Ethics principles

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The previous edition of the American College of Physicians’ (ACP’s) Ethics Manual was published in 2005. The current publication updates this manual, with important new recommendations regarding the use of medical information and physician reimbursement practices.

• Beneficence: the duty to promote good and act in the best interest of the patient and society; nonmaleficence: the duty to do no harm to patients; respect for patient autonomy; and justice: the equitable distribution of life-enhancing opportunities afforded by healthcare.
• Face-to-face patient care is still encouraged above all, although other means of communication can be used to augment patient care. However, the act of writing prescriptions based solely on telephone conversations or the results of questionnaires with patients unknown to the physician is not an acceptable standard of care.
• In the absence of a preexisting relationship, the physician is not morally bound to provide care for a patient unless it is an emergency or there are no other physicians available to see the patient.
• In the rare case when the physician decides to end the relationship with a patient, the patient should be notified in writing and the physician should arrange for the appropriate transfer of care.
• The physician is not obliged to provide secrecy in cases when a person close to the patient divulges information and asks that the patient not be informed of the disclosure.
• Physicians should disclose errors made in the process of care to patients.
• Patient competence to make clinical decisions can be difficult to assess, and should be evaluated for a specific decision at the time of that choice.
• When a surrogate makes a medical decision for a patient, the physician should try to ensure that this decision fits with the patient’s beliefs and wishes, not what the surrogate may choose for herself or himself. Problematic cases can be referred to a hospital ethics committee.
• If a physician refuses to provide reproductive services on moral grounds, he or she is still obliged to discuss all options or refer the patient appropriately.
• In a catastrophic disaster, the moral guidelines of autonomy and beneficence may have to cede to utility, fairness, and stewardship.
• Providing medical care to individuals with whom the physician already has a nonprofessional relationship, such as friends and coworkers, is discouraged.
• Physicians who use social media should take care not to blur social and professional boundaries.
• An order not to intubate a patient should be accompanied by a complete do-not-resuscitate order.
• The ACP does not support the practice of physician-assisted suicide or euthanasia.
• Physicians should disclose potential financial conflicts of interest with patients. They should not refer patients to treatment centers in which they have invested money, but do not provide direct care.
• The practice of selling products out of the physician office is discouraged. Such products should meet urgent needs of patients, which would not apply to products such as supplements or cosmetic aids.
• Physicians should not be involved in interrogations. The participation of physicians in the execution of prisoners, except to pronounce death, is considered unethical.
• Physicians should not participate in strikes that reduce patient access to care.

(Source: Ann Intern Med. 2012;156:73-104)