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I-08 Open Forum
Council on Ethical and Judicial Affairs Open Forum
In conformity with Resolution 14 (I-94), which requires the Council on Ethical and Judicial Affairs (CEJA) to “conduct an Open Forum at all future meetings for the purpose of discussing pending ethical opinion issues,” the 2008 Annual Meeting Open Forum will be held on Monday, November 10 th , 2008, from 9:30 a.m. to 11:00 a.m., in Grand Ballroom 8B of the Marriot World Center, Orlando FL.
The Open Forum will be open to all AMA members, interested non-members, other guests, and the press.
1. New proposed issues
Open Forum attendees are invited to introduce emerging ethical issues that may warrant attention from CEJA and inclusion in the AMA Code of Medical Ethics.
2. Clinical ethics consultations: when, why, and how?
Over the past decades clinical ethics consultation services have evolved and grown into a legally required entity in some medical settings. It has been noted, in the literature, that there is a need for patients, families, and health care providers to have competent guidance on the complex and difficult decisions that they inevitably confront within the modern health care system. However, the specifics of when, why, and how clinical ethics consultations should be utilized are still up for debate amongst physicians as patients.
Relevant Principles of Medical Ethics:
Principles VI, V.
Relevant Opinion in the Code of Medical Ethics:
E-9.115 Ethics Consultations
Relevant Literature:
Aulisio M.P. and Arnold R.M. Role of the ethics committee: Helping to address value conflicts or uncertainties. Chest. 2008;134(2):417-424.
Lo B. Answers and questions about ethcis consultations. JAMA 2003;290:1208-1210.
Perkins H.S. Culture as a useful conceptual tool in clinical ethics consultation. Camb Q Healthc Ethics. 2008;17(2):164-172.
Schneiderman L.J., Gilmer T., Teetzel H.D., et al. Effect of ethics consultations on nonbeneficial life-sustaining treatments in the intensive care setting: A randomized controlled trial. JAMA 2003;290:1166-1172.
3. Physicians as employees of nonphysicians
Resolutions 005-A-08 and 013-A-08 ask CEJA to examine the ethics of specific employment scenarios. A key question is if physicians can be ethically employed by nonphysicians that they are responsible for supervising. These resolutions raise further questions regarding topics such as the ethical conduct of clinical management to conflicts of interest and their impact on patient care. As CEJA explores this newly identified ethical dilemma, the Council would like to hear the thoughts of a broader range of physicians. The discussion and debate should prompt anticipation of current and future possibilities of being employed by nonphysician medical professionals that are under their clinical supervision. Should such situations be avoided? If not, what sorts of policies should be in place to manage potential conflicts of interests? What ethical implications are there for interprofessional relationships? What ethical implications are there for patient care?
Relevant Principles of Medical Ethics:
Principles I, II, III, IV and VI.
Relevant Opinion in the Code of Medical Ethics:
E-8.03 Conflicts of Interest: Guidelines
E-8.05 Contractual Relationships
E-3.03 Allied Health Professionals
Relevant Literature:
Roberts L.W., Warner T.D., Hammond K.A.G., et al. Becoming a good doctor: Perceived need for ethics training focused on practical and professional development topics. Academic Psychiatry 2005;29(3):301-309.
Kilminster S.M., Jolly B.C. Effective supervision in clinical practice settings: A literature review. Medical Education 2000;34:827-840.
Harrar WR, VandeCreek L, Knapp S. Ethical and legal aspects of clinical supervision. Professional Psychology: Research and Practice. 1990;21(1):37-41.
Premeaux SR. The current link between management behavior and ethical philosophy. Journal of Business Ethics. 2004;51:269-278.
Cooper RA. Health care workforce for the twenty-first century: the impact of nonphysician clinicians. Annu Rev Med. 2001;52:51-61.
Sangvai D, Lyn M, Michener L. Defining high-performance teams and physician leadership. Physician Exec. Mar-Apr 2008;34(2):44-51.
Procedural guidelines
A member of the Council on Ethical and Judicial Affairs will briefly present each topic on the agenda. After an issue has been introduced, the audience will be invited to discuss, with the Council, the ethical and professional considerations most relevant to the development of ethical guidelines on the topic at hand . In addition, the Council will collect written testimony for consideration at the time of the Open Forum or prior to it. Advance written testimony can be submitted to the Council staff, by e-mail at rebecca.shore@ama-assn.org or by fax at (312) 464-4799. Written testimony submitted to the Council will be given the same consideration as if it had been delivered orally.
Any member of the Association is privileged to speak on agenda items. Members should be mindful to disclose any conflict of interest that may influence their testimony. All other individuals should request from the Chair the privilege to provide oral testimony, indicating their identity and affiliation. Such a request will be honored upon approval of the Chair. Due to time constraints or other considerations, however, the Chair may not approve such requests.
All commentary should directly relate to the AMA Principles of Medical Ethics:
I. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
II. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.
III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements, which are contrary to the best interests of the patient.
IV. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
V. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
VI. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.
VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.
VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
IX. A physician shall support access to medical care for all people.
The Chair may establish rules on the presentation of testimony with respect to time constraints, repetitive statements, etc. The Chair also has the authority to prohibit photography, filming, and audio or video recording if the Chair feels that such factors would be undesirable for the orderly conduct of the meeting. Adherence to these guidelines will ensure that the forum runs smoothly and that the results are satisfactory to all.
Individuals involved with planning and presenting this activity have no relevant financial relationships to disclose.The American Medical Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Learning objectives:
- Identify emerging and currently relevant issues in medical ethics and suggest topics to be addressed in future reports and opinions.
- Debate the ethical questions regarding the quality, consistency and frequency of clinical ethics consultations.
- Debate the ethical issues surrounding physicians as employees of non-physicians.
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
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