The Principles of Medical Ethics (The American Medical Association, 2001), w/ Commentary

[Comments following the document]

ama-logo
I. Preamble

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. 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. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

II. Principles of medical ethics

  1. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.
  2. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

  1. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.
  2. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.
  3. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.

  1. A physician shall support access to medical care for all people.

* Adopted June 1957; revised June 1980; revised June 2001.
Comments [By: Dr. John D. Ferrer)

I. Preamble
The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. 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. The following Principles adopted by the American Medical Association are not laws, but standards of conduct which define the essentials of honorable behavior for the physician.

The well-meaning medical professional can rightly focus his or her attention on the patient. While there are greater goods besides the interests strictly of that patient, there is a presumed right of autonomy, and a demarcated domain of responsibility to where the Doctor is most responsible for his patient and only secondarily responsible for other concerns bearing upon, the patient’s family, other medical professionals, the medical profession, the community, or society at large. The doctor does not act in a vacuum, but neither can he or she do the job if forced to treat all affected parties equally. The patient is his or her no. 1 concern/responsibility. The principles that follow are given with the understanding that the doctor-patient relation is a special and important relation putting patient autonomy and well-being above anyone else’s autonomy or well-being. Implied with the “patient’s interests” are issues of privacy, lifestyle choice, informed consent, security of property, and so on.

II. Principles of medical ethics
1. A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.

The first principle of medical ethics obligates the medical professional to (1) compassion and (2) respectful care. That respect is both for (2a) human dignity and (2b) human rights. This statement cautiously avoids the more contentious phrase “sanctity of life.” While sanctity can have a non-religious sense, and that’s a large part of how the phrase is used in U.S. legal history, it can also have a religious sense. And this document is not intended to meddle in theological or religious matters. Plus, the term itself has been a hotbed of debate (ex., Unsanctifying Life) Also noteworthy is the term “rights,” or, more specifically “human dignity and rights.” The child-in-utero is a human being, and that is medically and scientifically beneath dispute. A legal battle has been waged, and, for the most part settled, that “personhood” rather than “humanity” is the key foundation necessary for legal protection under the law, at least when it comes to any “right to life” claim. In short, (legally defined) “persons” have a right to life but no such reassurance is guaranteed for any other human beings. Implicitly then, all other human beings fail to have a legally recognized right to life.

Abortion raises some stiff challenges to this fundamental principle of medical ethics. While the mother’s autonomy, informed consent, and privacy concerns might comport with a pro-choice medical practice, the same pro-choice persuasion militates against the “human dignity and rights” of the child. Doctors are to treat the mothers “dignity and rights” of privacy, autonomy, informed consent, etc. above the life of the child. Also, the pro-choice position would have to understand this principle to be saying that the doctor’s patient is the mother and not (also) the child. If the doctor had a doctor-patient relation with both patients, mother and child, then he’d be responsible for compassion towards both, for dignity towards both, and for rights of both.

(II) 1. A physician shall uphold the standards of professionalism, be honest in all professional interactions, and strive to report physicians deficient in character or competence, or engaging in fraud or deception, to appropriate entities.

Here is stated the collegial ethic expected in the medical profession. Doctors should hold each other to a high standard of moral fiber, professional decorum, and overall integrity. Applied to the abortion industry, however, one does not have to look far to find that the abortion procedure, combined with the ethical and social baggage it carries has tended push the abortion industry down to the “bottom of the barrel” in medical culture. Stated another way, Bernard Nathanson, who conducted or presided over tens of thousands of abortions admits that abortion clinics were often “staffed with incompetents and losers” not to mention perverts and criminals (Nathanson, M.D., The Hand of God: A Journey From Death to Life by the Abortion Doctor Who Changed His Mind, pg. 102-21). Now these are bold accusations, but there are practical reasons why the abortion industry is troubled by integrity issues.

First, medical practice is largely understood to be about helping not harming humans, yet abortion harms human beings in the worst way, by killing them. This potentially eviscerates the ethical core of medicine. “Medical harm” is a contradiction in terms, especially in the case of “medically killing innocent healthy human beings.”

Second, as Nathanson points out, the abortion procedure itself is banal and uninteresting–the more cutting edge technology would, instead, be obstetrics or fetology or neo-natal health. By 1991 “only 12 percent of residency training programs required training in first-trimester abortions. Abortion is surgically unchallenging work that hardly fits within the classic bounds and aspirations of young physicians in training” (Nathanson, 123-24).

Third, since abortion is a morally contentious procedure involving the willful killing of human beings, the more high-minded physicians and surgeons, especially the skillful elite who want to “change the world” and make big money doing it, they gravitate to other medical fields like cardiology or oncology, where they can serve in protecting, extending, and improving life. The reality of abortive medicine, according to Nathanson, is that of a “tedious, assembly-line, marginally respectable occupation that demanded little or nothing from the physician technically or ethically. . . . [T]he doctor would examine [the mothers] once they were under anesthesia, and then suction out the uterus–never to see the patient again. . . . [I]s it any wonder that flotsam and jetsam like [list of convicted criminals in the abortion industry] and their ilk are driven to the scummy shores of abortion?” (1991, 122).

Fourth, medical practice is hard enough on it’s own. It can be thankless, stressful work, with long hours, under high regulation, tons of policies, and the ever-present threat of lawsuits and just bad press from patient complaints. When the psychological burden of abortion is added in, it becomes even harder to maintain a healthy, community minded, classy work environment. The abortion industry just is not the kind of career field to which upstanding and talented students generally aspire.

Fifth, by the law of supply and demand, the simpler surgical procedures are relatively easy to offer driving down the price for abortions. While bypass heart surgeries, colon resections, and cancer treatments can cost into the six figures ($100,000 +), the typical abortion costs about the same as a Botox treatment, $300-500. Both are outpatient surgeries. Both are relatively easy to perform. Both are convenience industries where there is little/no threat to the life of the person involved. And the ethical gains are questionable or merely subjective. Medical professionals who spend long years in training, and aspiring towards medicine for many years prior, rarely gravitate towards abortion as their first choice just as clothes designers don’t aspire to have their designs relegated strictly to thrift store racks.

III. A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

Legality and morality dovetail here as physicians recognize the importance of both, and seek to honor both as much as possible. There may be some subjectivity or dispute over what counts as the “best interests of the patient.” We cannot assume that patients generally or always know what is best for them. But neither can we assume that doctors always know what’s best for their patients. Hopefully, however, if both the doctor and patient are seeking the do what is best for the patient, then between the two of them they can come up with a viable health plan. The doctor still has a duty to respect the law even if he recognizes an occasional tension between the law of the land and the patient’s needs. In such cases, it is not uncommon for doctors to “prescribe” health plans where a certain medicine or medical procedure is made available through non-traditional means, such as non-FDA approved medicine, or late-term abortions illegal in a given state. This “round about” methodology may or may not be “good,” but it’s probably better than directly contradicting the state or federal laws, for example, as did Dr. Kermit Gosnell , or Dr. Allan Kline, or Dr. David Benjamin, or Dr. Robert Crist, or Alicia Ruiz Hanna, or Dr. Mind Kow Hah, or Dr. Abu Hayat all of whom are criminally convicted abortionists.

This point, however, does not assume that the “law of the land” is always right. So these “round about” methods may be necessary, for example, if at some point in the past medical laws prohibited the use of the only known cure for a disease, or if FDA regulations are obstructing the release of good medicine because of crony capitalism or political interference. Now, the doctors just mentioned would amount to a pretty poor case for “righteous revolution,” but there could still be medically revolutionary actions where the law is contradicted on ethically higher grounds.

1. A physician shall respect the rights of patients, colleagues, and other health professionals, and shall safeguard patient confidences and privacy within the constraints of the law.

This respect for the law is clarified in terms of the various “rights of patients, colleagues and other health professionals.” Privacy laws are understood not in the strict “rights over my body” sense (Roe v. Wade and Doe v. Bolton, 1973) but also in the sense of doctor-patient confidence. Patients have a right to expect their doctors not go about, unprofessionally, gossiping about patient needs and issues, or worse go broadcasting and selling patient information for a profit.

This AMA statement is only a brief synopsis and not an explicit analysis, so we should not expect a full-length discourse on what “rights” are included. It is enough to have suggested “compassion,” “dignity,” and “privacy.” Although, one wonders if such a rudimentary right as “life” or “well-being” is left unmentioned precisely because of abortion or euthanasia where modern medicine has, potentially caved in on itself conflating “compassion” with “killing human beings.”

2. A physician shall continue to study, apply, and advance scientific knowledge, maintain a commitment to medical education, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

Medical professionalism entails a commitment to continuing education, patient information, and professional cooperation. The abortion industry, however, runs counter to these in several ways.

First, informing the patient is bad for business, specifically, women are at least a little less likely to follow through with an abortion after having an ultra-sound. Dr. Joseph Randall, former abortion doctor, explains, “They [the women] are never allowed to look at the ultrasound because we knew that if they so much as heard the heart beat, they wouldn’t want to have an abortion.” (Randall, “Pro-Choice 1990: Skeletons in the Closet,” New Dimensions, October 1990). The procedure is simple, effective, relatively inexpensive, easy to perform, highly informative, and would be a foregone conclusion if a women has an actual cyst or tumor in that part of her body (such as an ovarian cyst). In the case of pregnancy ultra-sound could help identify stage of development (if the woman is unsure), thus affected which abortion procedure would be best; and it can also identify a host of complications such as tubal or ectopic pregnancy, which can be life-threatening. There is some dispute over what percentage of women actually decline an abortion because of an ultra-sound, but there remains a strong enough possibility that women (or doctors!) see the gestating child and lose heart. Dr. Bernard Nathanson credits ultrasound as the main cause for his leaving the abortion industry, even though he was one of the founders of NARAL (1991, 125ff). His video “The Silent Scream” (1984) is little more than an ultra-sound video with commentary and has come to be an icon of the pro-life initiative.

Second, the abortion doctor is not acting in good faith towards his medical colleagues in neo-natal medicine, fetology, or embryology. He makes his living in by killing their patients. This is not “cooperation” but contradiction. As one doctor is delivering a 22 week old premature baby on one floor of the hospital, another doctor may be performing an abortion on another 22 week old child in utero.

3. A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to serve, with whom to associate, and the environment in which to provide medical care.

Medical doctors serve within the free-market so they have great liberty to choose their field, their associates, their work-environment, and so on, at least as as far as they are trying to serve the best interests of the patients within the normal and realistic constrains of modern medicine. This principle is in place, in part, because of conscientious objections on the part of medical professionals who do not wish to be forced to work with certain people whom the don’t trust, or serve particular patients who are (for various reasons) problematic, or conduct procedures to which they conscientiously object. Procedures may be objectionable because of their questionable merit, unjustified danger, or because they are intrinsically wrong (or believed to be wrong). This principle, however, may come under fire or be forced into reinterpretation under the recent healthcare mandate where the Government has taken a much more active role in private healthcare insurance. Time will tell how this debate will play out, and whether doctors will be forced to take questionable patients, or perform procedures against their conscience.

Of course, it is problematic to define “appropriate patient care” in such a way as to include willfully killing human beings. Yet, abortion explicitly does just that. When applied to abortion the various terms for the medical field–such as “healthcare,” “well-being,” “patient care,” or “appropriate”–become errant irony; a kind of bad joke that pulls a smiley mask over millions of dead babies.

VII. A physician shall recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health.

The physician understands his work as a kind of service, entailing responsibility to improve the community by serving the healthcare interests of his patients. He or she has a mind not just for individuals but for the larger picture of public health. Abortion raises a stiff counterargument here though since each abortion procedure nullifies it’s healthcare gains by killing a human being every time.

One may theorize about how abortions tend to occur among low-income and single-parent households, meaning that aborted is a kind of pre-natal crime prevention. There may be some merit to this argument,  but make no mistake, it is a utilitarian argument–and illustrates the utilitarian fallacy dehumanizing a human being; objectifying a human subject. It treats an individual human life not in terms of any intrinsic value, or as some rights bearing individual. Yet if the child-in-utero is a right-bearing individual (or if it might be so) then the living world should treat that child-in-utero with at least the minimal “compassion and dignity” as any other defenseless dependent human being. Even if the “better society” argument were true, and abortion did help reduce crime rates, it is not clear that we as a people are better people under this abortion-precedent, no matter what economic or legal gains we’ve made at the expense of our children (for an economist’s take on this subject see Levitt & Dubner, Freakonomics, Harper, 2009, ch. 4).

VIII. A physician shall, while caring for a patient, regard responsibility to the patient as paramount.
1. A physician shall support access to medical care for all people.

Concluding this list is a summary statement that the doctor is, foremost, responsible to the patient and that includes supporting access to medical care for all people. The AMA may have also tipped their hand politically prefiguring a kind of universal healthcare almost a decade before the Affordable Care Act was passed. Nevertheless, conservatives and liberals alike can stand by the idea of having as many people as possible receiving reasonably inexpensive by quality healthcare. They may disagree over how that is best achieved, but no one is arguing that people should be unhealthy or neglected in the healthcare system.

Again, it must be noted, that it is assumed that the doctor does not treat the child-in-utero as a patient. The terminology here is critical: “medical care for all people.” If that said “all human beings” then children-in-utero would be included. As it stands, this statement specifically excludes such non-persons so that a whole class of human beings can be willfully and maliciously destroyed for the convenience and arbitrary interests of an oppressor class all without contradictory the idealistic language of this statement.

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About intelligentchristianfaith

Married man. Teacher. Theologian. Philosopher. Workout nut. Prefer cats to dogs. Coffee buff. Transplant to Texas. Carolina Panthers fan. Perpetually pursuing the world's best burger.
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