Code of Medical Ethics of the American Medical Association, 2014-2015 Ed

622 Pages·2014·3.87 MB·English

by  American Medical Association

Code of
Medical Ethics
of the American Medical Association
Council on Ethical and Judicial Affairs
Current Opinions with Annotations
2014–2015 Edition
Annotations prepared by the
Southern Illinois University Schools of Medicine and Law
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Contents
Contents

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
History. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Guide to Use of Annotations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Principles of Medical Ethics
Preamble. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Principles of Medical Ethics, with annotations. . . . . . . . . . . . . . . . . . . . xvi
Principles of Medical Ethics I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi
Principles of Medical Ethics II. . . . . . . . . . . . . . . . . . . . . . . . . . . . xxvii
Principles of Medical Ethics III . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxv
Principles of Medical Ethics IV . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxix
Principles of Medical Ethics V . . . . . . . . . . . . . . . . . . . . . . . . . . . . .lix
Principles of Medical Ethics VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . lxiii
Principles of Medical Ethics VII. . . . . . . . . . . . . . . . . . . . . . . . . . . . lxxii
Principles of Medical Ethics VIII . . . . . . . . . . . . . . . . . . . . . . . . . . .lxxv
Principles of Medical Ethics IX . . . . . . . . . . . . . . . . . . . . . . . . . . . .lxxx
1.00 Introduction
1.01 Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.02 The Relation of Law and Ethics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2.00 Opinions on Social Policy Issues
2.01 Abortion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.015 Mandatory Parental Consent to Abortion . . . . . . . . . . . . . . . . . . . . . . . 6
2.02 Physicians’ Obligations in Preventing, Identifying, and Treating
Violence and Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
2.03 Allocation of Limited Medical Resources. . . . . . . . . . . . . . . . . . . . . . . . 12
2.035 Futile Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
2.037 Medical Futility in End-of-Life Care . . . . . . . . . . . . . . . . . . . . . . . . . .18
2.04 Artificial Insemination by Known Donor. . . . . . . . . . . . . . . . . . . . . . . . 20
2.05 Artificial Insemination by Anonymous Donor . . . . . . . . . . . . . . . . . . . . .22
2.055 Ethical Conduct in Assisted Reproductive Technology . . . . . . . . . . . . . . . .23
2.06 Capital Punishment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
2.065 Court-Initiated Medical Treatments in Criminal Cases . . . . . . . . . . . . . . . .35
2.067 Torture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
2.068 Physician Participation in Interrogation . . . . . . . . . . . . . . . . . . . . . . . .37
2.07 Clinical Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
2.071 Subject Selection for Clinical Trials. . . . . . . . . . . . . . . . . . . . . . . . . . . 43
2.075 The Use of Placebo Controls in Clinical Trials. . . . . . . . . . . . . . . . . . . . . 44
2.076 Surgical “Placebo” Controls. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
2.077 Ethical Considerations in International Research . . . . . . . . . . . . . . . . . . .46
2.078 Guidelines to Prevent Malevolent Use of Biomedical Research . . . . . . . . . . . .47
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2.079 Safeguards in the Use of DNA Databanks in Genomic Research . . . . . . . . . . .48
2.08 Commercial Use of Human Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . .49
2.09 Costs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
2.095 The Provision of Adequate Health Care . . . . . . . . . . . . . . . . . . . . . . . .53
2.10 Fetal Research Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
2.105 Patenting Human Genes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56
2.11 Gene Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .57
2.12 Genetic Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .58
2.13 Genetic Engineering. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
2.131 Disclosure of Familial Risk in Genetic Testing . . . . . . . . . . . . . . . . . . . . .60
2.132 Genetic Testing by Employers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
2.135 Insurance Companies and Genetic Information . . . . . . . . . . . . . . . . . . . .64
2.136 Genetic Information and the Criminal Justice System . . . . . . . . . . . . . . . . .64
2.137 Ethical Issues in Carrier Screening of Genetic Disorders. . . . . . . . . . . . . . . . 66
2.138 Genetic Testing of Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
2.139 Multiplex Genetic Testing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
2.14 In Vitro Fertilization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
2.141 Frozen Pre-embryos . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
2.145 Pre-embryo Splitting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
2.146 Research With Stem Cells. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
2.147 Cloning to Produce Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .73
2.15 Transplantation of Organs From Living Donors . . . . . . . . . . . . . . . . . . . .74
2.151 Cadaveric Organ Donation: Encouraging the Study of Motivation . . . . . . . . . .77
2.152 Solicitation of the Public for Directed Donation of Organs
for Transplantation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78
2.155 Presumed Consent and Mandated Choice for Organs
From Deceased Donors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
2.157 Organ Donation After Cardiac Death . . . . . . . . . . . . . . . . . . . . . . . . .81
2.16 Organ Transplantation Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . .82
2.161 Medical Applications of Fetal Tissue Transplantation . . . . . . . . . . . . . . . . .84
2.162 Anencephalic Neonates as Organ Donors . . . . . . . . . . . . . . . . . . . . . . .84
2.165 Umbilical Cord Blood Banking . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86
2.169 The Ethical Implications of Xenotransplantation . . . . . . . . . . . . . . . . . . .87
2.17 Quality of Life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .88
2.18 Surrogate Mothers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
2.19 Unnecessary Medical Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . .92
2.191 Advance Care Planning. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
2.20 Withholding or Withdrawing Life-Sustaining Medical Treatment. . . . . . . . . . . 94
2.201 Sedation to Unconsciousness in End-of-Life Care . . . . . . . . . . . . . . . . . . 114
2.21 Euthanasia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
2.211 Physician-Assisted Suicide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
2.215 Treatment Decisions for Seriously Ill Newborns . . . . . . . . . . . . . . . . . . . 128
2.22 Do-Not-Resuscitate Orders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
2.225 Optimal Use of Orders Not-to-Intervene and Advance Directives. . . . . . . . . . 133
2.23 HIV Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
2.24 Impaired Drivers and Their Physicians . . . . . . . . . . . . . . . . . . . . . . . . 137
2.25 The Use of Quarantine and Isolation as Public Health Interventions . . . . . . . . 138
2.30 Information From Unethical Experiments . . . . . . . . . . . . . . . . . . . . . . 140
2.40 Radio-Frequency ID Devices in Humans . . . . . . . . . . . . . . . . . . . . . . . 140
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3.00 Opinions on Interprofessional Relations
3.01 Nonscientific Practitioners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
3.02 Nurses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
3.03 Allied Health Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
3.04 Referral of Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
3.041 Chiropractic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
3.05 Physician Employment by a Nonphysician Supervisee . . . . . . . . . . . . . . . . 148
3.06 Sports Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
3.08 Sexual Harassment and Exploitation Between Medical
Supervisors and Trainees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
3.09 Medical Students Performing Procedures on Fellow Students . . . . . . . . . . . . 150
4.00 Opinions on Hospital Relations
4.01 Admission Fee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
4.02 Assessments, Compulsory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
4.03 Billing for Housestaff and Student Services. . . . . . . . . . . . . . . . . . . . . . 151
4.04 Economic Incentives and Levels of Care . . . . . . . . . . . . . . . . . . . . . . . 152
4.05 Organized Medical Staff. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
4.06 Physician-Hospital Contractual Relations . . . . . . . . . . . . . . . . . . . . . . 153
4.07 Staff Privileges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
5.00 Opinions on Confidentiality, Advertising,
and Communications Media Relations
5.01 Advertising and Managed Care Organizations . . . . . . . . . . . . . . . . . . . . 155
5.015 Direct-to-Consumer Advertisements of Prescription Drugs . . . . . . . . . . . . . 156
5.02 Advertising and Publicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
5.025 Physician Advisory or Referral Services by Telecommunication . . . . . . . . . . . 161
5.026 The Use of Electronic Mail . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
5.027 Use of Health-Related Online Sites. . . . . . . . . . . . . . . . . . . . . . . . . . 163
5.04 Communications Media: Standards of Professional Responsibility. . . . . . . . . . 164
5.045 Filming Patients in Health Care Settings. . . . . . . . . . . . . . . . . . . . . . . 165
5.046 Filming Patients for the Education of Health Professionals. . . . . . . . . . . . . . 167
5.05 Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
5.051 Confidentiality of Medical Information Postmortem. . . . . . . . . . . . . . . . . 187
5.055 Confidential Care for Minors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
5.059 Privacy in the Context of Health Care . . . . . . . . . . . . . . . . . . . . . . . . 190
5.0591 Patient Privacy and Outside Observers to the Clinical Encounter . . . . . . . . . . 191
5.06 Confidentiality: Attorney-Physician Relation. . . . . . . . . . . . . . . . . . . . . 191
5.07 Confidentiality: Computers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
5.075 Confidentiality: Disclosure of Records to Data Collection Companies . . . . . . . 196
5.08 Confidentiality: Insurance Company Representative. . . . . . . . . . . . . . . . . 197
5.09 Confidentiality: Industry-Employed Physicians and Independent
Medical Examiners. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198
5.10 A Physician’s Role Following a Breach of Electronic Health Information . . . . . . 200
6.00 Opinions on Fees and Charges
6.01 Contingent Physician Fees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202
6.02 Fee Splitting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204
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6.021 Financial Incentives to Patients for Referrals . . . . . . . . . . . . . . . . . . . . . 206
6.03 Fee Splitting: Referrals to Health Care Facilities . . . . . . . . . . . . . . . . . . . 206
6.05 Fees for Medical Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
6.07 Insurance Form Completion Charges. . . . . . . . . . . . . . . . . . . . . . . . . 208
6.08 Interest Charges and Finance Charges . . . . . . . . . . . . . . . . . . . . . . . . 208
6.09 Laboratory Bill. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
6.10 Services Provided by Multiple Physicians. . . . . . . . . . . . . . . . . . . . . . . 209
6.11 Competition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210
6.12 Forgiveness or Waiver of Insurance Copayments . . . . . . . . . . . . . . . . . . . 210
6.13 Professional Courtesy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
7.00 Opinions on Physician Records
7.01 Records of Physicians: Availability of Information to Other Physicians . . . . . . . 213
7.02 Records of Physicians: Information and Patients . . . . . . . . . . . . . . . . . . . 214
7.025 Records of Physicians: Access by Nontreating Medical Staff. . . . . . . . . . . . . 216
7.03 Records of Physicians Upon Retirement or Departure From a Group . . . . . . . . 216
7.04 Sale of a Medical Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
7.05 Retention of Medical Records. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
8.00 Opinions on Practice Matters
8.01 Appointment Charges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
8.02 Ethical Guidelines for Physicians in Administrative
or Other Nonclinical Roles . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
8.021 Ethical Obligations of Medical Directors . . . . . . . . . . . . . . . . . . . . . . . 222
8.03 Conflicts of Interest: Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
8.031 Conflicts of Interest: Biomedical Research . . . . . . . . . . . . . . . . . . . . . . 229
8.0315 Managing Conflicts of Interest in the Conduct of Clinical Trials . . . . . . . . . . 231
8.0321 Physicians’ Self-referral . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
8.04 Consultation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238
8.041 Second Opinions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
8.043 Ethical Implications of Surgical Comanagement . . . . . . . . . . . . . . . . . . . 240
8.045 Direct-to-Consumer Diagnostic Imaging Tests . . . . . . . . . . . . . . . . . . . . 241
8.047 Industry Representatives in Clinical Settings. . . . . . . . . . . . . . . . . . . . . 242
8.05 Contractual Relationships. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
8.0501 Professionalism and Contractual Relations . . . . . . . . . . . . . . . . . . . . . . 246
8.051 Conflicts of Interest Under Capitation . . . . . . . . . . . . . . . . . . . . . . . . 246
8.052 Negotiating Discounts for Specialty Care. . . . . . . . . . . . . . . . . . . . . . . 248
8.053 Restrictions on Disclosure in Health Care Plan Contracts. . . . . . . . . . . . . . 248
8.054 Financial Incentives and the Practice of Medicine . . . . . . . . . . . . . . . . . . 249
8.055 Retainer Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
8.056 Physician Pay-for-Performance Programs . . . . . . . . . . . . . . . . . . . . . . . 253
8.06 Prescribing and Dispensing Drugs and Devices. . . . . . . . . . . . . . . . . . . . 254
8.061 Gifts to Physicians From Industry. . . . . . . . . . . . . . . . . . . . . . . . . . . 257
8.062 Sale of Non–Health-Related Goods From Physicians’ Offices . . . . . . . . . . . . 272
8.063 Sale of Health-Related Products From Physicians’ Offices . . . . . . . . . . . . . . 272
8.07 Expedited Partner Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274
8.08 Informed Consent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
8.081 Surrogate Decision Making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
8.082 Withholding Information From Patients . . . . . . . . . . . . . . . . . . . . . . . 287
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8.083 Placebo Use in Clinical Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . 289
8.085 Waiver of Informed Consent for Research in Emergency Situations . . . . . . . . . 290
8.087 Medical Student Involvement in Patient Care . . . . . . . . . . . . . . . . . . . . 291
8.088 Resident Physicians’ Involvement in Patient Care . . . . . . . . . . . . . . . . . . 292
8.09 Laboratory Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
8.095 Reporting Clinical Test Results: General Guidelines. . . . . . . . . . . . . . . . . 294
8.10 Lien Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
8.11 Neglect of Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294
8.115 Termination of the Physician-Patient Relationship. . . . . . . . . . . . . . . . . . 297
8.12 Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
8.121 Ethical Responsibility to Study and Prevent Error and Harm . . . . . . . . . . . . 303
8.13 Managed Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
8.132 Referral of Patients: Disclosure of Limitations . . . . . . . . . . . . . . . . . . . . 313
8.135 Cost Containment Involving Prescription Drugs in Health Care Plans . . . . . . . 315
8.14 Sexual Misconduct in the Practice of Medicine . . . . . . . . . . . . . . . . . . . 317
8.145 Sexual or Romantic Relations Between Physicians and Key Third-Parties. . . . . . 322
8.15 Substance Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
8.16 Substitution of Surgeon Without Patient’s Knowledge or Consent. . . . . . . . . . 324
8.17 Use of Restraints. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
8.18 Informing Families of a Patient’s Death. . . . . . . . . . . . . . . . . . . . . . . . 327
8.181 Performing Procedures on the Newly Deceased for Training Purposes. . . . . . . . 327
8.19 Self-treatment or Treatment of Immediate Family Members . . . . . . . . . . . . . 328
8.191 Peers as Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329
8.20 Invalid Medical Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330
8.21 Use of Chaperones During Physical Exams. . . . . . . . . . . . . . . . . . . . . . 331
9.00 Opinions on Professional Rights and Responsibilities
9.01 Accreditation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
9.011 Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
9.0115 Financial Relationships With Industry in
Continuing Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . 334
9.012 Physicians’ Political Communications With Patients and Their Families . . . . . . 336
9.02 Restrictive Covenants and the Practice of Medicine . . . . . . . . . . . . . . . . . 337
9.021 Covenants Not-to-Compete for Physicians-in-Training. . . . . . . . . . . . . . . . 343
9.025 Advocacy for Change in Law and Policy . . . . . . . . . . . . . . . . . . . . . . . 343
9.03 Civil Rights and Professional Responsibility . . . . . . . . . . . . . . . . . . . . . 344
9.0305 Physician Health and Wellness . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344
9.031 Reporting Impaired, Incompetent, or Unethical Colleagues . . . . . . . . . . . . . 345
9.032 Reporting Adverse Drug or Device Events . . . . . . . . . . . . . . . . . . . . . . 348
9.035 Gender Discrimination in the Medical Profession . . . . . . . . . . . . . . . . . . 349
9.037 Signing Bonuses to Attract Graduates of US Medical Schools. . . . . . . . . . . . 350
9.04 Discipline and Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
9.045 Physicians With Disruptive Behavior . . . . . . . . . . . . . . . . . . . . . . . . . 351
9.05 Due Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
9.055 Disputes Between Medical Supervisors and Trainees. . . . . . . . . . . . . . . . . 354
9.06 Free Choice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
9.065 Caring for the Poor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359
9.0651 Financial Barriers to Health Care Access. . . . . . . . . . . . . . . . . . . . . . . 361
9.0652 Physician Stewardship of Health Care Resources. . . . . . . . . . . . . . . . . . . 362
9.067 Physician Obligation in Disaster Preparedness and Response . . . . . . . . . . . . 363
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Contents
9.07 Medical Testimony . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
9.08 New Medical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
9.09 Patent for Surgical or Diagnostic Instrument . . . . . . . . . . . . . . . . . . . . . 371
9.095 The Use of Patents and Other Means to Limit Availability of
Medical Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372
9.10 Peer Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375
9.11 Ethics Committees in Health Care Institutions . . . . . . . . . . . . . . . . . . . 375
9.115 Ethics Consultations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
9.12 Patient-Physician Relationship: Respect for Law and Human Rights. . . . . . . . . 379
9.121 Racial and Ethnic Health Care Disparities . . . . . . . . . . . . . . . . . . . . . . 381
9.122 Gender Disparities in Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . 384
9.123 Disrespect and Derogatory Conduct in the Patient-Physician Relationship . . . . . 386
9.124 Professionalism in the Use of Social Media. . . . . . . . . . . . . . . . . . . . . . 387
9.13 Physicians and Infectious Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . 388
9.131 HIV-Infected Patients and Physicians. . . . . . . . . . . . . . . . . . . . . . . . . 389
9.132 Health Care Fraud and Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396
9.133 Routine Universal Immunization of Physicians for
Vaccine-Preventable Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
9.14 Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
9.141 Physician Responsibilities for Safe Patient Discharge
from Health Care Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398
10.00 Opinions on the Patient-Physician Relationship
10.01 Fundamental Elements of the Patient-Physician Relationship . . . . . . . . . . . . 399
10.015 The Patient-Physician Relationship . . . . . . . . . . . . . . . . . . . . . . . . . . 409
10.016 Pediatric Decision Making . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415
10.017 Gifts From Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
10.018 Physician Participation in Soliciting Contributions From Patients. . . . . . . . . . 416
10.02 Patient Responsibilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
10.03 Patient-Physician Relationship in the Context of Work-Related and
Independent Medical Examinations. . . . . . . . . . . . . . . . . . . . . . . . 420
10.05 Potential Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
Appendix
American Medical Association: Relevant Bylaws. . . . . . . . . . . . . . . . . . . 424
Preface to the Rules of the Council on Ethical and Judicial Affairs . . . . . . . . . 434
General Rules of the Council on Ethical and Judicial Affairs . . . . . . . . . . . . 435
Rules for Review of Membership . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Rules of the Council on Ethical and Judicial Affairs in
Original Jurisdiction Cases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442
Table of Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Table of Articles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
Index to Opinions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509
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Preface
Preface

The Code of Medical Ethics: Current Opinions with Annotations represents the
Council on Ethical and Judicial Affairs’ application of the American Medical
Association’s (AMA) Principles of Medical Ethics to more than 200 ethi-
cal issues in medicine. This edition, which includes the Principles of Medical
Ethics most recently revised in 2001 and Opinions issued through 2013,
replaces all previous editions.
The nine Principles of Medical Ethics are the primary component of the
Code. They describe the core ethical principles of the medical profession. A
single Principle should not be read in isolation from others; the overall intent of
the nine Principles, read together, guides physicians’ behavior.
The AMA House of Delegates has the authority to establish the Principles
of Medical Ethics. However, the Council on Ethical and Judicial Affairs
is responsible for determining the Association’s positions on ethical issues
through its interpretations of the Principles, which are expressed in the
Opinions. Each Opinion is followed by one or more roman numerals to identify
the Principle(s) from which the Opinion is derived.
Most Opinions are explained by background reports, which provide a
detailed analysis of the salient ethical considerations, as well as the rationale
behind the Council’s recommendations. These reports are referenced at the end
of Opinions as appropriate and made available separately (www.ama-assn.org/
go/cejareports).
Finally, each Opinion is followed by a list of annotations reflecting citations
to the Opinion in judicial rulings and the medical, ethical, and legal literature
(as described in more detail in the Guide to Use of Annotations).
The Code of Medical Ethics is published every two years. New Opinions
are issued at the Annual and/or Interim meetings of the AMA’s House of
Delegates and are available through the Council’s online version of the Code
page (www.ama-assn.org/go/code) and the AMA’s online policy database,
PolicyFinder (www.ama-assn.org/go/policyfinder). The Council on Ethical and
Judicial Affairs encourages comments and suggestions for future editions of this
publication.
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