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The Charter on Medical Professionalism and the Limits of Medical Power
- Stanley J. Reiser, MD, MPA, PhD; and
- Ronald S. Banner, MD
- From The University of Texas Health Science Center at Houston; Houston, TX 77225; and Philadelphia, PA 19115.
Ethical codes are landmarks of medicine's professional development. They embody the values of the time in which they are written and the culture from which they spring. They provide an ethical structure to govern the practices of physicians and physicians' relationships with patients, society, and each other. They create the doctor's moral identity. The Hippocratic Oath (circa 400 BCE) and the ethical codes of the American Medical Association (written between 1847 to 1980) are examples of these works. Joining this group is the Charter on Medical Professionalism, written under the auspices of internal medicine organizations in the United States and Europe (1).
The Anatomy of the Charter
The stated rationale for writing the charter was the threat to professional values and patient commitments that physicians are experiencing from technological change, market forces, bioterrorism, and globalization. The charter contains four categories of recommendations (Table) designed to meet these challenges, all of which pertain to physician responsibilities.
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Until the mid-20th century, the physician had the power to fulfill such responsibilities, and older codes of ethics reflect this. For example, the 1957 Principles of Medical Ethics of the American Medical Association (2) address, as does the charter, the issues of serving humanity justly, improving medical knowledge, assuring physician competence, maintaining confidentiality, and protecting patient vulnerability. Some of these obligations also appear in the Hippocratic Oath. For a long time, physicians could make these commitments because they were the center of practice. Physicians, not their institutions or other health colleagues, called the medical tune.
Today, however, they do not, a fact responsible for the charter's existence. The charter asks physicians to reassert their authority and recapture the medical high ground to improve the welfare of patients. However, this requires en-gaging the new authorities of health care: corporate health institutions such as insurers, managed care organizations, and health systems …
