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Does The AMA APPLY TO Refractive Surgery? PDF Print E-mail

The American Medical Association’s Code of Medical Ethics addresses conflicts of interest and has four main guidelines:

  • Reward or financial gain must be subordinate to service to humanity;
  • physicians may not put financial interests ahead of patient welfare;
  • it is unethical for a physician to needlessly hospitalize a patient, prescribe drugs or conduct diagnostic tests for financial gain;
  • any conflict between a physician’s financial interest and obligations to a patient must be resolved in favor of the patient’s well-being.
  • AMA policy on co-management

    E-8.043 Ethical Implications of Surgical Co-Management

    For the purpose of this report, the term "surgical co-management" refers to the practice of allotting specific responsibilities of patient care to designated caregivers. The following guidelines stem from this understanding:
    (1) Physicians should engage in co-management arrangements only to assure the highest quality of care.
    (2) When surgical co-management arrangements are made between duly licensed physicians, their responsibilities should be delineated according to the scope of the physicians’ expertise. Likewise, when physicians enter into surgical co-management arrangements with allied health professionals, each caregiver’s responsibility should correspond to his or her qualifications.
    (3) Even though different caregivers will be responsible for rendering specific portions of the patient’s care, a single physician should be ultimately responsible for ensuring that the care is delivered in a coordinated and appropriate manner. Other caregivers should support this obligation by communicating with this physician.
    (4) The treating physicians are responsible for ensuring that the patient has consented not only to take part in the surgical co-management arrangement but also to the services that will be provided within the arrangement. In addition to disclosing medical facts to the patient, the patient should also be informed of other significant aspects of the surgical co-management arrangement such as the credentials of the other caregivers, the specific services each will provide, and the billing arrangement.
    (5) Physicians should ensure that their surgical co-management arrangements do not violate the ethical or legal restrictions on self-referral.
    (6) Referrals to another caregiver should be based only on that caregiver’s skill and ability to meet the patient’s needs and not on expected further referrals or other self-serving bases. Physicians who participate in surgical co-management arrangements must avoid such financial agreements as fee-splitting, which are both unethical and illegal.

    Physicians who participate in surgical co-management arrangements should employ appropriate safeguards to ensure that confidential information is protected. (I, II, IV, V, VI) Issued June 2000 based on the report "Ethical Implications of Surgical Co-Management," adopted December 1999.

    AMA policy on medical error and patient harm

    E-8.121 Ethical Responsibility to Study and Prevent Error and Harm

    In the context of health care, an error is an unintended act or omission, or a flawed system or plan, that harms or has the potential to harm a patient. Patient safety can be enhanced by studying the circumstances surrounding health care errors. This can best be achieved through a legally protected review process, which is essential for reducing health care errors and preventing patient harm.
    (1) Because they are uniquely positioned to have a comprehensive view of the care patients receive, physicians must strive to ensure patient safety and should play a central role in identifying, reducing, and preventing health care errors. This responsibility exists even in the absence of a patient-physician relationship.
    (2) Physicians should participate in the development of reporting mechanisms that emphasize education and systems change, thereby providing a substantive opportunity for all members of the health care team to learn. Specifically, physicians should work with other relevant health care professionals to:
    (a) Establish and participate fully in an effective, confidential, and protected error-reporting mechanism
    (b) Develop means for objective review and analysis of reports regarding errors, and to conduct appropriate investigations into the causes of harm to a patient
    (c) Ensure that the investigation of causes of harm, and the review and study of error reports result in preventive measures that are conveyed to all relevant individuals
    (d) Identify and promptly report impaired and/or incompetent colleagues so that rehabilitation, retraining or disciplinary action can occur in order to prevent harm to patients
    (3) Physicians must offer professional and compassionate concern toward patients who have been harmed, regardless of whether the harm was caused by a health care error. An expression of concern need not be an admission of responsibility. When patient harm has been caused by an error, physicians should offer a general explanation regarding the nature of the error and the measures being taken to prevent similar occurrences in the future. Such communication is fundamental to the trust that underlies the patient-physician relationship, and may help reduce the risk of liability.
    (4) Physicians have a responsibility to provide for continuity of care to patients who may have been harmed during the course of their health care. If, because of the harm suffered under the care of a physician, a patient loses trust in that physician, the obligation may best be fulfilled by facilitating the transfer of the patient to the care of another physician.
    (5) Physicians should seek changes to the current legal system to ensure that all errors in health care can be safely and securely reported and studied as a learning experience for all participants in the health care system, without threat of discoverability, legal liability, or punitive action. (I, II, III, IV, VIII) Issued December 2003 based on the report "Ethical Responsibility to Study and Prevent Error and Harm in the Provision of Health Care,' adopted June 2003.

    AMA policy on incompetent, corrupt, dishonest, unethical MDs

    E-9.04 Discipline and Medicine

    Incompetence, corruption, or dishonest or unethical conduct on the part of members of the medical profession is reprehensible. In addition to posing a real or potential threat to patients, such conduct undermines the public’s confidence in the profession. A physician should expose, without fear or loss of favor, incompetent or corrupt, dishonest, or unethical conduct on the part of members of the profession. Questions of such conduct should be reported and reviewed in accordance with Opinion 9.031, "Reporting Impaired, Incompetent, or Unethical Colleagues."
    Violation of governmental laws may subject the physician to civil or criminal liability. Expulsion from membership is the maximum penalty that may be imposed by a medical society upon a physician who violates the ethical standards involving a breach of moral duty or principle. However, medical societies have a civic and professional obligation to report to the appropriate governmental body or state board of medical examiners credible evidence that may come to their attention involving the alleged criminal conduct of any physician relating to the practice of medicine.
    Although a physician charged with allegedly illegal conduct may be acquitted or exonerated in civil or criminal proceedings, this does not discharge a medical society from its obligation to initiate a disciplinary proceeding against a member with reference to the same conduct where there is credible evidence tending to establish unethical conduct.
    The Council cannot pass judgment in advance on a situation that may later come before it on appeal. The Council cannot be an attorney for a society or a member thereof and later judge in the same factual situation. The local medical society has the initial obligation of determining all the facts and whether or not disciplinary action is indicated. Questions asking for a review of a proposed course of action or an evaluation of an existing factual situation should be presented to the appropriate official of the physician’s local society. (II, III, VII) Issued prior to April 1977; Updated June 1994.

    AMA policy on reporting negative outcomes

    E-9.08 New Medical Procedures

    In the ethical tradition expressed by Hippocrates and continuously affirmed thereafter, the role of the physician has been that of a healer who serves patients, a teacher who imparts knowledge of skills and techniques to colleagues, and a student who constantly seeks to keep abreast of new medical knowledge.
    Physicians have an obligation to share their knowledge and skills and to report the results of clinical and laboratory research. Both positive and negative studies should be included even though they may not support the author’s hypothesis. This tradition enhances patient care, leads to the early evaluation of new technologies, and permits the rapid dissemination of improved techniques.
    The intentional withholding of new medical knowledge, skills, and techniques from colleagues for reasons of personal gain is detrimental to the medical profession and to society and is to be condemned.
    Prompt presentation before scientific organizations and timely publication of clinical and laboratory research in scientific journals are essential elements in the foundation of good medical care. (I, II, V, VII) Issued December 1984; Updated June 1994.

    AMA policy on dishonest expert witnesses

    E-9.07 Medical Testimony

    In various legal and administrative proceedings, medical evidence is critical. As citizens and as professionals with specialized knowledge and experience, physicians have an obligation to assist in the administration of justice.

    When a legal claim pertains to a patient the physician has treated, the physician must hold the patient’s medical interests paramount, including the confidentiality of the patient’s health information, unless the physician is authorized or legally compelled to disclose the information.

    Physicians who serve as fact witnesses must deliver honest testimony. This requires that they engage in continuous self-examination to ensure that their testimony represents the facts of the case. When treating physicians are called upon to testify in matters that could adversely impact their patients’ medical interests, they should decline to testify unless the patient consents or unless ordered to do so by legally constituted authority. If, as a result of legal proceedings, the patient and the physician are placed in adversarial positions it may be appropriate for a treating physician to transfer the care of the patient to another physician.

    When physicians choose to provide expert testimony, they should have recent and substantive experience or knowledge in the area in which they testify, and be committed to evaluating cases objectively and to providing an independent opinion. Their testimony should reflect current scientific thought and standards of care that have gained acceptance among peers in the relevant field. If a medical witness knowingly provides testimony based on a theory not widely accepted in the profession, the witness should characterize the theory as such. Also, testimony pertinent to a standard of care must consider standards that prevailed at the time the event under review occurred.

    All physicians must accurately represent their qualifications and must testify honestly. Physician testimony must not be influenced by financial compensation; for example, it is unethical for a physician to accept compensation that is contingent upon the outcome of litigation.

    Organized medicine, including state and specialty societies, and medical licensing boards can help maintain high standards for medical witnesses by assessing claims of false or misleading testimony and issuing disciplinary sanctions as appropriate. (II, IV, V, VII) Issued December 2004 based on the report "Medical Testimony," adopted June 2004.