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Medical Ethics Issues: Position Papers & Resources

In addition to the ACP Ethics Manual, ACP publishes ethics position papers on a broad range of health care ethics issues including clinical ethics, professionalism, the delivery of health care, teaching, medical research, human rights and other topics. ACP ethics policy is approved by the Board of Regents and serves as the basis for the development of ACP ethics education and practice resources and legislative, regulatory and policy implementation activities.

Current ACP Ethics Policies and Resources

Electronic and Online Professionalism

Ethics Manual

electronic patient-physician communication, electronic health records, telemedicine, and online professionalism

Case Studies

Position Papers

End-of-Life Care

Ethics Manual

Comments and Letters

  • 2011 Letter and 2009 letter to Congressman Blumenauer regarding ACP’s support for legislation to pay for voluntary end-of-life care consultations (see H.R. 1898, the Life Sustaining Treatment Preferences Act of 2009).

  • ACP Letter to the DEA (January 4, 2005) on the need for reasonable, clear and final guidance from the DEA on pain management issues. DEA's Response to ACP.

Resources

End-of-Life (PEACE) Brochures
(ACP. 2014)
The PEACE brochures were developed by the Patient Education Work Group, which was convened in conjunction with the Consensus Panel project. Order copies of printed brochures

ACP-ASIM End-of-Life Care Consensus Panel Papers
(1999-2001)
ACP convened this Greenwall Foundation supported consensus panel to develop ethical, policy, and clinical recommendations for physicians and other clinicians on end-of-life decisions.

Physician's Guide to End-of-Life Care
Edited by Lois Snyder, JD, and Timothy Quill, MD, FACP (ACP Books. 2001)

Advance Directive Forms for Your State
Contact Caring Connections, a program of the National Hospice and Palliative Care Organization (NHPCO).

National Healthcare Decisions Day, April 16
Details and resources on NHDD and the importance of advance care planning.

Expert Witnesses

Ethics Manual

Case Studies

To Be or Not to Be: Should I Serve as an Expert Witness? CME
(ACP Ethics Case Studies Series. CME by Medscape. 2014)

Position Papers

Guidelines for the Physician Expert Witness
(Ann Intern Med. 1990;113:789)

Family Caregivers

Position Papers

Resources

Information Resources for Physicians Supporting Family Caregivers
(ACP. 2010)
This appendix of resources was developed in conjunction with the ACP position paper to help physicians manage relationships with patients and caregivers.

Case Studies

Patient/Physician/Family Caregiver Relationships: When the Family Caregiver Is a Physician CME
(ACP Ethics Case Studies Series. CME by Medscape. 2011)

Genetic Testing and Precision Medicine

Ethics Manual

Comments and Letters

ACP Comments on privacy protection and human genome sequencing
(May 24, 2012)
ACP provided comments to the Presidential Commission for the Study of Bioethical Issues regarding the ethical implications of evolving notions of privacy and access in relation to the integration of large-scale human genome sequencing into research and clinical care.

Position Papers

Genetic Testing and Reuniting Families
(July 10, 2018)

Global Health Clinical Experiences

Health and Human Rights

"Health and human rights are interrelated. When human rights are promoted, health is promoted ... Physicians have important roles in promoting health and human rights and addressing social inequities." (Ethics Manual, seventh edition).

Comments and Letters

ACP's Human Rights Page: ACP policy statements and letters of support, as well as documents related to College advocacy for the humane treatment of prisoners and detainees.

Patient–Physician Relationship

Position Papers

Case Studies

Physicians and Society

Physician-Assisted Suicide and Euthanasia

Physician Impairment

Ethics Manual

Case Studies

When an Aging Colleague Seems Impaired CME
(ACP Ethics Case Studies Series. CME by Medscape. 2017)

Position Papers

Physician Impairment and Rehabilitation: Reintegration Into Medical Practice While Ensuring Patient Safety
(Ann Intern Med. 2019;170(12):871-879.)

Resources

ACP’s Physician Well-being and Professional Satisfaction initiative aims to foster a culture of wellness, reduce administrative burdens on physicians, improve practice efficiency and enhance individual physician well-being. The project website includes tools and programs for individual members, their practices, and ACP Chapters.

Physician–Industry Relations

Ethics Manual

Resources

Physician Open Payments (Sunshine Rule)
This ACP webpage provides guidance and related tools for physicians on the Physician Payment Sunshine Rule (also referred to as the National Physician Payment Transparency Program, or Open Payments). The Open Payments system, implemented by the Centers for Medicare and Medicaid Services (CMS) in 2015, provides a mechanism for the public reporting of physician and teaching hospital financial relationships with industry.

Position Papers

Practice Models, the Business of Medicine and the Changing Practice Environment

Prescription Drug Abuse

Position Papers

Prescription Drug Abuse
(Ann Intern Med. 2014;160:198-200)

Professionalism

ACP Pledge

American College of Physicians Pledge
(ACP. 1982 [updated; original 1924])
The ACP Pledge is taken by new Fellows at Convocation at each Internal Medicine annual meeting. The Pledge affirms the physician’s membership in an ethical and moral community dedicated to healing, comfort, and altruism.

Physician Charter on Professionalism

Medical Professionalism in the New Millennium: A Physician Charter
(Ann Intern Med. 2002;136:243-6)

Ethics Manual

Position Papers

ACP Professional Accountability Principles
(ACP. March 2018)

Case Studies

Research Ethics and Human Subjects

Ethics Manual

  • Research
    Sections within the chapter include “Protection of Human Subjects,” “Use of Human Biological Materials in Research,” “Placebo Controls,” “Innovative Medical Therapies,” “Scientific Publication,” “Sponsored Research” and “Public Announcement of Research Discoveries.”

Responsible Conduct of Research (RCR) Project

Under a grant from the Association of American Medical Colleges and the DHHS Office of Research Integrity, ACP Ethics staff has implemented member education and support programs on the responsible conduct of office-based research. Workshops have been presented at ACP's annual meeting as well as at several ACP chapter meetings.

Resources

Case Studies

Research Ethics Training Resources

Comments and Letters

ACP supports National Academies’ call for withdrawal of Notice of Proposed Rulemaking (NPRM) for ‘Common Rule’ and for appointing a new commission
(Dec. 31, 2015)
ACP issued a statement in support of the National Academies' call for withdrawal of the Common Rule NPRM and for appointing a new research ethics commission.

ACP Comments on Notice of Proposed Rule Making (NPRM)
(Dec. 31, 2015)
ACP submitted comments to the Office for Human Research Protections of the U.S. Department of Health and Human Services on the Notice of Proposed Rule Making, "Federal Policy for the Protection of Human Subjects," also known as the Common Rule. ACP also submitted an earlier round of comments on the proposed rule making on Oct. 25, 2011.

Stewardship of Health Care Resources

"Physicians have a responsibility to practice effective and efficient health care and to use health care resources responsibly in practicing high-value care. Parsimonious care that utilizes the most efficient means to effectively diagnose a condition and treat a patient puts the patient first but also respects the need to use resources wisely and to help ensure that resources are equitably available" (Ethics Manual, seventh edition).

Conflicting duties? The physician's primary duty, first and foremost, is to the individual patient. She or he must advocate for the patient—in a health care system that grows more and more complex by the year—based on the best interests of the patient. But the physician also should use health care resources responsibly and efficiently. Are these duties in conflict? The Ethics Manual and ethics case studies explore these issues and provide help in sorting them out.

Is it rationing? Parsimonious care is not rationing. The goal of medical parsimony is to provide the care necessary for the patient's good on the basis primarily of evidence-based medicine. Although this may have the welcome side effect of preserving resources, reducing resource use is not the intent. It is this difference in intent and action that helps provide a foundation for the ethical distinction between parsimonious medicine and rationing.

Ethics Manual

Resources

ACP’s High Value Care Project aims to improve health, avoid harms, and eliminate wasteful practices. The project website offers learning resources for clinicians and medical educators, clinical guidelines, best practice advice, case studies and patient resources on a wide variety of related topics.

Case Studies

The following ethics case studies were developed through an award from the ABIM Foundation's Putting the Charter into Practice project. Watch a video report of the ACP's work on this project presented by Dr. David Fleming, former President of the College.

Teaching, Training and the Hidden Curriculum

Ethics Manual

Case Studies

Position Papers

Hidden Curricula, Ethics, and Professionalism: Optimizing Clinical Learning Environments in Becoming and Being a Physician
(Ann Intern Med. 2018;168:506-8)

Resources

CME/MOC activities based on this ACP position paper are available: