Lois Snyder Sulmasy, JD; Thomas A. Bledsoe, MD; for the ACP Ethics, Professionalism and Human Rights Committee *
Acknowledgment: The College and the ACP Ethics, Professionalism and Human Rights Committee thank former Committee members who made contributions to the development of the Manual through their work on previous editions. They also thank the many leadership, journal, and other reviewers of this edition of the Manual for helpful comments on drafts; Matthew DeCamp, MD, PhD, for consulting and research assistance with the research chapter of the Manual, for which contributions he received compensation; and staff to the Committee from the ACP Center for Ethics and Professionalism, Daniel T. Kim, Lois Snyder Sulmasy, and Kathy Wynkoop, who worked on this edition.
Financial Support: Financial support for the development of the Manual came exclusively from the ACP operating budget.
Disclosures: Disclosure forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2160.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Proctor & Gamble, Pfizer, and Johnson & Johnson.
Corresponding Author: Lois Snyder Sulmasy, JD, American College of Physicians, Center for Ethics and Professionalism, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, firstname.lastname@example.org.
Current Author Addresses: Ms. Snyder Sulmasy: Center for Ethics and Professionalism, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, email@example.com.
Dr. Bledsoe: Alpert Medical School, Brown University, 375 Wampanoag Trail, East Providence, RI 02915.
Author Contributions: Analysis and interpretation of the data: L.S. Sulmasy.
Drafting of the article: L.S. Sulmasy, T.A. Bledsoe.
Critical revision for important intellectual content: T.A. Bledsoe.
Final approval of the article: L.S. Sulmasy, T.A. Bledsoe.
Collection and assembly of data: L.S. Sulmasy.
Medicine, law, and social values are not static. Reexamining the ethical tenets of medicine and their application in new circumstances is a necessary exercise. The seventh edition of the American College of Physicians (ACP) Ethics Manual covers emerging issues in medical ethics and revisits older ones that are still very pertinent. It reflects on many of the ethical tensions in medicine 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, the Manual may help physicians 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 duties of the medical profession.
The secret of the care of the patient is in caring for the patient.
—Francis Weld Peabody (1)
Changes to the Manual since the 2012 (sixth) edition.
Table 1. Principles That Guide the ACP Ethics Manual Recommendations
Definition of profession as used in the Manual.
Telemedicine and ethics.
Precision medicine and genetics.
Table 2. Advance Care Planning and Surrogate Decision Making
Ethics and population health.
Patients first, and stewardship of resources.
Physician–industry relations and gifts.
The duty to teach.
Human subjects research.
Faculty, Department of Pharmacology, Government Medical College and Hospital Chandigarh-160030, India.
January 22, 2019
Conflict of Interest:
No conflicts of interest
Seventh Edition of ACP’s Ethics Manual is very informative and will be practical guide to other countries.
Medicine, law, and social values are not stable but a dynamic process, is very true.Hence “Need Based changes” in ethical principles are required.However the revised ethical principles must be judiciously authentic, reliable, and applicable to both health care professionals & patients community (satisfy the health care need of the patients in the present time of electronic communications & telimedicines), and not modernized only.Updated & revised ethical principles should carefully address the advance care planning and surrogate decision making to avoid it’s misuse.Seventh Edition of ACP’s Ethics Manual is very informative and will be practical guide to other countries.Regards,Dr.Rajiv Kumar, Faculty, Department of Pharmacology, Government Medical College and Hospital Chandigarh-160030,India.DRrajiv.firstname.lastname@example.org
Nancy J Heisel, MD
Internal Medicine Physician
January 21, 2019
DNA and pre-existing conditions
We need to address the future of insurance no longer covering pre-existing conditions and of DNA revealing family medical history, or actual DNA, that could be used by insurance companies to discriminate. I had a patient who asked me not to document his family history of Huntington's until after his life insurance physical. For Christmas I gave my 20 something niece and nephew the Ancestry DNA kit but they decided not to do it due to fear it would be sold to health insurance companies, or elsewhere. They believe they need to withhold family history because future health insurance will no longer cover pre-existing conditions. My niece is a PA student and she has been taught this and told if, for instance, a BRCA gene is found, medical care for breast or ovarian cancer will not be covered by insurance. I consider myself to be very up to date on health and medical information and read all ACP literature, on line and in print. I was shocked to learn my niece and nephew were too afraid to do DNA testing for "fun" and they think I am too naive. They are withholding family history of cancer and heart disease from their physicians. I've been an ACP member for 30 years and this is one the most shocking and sickening developments I've run in to. How are we going to progress with preventive care when information is withheld?
January 14, 2020
We need to have an ethics committee about some of these questions and their answers.
Sulmasy LS, Bledsoe TA, for the ACP Ethics, Professionalism and Human Rights Committee. American College of Physicians Ethics Manual: Seventh Edition. Ann Intern Med. 2019;170:S1–S32. doi: https://doi.org/10.7326/M18-2160
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Published: Ann Intern Med. 2019;170(2_Supplement):S1-S32.
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