Position Papers
1 April 1998

Ethics Manual: Fourth Edition

Publication: Annals of Internal Medicine
Volume 128, Number 7

Abstract

Medicine, law, and social values are not static.Reexamining the ethical tenets of medical practice and their application in new circumstances is a necessary exercise. The fourth edition of the American College of Physicians Ethics Manual covers emerging issues in medical ethics and revisits old ones. It reflects on many of the ethical tensions faced by internists and their patients and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, it may help physicians to avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared obligations and duties of the medical profession.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Peabody FW. The care of the patient. JAMA. 1927; 88:877-82.
2.
Dunn PM, Gallagher TH, Hodges MO, Prendergast, TJ, Rubenfeld GD, Tolle SW. Medical ethics: an annotated bibliography. Ann Intern Med. 1994; 121:627-32.
3.
American College of Physicians Ethics Manual. Part 1: History; the patient; other physicians. American College of Physicians. Ann Intern Med. 1989; 111:245-52.
4.
American College of Physicians Ethics Manual. Part 2: The physician and society; research; life-sustaining treatment; other issues. American College of Physicians. Ann Intern Med. 1989; 111:327-35.
5.
Jonsen AR. The New Medicine and the Old Ethics. Cambridge, MA: Harvard Univ Pr; 1990.
6.
Reiser SJ, Dyck AJ, Curran WJ. Ethics in Medicine: Historical Perspectives and Contemporary Concerns. Cambridge, MA: MIT Pr; 1977.
7.
Rothman DJ. Strangers at the Bedside: A History of How Law and Bioethics Transformed Medical Decision Making. New York: Basic Books; 1991.
8.
Veatch RM. A Theory of Medical Ethics. New York: Basic Books; 1981.
9.
Beauchamp TL, Childress JF. Principles of Biomedical Ethics. 4th ed. New York: Oxford Univ Pr; 1994.
10.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Making Health Care Decisions: A Report on the Ethical and Legal Implications of Informed Consent in the Patient-Practitioner Relationship. Washington, DC: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research; 1982.
11.
Katz J. The Silent World of Doctor and Patient. New York: Free Pr; 1997.
12.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Securing Access to Health Care: A Report on the Ethical Implications of Differences in the Availability of Health Services. Washington, DC: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research; 1983.
13.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Screening and Counseling for Genetic Conditions: A Report on the Ethical, Social, and Legal Implications of Genetic Screening, Counselling, and Educational Programs. Washington, DC: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research; 1983.
14.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Splicing Life, A Report on the Social and Ethical Issues of Genetic Engineering with Human Beings. Washington, DC: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research; 1982.
15.
President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Deciding to Forgo Life-Sustaining Treatment: A Report on the Ethical, Medical, and Legal Issues in Treatment Decisions. Washington, DC: President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research; 1983.
16.
Guidelines on the Termination of Life-Sustaining Treatment and the Care of the Dying. Briarcliff Manor, NY: The Hastings Center; 1987.
17.
Snyder L, Weiner J. Ethics and Medicaid Patients. In: Snyder L, ed. Ethical Choices: Case Studies in Medical Practice. Philadelphia: American Coll Physicians; 1996; 63-70.
18.
Health care needs of the adolescent. American College of Physicians. Ann Intern Med. 1989; 110:930-5.
19.
Burnum JF. Secrets about patients. N Engl J Med. 1991; 324:1130-3.
20.
Roter DL, Stewart M, Putnam SM, Lipkin M Jr, Stiles W, Inui TS. Communication patterns of primary care physicians. JAMA. 1997; 277:350-6.
21.
Quill TE, Townsend P. Bad news: delivery, dialogue, and dilemmas. Arch Intern Med. 1991; 151:463-8.
22.
American Academy of Pediatrics Committee on Adolescence: counseling the adolescent about pregnancy options. Pediatrics. 1989; 83:135-7.
23.
Geller G, Botkin JR, Green MJ, Press N, Biesecker BB, Wilfond B, et al. Genetic testing for susceptibility to adult-onset cancer. The process and content of informed consent. JAMA. 1997; 277:1467-74.
24.
Weiner J. The duty to treat HIV-positive patients. In: Snyder L, ed. Ethical Choices: Case Studies for Medical Practice. Philadelphia: American Coll Physicians; 1996:71-8.
25.
The acquired immunodeficiency syndrome (AIDS) and infection with the human immunodeficiency virus (HIV). Health and Public Policy Committee, American College of Physicians; and the Infectious Diseases Society of America. Ann Intern Med. 1988; 108:460-9.
26.
Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States. Prevalence, costs, and patterns of use. N Engl J Med. 1993; 328:246-52.
27.
Murray RH, Rubel AJ. Physicians and healers-unwitting partners in health care. N Engl J Med. 1992; 326:61-4.
28.
Zinn W, Furutani N. Physician perspectives on the ethical aspects of disability determination. J Gen Intern Med. 1996; 11:525-32.
29.
Sexual misconduct in the practice of medicine. Council on Ethical and Judicial Affairs, American Medical Association. JAMA. 1991; 266:2741-5.
30.
Weiner J, Tolle SW. Sex and the single physician. In: Snyder L, ed. Ethical Choices: Case Studies for Medical Practice. Philadelphia: American Coll Physicians; 1996:53-60.
31.
A controlled trial to improve care for seriously ill hospitalized patients. The Study To Understand Prognoses and Preferences for Outcomes and Risks of Treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA. 1995; 274:1591-8.
32.
Institute of Medicine. Approaching Death: Improving Care at the End of Life. Washington, DC: National Academy Pr; 1997.
33.
Cassel CK, Vladek BC. ICD-9 code for palliative or terminal care. N Engl J Med. 1996; 335:1232-4.
34.
Buchan ML, Tolle SW. Pain relief for dying persons: dealing with physicians' fears and concerns. J Clin Ethics. 1995; 6:53-61.
35.
Compulsory treatment and the need for consent. In: Rozovsky FA. Consent to Treatment: A Practical Guide. 2d ed. Boston: Little, Brown; 1990.
36.
Snyder L. Life, death, and the American College of Physicians: the Cruzan case. Ann Intern Med. 1990; 112:802-4.
37.
Annas GJ. The health care proxy and the living will. N Engl J Med. 1991; 324:1210-3.
38.
Tolle SW, Bennett WM, Hickm DH, Benson JA Jr. Responsibilities of primary physicians in organ donation. Ann Intern Med. 1987; 106:740-4.
39.
Persistent vegetative state and the decision to withdraw or withhold life support. Council on Scientific Affairs and Council on Ethical and Judicial Affairs. JAMA. 1990; 263:426-30.
40.
Position of the American Academy of Neurology on certain aspects of the care and management of the persistent vegetative state patient. Adopted by the Executive Board, American Academy of Neurology, April 21, 1998, Cincinnati, Ohio. Neurology. 1989; 39:125-6.
41.
Withholding and withdrawing life-sustaining therapy. This Official Statement of the American Thoracic Society was adopted by the ATS Board of Directors, March 1991, Am Rev Respir Dis. 1991; 144(3 Pt 1):726-31.
42.
When Death Is Sought: Assisted Suicide and Euthanasia in the Medical Context. Albany, NY: New York State Task Force on Life and the Law; 1994.
43.
Physician-assisted suicide: toward a comprehensive understanding. Report of the Task Force on Physician-assisted Suicide of the Society for Health and Human Values. Acad Med 1995; 70:583-90.
44.
Tolle SW, Snyder L. Physician-assisted suicide revisited: comfort and care at the end of life. In: Snyder L, ed. Ethical Choices: Case Studies for Medical Practice. Philadelphia: American Coll Physicians; 1996:17-23.
45.
Povar G. Moreno J. Hippocrates and the health maintenance organization. A discussion of ethical issues. Ann Intern Med. 1988; 109:419-24.
46.
LaPuma J, Schiedermayer D, Seigler M. Ethical issues in managed care. Trends Health Care Law Ethics. 1995; 10:73-7.
47.
Mechanic D, Schlesinger M. The impact of managed care on patients' trust in medical care and their physicians. JAMA. 1996; 275:1693-7.
48.
Snyder L, Hillman AL. Financial incentives and physician decision making. In: Snyder L, ed. Ethical Choices: Case Studies for Medical Practice. Philadelphia: American Coll Physicians; 1996:105-12.
49.
Conflicts of interest. Physician ownership of medical facilities. Council on Ethical and Judicial Affairs, American Medical Association. JAMA. 1992; 267:2366-9.
50.
Physicians and the pharmaceutical industry. American College of Physicians. Ann Intern Med. 1990; 112:624-6.
51.
The relationship between physicians and the pharmaceutical industry. A report of the Royal College of Physicians. J R Coll Physicians Lond. 1986; 20:235-42.
52.
Ethics case study: deciding how much care is too much. ACP Observer. 1997; 17:1, 30-1.
53.
United Nations. First Congress on the Prevention of Crime and the Treatment of Offenders. Standard Minimum Rules for the Treatment of Prisoners. 1955.
54.
Fletcher JC, Siegler M. What are the goals of ethics consultation? A consensus statement. J Clin Ethics. 1996; 7:122-6.
55.
Accreditation Manual for Hospitals. Chicago: Joint Commission on Accreditation of Hospitals; 1992:106.
56.
Guidelines for the physician expert witness. American College of Physicians. Ann Intern Med. 1990; 113:789.
57.
Varki A. Of pride, prejudice, and discrimination. Why generalizations can be unfair to the individual. Ann Intern Med. 1992; 116:762-4.
58.
Conley FK. Toward a more perfect world-eliminating sexual discrimination in academic medicine [Editorial]. N Engl J Med. 1993; 328:351-2.
59.
Snyder L. Referrals and patients' wishes. In: Snyder L, ed. Ethical Choices: Case Studies in Medical Practice. Philadelphia: American Coll Physicians; 1996:35-40.
60.
Weiner J, Snyder L. The impaired colleague. In: Snyder L, ed. Ethical Choices: Case Studies in Medical Practice. Philadelphia: American Coll Physicians; 1996:79-84.
61.
Commission on Research Integrity. Integrity and Misconduct in Research: Report to the Secretary of Health and Human Services, The House Committee on Commerce and the Senate Committee on Labor and Human Resources. Washington, DC: US Dept of Health and Human Services, Public Health Service; 1995.
62.
Cognitively impaired subjects. American College of Physicians. Ann Intern Med. 1989; 111:843-8.
63.
Lind SE. Finder's fees for research subjects. N Engl J Med. 1990; 323:192-5.
64.
Lind SE. Innovative medical therapies: between practice and research. Clin Res. 1988; 36:546-51.
65.
Levine RJ. Ethics and Regulation of Clinical Research. 2d ed. Baltimore: Urban & Schwarzenberg; 1986.
66.
Uniform requirements for manuscripts submitted to biomedical journals. International Committee of Medical Journal Editors. N Engl J Med. 1997; 336:309-15.

Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 128Number 71 April 1998
Pages: 576 - 594

History

Published in issue: 1 April 1998
Published online: 15 August 2000

Keywords

Authors

Acknowledgments: The American College of Physicians and the ACP Ethics and Human Rights Committee are solely responsible for the contents of the Manual. Both thank former Committee members who made contributions to the development of this Manual through their reviews of drafts: Elias Abrutyn, MD; Samuel Asper, MD; Jeremiah A. Barondess, MD; Michael Bernstein, MD; Stuart Bondurant, MD; John F. Burnum, MD; Christine K. Cassel, MD; Errol D. Crook, MD; Harriet P. Dustan, MD; Saul J. Farber, MD; Daniel Federman, MD; Arthur Feinberg, MD; Norton J. Greenberger, MD; Eugene A. Hildreth, MD; Edwin P. Maynard, MD; John A. Mitas II, MC USN; Robert H. Moser, MD; Warren Point, MD; William A. Reynolds, MD; Lawrence Scherr, MD; Gerald E. Thomson, MD; Susan W. Tolle, MD; Richard W. Vilter, MD; and Ralph Wallerstein, MD.
Corresponding Author: Lois Snyder, JD, American College of Physicians, Independence Mall West, Sixth Street at Race, Philadelphia, PA 19106.

Metrics & Citations

Metrics

Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format





Download article citation data for:
Ethics Manual: Fourth Edition. Ann Intern Med.1998;128:576-594. doi:10.7326/0003-4819-128-7-199804010-00012

View More

Get Access

Login Options:
Purchase

You will be redirected to acponline.org to sign-in to Annals to complete your purchase.

Create your Free Account

You will be redirected to acponline.org to create an account that will provide access to Annals.

View options

PDF/ePub

View PDF/ePub

Related in ACP Journals

Full Text

View Full Text

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media