Rosamond Rhodes, PhD, director of Bioethics Education at Icahn School of Mount Sinai, New York, is troubled by a number of conceptual problems in this and similar ethics statements. She tells Reuters Health in an email interview, “In their discussion of the patient-physician relationship, the authors assert that ‘The relationship has mutual obligations.’ I understand that physicians would wish this to be true and that (they) sincerely want patients to regard themselves as being obligated to maintaining their own health, but it is nowhere explained why patients have obligations or what they are. Can that be true of children or the demented? This is a feature of the document that I find troubling. A parent cannot abdicate responsibilities to a young child claiming that the child has not fulfilled her/his obligations. Similarly, I don’t think doctors should feel free to abdicate responsibilities to a patient.”
She notes, “In that section they also repeat the assertion that physicians must ‘serve the best interests of the patient,’ and later in the section on medical risk they assert that ‘Physicians’ ethical obligation to the welfare of patients is fundamental.’ At the same time, they maintain that a physician need not accept a patient and may dismiss a patient. That apparent contradiction is not explained. It also raises problems in the sections on obligations to society, resource allocation, and research which the authors describe as ‘tension.’ These serious problems should alert the authors to the fact that they have overstated the obligation to the individual patient.”
Despite these and other problematic aspects she found in the sections on catastrophes and futile treatment, Dr. Rhodes says, “On the whole, I don’t notice anything that is seriously troubling or dramatically controversial in this newest version of the American College of Physicians Ethics Manual. It is a cautious document that is in line with other statements on medical and research ethics.”
The complete updated manual appears in the Jan. 15th Annals of Internal Medicine.
References
- Sulmasy LS, Bledsoe TA; ACP Ethics, et al. American College of Physicians ethics manual: Seventh edition. Ann Intern Med. 2019 Jan 15;170(2_Supplement):S1–S32. doi: 10.7326/M18-2160.
- Blumenthal-Barby JS, Lo B. Building on the American College of Physicians ethics manual. Ann Intern Med. 2019 Jan 15;170(2):133–134. doi: 10.7326/M18-3120.
