This article summarizes the report of the American Medical Association's (AMA) Council on Ethical and Judicial Affairs (CEJA) on ethical practice in telehealth and telemedicine. Through its reports and recommendations, CEJA is responsible for maintaining and updating the AMA Code of Medical Ethics (Code). CEJA reports are developed through an iterative process of deliberation with input from multiple stakeholders; report recommendations, once adopted by the AMA House of Delegates, become ethics policy of the AMA and are issued as Opinions in the Code. To provide enduring guidance for the medical profession as a whole, CEJA strives to articulate expectations for conduct that are as independent of specific technologies or models of practice as possible. The present report, developed at the request of the House of Delegates, provides broad guidance for ethical conduct relating to key issues in telehealth/telemedicine. The report and recommendations were debated at meetings of the House in June and November 2015; recommendations were adopted in June 2016 and published as Opinion E-1.2.12, Ethical Practice in Telemedicine, in November 2016. A summary of the key points of the recommendations can be found in Appendix A (online), and the full text of the opinion can be found in Appendix B (online).
Death determination is fraught with clinical, cultural, and ethics questions. This article considers relevant history that informs the AMA Code of Medical Ethics opinions about neurological criteria for death.
The AMA Code of Medical Ethics offers guidance on topics related to prescription drugs, including access, stewardship, and professionalism. Physicians' traditional role as stewards of limited health care resources is being reinterpreted in terms of their relationships with key players in the health care sector. While physicians still assess risks and benefits when prescribing medications for patients, rising drug prices, 1 formulary restrictions, and quantity limitations 2 introduce new complications to stewardship decisions. Physicians must not only prescribe clinically appropriate treatments but also coordinate 3 and advocate 4 for patients' access to needed interventions. Additionally, multidisciplinary care teams, necessitated in part by an expanding pharmacopeia and growing demands for access to quality health care, introduce new fields of expertise to clinical encounters. The American Medical Association (AMA) Code of Medical Ethics offers guidance to physicians making care plans with colleagues and offering treatment recommendations to patients that are relevant to physicians' stewardship role. Availability of services and benefits covered by patients' insurance plans, for example, can influence clinical judgment. 5 Opinion 11.2.1, "Professionalism in Health Care Systems," states: Structures that influence where and by whom care is delivered-such as accountable care organizations, group practices, health maintenance organizations, and other entities that may emerge in the future-can affect patients' choices, the patient-physician relationship, and physicians' relationships with fellow health care professionals. 6
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