Vital Standards That Ensure Medical Consultations Remain Ethical

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Your Health Magazine Contributor

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Vital Standards That Ensure Medical Consultations Remain Ethical

Ethics lie at the core of medical consultations, and hospitals, medical centers, and clinics worldwide are pioneering structured clinical ethics consultation models that serve as references for similar institutions. The Mayo Clinic in the U.S., for instance, has founded an Ethics Consultation Service that integrates seamlessly into staff clinical workflows, offering non-binding recommendations that support patients rather than dictating clinical decisions. Similar programs have been adopted in Europe—for instance, in the region of Lleida, which introduced the role of “healthcare ethics consultant.” Under this model, ethical consultation is provided to healthcare professionals (HCPs) and patients, focusing on key aspects of clinical ethics. The growing complexity of healthcare, driven by technological innovation and economic pressure, makes ethics a more crucial goal than ever to ensure transparency, integrity, and trust in health institutions.

Key Ethical Issues

The healthcare ethics consultant service established in Lleida, mentioned above, received numerous queries from HCPs and patients, reflecting some of the most important ethical questions faced in health institutions. The ethical consultations concerned refusal of treatment, termination of pregnancy, autonomy, euthanasia, genetics and genetic disease, limitation of therapeutic effort, information, and others. The two most frequent areas of consultation were treatment refusal (28.5% of queries) and limitation of therapeutic effort (22.8%). These two categories highlight the tension that can arise between respecting patient autonomy and ensuring patient welfare, especially when rapid decisions are required. For instance, a patient may refuse to receive life-saving treatment, even if they understand the potential consequences. 

Informed Consent

Informed consent is another key ethical standard because it ensures patients understand the benefits, risks, and alternatives associated with a specific medical treatment, test, or procedure before giving consent. It is best approached through shared decision-making, in which HCPs understand the patient’s goals, concerns, needs, and preferences. It also involves discussing the available options, their possible benefits and harms, and the likelihood of those outcomes. Numerous factors impact a patient’s understanding, including cultural differences, disabilities, language, neurodiversity, and health literacy. Checking each patient’s understanding and encouraging questions should be central to these conversations. 

The AMA Code of Medical Ethics

The AMA Principles of Medical Ethics, created by the American Medical Association, are standards of conduct that define the essentials of honorable behavior for physicians. These principles include compassion, honesty, reporting inappropriate physician behavior, seeking legal changes when they are in patients’ best interests, committing to medical education, putting patients first, and supporting access to medical care for all people. Informed consent, meanwhile, is treated as a process of communication and voluntary decision-making rather than simply signing a consent form. In addition to providing information about a patient’s diagnosis and potential treatment, physicians should also establish that the patient understands the relevant medical information and the implications of different options, so they can make an independent, voluntary decision. Doctors should also provide information accurately and sensitively, taking into account a patient’s preference for how much medical information they receive. If the patient lacks decision-making capacity, an appropriate surrogate may give consent. In emergencies where urgent treatment is required, patients cannot participate, and surrogates are unavailable, treatment may begin without prior consent. Patients or their surrogates should be informed as soon as possible so that consent can be obtained for continued treatment. The AMA Code of Medical Ethics also covers professional conduct, patient interests, and conflicts of interest to ensure physicians provide treatment based on patients’ needs rather than financial relationships with pharmaceutical companies, referral arrangements, or incentives tied to specific products or services. 

Documentation and Follow-Ups

Physicians must maintain accurate documentation that includes the patient’s concerns and symptoms, information provided to the patient, treatment options discussed, the patient’s consent, refusal, or queries, and advice and follow-up arrangements. They must create records immediately, ensure these are completely accurate, and make them accessible to authorized professionals. Pharmaceutical advisory boards operate in a different area of healthcare, but they face similar documentation challenges. These advisory boards typically rely on CRMs that capture advisor contributions from live and asynchronous discussions and organize them in an accessible, structured way. In the U.S., documentation and follow-up standards aren’t in a single rulebook. Instead, they may derive from federal regulations, state law, professional ethics, and organizations such as The Joint Commission. For hospitals participating in Medicare, for instance, the Centers for Medicare & Medicaid Services requires medical-record entries to be complete, dated, timed, and authenticated by the person responsible for providing or evaluating the service.

Protecting Medical Information

Data privacy is another pillar of medical ethics. In the U.S., the HIPAA Privacy Rule sets privacy standards to protect individuals’ medical records and other individually identifiable health information. The rules require safeguards to protect the privacy of protected health information and limit the uses and disclosures that may be made without an individual’s authorization. The Rule also gives individuals rights over their protected health information, including the right to examine and obtain a copy of their health records, direct a covered entity to transmit an electronic copy of their protected health information in an electronic health record to a third party, and request corrections. Practical safeguards also include giving patients the privacy they need to disclose sensitive information. For instance, electronic health record systems must be secure, and access controls should be role-based. Patients should have private spaces to discuss their health issues and concerns with physicians.

In the U.S., various safeguards help ensure medical consultations remain ethical, including the AMA Principles of Medical Ethics, the HIPAA Privacy Rule, and standards set by the Centers for Medicare & Medicaid Services. These standards aim to put the patient first by protecting data privacy and ensuring patients are well informed. Key safeguards include informed consent, confidentiality, independent professional judgment, and accurate documentation. Patients should also leave consultations with a clear understanding of their options and a clear follow-up plan.