Preface & Preamble
The Principles of Medical Ethics with which the Code opens “are not laws, but standards of conduct that define the essentials of honorable behavior for physicians.” The Opinions of the Council on Ethical and Judicial Affairs that make up the bulk of the Code are likewise not laws or rules, but guidance for engaging the ethical dilemmas that arise in contemporary medicine.
The Opinions distinguish among levels of ethical obligation, from action that is ethically required (must) about which physicians may not use judgment or discretion; to action that is strongly recommended and expected of physicians in most, but not necessarily all, instances (should); to action that is ethically permissible (may) so long as qualifying conditions set out in guidance are met. Physicians are expected to use skills of ethical discernment and reflection to determine how best to adhere to the goals and spirit of guidance when it cannot be upheld strictly as written.
Guidance in individual opinions is not always equally applicable to every individual physician, depending on the nature of the physician’s practice. Nonetheless, physicians are expected to be aware of guidance that may not be routinely relevant to their practice, to be sensitive to occasions when such guidance might be pertinent and, in such cases, to respond in keeping with guidance.
Opinions of the AMA Council on Ethical and Judicial Affairs lay out the ethical responsibilities of physicians as members of the profession of medicine. In these opinions, the term “ethical” refers to matters involving moral principles, values, and practices, as well as matters of social policy involving issues of morality in the practice of medicine.
Council opinions articulate the expectations for professional conduct in the areas addressed, at times laying out specific duties and obligations. Conduct that violates these expectations or specific duties and obligations is not acceptable ethically and is unprofessional. Violations of ethical responsibilities may justify disciplinary actions against a physician’s medical society membership.
The relationship between ethics and law is complex. Ethical values and legal principles are usually closely related, but ethical responsibilities usually exceed legal duties. Conduct that is legally permissible may be ethically unacceptable. Conversely, the fact that a physician who has been charged with allegedly illegal conduct has been acquitted or exonerated in criminal or civil proceedings does not necessarily mean that the physician acted ethically.
In some cases, the law mandates conduct that is ethically unacceptable. When physicians believe a law violates ethical values or is unjust they should work to change the law. In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal duties.