Recommended core educational guidelines on medical ethics for family practice residents

Recommended core educational guidelines on medical ethics for family practice residents – American Academy of Family Physicians Core Educational Guidelines

This document was developed by representatives of, and has been endorsed by, the American Academy of Family Physicians.

Approved by the AAFP Board of Directors in November 1991, these guidelines represent the “core” educational objectives for training family practice residents in the field of medical ethics. Family physicians in practice may wish to review the guidelines in preparing for their Board examinations. Other specialists may refer to the guidelines in developing continuing education courses for family physicians or in preparing articles for American Family Physician.

The ultimate concern of all physicians must be the welfare of each patient in the context of the family. In providing a wide range of medical services, the family physician often is required to make health care decisions based on both ethical issues and medical parameters. A physician’s ethical standard is based on family upbringing, religion, education, and personal values and experience. A physician must be cognizant of societal forces as well as the perceived and real needs or desires of the patient.

As health care has become more highly technical, compartmentalized and impersonal, it becomes apparent that certain medicoethical considerations are becoming more complex and difficult to resolve. As various forces challenge the controlling role of physicians in our health care system, it will become imperative that family physicians continue to embrace the roles of personal physician and long-term advocate for the patient.

Attitudes

The resident should develop attitudes that encompass:

A. The sanctity and dignity of human life.

B. An understanding of cultural, social and religious customs and beliefs that differ from his or her own.

C. A commitment to ethical practice.

D. A willingness to embrace the ethical dilemmas presented by his or her patients, to discuss options with the patient and family when appropriate, and to work toward solutions that are mutually acceptable.

Knowledge

A. Belief systems, values and biases

1. The physician’s

2. The patient’s

3. The family’s

4. Influence of the belief system on decision making

B. Analysis and decision making

1. Identification of issues and components

2. Prioritization of issues and components

3. Articulation of issues and their consequences

C. Principles of ethics

1. Autonomy–patient rights and physician rights

2. Responsibilities and duties of patients and physicians

3. Beneficence–acting in the best interest of patients

4. Nonmaleficence–to do no harm (or the least harm possible)

5. Truth telling

6. Confidentiality

7. Informed consent

a. Ethical approach

b. Legal approach (varies from state to state)

8. Justice

a. Microallocation– allocation of resources at the hospital and office level

b. Macroallocation– allocation of resources at the state and national level

D. Business and professional ethics

1. American Medical Association code of ethics

2. Code of behavior for dealing with pharmaceutical firms and other proprietary industries

3. Appropriate medical charges and billing practices

4. Managed health care E. Applicable government regulations

1. Advance directives

a. Living wills

(1) Life support

(2) Treatment refusal or modification

b. Durable power of attorney

c. Guardianship

2. Organ donation

3. Incompetent patients

a. Identification

b. Documentation

c. Legal issues

4. Human reproductive issues

F. Stress in practicing medicine

1. Effects of stress on perception, integration and decision making

2. Skills and techniques for combating professional stress

3. Physician integrity and behavior

4. Physician error

5. The impaired physician

6. Balancing physician and patient performance expectations

Skills

The resident should demonstrate the ability to:

A. Identify the moral aspects of a particular case.

B. Obtain a valid consent or a valid refusal of treatment.

C. Act appropriately if a patient is only partially competent or is incompetent to consent to or refuse treatment.

D. Act appropriately if a patient refuses treatment.

E. Decide when it is morally justified to withhold information from a patient.

F. Decide when it is morally justified to breach confidentiality.

G. Care for patients with a poor prognosis, including patients who are terminally ill.

H. Present differing priorities and options to the patient and his or her support group (i.e., family, legal guardian) when dealing with conflicting ethical issues.

I. Incorporate the team approach in dealing with ethical and moral issues to provide not only understanding and acceptance, but also a support system for the patient.

Resources

1. 1989 Current Opinions of the Council on Ethical and Judicial Affairs of the American Medical Association: Including the Principles of Medical Ethics and Rules. Chicago: American Medical Association, 1989.

2. Academy Policy. Compendium of AAFP Positions on Selected Health Issues. Kansas City, Mo.: American Academy of Family Physicians, 19901991:87-8.

3. Jonsen AR, Siegler M, Winslade WJ. Clinical Ethics: a Practical Approach to Ethical Decisions in Clinical Medicine. 3d ed. New York: Pergamon Press, 1991.

4. Brody H. Ethical Decisions in Medicine. 2d ed. Boston: Little, Brown, 1981.

To order reprints of these core educationalguidelines (AAFP Reprint No. 279) or to obtain a list of topics for which similar guidelines are available, contact AAFP’s Order Department, 8880 Ward Pkwy., Kansas City, MO 64114-2797; 800-944-0000.

COPYRIGHT 1992 American Academy of Family Physicians

COPYRIGHT 2004 Gale Group