practiced primary care for almost 22 years in a community which is home to one of the most active anti-vaccine organizations in my state. This experience obviously informs my perspective on this important topic.While I appreciate the approach taken by the authors to categorize the values and motivations which are relevant to the question of accepting patients whose parents refuse vaccinations, it is my opinion that their arguments are perilously reliant on semantics and faulty casuistry. For example, the authors assert that the accepted freedom to select one's patients [American Medical Association Code of Medical Ethics (§1.1.2)] does not permissibly extend to the freedom to refuse patients whose parents do not vaccinate. Such a refusal to accept such patients would putatively be based upon the parents' demand for medically inappropriate care, the inability of the clinician to provide competent care, or the compromising of care of existing patients by accepting said new patients who refused vaccinations.They state that the refusal to vaccinate is not an example of demanding medically inappropriate care but rather a refusal of appropriate care. I do not think that this is a meaningful difference and I find the argument unconvincing. One can also reasonably argue that being prevented from providing recommended vaccinations significantly reduces the ability to provide competent, good quality care. Being compelled to participate in care which is categorically substandard would also potentially injure the professional integrity of the clinician in question. Finally, there is the question of the clinician's duty to existing patients, which cannot be superseded by the clinician's duty to a possible new patient. While the quantity of risk of accepting patients who do not vaccinate may be debatable, that risk is not zero. The choice to not vaccinate one's child is not equivalent casuistically to a choice to provide poor nutrition to one's child. And, if the clinician makes an affirmative choice to accept patients who do not vaccinate and that results in transmission of a serious disease to existing patients in the practice, then that clinician is partly responsible for the morbidity or mortality that might arise from that occurrence.Let me say that I quite agree that every opportunity should be undertaken to educate and counsel families who are vaccine-hesitant; I do this regularly and am successful in the vast majority of these encounters. This is a heterogeneous population and most may be educable and receptive to that counsel. However, there are some families who will be unreceptive and hostile to such counsel. If a primary care practice determines that a family is firm in their refusal to accept vaccinations and will be hostile to counsel on this topic, then it should be permissible to determine that beginning a doctor patient relationship will be fraught with risk and untenable.

Reasons to Accept Vaccine Refusers in Primary Care.

* Abbreviation: AAP — : American Academy of Pediatrics Vaccine refusal forces us to confront tensions between many values, including scientific expertise, parental rights, children’s best interests, social responsibility, public trust, and community health. Recent outbreaks of vaccine-preventable and emerging infectious diseases have amplified these issues. The prospect of a coronavirus disease 2019 vaccine signals even more friction on the horizon. In this contentious sociopolitical landscape, it is therefore more important than ever for clinicians to identify ethically justified responses to vaccine refusal. The American Academy of Pediatrics (AAP) says dismissing families who continue to refuse vaccines is an “acceptable option,”1 but some practices have gone further by not accepting vaccine refusers as patients at all.2,3 The phenomenon of nonacceptance has been underexplored; in both empirical studies and ethics analyses, researchers largely focus on dismissal.4–7 In this article, we first criticize arguments for nonacceptance that invoke a supposed right to choose one’s patients. We then argue that nonacceptance is problematic because (1) some of its motivations are intrinsically immoral, (2) it does not appear to accomplish some of its goals, and (3) even when nonacceptance does accomplish its goals, it fails to appropriately balance the various values it implicates. Throughout the article, we engage with the existing ethics literature about dismissal and conclude that even if dismissal is sometimes justifiable, nonacceptance is not. Some may argue that nonacceptance is ethically justified because they believe the clinical relationship is fundamentally a free association between clinicians and patients, as the American Medical Association Code of Medical … Address correspondence to Mark C. Navin, PhD, Department of Philosophy, Oakland University, 746 Mathematics and Science Center, 146 Library Dr, Rochester, MI 48309-4479. E-mail: navin{at}oakland.edu

Identification of Informed Consent in Patient Videos on Social Media: Prospective Study.

BackgroundThe American Medical Association Code of Medical Ethics states that any clinical image taken for public education forms part of the patient’s records. Hence, a patient’s informed consent is required to collect, share, and distribute their image. Patients must be informed of the intended use of the clinical image and the intended audience as part of the informed consent.ObjectiveThis paper aimed to determine whether a random selection of instructional videos containing footage of central venous catheter insertion on real patients on YouTube (Google LLC) would mention the presence of informed consent to post the video on social media.MethodsWe performed a prospective evaluation by 2 separate researchers of the first 125 videos on YouTube with the search term “central line insertion.” After duplicates were deleted and exclusion criteria applied, 41 videos of patients undergoing central line insertion were searched for reference to patient consent. In the case of videos of indeterminate consent status, the posters were contacted privately through YouTube to clarify the status of consent to both film and disseminate the video on social media. A period of 2 months was provided to respond to initial contact. Furthermore, YouTube was contacted to clarify company policy. The primary outcome was to determine if videos on YouTube were amended to include details of consent at 2 months postcontact. The secondary outcome was a response to the initial email at 2 months.ResultsThe researchers compiled 143 videos. Of 41 videos that contained footage of patient procedures, 41 were of indeterminate consent status and 23 contained identifiable patient footage. From the 41 posters that were contacted, 3 responded to initial contact and none amended the video to document consent status. Response from YouTube is pending.ConclusionsThere are instructional videos for clinicians on social media that contain footage of patients undergoing medical procedures and do not have any verification of informed consent. While this study investigated a small sample of available videos, the problem appears ubiquitous and should be studied more extensively.

AMA Code of Medical Ethics' Opinions Related to Organizational Influence in Health Care.

In recent decades, organized health care has displaced some traditional solo-practitioner physician roles. As larger organizations become more influential in the health care sector, American Medical Association (AMA) positions on professionalism and organizational development, as outlined in the Code of Medical Ethics, can help physicians navigate organizations' influence on practice.

Patients’ rights and professional conduct issues in hospitals’ codes of ethics

PurposeThe purpose of this study is to explore the presence of ethical standards in the content of international hospitals codes of ethics disclosed in their websites.Design/methodology/approachFirstly, the focus is on developing an integrated framework of universal values and hospital responsibilities for the content of hospitals’ codes of ethics documents. A list of key ethical issues was determined through an examination of the American Medical Association Code of Medical Ethics (2016), the WAMA (2017), International Code of Medical Ethics and relevant peer-reviewed journal articles (Finseschi, 1997; Vergallo, 2016; Suhonen et al., 2011; Reader et al., 2014). Based on the detailed literature review, 48 concepts, which were evenly, classified under two groups; professional conduct issues and patients’ rights. In the second stage, the issues were ranked related to professional conduct and patients’ rights from most to least frequent for the proposed conceptual framework, using World Global Hospitals codes of ethics.FindingsIt was found that only 62% of the top 100 hospitals have an ethics code report in their websites. The findings of the study have significant theoretical and practical implications. First, most of the hospitals’ ethical codes extensively emphasize professional conduct and patients’ rights, whereas they differ in what they include or exclude from their codes and the wording used. The number and frequency of the professional conduct issues is higher than patients’ rights. Emerging ethical issues, such as physicians’ and patients’ freedom of choice, sperm donation and artificial reproduction, were not widely mentioned, whereas abortion, euthanasia, human rights and transplantation issues were disregarded entirely.Practical implicationsThis study provides a benchmark for hospitals to assess their codes against other hospitals’ codes in terms of the specific items they address.Social implicationsThe results of this study provide a benchmark for evaluating and developing ethical codes for hospitals in light of the international health standards and norms.Originality/valueTo the best of the knowledge, no previous study has theoretically or practically analyzed hospitals’ codes of ethics.

Why Health Professionals Should Speak Out Against False Beliefs on the Internet.

Broad dissemination and consumption of false or misleading health information, amplified by the internet, poses risks to public health and problems for both the health care enterprise and the government. In this article, we review government power for, and constitutional limits on, regulating health-related speech, particularly on the internet. We suggest that government regulation can only partially address false or misleading health information dissemination. Drawing on the American Medical Association's Code of Medical Ethics, we argue that health care professionals have responsibilities to convey truthful information to patients, peers, and communities. Finally, we suggest that all health care professionals have essential roles in helping patients and fellow citizens obtain reliable, evidence-based health information.

Physician Wellness Is an Ethical and Public Health Issue.

Attention to physician well-being has traditionally focused on substance abuse, usually with disciplinary implications. But, in recent years, greater notice has been granted toward physician burnout and overall wellness. Burnout and its sequelae not only affect physicians and physicians-in-training as individuals, but the impact then multiplies as it affects these physicians' patients, colleagues, and hospital systems. In addition, the American Medical Association Code of Medical Ethics charges physicians with a responsibility to maintain their own health and wellness as well as promote that of their colleagues. Therefore, the question of physician wellness has both public health and ethical implications. The causes of burnout are multifactorial, and the solutions to sustainable change are multitiered.

AMA Code of Medical Ethics' Opinions Related to Urgent Decision Making

The American Medical Association (AMA) Code of Medical Ethics opinions underscore a physician’s responsibility to act in an emergency when patients cannot give informed consent and a surrogate or advance directive is unavailable. The duty to provide urgent care extends even to patients with whom the physician has a familial

Informing offspring of their conception by gamete or embryo donation: an Ethics Committee opinion

This document discusses the ethical implications of informing offspring about their conception using gamete or embryo donation. It replaces the 2013 ASRM Ethics Committee document of the same name (Fertil Steril 2013;100:45-9).

Does Volk v DeMeerleer Conflict with the AMA Code of Medical Ethics on Breaching Patient Confidentiality to Protect Third Parties?

A recent Washington State case revisits the obligation of mental health clinicians to protect third parties from the violent acts of their patients. Although the case of Volk v DeMeerleer raises multiple legal, ethical, and policy issues, this article will focus on a potential ethical conflict between the case law and professional guidelines, namely the American Medical Association's Code of Medical Ethics.

Radiology and Ethics Education.

The purpose of this study is to assess medical ethics knowledge among trainees and practicing radiologists through an online survey that included questions about the American College of Radiology Code of Ethics and the American Medical Association Code of Medical Ethics. Most survey respondents reported that they had never read the American Medical Association Code of Medical Ethics or the American College of Radiology Code of Ethics (77.2% and 67.4% of respondents, respectively). With regard to ethics education during medical school and residency, 57.3% and 70.0% of respondents, respectively, found such education to be insufficient. Medical ethics training should be highlighted during residency, at specialty society meetings, and in journals and online resources for radiologists.

Ethics and Medical Practice: Why Psychiatry is Unique.

Byline: Navneet. Sidhu, Jagannathan. Srinivasraghavan Since ancient times, societies have held physicians to high standards of ethics owing to the caring nature of the medical profession as well as the vulnerability of people in their care. While we are all familiar with the Hippocratic oath, the Formula Comitis Archiatrorum [sup][1] , written in the 5 [sup]th century, is considered by some to be the earliest known code of medical ethics. Modern day medical ethics can be traced to Thomas Percival, an English physician and philosopher who wrote Medical Ethics, or a Code of Institutes and Precepts, Adapted to the Professional Conduct of Physicians and Surgeons in 1803 [sup][2] . His ideas such as conduct of physicians towards patients and inter-professional relationships have been a dominant influence in development of the field. Medical Ethics served as a key source for the American Medical Association (AMA) code, which the association adopted in 1847 [sup][3] . In it's current form, the AMA code of Medical Ethics stresses principles such as professionalism, respect for human dignity and rights, medical knowledge, privacy and access to medical care for all people, and the importance of focusing on patients' best interests [sup][4] . In the United States, organizations such as the American Psychiatric Association (APA) and American Psychological Association have also laid out guidelines that inform psychiatric and psychological practice [sup][5],[6] . Srinivasaraghavan et al . [sup][7] have discussed the unique nature of psychiatry, the presence of stigma in mental illness, the socio-economic disadvantages often present in the mentally ill population and the need for psychiatric ethics to go beyond the ethical standards of General medicine. In this paper, we want to highlight how the everyday practice of psychiatry demands high moral and ethical standards of its' practitioners and is unique in its challenges and ethical dilemmas. I. Privacy and Confidentiality Physicians of all specialties owe complete confidentiality to their patients in most circumstances. The effectiveness of the patient- physician relationship and therapeutic alliance relies heavily on this obligation. It is unethical and illegal to share information discussed within the confines of the medical office, without the explicit and informed permission of the patient. In psychiatry, we often hear our patients' innermost fears, worries, fantasies and desires. To a psychiatrist, patients' often expose their vulnerabilities and discuss concerns that could expose them to the prevalent stigma in society. Were a physician not bound by the promise of confidentiality, the therapeutic relationship would be hindered, and treatment would be impeded. Consider the example of a woman telling her psychiatrist of marital discord in her relationship, or a man talking about sexual dysfunction in treatment. Or the case of an employer calling the psychiatrist about the mental health of employee. It is obvious that if such information were to become known outside the confines of therapy, the consequences could be potentially disastrous. In the United States, the Health Insurance Portability and Accountability Act (HIPAA) [sup][8] of 1996 places civil and criminal penalties on health care providers and entities that disclose protected information to unauthorized individuals or sources. So when can a psychiatrist share information? Organizations like APA have recognized the limits of this confidentiality in the legal setting. For example, if a physician is required by the law to produce medical records, confidentiality is waived. In such situations, the limits of confidentiality should be explained to the patient. Following the landmark United States case [sup][9] involving the killing of a university student, Tatiana Tarasoff by another student in 1969, many U.S states [sup][10] have enacted duty to warn and duty to protect mandates which require a psychiatrist or therapist to reveal information to police or potential victims about dangerous patients in the interest of public safety. …

Clinical Use of Placebos: Still the Physician's Prerogative?

The American Medical Association's Code of Ethics holds that if a physician believes a treatment to be a placebo, then the patient should be informed of that belief, and the treatment should not be prescribed unless the patient agrees to its use. But this is not clearly the best way either to protect patients or to benefit them. The physician's own beliefs should not be decisive.