CODE OF ETHICS 

Ethics is the branch of philosophy related to morals or moral  principles. Morals are what a person believes to be the  acceptable or right way to live. Morals govern a person’s  behavior. The study of ethics involves the examination of  human character and conduct, the distinction between right  and wrong, and a person’s moral duty and obligations to the  community. Ethics have been part of the medical profession  since the earliest days of the profession. 

The earliest code of ethics or principles to govern conduct for those in medicine dates back to around 1800 BC,  to the Code of Hammurabi. In 400 BC, Hippocrates, a  Greek physician referred to as the “Father of Western Medicine,” wrote a statement of principles for his medical students to follow. This statement of principles is known as the  Hippocratic Oath (Box 2-1 in the chapter titled “Medical  Science: History and Practice”) and it remains important  today. This oath reminds medical students of the importance of their profession, the need to teach others, and the  obligation they have to act in such a way as to never knowingly harm a patient or divulge a confidence. The Hippocratic Oath is recited at medical school graduation  ceremonies, and has been for centuries, as it carries an  important ethical message for physicians. Modern codes of  ethics have been developed as medical science has continued  to advance. 

 

MEDICAL ETHICS 

Medical ethics refer to the moral conduct of people in  medical professions. This moral conduct of medical professionals is governed by the high principles and standards  that these professionals set for themselves and willingly  choose to follow through personal dedication. Every medical profession has a code of ethics that sets the moral  standards to which members of that profession are expected  to adhere. 

 

Ethical Standards of Behavior  Ethical standards are generally more severe than standards  required by law. In many cases, ethical standards are more  demanding than the law. A violation of an ethical standard  could mean the loss of the physician’s reputation.

 

Ethical behavior, according to the American Medical  Association (AMA), refers to moral principles or practices,  the customs of the medical profession, and matters of medical policy. Any actions that do not follow these ethical standards constitute unethical behavior. When a physician is  accused of unethical behavior or conduct in violation of these  standards, the AMA can issue a warning or censure. The  AMA Board of Examiners may recommend the expulsion or  suspension of a physician from membership in the association. Expulsion, or being forced out of the association, is a  severe penalty for physicians because it limits the physician’s  ability to practice medicine. 

Not all physicians are members of the AMA, and the  AMA does not have authority to bring legal action against  nonmembers for unethical conduct. However, the state medical board that issued the physician’s license may limit  the physician’s practice or revoke the license altogether for  ethical misconduct. If it is alleged (asserted or declared  without proof) that a physician has committed a criminal  act, the medical society is required to report it to the state  board or governmental agency. A violation of the law that  is followed by a conviction for the crime may result in a  fine, imprisonment, or both. The state medical board can  then revoke (cancel) the physician’s license to practice  medicine.

 

**PROFESSIONALISM THE LAW

As an agent or representative of the physician, the  medical assistant is responsible for understanding  ethical standards related to any office issue. It is  important to remember that the medical assistant cannot  diagnose or treat illnesses, although educating the patient  about information the physician has given is expected.  Patient confidentiality cannot be breached for any reason.  Staff members should not access or open any chart for  which they do not have a specific, work-related need.

 

PROCEDURE 3-2 Reporting Illegal Activity in the Health  Care Setting  Procedure

 

Equipment and Supplies  Pen and paper; phone book; computer with Internet access and  word processing software; printer  Method  1. Create a list that identifies examples of illegal activity that  may occur in the health care setting.  2. Next to each example, identify the proper authority or governing agency that would be contacted in order to report  the illegal behavior (e.g., local police department, Drug  Enforcement Agency).  3. Using a phone book or an Internet search engine, locate  the contact information for each governing authority  identified in the step above.  4. Create a document using word processing software that  could be used in the medical office as an informative  reference guide that summarizes the information in  steps 1–3.  5. On a separate sheet of paper, write a paragraph describing the steps you would take if you found out the medical  office where you worked was committing insurance fraud  by billing insurance companies for services that were not  performed on patients.

 

 

 

 

 

AMA Principles of Medical Ethics 

In the United States, the American Medical Association  (AMA) has taken a leadership role in setting standards for  the ethical behavior of physicians. The AMA was organized  in New York City in 1846, and its first code of ethics was  formed shortly after that in 1847. 

The AMA Principles of Medical Ethics encompass human  dignity, honesty, responsibility to society, confidentiality,  the need for continued study, freedom of choice, and a  responsibility of the physician to improve the community.  For more information about the AMA Principles of Medical  Ethics, visit the AMA’s website at www.ama-assn.org. 

 

MEDICAL ASSISTANTS’ PRINCIPLES  OF PERSONAL AND PROFESSIONAL  ETHICS  Medical assistants may not be involved with the life-anddeath ethical decisions that face the physician. However, they  do face many dilemmas regarding right or wrong behavior on  an almost daily basis. Examples include a coworker violating  patient confidentiality, a medical assistant using foul language in front of a patient, or a team of care givers treating a  patient disrespectfully because of the patient’s body odor.  More severely, a medical assistant may be asked to perform  unethical or even illegal actions by their physician-employers.  It is important to remember that medical assistants, by law  and scope of practice, are required to treat patients lawfully  and ethically. A medical assistant may question whether an  order from a physician crosses legal or ethical lines. The  Blanchard and Peale Ethical Model can help the medical  assistant distinguish and recognize legal and ethical issues.  The model is based on applying a set of questions to determine issues of ethics and legality to given situations. 

The Blanchard and Peale Ethical Model 

1. Is it legal?
2. Is it ethical?
3. How will the action make me feel?
4. How would I feel if the action and my participation were to be published in a local newspaper? (This is often referred to as the Front Page of the Newspaper  Test.) 

As each situation varies, so will the appropriate response regarding how it should be handled. 

 

Ethics, Morals, and Your Profession 

Ethics differ from laws in key ways. Laws are legally enforceable and carry penalties (fines or imprisonment), whereas ethics are valued by professional organizations and rarely  result in severe penalties for ethical violations. If an ethical  violation occurs, the guilty party may be shunned professionally or have a certification revoked, but no severe penalties exist for ethical violations. 

Moral decisions are different from legal and ethical decisions. For instance, it isn’t illegal for two consenting adults  to engage in sexual relations. However, it is considered  unethical to have a sexually intimate relationship with a  patient. Similarly, many people hold the moral belief that it  is not appropriate to have sexual affairs before or outside a  marriage. Although some acts that are considered immoral  do not have a civil or professional penalty, an individual  might be socially shunned by those who don’t approve of  certain moral choices. 

In some cases, the medical assistant may have a personal  moral, religious, or ethical reason for wishing not to be  involved in particular procedures, such as abortions or artificial insemination. These preferences should be stated to  the employer before employment, allowing them to be  considered when making a hiring decision. In the event  that the situation arises after employment begins, all concerns should be communicated to the employer immediately. If there is a moral or ethical disagreement, it is very  important not to judge the physician’s interpretation of  ethical guidelines. However, you may request to be excused  from participating in any procedures about which you have  ethical doubts. 

Bioethics is a term that refers to ethical decisions regarding life issues. For example, stem cell research, in vitro fertilization, and abortion rights are sometimes controversial  issues that concern human life. The medical assistant must  reflect on bioethical decisions but support the patient in the  patient’s own decision making. Working as a medical assistant, you must never impose your personal ethics or morals  on a patient. Regardless of their personal decisions, you  must always treat them with dignity and the utmost respect.  If a medical assistant’s choice to not assist the physician in  a specific procedure jeopardizes the health and safety of a  patient, or interferes with the physician’s ability to do the  procedures, it may be necessary for that medical assistant to  seek other employment. 

 

Scientific Discovery and Ethical Issues 

Many areas of medical ethics—When should life support be  withdrawn? When does a life begin? Is euthanasia ever permissible? Should the unborn baby’s life be sacrificed to save the  mother? and more—have no conclusive answers. Scientific discoveries present new medical possibilities and choices every  day. With these possibilities, more complicated ethical issues often need to be addressed before choices can be made. The  medical assistant has a responsibility to keep current on medical advances and form opinions based on sound medical ethics  and practice. Procedure 3-3 will help the medical assistant  understand how to separate personal and professional ethics. 

 

AAMA Code of Ethics 

The Code of Ethics of the American Association of Medical  Assistants (AAMA) is a professional standard that medical  assistants are expected to follow. The code, which describes ethical and moral conduct for the medical assistant, is similar to the AMA’s Principles of Medical Ethics. Box 3-5 lists  the code of ethics of the AAMA. Medical assistants assume a  position of trust and must try to live up to the standards of  the profession as stated in the code. 

 

AAMA Creed 

The Creed of the AAMA can be best followed by the medical  assistant who spends time reading about and discussing ethical problems, such as transplants, artificial insemination, abortion, and the right to die with dignity. To be true to this  creed, the medical assistant must know about the ethical  issues the patient faces and be committed to treating the  patient with respectful care regardless of the patient’s religious beliefs or cultural practices. 

Creed of the American Association of Medical  Assistants 

I believe in the principles and purposes of the profession of  medical assisting. 

I endeavor to be more effective. 

I aspire to render greater service. 

I protect the confidence entrusted to me. 

I am dedicated to the care and well-being of all people. 

I am loyal to my employer. 

I am true to the ethics of my profession. 

I am strengthened by compassion, courage, and faith. 

Copyright by the American Association of Medical Assistants,  Inc. Reprinted with permission. 

 

AMT Standards of Practice 

The American Medical Technologists (AMT) has standards of practice that reflect the ethical expectations for  those with the Registered Medical Assistant (RMA) credential. Similar to the AAMA creed, the AMT Standards  of Practice call for ethical behavior by medical assistants.  AMT seeks to encourage, establish, and maintain the  highest standards, traditions, and principles of the practices that constitute the profession of the registry. Members of the AMT certification agency and the registry  must recognize their responsibilities, not only to their  patients but also to society, to other health care professionals, and to themselves. 

The following standards of practice are principles adopted  by the AMT Board of Directors, which defines the essence of  honorable and ethical behavior for a health care professional.  AMT requires that any known violations of the standards are  reported so they can be referred to the Judiciary Committee  of AMT for consideration of revocation of the individual’s  certification or other disciplinary sanctions. 

AMT Standards of Practice 

1. While engaged in the Arts and Sciences, which constitute the practice of their profession, AMT professionals shall be dedicated to the provision of competent and  compassionate service and shall always meet or exceed  the applicable standard of care. 
2. The AMT professional shall place the welfare of the patient above all else.

• When performing clinical duties and procedures, the AMT professional shall act within the lawful limits of  any applicable scope of practice, and when so required  shall act under and in accordance with appropriate supervision by an attending physician, dentist, or other  licensed practitioner.

1. The AMT professional shall always respect the rights of patients and of fellow health care providers, shall  comply with all applicable laws and regulations governing the privacy and confidentiality of protected  health care information, and shall safeguard patient  confidences unless legally authorized or compelled to  divulge protected health care information to an authorized individual, law enforcement officer, or other  legal or governmental entity. 
2. AMT professionals shall strive to increase their technical knowledge, shall continue to learn, and shall continue to apply and share scientific advances in their  fields of professional specialization.  The AMT professional shall respect the law and will  pledge to avoid dishonest, unethical or illegal practices, breaches of fiduciary duty, or abuses of the position of trust into which the professional has been  placed as a certified health care professional.  VII. AMT professionals understand that they shall not  make or offer a diagnosis or dispense medical advice  unless they are duly licensed practitioners or unless  specifically authorized to do so by an attending licensed practitioner acting in accordance with applicable law.  VIII. The AMT professional shall observe and value the  judgment of the attending physician, dentist, or  other attending licensed practitioner, provided that  so doing does not clearly constitute a violation of  law or pose an immediate threat to the welfare of  the patient.  IX. AMT professionals recognize that they are responsible for any personal wrongdoing, and that they have  an obligation to report to the proper authorities any  knowledge of professional abuse or unlawful behavior  by any party involved in the patient’s diagnosis, care,  and treatment.  X. The AMT professional pledges personal honor and integrity and to cooperate in protecting and advancing,  by every lawful means, the interests of the American  Medical Technologists and its Members. 

 

Copyright by the American Medical Technologists. Reprinted  with permission.

 

 

PROCEDURE 3-3 SEPARATING PERSONAL AND PROFESSIONAL ETHICS

Objective ◆ Identify and recognize an individual’s stance on ethical situations that impact health care;  identity how to professionally address the topics.

 

Equipment and Supplies  Pen and paper 

Method  1. Consider at least two ethical topics common to the health  care setting, such as abortion, stem cell research, and  physician-assisted suicide, to name a few. 

2. Review and apply the Blanchard and Peale Ethical Model presented in the text to the ethical topics of your choice.
3. Create and document a personal stance on each issue, and provide a brief explanation of your ethical beliefs.
4. Identify how each of your chosen issues should be approached professionally.
5. Consider if there any instances where, if presented with an ethical issue, it would impede your ability to perform your job.  6. Discuss the issues with a partner. When listening to opposing points of view, be sure to maintain professional  communication and respect for the individual.

 

BOX 3-5 | CODE OF ETHICS OF THE AMERICAN ASSOCIATION OF MEDICAL ASSISTANTS

 

Preamble  The Code of Ethics of the AAMA shall set forth principles of  ethical and moral conduct as they relate to the medical profession and the particular practice of medical assisting.  Members of the AAMA dedicated to the conscientious pursuit of their profession, and thus desiring to merit the high  regard of the entire medical profession and the respect of the  general public which they serve, do hereby pledge themselves  to strive always to: 

Human Dignity

1. Render service with full respect for the dignity of humanity;

Confidentiality 

1. Respect confidential information obtained through employment unless legally authorized or required by responsible performance of duty to divulge such information;

Honor 

• Uphold the honor and high principles of the profession and accept its disciplines;

Continued Study 

1. Seek to continually improve the knowledge and skills of medical assistants for the benefit of patients and professional colleagues; 

Responsibility for Improved Community 

1. Participate in additional service activities aimed toward improving the health and well-being of the  

Note: Copyright by the American Association of Medical Assistants,  Inc. Reprinted with permission.