AMA Updates Ethics, Addresses Zika, Juvenile Justice, Other Issues

The following are among the reports and resolutions approved by the AMA House of Delegates at last month’s policymaking meeting in Chicago.

• The Council on Ethical and Judicial Affairs (CEJA) Report on Modernization of Medical Ethics. In 2008, CEJA began a project to comprehensively review and update the AMA’s foundational document, the “Code of Medical Ethics,” the first thorough review of the document in more than 50 years. The report finalizes the project after being debated by the House multiple times since 2008. An important change in the final report is that each opinion in the code is accompanied by the following language: “This opinion is offered as ethics guidance for physicians and is not intended to establish standards of clinical practice or rules of law.”

• Resolution on “Funding for Zika Control and Research” urges Congress to enact legislation providing increased and sufficient funding for research, prevention, control, and treatment of illnesses associated with the Zika virus without diverting resources from other essential health initiatives. It also encourages the Centers for Disease Control and Prevention to work with experts in all relevant disciplines to develop U.S. and global strategies to limit the spread of the virus.

• The Council on Science and Public Health (CSPH) Report on “Juvenile Justice System Reform” explains research findings on adolescent brain development and the harms of solitary confinement and addresses the importance of reentry and aftercare services to reduce recidivism in the juvenile justice system. “Our report focuses on the inappropriate use of solitary confinement for juveniles, for which there is policy but one that is not followed in all 50 states,” said CSPH Chair Louis Kraus, M.D., a child psychiatrist. “The report also focuses on the need to address mental health and educational issues among juveniles in the justice system.”

• Resolution on “Policies on Intimacy and Sexual Behavior in Residential Aged-Care Facilities” encourages long-term-care facilities to adopt policies that preserve residents’ rights to pursue sexual relationships while protecting them from unsafe or abusive situations.

“The majority of long-term-care facilities have no formal policy on intimacy and sexuality,” said geriatric psychiatrist Allan Anderson, M.D., a delegate to the Section Council on Psychiatry from the American Association for Geriatric Psychiatry. “This can cause significant stress and can result in legal proceedings such as a recent case where a husband was brought up on rape charges because his wife did not recognize him during a time when they purportedly had sexual activities.”

Anderson said it is a complex problem involving whether individuals have the capacity to consent to participate in sexual activity.

• Resolution on “Clarification of Medical Necessity for Treatment of Gender Dysphoria” supports public and private health insurance coverage for treatment of gender dysphoria as recommended by the patient’s physician.

“Gender dysphoria is widely recognized as exacerbated by lack of access to gender-affirming treatments,” said Brian Hurley, M.D., the delegate from the Gay and Lesbian Medical Association to the Section Council on Psychiatry. “There are significant barriers faced by transgender people seeking gender-affirming care, so our AMA’s promotion of gender-affirming care is critically important to meeting the needs of this vulnerable population.”

Hurley also testified on a resolution, approved by the House, on “Sexual Orientation and Gender Identity Policies.” “The report eliminates the term ‘homosexual’ as a noun and replaces it with the terms ‘lesbian’, ‘gay,’ and ‘bisexual,’ ” Hurley said. “Further, where appropriate, we used the term ‘transgender’ to also discuss the health care needs of patients of all gender identities. This brings contemporary language into AMA policy and codifies the AMA’s commitment to supporting people with diverse sexual orientations and gender identities.”

• The CSPH Report on “Increasing Awareness of Nootropic Use” evaluates the use of nootropics—also known as “smart drugs”—which are prescription drugs, supplements, or other substances claimed to improve cognitive function, memory, learning, or intelligence. The CSPH recommends that the AMA oppose prescription of controlled substances for the purpose of cognitive enhancement in otherwise healthy individuals, discourage nonmedical use of prescription drugs for cognitive enhancement in schools and workplaces, and urge the Federal Trade Commission to examine advertisements for dietary supplements and herbal remedies that claim cognitive enhancement to ensure they are not misleading and are substantiated.

• The Council on Medical Education Report on “Update on Maintenance of Certification and Osteopathic Continuous Certification.” The council asks the AMA to examine the activities that medical specialty organizations have undertaken for alternative pathways to board certification; asks the American Board of Medical Specialties (ABMS) to ensure that all ABMS member boards provide transparency related to costs of maintenance of certification and certifying exams; and encourages the ABMS to review policies regarding maintaining underlying primary or initial specialty board certification in addition to subspecialty certification.

• Resolution on “Fixing the VA Physician Shortage With Physicians” calls on the AMA to work with the VA to enhance its loan forgiveness efforts to further incentivize physician recruiting and retention and improve patient access in Veterans Administration facilities. It also calls for an immediate change in the Public Service Loan Forgiveness Program to allow physicians to receive immediate loan forgiveness when they practice in a Veterans Administration facility. ■