ACCF/AHA Consensus Conference Report on Professionalism and Ethics
(Full article available on request. Artigo completo deve ser pedido por e-mail: achutti@cardiol.br)
Richard J. Popp, Conference Co-Chair Sidney C. Smith, Jr, Conference Co-Chair
The recommendations set forth in this report are those of the conference participants and do not necessarily reflect the official position of the American College of Cardiology Foundation and the American Heart Association, Inc.
When citing this document, the American College of Cardiology Foundation and the American Heart Association would appreciate the following citation format: ACCF/AHA consensus conference report on professionalism and ethics. Presented in Bethesda, Maryland, June 2–3, 2004. Circulation. 2004;110:2506 –2549.
The health care professions have always enjoyed special trust and position in our society. Patients trust health care professionals (HCPs) to guard their health, inform them, and put a patient’s interests above any other consideration.
This is one definition of “professionalism.” When HCPs deal with human subjects in research there are basic ethical principles, articulated in the classic Belmont Report of 1979, that have been accepted by all (1).
We believe from our experience that the members and staff of the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) strive to do “good” for society in general and for patients specifically.
They put patients’ interests first, above their own, in an overwhelming majority of situations. There are virtually hundreds of thousands of patient-HCP encounters daily in the U.S. It is assumed that HCPs are trying their utmost to benefit their patients even when the outcome is not optimal or when disease progression cannot be effectively treated. Complications of therapy occur despite the best of intentions. Clinician-scientists and the medical industry develop new therapies to improve the lives of patients living with cardiovascular disease, and society has seen the benefits of this effort over the past several years. Everything in this system works well until or unless a conflict between the HCP’s interests and those of the patient results in actions that harm the patient. Then it is assumed that there has been a breach of that respected patient-HCP trust. Many modern situations exist in which the personal interest of the HCP may not be aligned with that of the patient. Ethical choices must be made by the HCP in these situations. Examples include:
● A physician is awakened and gets out of bed in the middle of the night to assess a patient with chest pain.
● A procedure is done or an antibiotic is given with marginal indication by the HCP to satisfy the patient’s wishes rather than the HCP providing a long or detailed explanation of why the action need not be taken.
● Procedures produce income for HCPs and provide experience and prestige that are valuable for the HCP in ways beyond those only for the individual patient’s direct benefit.
● Medical scientists have a deep interest in developing new methods or therapies requiring testing in humans despite the initial imperfection of the agents being tested.
● HCPs continue to devote precious time to help patients make important behavioral changes (smoking and substance abuse cessation, dietary counseling, and so on), despite a lack of reimbursement or support from health care delivery systems and payers.
● An HCP advocates for a product or procedure because of his or her role as an adviser or consultant to a company profiting from the product or procedure while trying to differentiate this role from that of an impartial physician or other HCP educator.
● The HCPs are chosen for their opinions to serve as paid experts in legal actions, de facto taking “sides” in cases related to patient care or product liability issues.
● A physician prescribes a new statin drug for secondary prevention because he or she heard about it at a recent meeting hosted by a drug representative, although this drug is less proven to prevent subsequent events than older medications.
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