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Charter on Medical Professionalism: Putting the Charter into Practice
- Sylvia L. Cruess, MD; and
- Richard L. Cruess, MD
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IN RESPONSE:
Although Dr. Arnett's points are well taken, the charter is not a code of ethics, nor is it intended to detract from or supplant the Hippocratic tradition that has long enriched medicine's history. It is a statement of contemporary responsibilities—medicine's understanding of its obligations under today's social contract. We strongly disagree that individual rights and group rights are mutually exclusive and that “the physician can follow one of these two principles but not both.” We do not underestimate the difficulty of reconciling the two sets of responsibilities but believe passionately that medicine must attempt to do so. The alternative is for someone without medical knowledge or expertise to determine the societal rights in health care and how they are to be reconciled with the rights of individual patients. Do we really wish this to occur, or do we believe that it is better for individual physicians and their organizations to use their expertise to try to achieve the proper balance? The charter suggests the latter course. It does, however, state that physicians must put the welfare of the individual patient first, thus reaffirming our traditional fiduciary responsibilities. Our duties to individual patients must be carried out with a knowledge of the impact of our own decisions on the wider society, which we also serve. We also disagree that the allocation of resources to one patient does not diminish the resources available to others under a market-driven system. The attempts at cost containment seen throughout the world, no matter what the nature or structure of the health care system, indicate that this is not true. There is no question that contemporary physicians are expected to serve both their patients and society.
A second point of some importance refers to “equality of outcome.” We are not sure that equality of outcome can be termed “undesirable,” as Dr. Arnett stated, but certainly such an objective is unrealistic. Nowhere does the charter advocate equality of outcome as an objective.
Dr. Arnett interprets the charter as forbidding physicians' pursuit of private gain or personal advantage. Nowhere does it so state. The conflicts of interest section states that physicians must deal with these conflicts in an open and transparent way. We cannot eliminate conflicts of interest, but we must ensure that our integrity is preserved as we cope with and manage them and recognize the consequences of our decisions.
We agree with Dr. Arnett that without effective patient-centered ethics, medicine is no longer a profession. As already mentioned, the charter is not a code of ethics but a freely given statement of medicine's commitments and responsibilities, essentially outlining where we should stand in complex times. It is aimed at restoring the feeling of pride in the profession and public trust that all observers have agreed is so essential to the proper functioning of a profession and distinguishes it from a trade.
Sylvia L. Cruess, MD
Richard L. Cruess, MD
Center for Medical Education, McGill University; Montreal, Quebec H3G 1Y6, Canada
- Copyright ©2004 by the American College of Physicians
