The Council on Ethical and Judicial Affairs of the American Medical Association examines physicians’ professional ethical responsibility in the event that the security of patients’ electronic records is breached.

*The views expressed are the author's own. This article should not be construed as representing policies of the American Medical Association.

*Disclaimer: The views expressed are the author's and should not be ascribed to the American Medical Association.

At one time, the American Medical Association had a strong pro-life position regarding unborn human beings. Using an online AMA archives database, this research note contrasts early AMA pro-life commentary with its eventual pro-choice position. Strong pro-life advocacy in the mid-to-late 1800s, led by doctors such as Horatio Storer, gave way in the 1900s to a waning of pro-life zeal, and eventually developed into a pro-choice stance on abortion.

In 1964, the American Medical Association invited liberal theologian Abraham Joshua Heschel to address its annual meeting in a program entitled “The Patient as a Person” [1]. Unsurprisingly, in light of Heschel’s reputation for outspokenness, he launched a jeremiad against physicians, claiming: “The admiration for medical science is increasing, the respect for its practitioners is decreasing. The depreciation of the image of the doctor is bound to disseminate disenchantment and to affect the state of medicine itself” [1, (...) p. 35]. Heschel’s reference to “disenchantment” suggests that he may have been familiar with the work, or at least the outlook, of sociologist Max Weber, whose 1917 address “Science as a Vocation” portrays the modern world as disenchanted by the progress of rationalism. Heschel’s life’s vocation had been to uncover the inner meaning of religious faith and to translate that faith into principled action. Heschel saw disenchantment not as an inescapable aspect of modern life but rather as the byproduct of physicians’ conscious choices to seek worldly success and material comfort. Yet, because of their privileged position as witnesses to human vulnerability, physicians possess an obligation to develop their own personhood, to re-enchant medicine, and through medicine to spark a positive transformation in all of modern life. As Heschel says, “The doctor must realize the supreme nobility of his vocation, to cultivate a taste for the pleasures of the soul. … The doctor is a major source of moral energy affecting the spiritual texture and substance of the entire society” [1, pp. 34, 38]. While Heschel’s conception of the physician’s role is romanticized and idealized, changes in the organization and practice of medicine have validated his concerns. (shrink)

As practicing clinicians, physicians are expected to uphold the ethical norms of their profession, including fidelity to patients and respect for patients’ self-determination. At the same time, as individuals, physicians are moral agents in their own right and, like their patients, are informed by and committed to diverse cultural, religious, and philosophical traditions and beliefs. In some circumstances, the expectation that physicians will put patients’ needs and preferences first may be in tension with the need to sustain the sense of (...) moral integrity and continuity that grounds a physician’s personal and professional life. This article examines the implications for patients, physicians, and the medical profession when tensions arise between a physician’s professional commitments and his or her deeply held personal moral beliefs. It offers guidance on when a physician’s professional commitments should outweigh personal beliefs as well as when physicians should have freedom to act according to the dictates of conscience while still protecting patients’ interests. (shrink)

Objective: To identify factors that predict physicians’ intent to comply with the American Medical Association’s ethical guidelines on gifts from the pharmaceutical industry.Methods: A survey was designed and mailed in June 2004 to a random sample of 850 physicians in Florida, USA, excluding physicians with inactive licences, incomplete addresses, addresses in other states and pretest participants. Factor analysis extracted six factors: attitude towards following the guidelines, subjective norms , facilitating conditions , profession-specific precedents , individual-specific precedents and intent. (...) Multivariate regression modelling was conducted.Results: Surveys were received from 213 physicians representing all specialties, with a net response rate of 25.5%. 62% of respondents were aware of the guidelines; 50% had read them. 48% thought that following the guidelines would increase physicians’ credibility and professional image; 68% agreed that it was important to do so. Intent to comply was positively associated with attitude, subjective norms, facilitators and sponsorship of continuing medical education events, while individual-specific precedents had a negative relationship with intent to comply. Predictors of intent were attitude, subjective norms, the interaction term , sponsorship of CME events and individual-specific precedents.Conclusions: Physicians are more likely to follow the AMA guidelines if they have positive attitudes towards the guidelines, greater subjective norms, fewer expectations of CME sponsorship and fewer individual-specific precedents. Physicians believing that important individuals or organisations expect them to comply with the guidelines are more likely to express intent, despite having fewer beliefs that positive outcomes would result through compliance. (shrink)

(2004). From an Exercise in Professional Etiquette to Society's Wish List? Review of American Medical Association, Code of Medical Ethics: Current Opinions with Annotations. The American Journal of Bioethics: Vol. 4, No. 2, pp. 69-70. doi: 10.1162/152651604323097907.

The attitudes of physicians and drug manufacturers in the US toward patenting pharmaceuticals changed dramatically from the mid-nineteenth century to the mid-twentieth. Formerly, physicians and reputable manufacturers argued that pharmaceutical patents prioritized profit over the advancement of medical science. Reputable manufactures refused to patent their goods and most physicians shunned patented products. However, moving into the early twentieth century, physicians and drug manufacturers grew increasingly comfortable with the idea of pharmaceutical patents. In 1912, for example, the American (...) class='Hi'>Medical Association dropped the prohibition on physicians holding medical patents. Shifts in wider patenting cultures therefore transformed the ethical sensibilities of physicians. (shrink)

The American Medical Association enacted its Code of Ethics in 1847, the first such national codification. In this volume, a distinguished group of experts from the fields of medicine, bioethics, and history of medicine reflect on the development of medical ethics in the United States, using historical analyses as a springboard for discussions of the problems of the present, including what the editors call "a sense of moral crisis precipitated by the shift from a system of fee-for-service (...) medicine to a system of fee-for-system medicine, better known as 'managed care.'" The authors begin with a look at how the medical profession began to consider ethical issues in the 1800s and subsequent developments in the 1900s. They then address the sociological, historical, ethical, and legal aspects of the practice of medicine. Later chapters discuss current and future challenges to medical ethics and professional values. Appendixes display various versions of the AMA's Code of Ethics as it has evolved over time. Contributors: George J. Annas, J.D., M.P.H., Arthur Isak Applbaum, Ph.D., Robert B. Baker, Ph.D., Chester R. Burns, M.D., Ph.D., Arthur L. Caplan, Ph.D., Alexander Morgan Capron, J.D., Christine K. Cassel, M.D., Linda L. Emanuel, M.D., Ph.D., Eliot L. Freidson, Ph.D., Albert R. Jonsen, Ph.D., Stephen R. Latham, J.D., Ph.D., Susan E. Lederer, Ph.D., Florencia Luna, Ph.D., Edmund D. Pellegrino, M.D., Charles E. Rosenberg, Ph.D., Mark Siegler, M.D., Rosemary A. Stevens, Ph.D., Robert M. Tenery, Jr., M.D., Robert M. Veatch, Ph.D., John Harley Warner, Ph.D., Paul Root Wolpe, Ph.D. (shrink)

PurposeAsian Americans comprise 21% of matriculating medical students in the United States but little is known about their mental health. With the growing focus on addressing the mental health of medical students, this systematic, nationwide survey assesses the relationship between anxiety and depression symptoms and coping skills among Asian American medical students.Materials and methodsA survey tool comprised of Patient Health Questionnaire-9, General Anxiety Disorder-7, and questions related to coping were emailed to members of the Asian Pacific (...) American Medical Students Association enrolled in a United States medical school during the 2016–2017 academic year. We evaluated associations between anxiety and coping as well as depression and coping.ResultsA total of 511 Asian American medical students completed the survey. Anxiety symptoms were positively correlated with an increase in negative coping skills. Depressive symptoms were not correlated with an increase in negative coping skills.ConclusionProfessionals and medical schools that aim to improve the mental health of medical students should be aware of the needs of specific populations. Asian American students who experience anxiety were more likely to utilize avoidant or negative coping strategies. In addition, Asian American students who experience depressive symptoms were not more likely to utilize these negative coping strategies. Further research must be done to evaluate the factors that influence the use of negative coping strategies to better address anxiety within the Asian American medical student population. (shrink)

The Association of American Medical Colleges (AAMC) is urging academic medical centers to ban pharmaceutical detailing. This policy followed from a consideration of behavioral and neuroeconomics research. I argue that this research did not warrant the conclusions drawn from it. Pharmaceutical detailing carries risks of cognitive error for physicians, as do other forms of information exchange. Physicians may overcome such risks; those determined to do so may ethically engage in pharmaceutical detailing. Whether or not they should do (...) so is a prudential judgment about which reasonable people may disagree. The AAMC's ethical condemnation of detailing is unwarranted and will subvert efforts to maintain a realm of physician discretion in clinical work that is increasingly threatened in our present practice environment. (shrink)

(2010). Response to Open Peer Commentaries on “The Pitfalls of Deducing Ethics from Economics: Why the Association of American Medical Colleges is Wrong About Pharmaceutical Detailing”. The American Journal of Bioethics: Vol. 10, No. 1, pp. W1-W3.

This essay describes how longstanding conceptions of professionalism in American medical care came under attack in the decades since the enactment of Medicare in 1965 and how the reform strategy and core provisions of the 2010 Affordable Care Act illustrate the weakening of those ideas and the institutional practices embodying them.The opening identifies the dominant role of physicians in American medical care in the two decades after World War II. By the time Medicare was enacted in (...) 1965, associations of American physicians were almost completely in charge of medical education, specialist certification, and the enforcement of professional norms on their members. Who could be a doctor, what education and training would be required, and what collegial oversight was operative was first a professional matter and only secondly implicated the state through malpractice or major corporations via the employment of physicians. (shrink)

The American Medical Association's Code of Ethics prohibits physicians from giving substances they believe are placebos to their patients unless the patient is informed of and agrees to use of the substance. Various questions surround the AMA policy, however. One of these has to do with what should be disclosed. The AMA holds that any treatment that the physician believes is a placebo should be identified as such to the patient. But consider a more restrictive policy that requires (...) physicians to defer to the medical community's consensus view about which treatments have a specific effect on the condition being treated. In light of the ethical goals that the AMA identifies—namely, concerns about patient trust, autonomy, and benefit—there are potential advantages to the more restrictive policy. (shrink)

The American Medical Association’s (AMA’s) “Opinion 1.1.7, Physician Exercise of Conscience” attempts to help physicians strike a reasonable balance between their own conscientious beliefs and their patients’ medical interests in an effort to minimize harms to both. However, some ambiguity still remains as to whether the severity of harms experienced by physicians and patients is to be assessed externally (by policy makers or by a professional body like the AMA), or internally by the subjects of those harms. (...) Conflicts between conscientious physicians’ self-assessments of the moral harm associated with various actions and the AMA’s external assessments of such harms are likely to lead to challenges in the implementation of some provisions of its opinion. This commentary argues, however, that provisions (b) and (e) of the opinion, which describe the information physicians should provide about their own scope of practice and about the existence of controversial procedures, are less likely to conflict with physicians’ subjective assessments of moral harm, and therefore will face fewer challenges in implementation. (shrink)

Medical students and faculty explore the medical humanities for diverse reasons: as a medium for self-reflection, a means to cultivate professionalism and humanism, and a way to gain an appreciation for the broader contexts in which illness and health occur. One important area for development is increasing the exposure of learners and clinicians of various levels of training to the medical humanities and to role models in the field. Student-led programs in the medical humanities at the (...) American Medical Student Association (AMSA) address these needs by offering unique opportunities for learning and sharing experiences. AMSA programs connect physicians-in-training using technology to create virtual communication and learning opportunities. These include monthly book discussion webinars, the Writers' Institute and the Medical Humanities Scholars Program (MHSP). (shrink)

Although the AAMC requires annual reporting of medical humanities teaching, most literature is based on single-school case reports and studies using information reported on schools’ websites. This study sought to discover what medical humanities is offered in North American allopathic and osteopathic undergraduate medical schools. An 18-question, semi-structured survey was distributed to all 146 member schools of the American Association of Medical Colleges and the American Association of Colleges of Osteopathic Medicine. The survey (...) sought information on required and elective humanities content, hours of humanities instruction, types of disciplines, participation rates, and humanities administrative structure. The survey was completed by 134 schools. 70.8% of schools offered required and 80.6% offered electives in humanities. Global health and writing were the most common disciplines. Schools required 43.9 mean and 30 median hours in humanities. In the first two years, most humanities are integrated into other course work; most electives are offered as stand-alone classes. 50.0% of schools report only 0-25% of students participating in humanities electives. Presence of a certificate, concentration or arts journal increased likelihood of humanities content but decreased mean hours. Schools with a medical humanities MA had a higher number of required humanities hours. Medical humanities content in undergraduate curriculum is lower than is indicated in the AAMC annual report. Schools with a formal structure have a greater humanities presence in the curriculum and are taken by more students. (shrink)

The purpose of the study was to assess medical journals’ conflicts of interest in the publication of book reviews. We examined book reviews published in 1999, 2000, and 2001 in five leading medical journals: Annals of Internal Medicine, British Medical Journal, Journal of the American Medical Association, Lancet, and New England Journal of Medicine. The main outcome measure was journal publication of reviews of books that had been published by the journal’s own publisher, that had (...) been edited or authored by a lead editor of the journal, or that posed another conflict of interest. We also surveyed the editors-in-chief of the five journals about their policies on these conflicts of interests. During the study period, four of the five journals published 30 book reviews presenting a conflict of interest: nineteen by the BMJ, five by the Annals, four by JAMA, and two by the Lancet. These reviews represent 5.8%, 2.7%, 0.7%, and 0.7%, respectively, of all book reviews published by the journals. These four journals, respectively, published reviews of 11.9%, 25.0%, 0.9%, and 1.0% of all medical books published by the journals’ publishers. Only one of the 30 book reviews included a disclosure statement addressing the conflict of interest. None of the journals had a written policy pertaining to the conflicts of interest assessed in this study, although four reported having unwritten policies. We recommend that scientific journals and associations representing journal editors develop policies on conflicts of interest pertaining to book reviews. (shrink)

Despite tremendous advances in medical care for critically ill newborn infants, caregivers in neonatal intensive care units still struggle with how to approach those patients whose prognoses appear to be the most grim, and whose treatments appear to be the most futile. Although the practice of passive neonatal euthanasia, from a moral perspective, has been widely condoned, those clinicians and families involved in such cases may still be found legally guilty of child abuse or even manslaughter. Passive neonatal euthanasia (...) remains both a moral dilemma and a legal ambiguity. Even the definition of passive euthanasia remains unclear. This manuscript reviews the basic moral and legal considerations raised by the current practice of neonatal euthanasia, and examines the formal position statements of the American Medical Association and the American Academy of Pediatrics. The paper concludes by emphasising the need, at least in the United States, to clarify the legal status of this relatively common medical practice. (shrink)

The various statements and declarations of the World Medical Association that address conflicts of interest on the part of physicians as (1) researchers, and (2) practitioners, are examined, with particular reference to the October 2000 revision of the Declaration of Helsinki. Recent contributions to the literature, notably on conflicts of interest in medical research, are noted. Finally, key provisions of the American Medical Association’s Code of Medical Ethics (2000–2001 Edition) that address the various forms of (...) conflict of interest that can arise in the practice of medicine are outlined. (shrink)

David Hyman and Charles Silver are quite right. Opinion 6.01 in the American Medical Association's Code of Medical Ethics is difficult to defend. Ties between compensation and outcomes need not mislead patients into thinking that results are guaranteed; they are widely used in other fields with considerable success, even if they have some disadvantages; they can potentially bring patients more actively into decision-making about whether and from whom to purchase which medical care; and, if carefully tuned, (...) they can promote quality by aligning providers’ welfare more closely with patients’.The purpose of this commentary is thus not to disagree with the fundamental thesis that result-based compensation arrangements can be appropriate and useful in the health-care setting. Rather, the objective is to “cut the next swath,” so to speak. While Hyman and Silver are right that RBCAs have potential to do good, they may be overly optimistic about benefits, while underestimating the potential limitations and hazards. (shrink)

Luke Fildes's iconic painting The Doctor, first exhibited in 1891, has long served as a symbol of the caring, priest-like physician, watching over a sick child as the child's parents place their faith in his ministrations, technologically meager as they may be. As physicians acquired more visible and potent interventions—x-rays, antibiotics, the complex infrastructure of the hospital itself—the 19th-century British scene depicted by Fildes of an individual doctor's watchful waiting would be appropriated by the likes of the American (...) class='Hi'>Medical Association in the 1940s to remind the American public of this idealized patient-doctor relationship, augmented by increasingly powerful curative tools at the disposal of... (shrink)

When infertility clinics offer money-back guarantees, they prefer to give them more delicate names such as “shared risk,” “warranty,” or “outcome” programs. We should not allow such daintiness to distract us from the bottom line of these programs which are all about the bottom line.John Robertson and Theodore Schneyer defend such programs as special forms of insurance, what they call “risk-of-failure insurance.” They argue, in “Professional Self-Regulation and Shared-Risk Programs for In Vitro Fertilization,” that the criticisms of in vitro fertilization (...) shared-risk programs by the American Medical Association and others are off the mark. It would be sufficient, Robertson and Schneyer contend, to develop guidelines for informed consent or protocols that discourage risky clinical procedures. They acknowledge that shared risk plans “present problems if not offered with full disclosure and attention to patient interests,” but they insist that “there is no reason why they cannot be implemented in an ethically sound way.”. (shrink)

When infertility clinics offer money-back guarantees, they prefer to give them more delicate names such as “shared risk,” “warranty,” or “outcome” programs. We should not allow such daintiness to distract us from the bottom line of these programs which are all about the bottom line.John Robertson and Theodore Schneyer defend such programs as special forms of insurance, what they call “risk-of-failure insurance.” They argue, in “Professional Self-Regulation and Shared-Risk Programs for In Vitro Fertilization,” that the criticisms of in vitro fertilization (...) shared-risk programs by the American Medical Association and others are off the mark. It would be sufficient, Robertson and Schneyer contend, to develop guidelines for informed consent or protocols that discourage risky clinical procedures. They acknowledge that shared risk plans “present problems if not offered with full disclosure and attention to patient interests,” but they insist that “there is no reason why they cannot be implemented in an ethically sound way.”. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:PHARAOH'S.MAGICIANS: THE ETHICS AND EFFICA:CY OF HUMAN FETAiL TISSUE TRANSPLANTS ROBERT BARRY, O.P. Program for the Study of Religion University of Illinois, Champaign-Urbana DARREL KESLER Department of Animal Sciences University of Illinois, Champaign-Urbana. IN RECENT YEARS increasing attention ha;s been given to v:rurious types of scientific riese,arch involving the human fetus. In the 1970s, :a tremendous amount of concern was expres1 sed IJ.'egiaroing the fetus,a;.s a rSU!bject of e~erimenrtation. (...) In this debate, the announced " research impeiiat:i:ve " was pos,ed against other moral imperativ;es.1 Following much soctiet :JaJl drebarte, protootlive meiaisumeis 1 WeIDe il!dopited 1by oompireihensive regiutatiions in 1975 estaiblishiing protections foT a number of research sUibjects. These regulrutions protect the fetus from non-beneficiail experimentation. that iworuild pose more than minima;l risk rto the fetus. Current debates in science and ethics now swirl arlOiund a new topic regarding human '.fetal life: the fetus as a sourrce of tissue for triansplaintation into other persons ais run e~erimental thempy. It is an issue that is rapidly moving torward the same Jevel of" research imperative" as did the earlier debate on the 1 See Paul Ramsey, The Ethics of Fetal Research (New Haven: Yale University Press, 1975): "Today one often hears statements like' Fetal Research must be done,' or 'It would be immoral not to do this research'" (P. xv). The validity of such opinions and utterances entirely depends on a netbenefits ethics, and the validity of that moral universe has been called increasingly into question in recent years. 575 576 ROBERT BARRY, O.P. AND DARREL KESLER ~etus as subject. Recently,,a new level of intensity was added to this deharte rby the imposition of an indefinite moratorium on federal support for research on transplantrution experiments inv;olving human.fetirul tissue and other!humans. 1Thls " :indefinite moratorium " w1as a result of a process that 1 began with research p110posaJs considered rby the National In- 'stituites of Health (NIH) in October 1987. In Marich 1988 a momtorium wa;g plaioed on the r:eseareh, and an 1advisory panel was summoned to consider the ethical issues involved. This panel presented 1a cveoommendation for the procedures. However, the Secretary of the Department of Health and Ruman Se1wfoes (HHS), Dr. Louis Sullivan, decided against the research proposal on etmcal grounds. His decision w:as with the 'concU'l'Tenoe of the Assistant Secretary :£m.· Health of HHS, Dr. James Mason, who has Tespons~bility for the NIH. Secretary SulliV1an's decision was oommumcarted to the Acting Director of the NIH, Dr. William Raub, in Nov,ember 1989. A :firestorm of criticism erupted from,rudv;ocates of this research, including the Council of Judicial and Ethical Affairs of tihe American Medical Association, which 5.n June 1989 called for an end to the:ban.2 In this article, we wish to question both the science and the ethics of the rproposed fotal tissue transplantation therapy. We!Will 1support the £edeml funding moratorium and surggest new pmtections for the fetuses (whether po,ssibly living or de2 " Medical Applications of Fetal Tissue Transplantation", JAMA, Vol. 263, No. 4, January 26, 1990, 'PP· 565-570. There has been a.great deal of public debate, not only in the U.S. but also in Europe over whether human embryo research should be supported with public funds. Many Catholic countries in Europe have prohibited such research, while a number of other nations have allowed it. Dickson, D., "Europe Split on Embyro Research", Science, Vol. 242, November 21, 1988, pp. 1117-1118. The most interesting controversy is in West Germany where there is a strong movement to prohibit it because many there believe such an experimentation requires judgments that there are certain forms of human life that do not deserve to survive. Ibid., p. 1117. Many Germans regard these sorts of judgments as too close to those made by Nazis, and there is strong sentiment to prohibit such research altogether. Ibid. HUMAN FETAL TISSUE TRANSPLANTS 577 oea:sed) of elective a.bortfons. We will also describe new reseaooh directions in t~apy.for the diseases in which it is claimed that fetal... (shrink)

Little has been written recently about the obligations of lay people in professional relationships. Yet the Code of Medical Ethics adopted by the American Medical Association in 1847 included an extensive statement on ‘Obligations of patients to their physicians’. After critically examining the philosophical foundations of this statement, I provide an alternative account of lay obligations in professional relationships. Based on a hypothetical social contract and included in a full specification of professional as well as lay obligations, (...) this account requires lay people to honor commitments and disclose relevant information. Ethically, the account assumes that all parties in lay-professional relationships should be given equal consideration and respect in determining rights and obligations. Factually, it assumes that the treatment of many illnesses and injuries requires collaboration and cooperation among lay persons and health professionals, that medical resources and personnel are limited, and that medicine, nursing, and related health professions, are, in MacIntyre's sense, practices. Keywords: patient-physician relationship, moral responsibility of patients, health professionals' duties, contract theory and lay-health professional relationship, health professions as "practices", commitments, truth-telling CiteULike Connotea Del.icio.us What's this? (shrink)

BackgroundAn analysis of the position statements of secular US medical and surgical professional societies on physician-assisted suicide (PAS) and euthanasia have not been published recently. Available statements were evaluated for position, content, and sentiment.MethodsIn order to create a comprehensive list of secular medical and surgical societies, the results of a systematic search using Google were cross-referenced with a list of societies that have a seat on the American Medical Association House of Delegates. Societies with position statements (...) were identified. These statements were divided into 5 categories: opposed to PAS and/or euthanasia, studied neutrality, supportive, acknowledgement without statement, and no statement. Linguistic analysis was performed using RapidMinder in order to determine word frequency and sentiment respective to individual statements. To ensure accuracy, only statements with word counts > 100 were analyzed. A 2-tailed independentttest was used to test for variance among sentiment scores of opposing and studied neutrality statements.ResultsOf 150 societies, only 12 (8%) have position statements on PAS and euthanasia: 11 for PAS (5 opposing and 4 studied neutrality) and 9 for euthanasia (6 opposing and 2 studied neutrality). Although the most popular words used in opposing and studied neutrality statements are similar, notable exceptions exist (suicide,medicine, andtreatmentappear frequently in opposing statements, but not in studied neutrality statements, whereaspsychologists,law, andindividualsappear frequently in studied neutrality statements, but not in opposing statements). Sentiment scores for opposing and studied neutrality statements do not differ (mean, 0.094 vs. 0.104;P = 0.90).ConclusionsFew US medical and surgical societies have position statements on PAS and euthanasia. Among them, opposing and studied neutrality statements share similar linguistic sentiment. Opposing and studied neutrality statements have clear differences, but share recommendations. Both opposing and studied neutrality statements cite potential risks of PAS legalization and suggest that good palliative care might diminish a patient’s desire for PAS. (shrink)

This series of articles by Charles Dougherty, Robert Berenson, and Kathleen Powderly and Elaine Smith, as well as “Cost Containment: Challenging Fidelity and Justice” by E. Haavi Morreim (Hastings Center Report, December 1988), result from a Hastings Center project, “Ethics and Prospective Payment Systems: DRGs.” The two-year project was jointly funded by The General Electric Foundation and the American Medical Association Education and Research Foundation.The project tried to gauge the systematic effects of the introduction of cost containment strategies, (...) prospective payment by Diagnostic Related Groups in particular, on the provision of health care and the ethical practice of medicine. Cost containment strategies, no matter how necessary in curbing spiraling medical costs, leave no sector or participants in the health care system untouched—hospitals and other health care institutions; doctors, nurses, social workers and other health care professionals; patients, their families, and the thirty-six to forty million medically indigent. The articles discuss the several and interrelated ethical issues raised by the DRG prospective payment system (Dougherty); its particular affect on the doctor-patient relationship and how it is transforming the ethical practice of medicine (Berenson and Morreim); and its specific impact on the professions and professional ethics of nursing and social work (Powderly and Smith). The overall message of the articles is that the health professions, their provision of care, and the ethics of their practices—as driven by economic considerations and realities—are in the midst of a more or less radical sea change. (shrink)

On May 24, 1995, the American Medical Association Council on Ethical and Judicial Affairs issued a rather controversial opinion that it is ethically permissible to use anencephalic infants as living organ donors. Approximately 1,000 to 2,000 infants are born each year in the United States with anencephaly, a congenital birth defect whereby the infant has no forebrain and cerebrum. Without higher brain functions, the infants can never experience consciousness, thoughts, emotions, or pain. Fewer than half survive more than (...) a day, and more than 90 percent die within one week. However, by the time brain death occurs in anencephalic infants, their organs are no longer suitable for donor purposes because they have deteriorated beyond use.In 1988, the AMA Council declared that it is ethical to use the infants as organ donors only after they have died. Now the Council has revised that opinion, and it proposes to allow removal of organs before death, as long as the parents consent and two doctors concur in the diagnosis of anencephaly. (shrink)

*The views expressed in this commentary are those of the authors and do not necessarily represent the views of the American Medical Association.

International Humanitarian Law mandates that all wounded in war, no matter which party they belong to, shall receive aid in accordance with their medical condition, and that “there shall be no distinction among them founded on any grounds other than medical ones.” This principle of impartiality is endorsed by various other military and civilian institutions worldwide to include the ICRC, the US Department of Defense, and the American Medical Association. In this essay, I argue that in (...) some cases, we ought, morally speaking, to triage based on factors beyond one’s medical condition. More specifically, I argue that in these cases, we ought to triage, at least partly, based on one’s moral responsibility for one’s current medical predicament. I call this view Triage by Moral Responsibility (TMR). I support my argument for TMR by demonstrating its plausibility when applied to cases of medical treatment and disaster relief, and by drawing parallels between these situations and those considered in the ethics of defensive harming. I conclude by discussing the practicality of my moral conclusion for the practice of medical triage in pandemics and war. (shrink)

This paper reviews common advertising claims by egg freezing companies and evaluates the medical evidence behind those claims. It then surveys legal standards for truth in advertising, including FTC and FDA regulations and the First Amendment right to free speech. Professional standards for medical advertising, such as guidelines published by the American Society for Reproductive Medicine, the American College of Obstetricians and Gynecologists, and the American Medical Association, are also summarized. A number of claims, (...) many of which relate to the targeting of younger women for eOC, are found to breach legal and ethical standards for truth in advertising. The ethical implications of misleading advertising claims are also discussed, and the central narrative woven by OC ads — that egg freezing is empowering to women — is examined. The paper concludes that a more balanced approach to the risks and benefits of OC is necessary to truly respect women's autonomy. Moreover, justice requires us to look beyond a medical procedure accessible only to a minority of women in order to address inequities in the workplace. (shrink)

Considerable controversy has recently arisen regarding the patenting of medical and surgical processes in the United States. One such patent, viz. for a "chevron" incision used in ophthalmologic surgery, has especially occasioned heated response including a major, condemnatory ethics policy statement from the American Medical Association as well as federal legislation denying patent protection for most uses of a patented medical or surgical procedure. This article identifies and discusses the major legal, ethical and public policy considerations (...) offered by proponents and opponents of such patents. The existing literature divides up into those who favor such patents essentially without qualification, and those who condemn and wish to outlaw them. We advance a compromise position where administrative and legislative action is called for to provide more specific guidelines regarding the patentability of such processes by the Patent and Trademark Office. Our position, in sum, will be that too much is at stake in this complicated area for either the blanket prohibition, or wholesale, uncritical acceptance, of the patenting of medical and surgical processes or techniques. (shrink)

Just as physicians can object to providing services due to their ethical and/or religious beliefs, medical students can have conscience-based objections to participating in educational activities. In 1996, the Medical Student Section of the American Medical Association introduced a resolution calling on the AMA to adopt a policy in support of exemptions for students with ethical or religious objections. In that report, students identified abortion, sterilization, and procedures performed on animals as examples of activities that might (...) prompt requests for conscience-based exemptions. In response to the student initiative, the Council on Medical Education recommended the adoption of seven “principles to guide exemption of medical students from activities based on conscience.” The House of Delegates adopted these principles in their entirety. (shrink)

This article comments on a collection of remarkable narratives authored by fat writers addressing the American Medical Association’s decision to label obesity a disease. Endeavoring to avoid what has been termed “thinsplaining,” the commentary examines the voices of the writers in the hopes of identifying key themes and points that emerge from these fat narratives. The commentary canvasses the writers’ perspectives on topics such as the medicalization and pathologization of fat, the Western and especially American tendency to (...) emphasize individual culpability for fatness, and, of course, the horrific commonality and intensity of fat stigma. Stigma is a particular focus for the commentary, both because it is a principal theme in the collection, and also because it is important to understand precisely what stigma is and its deep connections to larger macrosocial structures. The commentary concludes with a simple admonition, gleaned from the narratives: we should strive to do better. (shrink)

It is unknown to what extent medical researchers generalize study findings beyond their samples when their sample size, sample diversity, or knowledge of conditions that support external validity do not warrant it. It is also unknown to what extent medical researchers describe their results with precise quantifications or unquantified generalizations, i.e., generics, that can obscure variations between individuals. We therefore systematically reviewed all prospective studies (n = 533) published in the top four highest ranking medical journals, Lancet, (...) New England Journal of Medicine (NEJM), Journal of the American Medical Association (JAMA), and the British Medical Journal (BMJ), from January 2022 to May 2023. We additionally reviewed all NEJM Journal Watch clinical research summaries (n = 143) published during the same time. Of all research articles reporting prospective studies, 52.5% included generalizations beyond specific national study populations, with the numbers of articles with generics varying significantly between journals (JAMA = 12%; Lancet = 77%) (p < 0.001, V = 0.48). There was no evidence that articles containing broader generalizations or generics were correlated with larger or more nationally diverse samples. Moreover, only 10.2% of articles with generalizations beyond specific national populations reported external validity strengthening factors that could potentially support such extrapolations. There was no evidence that original research articles and NEJM Journal Watch summaries intended for practitioners differed in their use of broad generalizations, including generics. Finally, from the journal with the highest citation impact, articles containing broader conclusions were correlated with more citations. Since there was no evidence that studies with generalizations beyond specific national study populations or with generics were associated with larger, more nationally diverse samples, or with reports of population similarity that may permit extensions of conclusions, our findings suggest that the generalizations in many articles were insufficiently supported. Caution against overly broad generalizations in medical research is warranted. (shrink)

Over the last two decades judges (and regulators) in all common law jurisdictions have increased their reliance on published medical and scientific literature. During the same period biomedical research has undergone fundamental and unprecedented change. This article explores some of the changes to the location, organization and funding of biomedical research in order to assess their implications for liability and proof. Focusing on peer review and publication, along with reforms promoted by the editors of some of the world's pre-eminent (...) general medical journals (e.g. British Medical Journal, the Lancet, Journal of the American Medical Association and the New England Journal of Medicine), this article considers how judges might respond to recent findings which suggest that corporate sponsorship systematically biases biomedical research. Given that common law judges have been reforming rules of evidence and procedure in search of impartial expertise and privileging published biomedical research, how should they respond to the strategic manipulation of the scientific record? (shrink)

In 1992, the United States Supreme Court, in Planned Parenthood of Southeastern Pennsylvania v. Casey, upheld the ruling in Roe v. Wade, namely that women have a right “to choose to have an abortion before viability and to obtain it without undue interference from the State.”1 However, since this ruling, some states have imposed regulations that greatly limit this right by restricting access. Texas is a recent example of this. Two proposed restrictions in House Bill 2, which will be discussed (...) in detail below, will force all but eight clinics that are located in metropolitan areas to shut down. The U.S. Supreme Court put the proposed restrictions on hold in October 2014, allowing several clinics to remain open while the restrictions are being appealed in the U.S. Court of Appeals for the Fifth Circuit. If the restrictions are passed, however, those clinics will be forced to shut down and, as a result, many women in Texas will be required to travel more than 100 miles in order to access a safe and legal abortion. Much of the focus of these restrictions has been on women and rightly so. However, I want to turn the attention to physicians. The requirements exacerbate unfair treatment of abortion providers compared with other physicians. Abortion providers face threats from the public—some of which turn into violent attacks—and they are often ostracized by their fellow medical practitioners. There are so few abortion providers to begin with and the proposed requirements limit these physicians’ opportunities to practice the branch of medicine of their choosing. Although the HB 2 requirements may not result in an unconstitutional undue burden on physicians, the challenges created by the bill limit physicians’ abilities to provide abortions. As a result of these limits, HB 2 creates an unconstitutional undue burden for women seeking abortions by creating barriers directed at abortion providers and clinic staff who are willing and able to provide abortions. The first of the two controversial HB 2 requirements is the admitting privileges requirement: “A physician performing or inducing an abortion must, on the date the abortion is performed or induced, have active admitting privileges at a hospital that is located not further than 30 miles from the location at which the abortion is performed or induced.”2 The second requirement is the ambulatory surgical center requirement: “The minimum standards for an abortion facility must be equivalent to the minimum standards adopted under [Texas Health & Safety Code] [...] for ambulatory surgical centres.”3 In order to meet these state-mandated obligations, some abortion clinics would have to spend more than $1 million in upgrades if they wish to remain open. The District Court decided that the ambulatory surgical center requirement places an unconstitutional undue burden on women, and that the two requirements together place an undue burden on women in Texas and especially in the Rio Grande Valley where the nearest clinic is a couple hundred miles away.4 Later, the U.S. Court of Appeals for the Fifth Circuit reversed the District Court’s decision and argued, “the admitting privileges requirement is constitutional on its face.”5 While the regulations are being appealed, the Supreme Court granted a stay of injunction, allowing about twelve abortion clinics to reopen until a final decision regarding the regulations is made. The District Court ruled that the purpose of the two regulations was to create a substantial obstacle for women seeking abortions in Texas. While the defendants argued that the regulations were designed to make abortions safer and reduce risk, the Court decided that this was not the case. An abortion, especially a first-term abortion, is a very safe procedure and is safer than many other routine surgical procedures. As stated in Planned Parenthood v. Casey, “Unnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on the right.”6 The undue burden in this case is imposed, not through restricting women’s access directly, but by restricting physicians’ freedom to perform abortions. The admitting privileges requirement has reduced the number of physicians who can perform abortions and the ambulatory surgical center requirement has reduced the number of clinics where abortions can be performed. The American Medical Association states, “[t]he Principles of Medical Ethics of the AMA do not prohibit a physician from performing an abortion in accordance with good medical practice and under circumstances that do not violate the law.”7 This means that physicians are not required to perform abortions, except in emergency situations, but can as long as the procedure is done safely and does not violate the law. The new Texas regulations, however, are so restrictive that few abortion providers, limited to only four urban areas, can legally perform abortions. Physicians do not have an absolute right to perform abortions as opposed to women who have an absolute right to have access to an abortion. Physicians do face many challenges that other professionals face in terms of obtaining qualifications and finding work. Abortion providers, however, face challenges that most other physicians do not. The restrictions imposed by these regulations exacerbate unfair treatment toward abortion providers and place further obstacles in their path in terms of providing the service they want and are qualified to provide. Both abortion clinics and abortion providers are being treated differently from other medical clinics and physicians. For instance, “grandfathering of existing facilities and the granting of waivers from specific requirements is prohibited for abortion providers, although other types of ambulatory surgical facilities are frequently granted waivers or are grandfathered.”8 Many abortion clinics cannot afford the necessary upgrades. Furthermore, it is extremely expensive to open a brand new clinic that complies with the ambulatory surgical center requirements. Being grandfathered in would be the only option available to abortion clinics that cannot afford the upgrade. However, unfair treatment of abortion clinics and providers is preventing those clinics from being grandfathered into the new system. As a result, many abortion clinics may be forced to close. Admitting privileges are proving difficult or impossible for physicians both to obtain and, for those who have already been granted privileges, to keep. Dr. Sherwood Lynn, an obstetrician-gynecologist who has performed abortions for decades, describes the process of obtaining admitting privileges and the difficulties abortion providers face. After sending in an application a physician must wait for the hospital to send them the required materials, “but if the address of the practice on the application is of an abortion provider or clinic, [the hospital] won’t send [them] the package of materials required. [They] simply can’t apply.”9 Dr. Lynn and several other physicians have surmised that hospitals are only withholding privileges from qualified physicians who perform abortions and that other physicians do not face this discriminatory treatment. Hospitals have also revoked privileges granted to physicians after learning that the physicians perform abortions. For instance, in Texas two doctors, “received notices [...] informing them that their admitting privileges to the University General Hospital of Dallas have been revoked, with the hospital’s CEO claiming the hospital was unaware they were providing abortion care and that the hospital believed such care would damage its reputation.”10 What is curious about this revocation is that, “federal and state laws [...] forbid hospitals from discriminating against doctors who perform abortions,” and yet hospitals are clearly doing just that.11 Dr. Pamela Richter, another abortion provider in Texas, had her temporary admitting privileges revoked with no explanation and because of this, the clinic where she performed abortions, Reproductive Services, can no longer provide abortions at all.12 As the hospital gave no reason for the revocation, it not clear Dr. Richter’s privileges were revoked because she performs abortions. Dr. Richter, however, has performed over 17,000 abortions and her privileges were revoked soon after HB 2 was introduced.13 According to the Texas Hospital Association, giving admitting privileges to doctors who do not work for the hospital is expensive and time-consuming but this does not account for the fact that hospitals are revoking previously granted privileges from physicians whom they learn are providing abortion services.14 As mentioned previously, the District Court found that the admitting privileges requirement and the ambulatory surgical center requirement do not further ensure the health and safety of women undergoing an abortion. Several physicians have testified to this fact. Dr. Lynn stated in an interview: The admitting privileges requirements are [...] absolutely unnecessary. If you have a number of patients waiting for procedures, and something happens and a patient needs to be transferred to a hospital, you’re not going to leave everyone else and go to the hospital. That makes no sense. You’re going to refer that person to a gynecologist at the hospital. There is no safety issue involved here. If a patient shows up with an emergency, every hospital is required to admit that patient. They have to by law.15 It is rare that complications will arise from an abortion performed in a clinic. Dr. Richter, for example, has performed more than 17,000 abortions and not once had to send a patient to a hospital because of complications resulting from the procedure. According to Dr. Lynn even if abortion providers were granted privileges to hospitals, it is unlikely that they will exercise them. In essence, having admitting privileges at a hospital does nothing to further ensure the safety of an already safe procedure. The only result of the admitting privileges requirement is to limit certain physicians’ ability to perform legal abortions. Not only do the HB 2 requirements fail to further ensure the health and safety of women, the HB 2 requirements may actually create more health risks to women who cannot access the eight remaining clinics. The first risk is that the remaining clinics would have an influx of patients that they may not be able to handle, forcing women to wait longer for an appointment. As stated by the District Court, “[e]ven assuming every woman in Texas who wants an abortion [...] could travel to one of the four metropolitan areas where abortions will still be available, the cumulative results of HB 2 are that, at most, eight providers would have to handle the abortion demand of the entire state.”16 Furthermore, “[t]hat the State suggests that these seven or eight providers could meet the demand of the entire state stretches credulity.”17 Abortion is a time sensitive procedure. It is safest when performed early in a pregnancy. The increase in patients to these remaining clinics, assuming all women in Texas can access them, will increase wait times and may force women to have abortions later in pregnancy. In the worst-case scenario, a woman would not see an abortion provider at all before viability. Such instances may be rare, but they are possible. In such cases, women’s access to legal abortions becomes impossible and thereby violate the ruling in Roe. Clinics may be able to avoid the aforementioned problems if they hire more physicians. However, there are two barriers to hiring more physicians. First, as mentioned previously, admitting privileges to Texas hospitals are difficult, if not impossible, for abortion providers to obtain. Second, given the negative treatment of abortion providers by anti-abortion groups, many physicians are not willing to perform abortions. The harassment abortion providers face is unique to those physicians and many physicians will not perform abortions for that reason. In an article published in the Austin Chronicle, anti- abortion activist Abby Johnson, “discusses how her group investigated appraisal district records to find the new location of where an Austin abortion physician plans to work.”18 Johnson states, “These abortionists are feeling the pressure from the pro-life movement in Texas. I think they feel like they’re on the run. And that’s how we want to keep it.”19 If the HB 2 requirements are passed and there remain at most eight abortion providers in Texas, these activists will concentrate on those clinics and, “the dangerous impact of their intimidation tactics will be exacerbated.”20 Even if the number of physicians needed to meet the demand in Texas can obtain admitting privileges and work at one of the remaining clinics, they may choose not to do such work because they are putting themselves at risk. The harm abortion providers face from such anti-abortion groups is not unique to Texas. There are stories from all over the country and from other countries where abortion is legal of physicians receiving death threats. Dr. George Tiller, an abortion provider in Kansas, was killed outside his church and had received numerous death threats prior to this. The HB 2 requirements are making it so that abortion providers either cannot provide their services any longer or will face increased threats and increased danger to themselves. Physicians are allowed to conscientiously object to providing medical interventions in certain circumstances for moral and religious reasons. However, there are limits on this right. According to the American Congress of Obstetricians and Gynecologists, “[w]hen conscientious refusals conflict with moral obligations that are central to the ethical practice of medicine, ethical care requires that the physician provide care despite reservations or that there be resources in place to allow the patient to gain access to care in the presence of conscientious refusal.”21 I would argue fear for one’s safety in the face of immediate threats is perhaps a stronger ground on which to refuse to provide care than a personal belief that abortion is immoral or against one’s religion. ACOG also states, “[p]roviders with moral or religious objections should either practice in proximity to individuals who do not share their views or ensure that referral processes are in place so that patients have access to the service that the physician does not wish to provide.”22 This responsibility has been largely disputed by the medical community but in cases of rape, incest, and health risks to women, referrals must be made without exception. However, under the requirements of HB 2, working in proximity to an abortion provider may not be possible because they are so geographically limited. Referrals are supposed to be made within reason. Some areas of Texas, such as the Rio Grande Valley, are up to 200 miles away from the nearest clinic that would remain open if HB 2 is passed. Referrals may simply not be feasible given the geographical distances and the decreasing number of available physicians. As mentioned above, there are two risks to the health and safety of women as a result of HB 2. The second of these is that if a woman cannot access one of the remaining clinics, she may seek out a more convenient but illegal and unsafe abortion, which is far more likely to result in a dangerous complication. Dr. Lynn states, “[b]ecause of the restrictions lawmakers impose, women will seek abortions illegally, and we’re going to see a rise in septic abortions.”23 Some areas of Texas might effectively revert back to a pre-Roe era where abortions were performed in unsanitary conditions by unqualified people resulting in dangerous medical complications far more often than legal abortion procedures do now. Physicians like Dr. Lynn who want to prevent this from happening generally cannot do so without facing legal sanction. Physicians have a duty to provide safe medical care and if they cannot obtain admitting privileges, they cannot exercise this duty. ACOG released a statement expressing their objections to the new requirements. They state that HB 2 is, “plainly intended to restrict the reproductive rights of women in Texas through a series of requirements that improperly regulate medical practice and interfere with the patient-physician relationship.”24 Executive Vice-President of ACOG, Hal C. Lawrence III stated: The Texas bills set a dangerous precedent of a legislature telling doctors how to practice medicine and how to care for individual patients. ACOG opposes legislative interference, and strongly believes that decisions about medical care must be based on scientific evidence and made by licensed medical professionals, not the state or federal government.25 Abortion is one of only a few areas of medicine where the legislature imposes so many regulations restricting particular physicians’ ability to practice medicine. Not only are abortions providers being regulated by the state, they are also facing clear discrimination from others within the medical community. The state is closing down clinics that do not meet the ambulatory surgical center requirements and hospitals are denying physicians admitting privileges because they perform abortions. In summary, abortion providers are being discriminated against both by the legislature and other members of the medical community. Other physicians who do not perform abortions are not denied admitting privileges on discriminatory grounds. Clinics that cannot afford upgrades to become an ambulatory surgical center are being grandfathered in, while abortion clinics are being forced to close down. Ob-Gyns who conscientiously object to performing abortions and who are not located in close proximity to at least one abortion provider cannot effectively fulfill their duty to refer patients. Lastly, given the barriers these regulations will create, there will likely be a rise in complications resulting from abortions provided under grossly unsafe conditions. Physicians, whose duty it is to provide safe and effective medical care, are being denied the right to exercise this duty. While this denial may not be unconstitutional, it is certainly unjust and discriminatory and creates obstacles that other physicians do not face. Most importantly, these obstacles are creating an undue burden for women. The HB 2 requirements do not increase the health and safety of abortions; all they do is create substantial obstacles for women. In light of these observations, the requirements seem to me to be in clear violation of Casey, in which it was decided that, “[u]nnecessary health regulations that have the purpose or effect of presenting a substantial obstacle to a woman seeking an abortion impose an undue burden on that right.”26 These regulations do just what Casey was meant to prohibit and this is accomplished through limiting physicians’ ability to practice safe abortions across the state of Texas. Therefore, the HB 2 requirements may not impose an undue burden on doctors but they do impose an undue burden on women. PDF available: Rachel Hill, "Texas HB 2," Voices in Bioethics. References: 1 Planned Parenthood of Southeastern Pennsylvania v. Casey, pg. 2. 2 Whole Women’s Health v. Lakey, pg. 2. 3 Ibid. 4 Ibid., 4. 5 Ibid., 2. 6 Planned Parenthood v. Casey, pg. 16 7 AMA Code of Medical Ethics, “Opinion 2.01 – Abortion,” American Medical Association. 8 Whole Women’s Health v. Lakey, pg. 10. 9 Dr. Sherwood Lynn, “A Texas Ob-Gyn Details the Horrific Consequences of Abortion Restrictions,” Cosmopolitan. 10 Feminist Newswire, “Texas Hospitals Revoke Admitting Privileges to Abortion Providers,” Feminist Majority Foundation Blog. 11 Ibid. 12 Ibid. 13 Ibid. 14 Glenn Hegar, “Texas Hospital Association’s Statement of Opposition to Section 2 of the Committee Substitute for Senate Bill 5,” Texas Hospital Association. 15 Dr. Lynn, “A Texas Ob-Gyn.” 16 Whole Women’s Health v. Lakey, pg. 10. 17 Ibid. 18 Mary Tuma, “Undercover Audio Reveals Anti-Abortion Tactics: Anti-abortion activists monitor and track providers, patients,” Austin Chronicle. 19 Ibid. 20 Ibid. 21 Committee on Ethics, “The Limits of Conscientious Refusal in Reproductive Medicine,” The American Congress of Obstetricians and Gynecologists. 22 Ibid. 23 Dr. Lynn, “A Texas Ob-Gyn.” 24 “Ob-Gyns Denounce Texas Abortion Legislation: Senate Bill 1 and House Bill 2 Set Dangerous Precedent,” The American Congress of Obstetricians and Gynecologists. 25 Ibid. 26 Planned Parenthood v. Casey, pg. 16. (shrink)