Principles of Veracity and Fidelity

Principles of Veracity & Fidelity Principle of Veracity “We should deal honestly with patients, that is, we must not lie to them, and we must disclose any information necessary for their informed judgment and consent.” Problem Areas for Veracity Condition of Doubt Paternalism Lying to Protect Colleagues Conflicts of Interest Patients Who Do Not Want to Know Access to Medical Records AMA Code of Ethics Opinion 8.12 - Patient Information It is a fundamental ethical requirement that a physician should at all times deal honestly and openly with patients. [1] Patients have a right to know their past and present medical status and to be free of any mistaken beliefs concerning their conditions. [2] Situations occasionally occur in which a patient suffers significant medical complications that may have resulted from the physician’s mistake or judgment. In these situations, the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred. Only through full disclosure is a patient able to make informed decisions regarding future medical care. Ethical responsibility includes informing patients of changes in their diagnoses resulting from retrospective review of test results or any other information. This obligation holds even though the patient’s medical treatment or therapeutic options may not be altered by the new information. Concern regarding legal liability which might result following truthful disclosure should not affect the physician’s honesty with a patient. (I, II, III, IV) Principle of Fidelity From the ABIM Physician Charter (1st of three “Fundamental Principles”): Principle of primacy of patient welfare. The principle is based on a dedication to serving the interest of the patient. Altruism contributes to the trust that is central to the physician-patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle. From the Declaration of Geneva: The health of my patient will be my first consideration. I will respect the secrets that are confided in me, even after the patient has died. Problem Areas for Fidelity Explicit and Implicit Promises Financial Conflicts of Interest Incompetent and Dishonest Colleagues AMA Code of Ethics Opinion 5.05 - Confidentiality The information disclosed to a physician by a patient should be held in confidence. The patient should feel free to make a full disclosure of information to the physician in order that the physician may most effectively provide needed services. The patient should be able to make this disclosure with the knowledge that the physician will respect the confidential nature of the communication. The physician should not reveal confidential information without the express consent of the patient, subject to certain exceptions which are ethically justified because of overriding considerations. When a patient threatens to inflict serious physical harm to another person or to him or herself and there is a reasonable probability that the patient may carry out the threat, the physician should take reasonable precautions for the protection of the intended victim, which may include notification of law enforcement authorities. When the disclosure of confidential information is required by law or court order, physicians generally should notify the patient. Physicians should disclose the minimal information required by law, advocate for the protection of confidential information and, if appropriate, seek a change in the law. (III, IV, VII, VIII)