Chapter 7 - Developing Professional Medical Standards
CHAPTER 7
DEVELOPING PROFESSIONAL
MEDICAL STANDARDS page 149
The medical profession has traditionally established standards
of conduct that govern its members. The standards are set in a
variety of ways, including statements by professional bodies such as
the American Medical Association, the actual practice of physicians,
expert opinion by physicians, and clinical research findings. The
standards also generally adhere to parameters or policies
established by the criminal and civil law. By delineating the
boundaries of appropriate medical conduct, professional standards
provide guidance to physicians on many aspects of clinical practice,
including physicians' duties to patients, the patient-physician
relationship, and ethical dilemmas posed by treatment decisions.
Ultimately, the responsibility for establishing guidelines for
medical practice rests with the medical profession itself. However,
certain ethical principles have emerged from the Task Force's
deliberations on assisted suicide and euthanasia that provide a
useful framework within which such guidelines can be formed. The
Task Force believes that professional standards should recognize the
provision of effective pain relief and palliative care, including
treatment for depression or referral for treatment, as a basic
obligation all physicians owe to their patients. The Task Force has
also concluded that the legal prohibitions against euthanasia and
intentional or reckless suicide assistance provide valuable guidance
for professional standards of conduct.
The medical profession should not simply restate legal
principles in setting professional standards on these sensitive
issues. In particular, concepts such as <169>intention<170> and
"recklessness" must be applied in the context of the profession's
own standards of accepted medical care. By addressing these
concepts in ways that are relevant to concerns that routinely arise
in clinical practice, the medical profession can assist physicians
who care for seriously and terminally ill patients and enhance the
care provided to these patients.
page 150 WHEN DEATH IS SOUGHT
The principles identified by the Task Force are set forth
below. The Task Force believes that these principles will offer
important guidance for physicians while respecting the need for
professional judgment in formulating treatment recommendations.
* Physicians have a professional obligation to provide
appropriate pain relief and palliative care.
* Physicians have a professional obligation to assess and treat
depression or refer patients for treatment.
* Physicians should not refrain from discussing a patient's
suicidal thoughts, and indeed should explore, discuss, and
respond to a patient's indications of suicidal thinking. This
is an important aspect of care and also may facilitate
prevention of suicide.
* Physicians should not perform euthanasia or assist a patient
to commit suicide. However, the provision of medication that
may hasten a patient's death is ethically and professionally
acceptable, provided the medication is not intended to cause the
patient's death or to assist the patient to commit suicide, and
the medication is provided in accord with accepted medical
standards.
* A physician may appropriately provide medication in the face
of a known risk of suicide, provided that the benefits of the
medication outweigh the risk and the physician has considered
the comparable benefits and risks of alternative treatment
options.
* The provision of medication used by a patient to commit
suicide does not, in itself, establish that the physician
intended to assist the patient to commit suicide. Rather, an
evaluation of the physician's intent must take into account a
range of factors, such as the physician's reasons for providing
the specific amount and type of medication, and whether the
amount and type of medication could have served a legitimate
medical purpose for the particular patient in light of
identified treatment goals.
The Task Force encourages professional medical societies to
expand on these principles by formulating guidelines for the care
and treatment of seriously ill patients. Such guidelines should
recognize that suicide assistance and euthanasia are not permitted,
but must also seek to promote the appropriate provision of pain
relief. Reducing misunderstanding and unwarranted fears of
professional sanctions for providing pain medication should be a
CHAPTER 7 -- DEVELOPING PROFESSIONAL MEDICAL STANDARDS page 151
central goal of professional standards. The guidelines should
recognize that, as with other treatments, physicians should document
their decisions about pain medication and the reasons for those
decisions.
In New York State, the State Board for Professional Medical
Conduct has a special obligation to apply professional medical
standards in particular cases to determine whether a physician has
breached accepted standards of care and, if so, to determine the
penalty that should result. The board should determine the penalty
from the full range of penalties available, weighing the particular
circumstances of each case.
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