NEW YORK (Reuters Health)—The 2019 edition of the American College of Physicians (ACP) ethics manual provides a six-step approach to resolving ethical dilemmas and adds or expands sections that address emerging issues in 21st century medicine.1
“The Manual provides succinct guidance on issues that affect the patient-physician relationship, and also issues that have to do with the physician’s relationship to other clinicians, the physician’s role in society, practice environment issues, and medical teaching and research,” Lois Snyder Sulmasy, JD from the American College of Physicians, Center for Ethics and Professionalism, Philadelphia, tells Reuters Health by email. “Topics are also addressed in more detail in ACP position papers on ethical issues and our ethics case study series.”
Snyder Sulmasy and Thomas A. Bledsoe, MD, from the Warren Alpert Medical School, Brown University, Providence, R.I.m drafted the Manual’s seventh edition on behalf of the ACP Ethics, Professionalism and Human Rights Committee. As with earlier additions, this updated version asserts that “the physician’s first and primary duty is to the patient.”
To address emerging issues, ACP’s latest ethics manual includes new or expanded sections on electronic communications, telemedicine ethics, electronic health record ethics, precision medicine and genetics, social media and online professionalism, the changing practice environment, population health, physician volunteerism, and research and protection of human subjects.
The updated manual also includes a revised method for ethics decision-making. This six-step process begins with assessing the medical situation and proceeds through framing the medical decision and ethical question, determining the principles and interests involved in the ethics question, identifying the participants and their motivations, balancing principles and interests to reach resolution, and considering how the ethical dilemma might have been avoided in the first place.
The section on telemedicine insists that a valid patient-physician relationship should be in place for a professionally responsible telemedicine service to take place. Any sort of telemedicine relationship should adhere to the standard of care required for in-person visits, and the benefits of increased access to care through telemedicine need to be balanced against the risks associated with the loss of the in-person encounter.
Ethical precision medicine and genetics must address issues of patient and physician education, counseling, privacy, confidentiality, cost, the patient’s best interests, and justice. Patients must be informed of the risks, benefits, limitations, and costs of testing before—not after–testing takes place so that they can make well-informed decisions about testing and disclosure of their genetic information.