A U.S. health care system that increasingly relies on collaborative teams of providers is in need of a uniform code of ethics for its disparate participants, including patients and the public, according to a new commentary co-authored by M.D.-Ph.D. student Dr. Sandeep Kishore.
While health care professionals of varying education levels and disciplines have traditionally each held their own social and ethical codes, the American health care system would operate more efficiently if all providers — from nurses to dentists to surgeons — worked towards shared goals and under the same ethical imperatives, Dr. Kishore writes in this week’s JAMA along with authors from the American Medical Association and American Psychological Association. Such a universal code, if it were to be adopted by leading professional bodies, would extend recent improvements in wellbeing and life expectancy that largely stem from health care and public health interventions, Dr. Kishore said.
Still, bringing health care professionals together will be no easy feat. “There are traditional turf wars on codes of practice — who owns what space conceptually and more centrally who gets paid for it,” said Dr. Kishore, who in 2012 earned his doctorate from the Weill Cornell Graduate School of Medical Sciences and will complete his medical degree in May. “These issues are difficult, as they tap into the souls of professions, of ego and of tradition for centuries, and will take a healthy dose of realpolitik and humanism to see them through.”
Dr. Kishore and his co-authors outline a social contract that includes two crucial tenants: reciprocity and public engagement. The former refers to managing the expectations between health professionals of different disciplines, as well as the expectations between them and their patients.
Public engagement would ensure that patients have a voice in the new social contract, whether through social media or other web-based technologies. “When the first doctors in the United Kingdom crafted the social contract that guides their profession centuries ago, they didn’t address their ethical relationship to the population as a whole, nor did they involve other health providers or the patients they serve. It was a unilateral contract,” Dr. Kishore said. That’s led to ethical breaches, the authors note, such as when the American Medical Association’s code in the 1980s didn’t fully obligate physicians to treat patients with HIV.
“What success looks like to me is creating an enforceable mechanism where patients and public have equal say with providers in developing a social contract for health,” Dr. Kishore said. “We highlight how professional codes of ethics include brief statements on shared decision making and team-based approaches, but few have truly recognized a need for fundamental changes to the codes of ethics that govern our work with relation to the patient or society — or with other health disciplines. It’s unclear if we are all on the same page, and that is a big problem.”
Reformers need to get various stakeholders together to revise and unify their codes of ethics, Dr. Kishore said. The new code across health disciplines would serve as the foundation for a social contract and create a singular health care profession with multi-disciplinary providers working toward a common purpose. Dr. Kishore and his co-authors are planning to convene a task force to jump-start this process.
“Ultimately, health professionals are servants of society,” Dr. Kishore said. “We hope that we help generate national interest in developing a 21st century code of ethics that all health providers can sign onto, and one that the public and our patients have helped create. We have never done that before and I’m keen to see the next generation of trainees lead the charge.”