Code of ethics in professional practice

¶ … grey areas associated with medical ethics is that executive personnel in the medical community are not always subject to the same rigorous ethical codes that other workers in the field are. Arthur Lazarus notes, "American Medical Association (AMA) Principles of Medical Ethics provides norms for treating patients, but provides little guidance for physician executives in terms of helping their organizations comply with legal and regulatory requirements, avoiding litigation, improving productivity and quality and building organizational trust and integrity."

This is particularly true regarding executive practitioners in nontraditional medical fields and private practice. Fundamentally, the wide variety of organizational settings in modern medicine can generate an atmosphere where the straightforward application of any single code of ethics is simply not possible. Additionally, modern ethical codes need "to reflect the medical technology industry's unique relationships with health care professionals."

So, while the doctrines set forward by the AMA, American Psychiatric Association, American Association of Psychiatric Administrators, American College of Healthcare Executives, and the American Academy of Pharmaceutical Physicians all provide detailed and useful guidelines for ethical conduct in the actual administration of medicine, broader social and moral conflicts can arise in which medical executives are forced to make difficult decisions.

Lazarus, a psychiatrist employed in the pharmaceutical industry, finds that all of these ethical codes could potentially apply to his practice. He writes that "many pharmaceutical physicians adhere to the AAPP code of ethics, which basically guides ethical decision making related to patients (subjects) in clinical trials, but not to patients seen in clinical practice."

However, this code is far from comprehensive with reference for to psychiatrics in managed care positions. Overall, the conflicts that exist between existing codes of ethics when it is unclear as to whether one or another should be applied undermines the validity of all the major ethical standards in medicine.

One problem has arisen with the APA code of ethics came to the forefront when a patient complained that their psychiatrists behaved unethically when they conducted insurance reviews with the attending physician. The problem was that the APA standards were set before the era of managed care; accordingly, the application of the APA code of ethics to these particular psychiatrists was utterly ambiguous. Psychiatrists in managed care essentially need to conduct insurance reviews for their practices to function properly, but from the perspective of the APA this was a grievous breech of medical ethics. Eventually, "The psychiatrists were exonerated, and later an addendum to the APA's code of ethics was incorporated to clarify existing standards for psychiatrists practicing in 'organized settings.'"

The APA's central goal is to set forward a code of ethics that is capable of providing the best possible care for the patient. Consequently, the addendum that addressed this specific issue fell in line with this approach:

A psychiatrist shall not conduct reviews or participate in reviews in a manner likely to demean the dignity of the patient by asking for highly personal material not necessary for the conduct of the review. A reviewing psychiatrist shall strive as hard for a patient he or she reviews as for one he or she treats to prevent the disclosure of sensitive patient material to anyone other than for clear, clinical necessity.

Although this statement is relatively linear in its reasoning, it is also exceedingly vague; it leaves the ethical choices purely in the hands of each individual practitioner's judgment. In other words, it is not altogether obvious just what manner of reviews is likely to demean the dignity of any given patient. Certainly, it must be associated with the intimate nature of the information that is required and balancing this against information which might not be as pertinent. However, exactly where the line is drawn is wholly up to the one conducting the review, and again, rests within the bounds of their own judgment.

So, the intended ethical principle that the American Psychiatric Association adheres to is fairly plain: the best possible care for the patient is the aim. This doubtlessly rests upon the principle that human beings should be entitled to the medical remedies and treatments of society and that they are entitled to a certain level of privacy. The code is an attractive one for this reason: the well-being of the entire medical establishment should not be considered in ethical decisions. Although the individual is the one that ultimately makes moral choices, a number of perspectives need to be taken into consideration. According to the APA's ethical code preamble: "As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self."

Such a broad standpoint is somewhat unique among the numerous ethical doctrines in medicine.

The AAPA ethical code, on the other hand, "stipulates that psychiatric administrators are responsible for the well being of the organization that is being administered, in addition to the welfare of patients."

For the APA, the number one concern is a direct consequence of the centerpiece of their moral position: a primary concern for human rights and human dignity. Yet, as we have already seen, the latter can be rather indefinite in many cases.

As with most practically applied ethical codes, however, the APA standards must routinely defer to social norms and laws. Laws concerning human privacy, fraud, and deception must all be in accordance with the laws of the United States, and grow out of many of the principles outlined in the United States Constitution. But the defining factor of the APA's moral stand -- that everyone should be treated with regard for their human rights and dignity -- leads to one of the more remarkable positions that motivate the doctrine. Namely, "A physician shall support access to medical care for all people."

Clearly, this is a moral viewpoint that does not draw directly from the philosophical principles of the United States. After all, medicine costs money and the founders of the United States at no point assumed that a classless society should prevail. Yet, the APA formally asserts that all patients should be approached with equal care irrespective of their social rank.

Ethics committees are put in charge of any grievance procedures under the APA standards. "Once a final decision is reached, the district branch shall notify the complainant and the respondent by certified mail or by overnight mail (signature required)."