Although the tenets of medical ethics remain unchanged, “the specific challenging circumstances evolve,” says William J. Oetgen, MD, MBA, FACC, of recently reformed recommendations from the American Heart Association (AHA) and American College of Cardiology (ACC).1

Administrators should “determine which recommendations are most relevant to their organizations, and proactively partner with their boards of directors to address those,” says Oetgen, noting the 2021 AHA/ACC report is directed at clinicians of all types. “The document recognizes that modern cardiovascular care is frequently provided in a team setting,” says Oetgen, report co-author.

The motivation for the AHA/ACC’s Consensus Conference on Professionalism and Ethics came in late 2019. “Leadership realized that 16 years had passed since there had been a statement on professionalism and ethics from the two organizations,” says Oetgen, clinical professor of medicine at Georgetown. Previous conferences concentrated on specific ethics issues:

  • 1989: Ethics of physician-owned organizations, distributive justice in the allocation of scarce resources, and professionalism in the care of AIDS patients.
  • 1997: End-of-life and futility issues, and the ethics of cardiovascular genetics.
  • 2004: Human subjects research codes of conduct, and physician self-referrals.

All three conferences, plus the 2021 gathering, focused on relationships with industry and conflicts of interest. “In the ensuing two decades, new issues have arisen, which required thought and attention,” Oetgen notes.

In 2021, new insights on diversity, equity, inclusion, and belonging are a major focus. “The tenet of justice demands that clinicians, hospitals, and healthcare systems give strong consideration to how they can ameliorate the effects of the social determinants of health for patients whose circumstances result in healthcare disparities,” Oetgen says.

Elsewhere in the 2021 AHA/ACC report, Oetgen and colleagues wrote about clinician well-being. “This is a topic of urgency, and is deserving of board-level attention,” Oetgen says.

The authors reported a more sophisticated understanding of the problem is needed. “Boards should expect that hospital- or systemwide efforts go well beyond clinician-resilience training,” Oetgen explains. Some factors negatively affecting clinicians are, in fact, systemic issues. Physicians struggle with insufficient clerical support for clinicians, burdensome electronic health record requirements, and unreasonable clinical workloads. Dysfunctional clinical team dynamics are another underlying factor. “Boards should expect their organizations to deal promptly, fairly, and compassionately with disruptive clinician behavior, which can have severely negative implications for both patient safety and clinician well-being,” Oetgen cautions.

Finally, the AHA/ACC report authors touched on the ethics of evolving healthcare delivery systems. “All ethical tenets are under challenge in the increasingly common circumstance where clinicians are the paid employees of hospitals and systems,” Oetgen says. 


  1. Executive Committee; Benjamin IJ, Valentine CM, Oetgen WJ, et al. 2020 American Heart Association and American College of Cardiology consensus conference on professionalism and ethics: A consensus conference report. J Am Coll Cardiol 2021 May 5; S0735-1097(21)01185-2. doi: 10.1016/j.jacc.2021.04.004.