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Ethics Guidelines for Physicians Updated on Sex, Drunkenness, Gifts & Other Issues

Who is to say whether a doctor should help a patient commit suicide, sell vitamins out of their office, or recommend the Pill?

Every doctor, like every person, ultimately must make these ethical decisions themselves, but in the event they're looking for some advice, they may take comfort in knowing that the American College of Physician's (ACP) has updated their Ethics Manual--for the first time since 1998.


Doctors looking for advice on tricky ethical dilemmas can consult the American College of Physician's just-updated Ethics Manual.

As it says in the Manual's introduction, "Medicine, law, and social values are not static. Reexamining the ethical tenets of medical practice and their application in new circumstances is a necessary exercise." As such, the ACP, the nation's largest medical specialty group, spent two years reviewing their past manual, revising opinions, adding new ones and leaving others unchanged.

No one is required to follow the ACP's guidelines, however many doctors and hospitals refer to the manual when confronted with ethical dilemmas.

The ACP points out that while its Ethics Manual "is not a substitute for the experience and integrity of individual physicians," it is "intended to facilitate the process of making ethical decisions in clinical practice and medical research."

The newest fifth edition also includes a case method to help physicians with ethical decision making. Here's a closer look at some of the ethical dilemmas doctors face, and the ACP's opinion of the "right" thing for doctors to do:

Abortion and Contraception: If a doctor has a moral conflict in recommending, performing or prescribing abortion, sterilization, contraception, or other reproductive services to a patient, he or she is not obligated to do so. However, the doctor is obligated to inform a patient of such options, or refer them to another doctor who will.

Doctors' Pay/Money: Doctors' fees should "accurately reflect the services provided," but the doctor should have a sense of duty to patients that takes "precedence over concern about compensation." All doctors should also "do their fair share to provide services to uninsured and underinsured persons."

Doctor and Patient

While doctors aren't required to consult ACP's Ethics Manual, many do.

Doctors Only for the Wealthy: Doctors have a professional obligation to care for all classes of patients who need medical care. As such, those who accept retainer fees (called "boutique" or "concierge" medicine) from wealthy patients in exchange for 24-hour availability and service risk compromising this obligation.

Selling Products: Selling products from a doctor's office might "negatively affect the trust necessary to sustain the patient-physician relationship." Most products should not be sold in the office; those that can be should:

  • "Be specifically relevant to the patient's care
  • Offer a clear benefit based on adequate clinical evidence and research
  • Meet an urgent need of the patient"

For instance, while a splint or crutches would be OK, vitamin supplements and cosmetic items would be "ethically suspect." Moreover, charges for products that are sold should be limited to reasonable costs that result from making them available.

End-of-Life Care: Physician-assisted suicide is not ethical and should not be performed, even in Oregon where it's legal. However, doctors can provide comfort to a dying person, for instance administering more pain medication, even if it will inadvertently shorten the patient's life. As this is still a much-debated topic, ACP says that doctors and patients should "continue to search together for answers to the problems posed by the difficulties of living with serious illness before death ... "

Accepting Gifts: While accepting small gifts of appreciation from patients is OK, before accepting any gift from a patient, a doctor should consider:

  • "The nature of the gift
  • The potential implications for the patient-physician relationship
  • The patient's probable motivation and expectations"

However, accepting gifts from the health care industry (drug companies, etc.) is strongly discouraged. "The acceptance of even small gifts has been documented to affect clinical judgment and heightens the perception (as well as the reality) of a conflict of interest."

Sleeping With a Patient: It's unethical for a doctor to become sexually involved with a current patient, even if the patient initiates it. A sexual relationship with a former patient is unethical if the doctor "uses or exploits the trust, knowledge, emotions or influence derived from the previous professional relationship."

Strikes: Rather than engaging in strikes, work stoppages, slowdowns, boycotts and other actions that could deny patients of medical care, doctors should advocate for changes by lobbying lawmakers and working to educate the public, patient groups and policymakers about their concerns.

Impairment: A doctor who is impaired in any way, whether from the use of alcohol or drugs or from a psychiatric, physiologic or behavioral disorder or disease that affects cognitive or motor skills, must seek assistance in caring for patients, and must not perform any patient care that can't be done safely and effectively.

Recommended Reading

Riding the Waves of Change

EPA Study to Assess the Health Effects of Pesticides on Kids Halted

American College of Physicians Ethics Manual

Chicago Sun Times April 11, 2005

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