The AMA was founded in part to establish the first national code of medical ethics. Today the Code is widely recognized as authoritative ethics guidance for physicians through its Principles of Medical Ethics interpreted in Opinions of AMA’s Council on Ethical and Judicial Affairs that address the evolving challenges of contemporary practice.
Physicians enjoy the right to advocate for change in law and policy, in the public arena, and within their institutions; Physicians have an ethical responsibility to seek change when they believe the requirements of law or policy are contrary to the best interests of patients. However, they have a responsibility to do so in ways that are not disruptive to patient care.
Informed consent to medical treatment is fundamental in both ethics and law. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care.
Withholding pertinent medical information from patients in the belief that disclosure is medically contraindicated creates a conflict between the physician’s obligations to promote patient welfare and to respect patient autonomy. Except in emergency situations in which a patient is incapable of making an informed decision, withholding information without the patient’s knowledge or consent is ethically unacceptable.
A placebo is a substance provided to a patient that the physician believes has no specific pharmacological effect on the condition being treated. In the clinical setting, the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship, and result in medical harm to the patient.
Patients are entitled to choose their own physicians. A surgeon who allows a substitute to conduct a medical procedure on his or her patient without the patient’s knowledge or consent risks compromising the trust-based relationship of patient and physician.
In giving or withholding permission for medical treatment for their children, parents/guardians are expected to safeguard their children’s physical health and well-being and to nurture their children’s developing personhood and autonomy; Physicians should evaluate minor patients to determine if they can understand the risks and benefits of proposed treatment; The more mature a minor patient is, the better able to understand what a decision will mean, and the more clearly the child can communicate preferences, the stronger the ethical obligation to seek minor patients’ assent to treatment.
Physicians have a responsibility to protect the confidentiality of minor patients, within certain limits. In some jurisdictions, the law permits unemancipated minors to request and receive confidential services relating to: contraception, pregnancy testing, prenatal care, delivery services and care to prevent, diagnose, or treat sexually transmitted disease, substance use disorders, or mental illness.
In many jurisdictions, unemancipated minors are not permitted to request or receive abortion services without their parents’ (or guardian’s) knowledge and consent. As such, when minors seek abortion care, this may create a conflict between the value of confidentiality and the legal obligation to obtain parental consent.
Decisions not to initiate care or to discontinue an intervention can be emotionally wrenching for the parents of a seriously ill newborn. Physicians should help parents, families, and fellow professionals understand that there is no ethical difference between withholding and withdrawing treatment, when an intervention no longer helps to achieve the goals of care or promote the quality of life.