News Briefs

New ethics manual issued by ACP

The sixth edition of the American College of Physicians' (ACP's) Ethics Manual addresses ethical decisions in clinical practice, teaching, and medical research, as well as the underlying principles and the physician's role in society and with colleagues. The updated manual, approved by ACP's Board of Regents published in a recent issue of the Annals of Internal Medicine.1

The current update of the ACP's manual covers surrogate decision-making and end-of-life care, use of complementary and alternative medicine, physician-assisted suicide, relationship between physicians and industry, genetic testing, and research ethics.

The new edition also highlights the patient–physician relationship during health catastrophes, culturally sensitive care, research use of human biologic materials, social media and online professionalism, and industry-sponsored research. A first time topic for the manual is the challenges associated with offering care to "very important persons" experiencing unusual fame or prestige.

Other new or expanded sections include treatment without interpersonal contact, confidentiality and electronic health records, therapeutic nondisclosure, caring for oneself or persons with whom the physician has a previous nonprofessional relationship, boundaries and privacy, pay-for-performance, interrogation, attending physicians and physicians-in-training, the patient-centered medical home, protection of human subjects, placebo controls, and scientific publication.


  1. American College of Physicians Ethics Manual. Ann Intern Med 2012; 156:73-104.

Regulating transplants for troops and others

A proposed rule has been set forth by the Department of Health and Human Services (HHS) regulating face and hand transplants just as kidneys, hearts and other organs are already regulated. This development could mean the beginning of waiting lists and a national system to allocate body parts and donor testing.

Vascularized Composite Allografts (VCA) transplantation comprises transplants of a variety of body parts that are not currently regulated under the Organ Procurement and Transplantation Network (OPTN) final rule. The two most notable types to date have been hand and face transplants.

Although the body parts involved vary significantly, among their shared characteristics is the fact that they are susceptible to ischemia and that they need revascularization, done through a surgical reconnection of blood vessels to accomplish the transplant, as opposed to secondary ingrowth of vessels. In viable vascularized transplants, immunosuppression is necessary to prevent or treat rejection. This immunosuppression has risks, which have been justified in patients needing organs as presently defined in the OPTN final rule because of their lifesaving potential.

Clinical demand for VCA transplantation appears to be increasing now that immunosuppression protocols have proven safer and support for military and veterans VCA transplantation programs continues to expand.

The secretary seeks comments from the public on the proposals made. To be considered, comments on this proposed rule must be submitted by Feb. 14, 2012. (For information how to submit comments, see resources section, below.)

The Health Resources Services Administration, which regulates organ transplants, has proposed expanding the regulation to cover other body parts. The new rules would take effect later this year or early next year.


UK: Assisted suicide is legally possible

The Commission on Assisted Dying, Demos, London, United Kingdom, with members with expertise in law, medicine, social care, mental health, palliative care, theology, disability, and policing, published its final report after assessing more than 1,300 pieces of evidence on assisted suicide legality. The report suggests a framework that could allow people with a terminal illness the choice to end their lives while protecting those who are vulnerable.

The Commission on Assisted Dying, in addition to evaluating the strengths and weaknesses of the legal status quo, also set out to explore the question of what a framework for assisted dying might look like, if such a system were to be implemented in the UK, and what approach might be most acceptable to health and social care professionals and to the general public.

The report concluded that the current legal status of assisted suicide is inadequate and incoherent. While the current legal regime can be distressing for the people affected and their families, it is also unclear for health and social care staff, and it lays a deeply challenging burden on police and prosecutors, which could be eased by a new statutory framework, according to the report. A proposed legal framework for assisted dying is laid out in detail in the report, including strict criteria to define who might be eligible to receive assistance and robust safeguards to prevent abuse of any new law.