Audiey Kao, MD, PhD, on what physicians need to know about ethics in 2022; American Medical Association (AMA), January 5, 2022

American Medical Association (AMA); Audiey Kao, MD, PhD, on what physicians need to know about ethics in 2022

"AMA's Moving Medicine video series amplifies physician voices and highlights developments and achievements throughout medicine.

Kicking off 2022 with the AMA's "Look Forward/Look Back” series, AMA Chief Experience Officer Todd Unger talks with Audiey Kao, MD, PhD, the AMA's vice president of ethics, about the AMA's critical work in medical ethics and what to expect in the months ahead.

Speaker

• Audiey Kao, MD, PhD, vice president, ethics, AMA...

Unger: In addition to mandates, another one of these key ethics challenges that physicians faced in 2021, and this is a very painful one, is about allocating scarce resources. Throughout the pandemic, we've seen hospitals goal with shortages of ventilators, ICU beds, even staff to take care of critically ill patients. And sometimes, hospitals are forced to implement "crisis standards of care," in which they prioritize patients largely on their likelihood of survival. How did the AMA guide physicians and hospitals in what is an extremely difficult decision?

Dr. Kao: Yeah, I mean, you raise a great point. I mean, according to the AMA Code of Medical Ethics, allocation policies should be based on criteria relating to medical need. It's not appropriate to base allocation policies on social worth, perceived obstacles to treatment, patient contribution to illness or, frankly, past use of resources.

While the Code provides a general framework for addressing allocation decisions, the COVID pandemic revealed that much of the health care system was not prepared to implement allocation policies. To be blunt, these are not decisions we can make on the fly. So, we need to be better prepared. And for the Code, that means its ethical guidance on this critically important topic should be updated. As a living document, the Code is continually updated and this is a prime example of AMA's stewardship of the code I mentioned earlier.

Unger: That's interesting. It's almost this opportunity to take a look back at the year and look beyond what are, I don't know, more theoretical in terms of the ethics and how they were applied to help people learn that. When you're talking about a living document, is that what you're meaning?

Dr. Kao: Yeah, that's right. I mean, I think we have to have a strong dose of humility in medicine to know what we know and what we don't know. And so, to not learn the lessons of this pandemic to apply to how we should care for patients in the future would not speak well of our commitment to promote the health of the public."

Pandemic serves up new questions of medical right and wrong; American Medical Association, April 13, 2020

Timothy M. Smith, American Medical Association; Pandemic serves up new questions of medical right and wrong

"The COVID-19 pandemic is posing unfamiliar challenges for front-line physicians while also casting new light on longstanding health equity issues. An episode of the “AMA COVID-19 Update” explores several underlying ethical questions. Among these: How much risk is too much for physicians? Which patients should get priority access to scarce resources? And how do socioeconomic factors affect quality of care in an emergency?

In a conversation with the AMA’s chief experience officer, Todd Unger, three experts from the AMA delved into relevant ethical guidance.

The AMA and the Centers for Disease Control and Prevention are closely monitoring the COVID-19 global pandemic. Learn more at the  AMA COVID-19 resource center. Also check out pandemic resources available from the AMA Code of Medical Ethics, JAMA Network™, AMA Journal of Ethics®, and consult the  AMA’s physician guide to COVID-19."

Who Should Be Saved First? Experts Offer Ethical Guidance; The New York Times, March 24, 2020

Austin Frakt, The New York Times; Who Should Be Saved First? Experts Offer Ethical Guidance

"Facing this dilemma recently — who gets a ventilator or a hospital bed — Italian doctors sought ethical counsel and were told to consider an approach that draws on utilitarian principles.

In layman’s terms, a utilitarianism approach would maximize overall health by directing care toward those most likely to benefit the most from it. If you had only one ventilator, it would go to someone more likely to survive instead of someone deemed unlikely to do so. It would not go to whichever patient was first admitted, and it would not be assigned via a lottery system. (If there are ties within classes of people, then a lottery — choosing at random — is what ethicists recommend.)

In a paper in The New England Journal of Medicine published Monday, Dr. Ezekiel Emanuel, vice provost for global initiatives and chairman of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, and colleagues offer ways to apply ethical principles to rationing in the coronavirus pandemic. These too are utilitarian, favoring those with the best prospects for the longest remaining life.

In addition, they say prioritizing the health of front-line health care workers is necessary to maximize the number of lives saved."