The manual strongly discourages the acceptance by physicians of gifts, hospitality, trips, and subsidies of all types from the healthcare industry “that might diminish, or appear to others to diminish, the objectivity of professional judgment.”
“It may seem obvious that new issues in medicine are constantly emerging, and the Manual acknowledges that, but it is also critical to recognize that elements such as the patient-physician relationship are fundamental, timeless, and need to be reaffirmed in the face of technological and other challenges,” Ms. Sulmasy says. “ACP says physicians must be prepared to deal with relevant changes and to identify and reaffirm what is fundamental, applying principles and reasoned arguments in debates. The seventh edition of the Ethics Manual examines emerging issues in medical ethics and professionalism and revisits older issues that are still very pertinent.”
“The practice environment today is very challenging, with seemingly endless time pressures and other barriers to doing the right thing for patients,” she concludes. “The Manual continues to remind us that the patient must come first and of the centrality of the patient-physician relationship (and involvement of loved ones in care as desired by the patient). These are core responsibilities and also key to improving the delivery of health care and to ‘re-enchanting’ medicine for patient and physician.”
Dr. J. S. Blumenthal-Barby from Baylor College of Medicine’s Center for Medical Ethics and Health Policy, Houston, who co-authored an editorial related to this report, tells Reuters Health by email, “This manual is a wonderful resource for physicians, but ultimately, the ‘heart’ behind this manual is a spirit of professionalism whereby each physician sees herself as part of a larger community of individuals who are committed to acting with integrity and critical thought to preserve the integrity of the profession.”2
“It is not always clear what the ‘right’ answer is, but this commitment along with guiding principles of putting patient’s interests first, respecting patient autonomy and fostering informed and uncoerced choices, and working towards justice in the distribution of the life-enhancing opportunities afforded by health care will go a long way in leading physicians when encountering tough ethical issues,” she says.
Dr. Blumenthal-Barby adds, “As we point out in our editorial, there are several areas that are potentially controversial, including the positions on physician aid in dying, care of unauthorized immigrants, brain death, and potentially inappropriate (‘futile’) treatments. The manual could have acknowledged more explicitly that there is considerable disagreement among thoughtful positions on these issues, as well as analyze the reasons for such disagreement. In a country where these issues are deeply contested, recognizing disagreements is an important first step in respecting patients and colleagues who have different views.”
