AMA Code of Ethics still applies a century later

Panel evaluates code for relevance

Despite having been written 157 years ago, the American Medical Association’s (AMA’s) Code of Medical Ethics still is a critical tool for solving day-to-day ethical dilemmas, according to experts who recently evaluated the guide.

A panel convened to observe the World Medical Association’s Medical Ethics Day in September examined the latest version of the code with an eye toward determining its value in daily medicine.

The current update contains 185 ethical opinions, including 12 new and 14 amended items. Since it first was published in 1847 — the year the AMA was founded — the code was merely a pamphlet articulating the ideals of professional education and practice. The current code consists of more than 200 pages dealing with inherent matters including privacy, etiquette, and errors, as well as such 21st century topics as genomic research, electronic mail, health-related web sites, and cloning.

Panelist and former AMA ethics standards director Steven R. Latham, PhD, notes that the code was written by doctors for doctors. It has therefore occasionally been criticized as a document used to protect doctors. But, he says, the code "embodies a promise" from physicians to their patients that they will maintain a practice within the ethical boundaries found in the code. For physicians, Latham says, the code’s greatest strength is how doctors can "pull it off the shelf" and get answers to questions that are addressed nowhere else, as well as basic questions like, "Who owns the medical files of physicians who leave a group practice?" (Answer: The practice should hold the files until instructed by the patient whether to keep them or forward them to another physician.)

An ethical persuasive force

Arthur R. Derse, MD, director of medical and legal affairs at the Center for the Study of Bioethics at the Medical College of Wisconsin in Milwaukee, differentiates between the code’s usefulness in court and in the practice of medicine. He notes that the code does not have legal force, but it does have "ethical persuasive force" and that it has been cited in court decisions.

Derse says he uses 16 of the code’s ethical opinions in his medical ethics class, and adds that surveys indicate that 86% of his students agree that using the AMA code is helpful in understanding medical ethics. "It’s helpful for students to see in black and white what the largest and most influential medical organization has to say," he says.

Latham, however, counters that when the AMA ambitiously addresses issues like cloning in its code, it strays from the area of its biggest strength — providing useful advice on the correct way to run an ethical practice.

The Code of Medical Ethics preamble states that it is not a set of laws, but consists of "standards of conduct, which define the essentials of honorable behavior for the physician."