Code of Ethics

WHAT ARE ETHICAL CODES?

One would understand as disciplinary codes of conduct mostly adopted by the respective professionals governing bodies and institutions. This can be even enacted by Human Resources Department that attributes the disciplinary practices applicable to employees within that company. Whereas,  the professionals governing bodies or institutions will have published a document mostly with a title “Code of Ethics”.

Ethical Code is generally documented in detail based on the ethics required to adhere to for that specific corporation, institution or governing bodies of the professional organizations. Such document will have a common disciplinary code to adhere when dealing with their clients for professional services.

Ethics are normally taught at universities as part of their higher education, based on the professional discipline they are majoring in. After Graduation these professionals are trained to follow the “Code of Ethics” for their respective profession. These professionals can be best mentioned as Engineers, Physicians, Lawyers etc…

Though, the question remains:

How do a Physician apply Ethical Codes amongst Friends and Relatives?
Where do you study such Code of Ethics related to Friends and Relatives?
Friend and Relatives are not Institutions or some Governing Bodies for Professionals.

IT IS ALL ABOUT LIFETIME RELATIONSHIPS WITH FRIENDS & RELATIVES YOU WISH TO MANAGE.

Family physicians have the awesome responsibility of providing comprehensive medical care to each member of the family regardless of age, sex, or type of health problem. But does this responsibility include providing health care to your own family and friends?

Many of us have been asked at one time or another by a relative, coworker, or friend for medical advice or treatment, but often we are uncertain about how to handle this type of request. It can be a difficult situation when your sibling asks you to take care of his health condition or a friend asks you to prescribe medication over the weekend when she is unable to reach her physician. Although you may sincerely want to care for them, is it “ethical” to do so?

Relationship with the Friends are not the same as relationships with the Relatives. Each type of relationships implies unique dynamics in its own ways based on the number of factors. These may vary from the beliefs of one individual to another and the nature of acquaintances.

Ethics statements by the Medical Association, or the College of Physicians, and others warn that the patient-physician relationship can be complicated by pre-existing social and emotional relationships. They recommend that physicians first consider alternative sources of care or referrals to other physicians and take care of friends or relatives only if there are no other options. Additionally, physicians should treat patients with whom they have a prior nonprofessional relationship only if they have a short-term, minor problem or an emergent medical condition. In these cases, it is important to set expectations with relatives or friends and make every effort to treat them with the same professional judgment you would use for other patients.

Physicians should also be aware of the pros and cons of caring for Friends and Family. The physician-friend or physician-relative relationship might benefit patients, for example, by giving them easy access to their physician who may devote extra attention to their health concern. It may also be personally rewarding to the physician to help a friend or family member. On the other hand, the familiar relationship may come with risks, such as failure to take an adequate history, perform a thorough physical examination, provide counseling on sensitive issues, or keep appropriate medical records.

The physician-friend or physician-relative relationship is complex. State medical boards or insurance plans may have guidelines governing these relationships. But where there are no concrete rules, physicians must decide for themselves on appropriate boundaries. The key issue is whether you can maintain sound professional judgment, confidentiality, and objectivity. If not, it may be best for you, your loved one, and your relationship if you gently steer the person to another source of care.

The following summarized guidelines may help you make ethical decisions to maintain the integrity of the Friends and Family relationships while complying to Professional Codes Of Ethical Standards. It is crucial to balance the need to care for loved ones adhering to ethical responsibilities of maintaining professional boundaries.

1. 1. Each type of relationship is unique based on many factors.
   2. The most important attribute of maintaining healthy relationships with all Friends and Relatives that you are surrounded with is treating them with total RESPECT for what they are worth.
   3. As a practicing Physician, you should provide full autonomy to your Friends and Relatives and give them ultimate authority to make decisions on their own.
   4. Do not be forceful or so convincing to your Friends and Relatives, until all factors of their behavioral patterns or symptoms are carefully diagnosed by a medical specialist.
   5. Always consider your Friends and Relatives with their respective rights and their needs, before you indulge into detailed medical analysis.
   6. For new graduates coming out of the Medical School, you will need to TRANSFORM yourself into a Professional Physician when considering your Friends and Relatives as you patients, strictly complying to Medical Associations Code of Ethics guidelines.
   7. Be aware of indulging into casual conversations about medical needs for Friends and Relatives, to avoid any traps and surprises the next day.
   8. Do not be shy to share with Friends and Relatives, as a friendly reminder, as a Professional Medical Practitioner, “I have to comply to STRICT guidelines of my practice and services I offer. Failing that my Physicians License will be in jeopardy.”
   9. Always maintain your Friend or Family Members confidentiality and their rights of consent without any influence or pressure.

References:

• Chapter 1.2.1 of the AMA Code of Medical Ethics. https://www.ama-assn.org/sites/default/files/media-browser/code-of-medical-ethics-chapter-1.pdf. Accessed June 2, 2017.
• Professional standards and guidelines: treating self, family members, and those with whom you have a non-professional relationship. College of Physicians and Surgeons of British Columbia website. https://www.cpsbc.ca/files/pdf/PSG-Treating-Self-and-Family-Members.pdf. Accessed June 2, 2017.
• Snyder L; ACP Ethics, Professionalism, and Human Rights Committee; ACP Ethics Manual. Ann Intern Med. 2012;156:73-104.

The opinions expressed here are strictly of the author of this Post, not of the Academy of Family Physicians within  North America including Canada and USA.