AMA Goes Beyond ‘Goldwater Rule’ In Ethics Guidelines on Media Interaction
Abstract
How physicians should interact with media was just one of the issues that AMA delegates considered that has relevance for psychiatry.
Ethical issues were a focus of debate at last month’s Interim Meeting of the AMA’s House of Delegates in Honolulu.
Delegates approved ethical guidelines for physician conduct in the media outlined in a report by the AMA’s Council on Ethical and Judicial Affairs (CEJA). The CEJA report notes that media outlets may have interests and goals at variance with physicians’ ethical obligations to patients and the public.
Rebecca Brendel, M.D., J.D., a member of the AMA Section Council on Psychiatry, says AMA delegates wrestled with how organized medicine can formulate policy about physician-assisted suicide when opinions vary dramatically.
The report emphasizes that physicians who are featured in media reports should always—first and foremost—uphold the values, norms, and integrity of the profession. Like APA’s “Goldwater Rule,” the report urges physicians to refrain from making clinical diagnoses about individuals they have not personally examined; however, the CEJA report covers more ground, providing an overview and guidance regarding all manner of physician interaction with the media.
“The AMA’s guidance goes beyond what a physician can and can’t say about a particular individual to discuss all of the various roles a physician might find him or herself in,” said Rebecca Brendel, M.D., J.D., a member of the AMA Section Council on Psychiatry. “Whatever their role might be, physicians need to think about the identity and integrity of the profession and the implications of how they interact with the media in the public sphere.”
Brendel is a member of APA’s Committee on Ethics; she is not a member of CEJA.
According to the newly adopted guidance in the report, physicians who participate in the media should
Encourage the public to seek out qualified physicians to address the questions and concerns they have about their care when providing general medical advice.
Be aware of how their medical training, qualifications, experience, and advice are being used by the media and how this information is being communicated to the public.
Understand that as physicians they will be taken as authorities when they engage with the media and therefore should ensure that the medical information they provide is accurate, inclusive of known risks and benefits, commensurate with their medical expertise, and based on valid scientific evidence and insight gained from professional experience.
Confine their medical advice to their areas of expertise and clearly distinguish the limits of their medical knowledge where appropriate.
Fully disclose conflicts of interest.
Additionally, CEJA held an open forum at last month’s meeting on physician-assisted suicide. The forum featured small-group discussions and followed similar sessions held at the Interim and Annual meetings in 2016.
Brendel, psychiatrist Barry Wall, M.D., and past AMA President and past APA Assembly Speaker Jeremy Lazarus, M.D., were among the nine physicians who chaired the small-group discussions. Wall is a member of the AMA Section Council on Psychiatry from the American Academy of Psychiatry and the Law; like Brendel, Wall and Lazarus are not members of CEJA.
Brendel told Psychiatric News that the purpose of the forum was for CEJA to gain insight about how its guidance could address the deep differences of belief and commitment among morally thoughtful physicians in relation to physician participation in assisted suicide. The session featured a brief introduction, facilitated discussions, and a concluding plenary session in which groups shared insights and suggestions.
“The forum was an opportunity for dialogue between physicians in the House of Delegates and CEJA about an issue that has been quite polarizing, with large groups of people taking diametrically opposite points of view,” she told Psychiatric News.
She noted that the current CEJA opinion on physician-assisted suicide, written in 1993, expressly prohibits physician-assisted suicide as incongruous with the goals of medicine. Since then, some form of legislation permitting physician-assisted suicide has been approved in six states and the District of Columbia. The states are California, Colorado, Montana, Oregon, Vermont, and Washington.
She said her own small group was widely varied in terms of physician practice, background, and political orientation. “It was really a remarkably productive dialogue,” she said. “Everyone was very aware of the fact that there could be vast differences of opinion among reasonable people. The real question was, How does the medical profession maintain its identity while recognizing a diversity of opinion on a difficult subject?”
Harmonizing HIPAA and Addiction Treatment Regulations
Delegates at the meeting debated several other items relevant to psychiatry. The House approved a resolution sponsored by the Section Council on Psychiatry and the American Society of Addiction Medicine (ASAM) seeking regulatory and legislative changes to enable physicians treating patients with substance use disorders to collaborate with other physicians in coordinating services, while continuing to protect against unauthorized disclosure of treatment records.
The resolution seeks clarification of federal regulations known as “42 CFR Part 2” that have governed the use and disclosure of addiction treatment records. Those regulations were originally formulated in 1975, and updated by the Substance Abuse and Mental Health Services Administration early this year. The update was made to accommodate the development of integrated care, which relies on information sharing across networks (Psychiatric News, March 3).
APA has a number of concerns about the regulations and has been working with a coalition to promote legislation that will harmonize the updated rule with regulations under the Health Insurance Portability and Accountability Act.
The resolution passed by the House of Delegates calls on AMA to “support regulatory and legislative changes that better balance patients’ privacy protections against the need for health professionals to be able to offer appropriate medical services to patients with substance use disorders.”
Stuart Gitlow, M.D., M.P.H., past president of ASAM, told Psychiatric News that the AMA resolution speaks to the reduction of stigma, the need for parity, and the importance of addictive disease being treated in the same manner as other life-threatening and chronic health conditions. “The resolution states that disease states should be treated equally with respect to confidentiality and privacy regulations,” Gitlow said. He is the executive director of the Annenberg Physician Training Program in Addictive Disease.
“As it stands in many cases, medical records for addictive disease treatment must be secured and held confidential under different regulations from those impacting all other medical records,” he explained. “This has led to confusion at times with respect to documentation and to an absence of knowledge on the part of a given treatment team as to the existence of a life-threatening health condition.”
Gitlow cited the example of an unconscious patient being treated following an automobile accident. “The ER team pulls up the medical record, but it doesn’t include the diagnosis of opioid use disorder or the fact that the patient receives buprenorphine each day,” he said. “Or maybe the patient is alert and oriented and informs the ER team of his being on buprenorphine, but the team cannot confirm the dose.”
Other Business
Other resolutions of interest to psychiatry called for the AMA to
Oppose the removal of categories from the essential health benefits (EHB) package and their associated protections against annual and lifetime limits and out-of-pocket expenses.
Oppose waivers of EHB requirements that lead to the elimination of EHB categories and their associated protections against annual and lifetime limits and out-of-pocket expenses.
Urge the Food and Drug Administration to study the practicality and utility of naloxone rescue stations made publicly available via wall-mounted display/storage units that also include instructions.
Work with stakeholders to encourage the implementation of a routine protocol for depression screening for pregnant and postpartum women presenting during prenatal, postnatal, pediatric, or emergency room visits.
Advocate for legislation, standards, policies, and funding to encourage correctional facilities to increase access to evidence-based treatment of opioid use disorder, including initiation and continuation of opioid replacement therapy in conjunction with counseling. ■
Additional information about the House of Delegates meeting can be accessed here. Information about the 42 CFR Part 2 regulations is posted on APA’s website.
