Fix the medical miscode of ethics

A code of ethics and professional conduct outlines the ethical principles that govern decisions and behavior at a company or organization. They give general outlines of how employees should behave, as well as specific guidance for handling issues like harassment, safety, and conflicts of interest.

A code of conduct is more focused. It defines how employees or members should act in specific situations.

The Patient's Bill of Rights was created to try to reach 3 major goals: 1) To help patients feel more confident in the US health care system, the Bill of Rights: Assures that the health care system is fair and it works to meet patients' needs. Gives patients a way to address any problems they may have. Here are some examples.

The AMA code of ethics is an example from a medical society or association

Principles of Medical Ethics

The nine Principles of Medical Ethics are the primary component of the Code. They describe the core ethical principles of the medical profession.

Chapter 1: Ethics of Patient-Physician Relationships

Doctor-patient relationships are strengthened by the practice of medical ethics, which can help you create better communication and health care decisions.

Chapter 2: Ethics of Consent, Communication & Decision Making

Help your patients make well-considered decisions about their care and treatment by reading up on medical ethics of consent.

Chapter 3: Ethics of Privacy, Confidentiality & Medical Records

Respecting patients’ privacy is crucial. Find out how patient confidentiality ethics build trust, foster thoughtful decision making and improve care.

Chapter 4: Ethics of Genetics & Reproductive Medicine

Genetic testing can provide valuable information to support informed decision making about personal health care options as well as reproductive choices.  

Chapter 5: Ethics of Caring for Patients at the End of Life

Find out how advance care planning can give patients peace of mind knowing that their physicians understand their wishes for care at the end of life.

Chapter 6: Ethics of Organ Procurement & Transplantation

The need for organs for transplantation far outstrips the supply. Efforts to increase donation must protect the interests of living and deceased donors. 

Chapter 7: Ethics of Medical Research & Innovation

Physicians who are involved in clinical research have special responsibilities to protect the rights, safety and welfare of research participants that include matters of study design, informed consent and selection of participants.

Chapter 8: Ethics for Physicians & the Health of the Community

A doctor's job doesn't stop at individual care. Find out how caring for the health of the community can also lead to better health for individual patients.

Chapter 9: Ethics of Professional Self-Regulation

As practicing clinicians, educators, professional colleagues, businessmen and citizens, physicians should hold one another to high standards of conduct.

Chapter 10: Ethics of Interprofessional Relationships

Find out how physicians commit themselves to high standards of ethics in their relationships with fellow health professionals.

Chapter 11: Ethics of Financing & Delivery of Health Care

Patient-physician relationships are influenced by changing payment systems and models for delivering care and thus physicians must find new ways to balance responsibilities to multiple stakeholders.

Here are some issues that define the business code of ethics.

But, what happens when you try to define a code of ethics for medical entrepreneurship where there are significant differences but overlapping similarities with the ethics of business i.e. the primary interest in medicine is the patient while the primary interest of business is profit and creating shareholder value?

Recently, several issues and questions have forced medical societies and medical schools to rethink their code of ethics concerning innovation, particularly those that define the guardrails when working with sicktech companies.

1. When or if it is ethical for members to accept cash or equity for working with medical device, tech or pharmaceutical companies?
2. What is the definition of a "financial interest"?
3. What are acceptable policies and procedures to insure transparency and disclosure of conflict of interest?
4. How should stated ethical guidelines be enforced?
5. What should be the penalties or consequences for those who violate the code of ethics?
6. How do you resolve the conflicts between the ethos and ethics of medicine with the ethos and ethics of business?
7. What should an "ethics of innovation" curriculum include to inform and educate members? Should such education be mandatory?
8. Should participation on industry speaker's bureaus be allowed or not, and, if so, under what terms and conditions?
9. How should conflict of interests be disclosed at the institutional review board level?
10. What information about conflict of interest should be disclosed to patients about a treatment decision? What should be included in a patient bill of rights concerning industry participation conflict of interest?
11. How should we address the ethical responsibilities of working with digital health/ AI companies and using AI technologies in patient care?
12. What systemic rules, regulations and laws need to be changed to encourage ethical innovation?
13. What should be required in instructions to authors when submitting manuscripts to official society journals?
14. How to we include ethics education and training in bioinnovation and entrepreneurship programs in medical schools, residency training and medical societies?
15. How do we get BIG TECH, BIG DEVICE and BIG PHARMA to play nice with doctors interested in the innovation process?
16. What are the unintended consequences of conflict of interest disclosure?
17. Is more information better when disclosing conflict of interest

Conflict of interest is part and parcel of being a contemporary physician that impacts research, education and practice. The possible or perceived conflicts are intensifying because of employer entanglements, engagements and expectations, resource scarcity and payer mandates that places rationing over the patient's interest, personal involvement in entrepreneurial ventures and many more. Conflict of interest cannot be ignored or denied, but rather must be minimized, mitigated or managed by, among other means, declaring it and making it transparent. In addition, if you are a physician with an ownership interest in a company trying to sell your product to your hospital where you are on the medical staff, you will run into COI rules that preclude you from doing so.

When you ignore that mandate, you lose the trust of patients and cross the line separating the ethics of medicine from the ethics of other businesses.

Medical schools and professional associations have an obligation to confront the present realities of physician interest in participating in biomedical and clinical innovation and entrepreneurship and provide balanced guidance. Otherwise, doctors will pursue self interest and create workarounds to overcome the barriers with the resulting further erosion of patient and societal trust.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs