What are some ethical issues that may affect the delivery of healthcare?

Medical ethics can affect the professional and personal development of medical students, but what are the specific present-day issues medical educators should prepare them for as future physicians? If you’re searching for concrete insights, look no further. 

Although there isn’t one single approach to teaching medical ethics and professionalism, medical students must understand ethical standards and how to meet them while they’re still in medical school and as they prepare for medical practice. That’s where modernizing ethics education becomes valuable. 

Authors of “The Essential Role of Medical Ethics Education in Achieving Professionalism: The Romanell Report,” published in Academic Medicine, offered a comprehensive list of 26 proposed objectives for medical school and residency training programs.  

Here are 10 of the more emerging ethical issues for medical students to explore, as identified in the Romanell Report, with links to key resources from the AMA to help improve your understanding.

1. Maintaining health and wellness as a physician

   1. “When physician health or wellness is compromised, so may the safety and effectiveness of the medical care provided,” says the AMA Code of Medical Ethics. “To preserve the quality of their performance, physicians have a responsibility to maintain their health and wellness, broadly construed as preventing or treating acute or chronic diseases, including mental illness, disabilities, and occupational stress.” Learn how physicians—and future physicians—can fulfill this individual responsibility. 

2. Using social media professionally 

   1. “Participating in social networking and other similar opportunities can support physicians' personal expression, enable individual physicians to have a professional presence online, foster collegiality and camaraderie within the profession, provide opportunities to widely disseminate public health messages and other health communication,” says the AMA Code.
   2. “Social networks, blogs, and other forms of communication online also create new challenges to the patient-physician relationship.” Find out more about the considerations that physicians should weigh when maintaining an online presence. 

3. Reporting incompetent or unethical behaviors by colleagues 

   1. “Medicine has a long tradition of self-regulation, based on physicians’ enduring commitment to safeguard the welfare of patients and the trust of the public,” the AMA Code says. “The obligation to report incompetent or unethical conduct that may put patients at risk is recognized in both the ethical standards of the profession and in law and physicians should be able to report such conduct without fear or loss of favor.”  
   2. Learn more with the AMA Ed Hub education modules “Responsibilities to Impaired Physicians: Physician Wellness and Professional Conduct” and “Duties to Report Unprofessional Conduct: Physician Wellness and Professional Conduct.”  
   3. The AMA Ed Hub is an online platform with high-quality CME and education that supports the professional development needs of physicians and other health professionals. For physicians, it also offers an easy, streamlined way to find, take, track and report educational activities. 
   4. Learn more about AMA CME accreditation.  

4. Involving medical students in patient care 

   1. “Having contact with patients is essential for training medical students, and both patients and the public benefit from the integrated care that is provided by health care teams that include medical students,” the AMA Code of Medical Ethics says. “However, the obligation to develop the next generation of physicians must be balanced against patients’ freedom to choose from whom they receive treatment.” Find out how doctors should approach patients about medical student participation in care. 

5. Accepting gifts from patients 

   1. “Patients offer gifts to a physician for many reasons,” the AMA Code says. “The interaction of these factors is complex and physicians should consider them sensitively before accepting or declining a gift.” 
   2. Learn more about the factors to consider when you face this situation as a doctor. 

6. Working with surrogate decision-makers 

   1. This AMA Ed Hub module will help you recognize circumstances when a surrogate is needed, determine approaches for identifying a surrogate, and describe surrogate and physician responsibilities in making decisions for patients who lack capacity. 
   2. Also read this AMA Code of Medical Ethics opinion outlines considerations on making decisions for adults who lack capacity. 

7. Addressing disparities in health care 

   1. “Stereotypes, prejudice or bias based on gender expectations and other arbitrary evaluations of any individual can manifest in a variety of subtle ways,” says the AMA Code. “Differences in treatment that are not directly related to differences in individual patients’ clinical needs or preferences constitute inappropriate variations in health care. Such variations may contribute to health outcomes that are considerably worse in members of some populations than those of members of majority populations. 
   2. “This represents a significant challenge for physicians, who ethically are called on to provide the same quality of care to all patients without regard to medically irrelevant personal characteristics.” 
   3. The AMA is pushing the U.S. health system toward the goal of health equity or “optimal health for all.” Learn more by reading this interview with AMA Chief Health Equity Officer Aletha Maybank, MD, MPH. 
   4. Also find out what medical students need to know about social determinants of health. 

8. Managing conflicts of interest 

   1. “The primary objective of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration. Under no circumstances may physicians place their own financial interests above the welfare of their patients,” says the AMA Code of Medical Ethics opinion on conflicts of interest in patient care. 
   2. The Code also offers advice on conflicts of interest in research.  

9. Navigating genetics and reproductive medicine 

   1. Ongoing progress in genetic technologies opens new prospects for understanding and treating disease, while advances in reproductive technologies offer opportunities to create families in novel ways— posing challenges for patients, families, physicians and society. 
   2. The AMA Code of Medical Ethics covers key topics such as: 
   • Genetic testing for reproductive decision-making
   • Assisted reproductive technology
   • Storage and use of human embryos

10. Making decisions when professional, personal values diverge 

    1. This AMA Ed Hub module outlines how personal and professional identities can inform clinical decision-making, and how to balance professional integrity and patient expectations in these types of scenarios.  
    2. Learn to recognize how different elements of your identity inform your approach to clinical decision-making, analyze how to maintain professional integrity while caring for the patient and managing their expectations, and apply key considerations as a decision-making tool in these situations. 

For more on medical ethics education, read the Romanell Report and also learn about three big medical ethics scenarios medical school doesn’t prepare you for. 

Ethical decision-making necessarily takes place within larger systems, and nowhere is that truer than in medicine. The AMA Health Systems Science Learning Series provides medical students with a clear understanding of how health care is delivered, how health care professionals work together to deliver that care, and how the health system can improve patient care and health care delivery. 

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