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AMA Code of Medical Ethics – First of Its Kind

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In 1847, physicians representing 22 states and the District of Columbia came together to establish America’s first national professional association for physicians, the American Medical Association (AMA).

As one of its first acts, the AMA created the first national codification of ethics for any profession anywhere in the world. Authored by a committee chaired by Drs. John Bell and Issac Hays, the 1847 AMA Code of Medical Ethics was “unlike any ethics subscribed to by any earlier group of medical practitioners. No national assemblage had ever proposed to bind all of its members by a uniform code of ethics, and no previous code of ethics had ever been formulated as an explicit social contract between the profession, its patients, and the public.”(Baker et al., JAMA, 1997)

As the first of its kind, the 1847 AMA Code was reprinted by medical societies in Berlin, London, Paris, Vienna, and around the world. Throughout the rest of the 19th century, it was the most commonly printed medical document in the English language.(Baker et al. eds. The American Medical Ethics Revolution, Johns Hopkins University Press, 1999) Today, the AMA Code remains the only codification of professional conduct for all US physicians regardless of their medical specialty, practice type or location.

Ethics guidance is regularly added or amended in the AMA Code to reflect changes in medical science and societal expectations. As with any “living” document that is authored by different individuals over many decades, the AMA Code became fragmented and unwieldy. Ethics guidance on individual topics (referred to as Opinions in the AMA Code) were “difficult to find; lacked a common narrative structure, which meant the underlying value motivating the guidance was not readily apparent; and were not always consistent in the guidance they offered or language they used.”(Brotherton et al., JAMA, 2016)

To address these issues, the AMA embarked on a multi-year “modernization” project to comprehensively review and update the AMA Code. To make guidance easier to locate, Opinions were reorganized into 11 more intuitive topical chapters. Opinions that addressed overlapping topics were consolidated, reducing  the number of Opinions from 220 to 161. In addition, a consistent format was “constructed to ensure that each Opinion succinctly articulates the core ethical values on which guidance is based, defines the broad context in which guidance is relevant, and sets out specific ethical responsibilities in the form of practical actions for individual physicians or the profession as a whole to take.”(Brotherton et al.) Over the course of the modernization project, input and feedback was solicited from physicians representing the diversity of medicine. After much deliberation and debate, the AMA House of Delegates adopted the modernized AMA Code last June.

“The modernization project ensures that the Code of Medical Ethics will remain a useful and effective resource that physicians can continue to rely on, while remaining faithful to the virtues of fidelity, humanity, loyalty, tenderness, confidentiality and integrity enshrined in the original Code,” AMA Immediate Past President, Steven J. Stack, MD, said.

A commemorative, leather-bound edition of the modernized AMA Code is available.

 

 

 

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