The Code of Medical Ethics: Truth or just another marketing cliche?

by Hooman Noorchashm, M.D., Ph.D.

Published Jun. 8, 2015, 9:46 a.m. ET

Engineers and scientists use a specific technique to test the integrity of the systems they design or study. This technique entails assessing the integrity and capacity of their systems under extreme conditions.

Like any system, our healthcare establishment originated with a singular purpose – to protect the health of the population, to preserve the health of individuals in harm's way from acquired or inherited disease, and to dignify human birth and death.

Achievement of this purpose is guided by a code of ethical conduct in the United States.

The Code of Medical Ethics, as codified and re-evaluated routinely by the American Medical Association (AMA), is expected to govern the behavior of physicians and hospitals across the land. This code can be found here.

The Code, provides physicians with the standards for ethical conduct in fulfilling their professional obligation to their patients and to society at large. It is a sort of "system-design" that has evolved over centuries in the medical profession. And it is expected that all American physicians will abide by it.

Of course, having a Code is one thing - abiding by it in real life, is quite another story.

So, like any system, the ethical integrity of our healthcare establishment can and must be put to real life tests under extreme conditions – because this Code's mere existence does not guarantee its correct implementation.

Thus, the question is: Does our healthcare system maintain its ethical integrity in the extreme circumstances it confronts?

One such specific scenario has been delineated in a part of The Code, entitled Opinion 2.03: "Allocation of Limited Medical Resources". You can read it here.

In this section, The Code explicitly states that "Decisions regarding the allocation of limited medical resources among patients should consider only ethically appropriate criteria relating to medical need" and that "Non-medical criteria, such as ability to pay, age, social worth, perceived obstacles to treatment, patient contribution to illness, or past use of resources should not be considered."

Inability to pay for healthcare is, of course, a problem that definitively affects the nearly 13% uninsured subset of the US population – not counting those with insurance who cannot afford copay bills and undocumented aliens who are completely ineligible.

Indeed, a real time test of our healthcare system's ethical integrity rests in whether it can stay true to its Code of ethical conduct in treating individual patients, who cannot pay for limited life-saving resources.

This "integrity test" can be applied systemically or to individual hospitals and physicians.

The sad truth is that many in our healthcare establishment find themselves – knowingly or unbeknownst to themselves – discriminating against the minority subsets of patients with financial incapacity. This socioeconomic phenomenon finds itself on prominent display when it comes to limited, life-saving resources (for example, advanced therapies and organ transplants).

Of course, the reason for the establishment's discriminatory behavior, directed at the minority subset of patients with little to no socioeconomic power, is that corporate and profit seeking directives are disproportionately empowered within our healthcare establishment in the year 2015. As such, physicians permit corporate goals to over-ride the mandates of The Code - this, is especially easy to do to the disenfranchised, "minority" subsets of people who are voiceless because of their socioeconomic plight.

In almost all cases, the establishment leaders have promoted the abstract arguments of "majority benefit" and "societal distributive justice" in rationalizing their discrimination against individual patients on the basis of socioeconomics – this is wildly incorrect and unjust.

Socioeconomically discriminating against individual patients who are reasonable medical candidates for life-saving treatment, even when these are limited resources, is a blatant violation of our professional Code.

The Code of Medical Ethics in the United States is quite explicit: inability to pay cannot be used as a criterion to eliminate a patient's access to limited life-saving resources.

But, we do so hundreds, if not thousands, of times each day across this great nation – even at "non-profit" healthcare organizations. We do it so often that a wide majority of well-meaning American physicians have accepted this awful fact as a "constant reality" - after all, "our resources ARE limited" and we are doing good for the wide "majority" of our patients - so it is "OK" to abandon the socioeconomically dis-empowered and disenfranchised.

Or is it?

The truth is that our system's treatment of "the uninsured patient" is a litmus test of our character and integrity as a profession and as individual doctors – and it is a test we cannot afford to fail.

Very certainly, any physician (or hospital) who accepts this violation of our Code, in favor of corporate interests and payment, or in favor of abstract "societal benefit" arguments, has veered tragically away from the sacred institution whose singular purpose is to save and honor individual human lives.

Ultimately, if healthcare continues to be run dominantly as a profiteering business, and if an increasing number of doctors accept socioeconomic discrimination against a minority subset of the sick – despite our beautiful buildings, clean floors and sharp marketing clichés – the health of our nation will stand compromised.

Because saving lives and protecting the public's health cannot be accomplished using the physics of business or the politics of money. Rather, this establishment, on all levels, must be run dominantly by an ethical commitment to every individual life in harm's way – irrespective of socioeconomics.

The health and wealth of the United States rests on the medical establishment. So unless doctors and hospitals are able to focus squarely and only on fulfilling their duty to every single patient under their care 100% of the time - and particularly at the extremes of illness and socioeconomic misfortune - we will stand compromised.

Without a question, the test of our professional integrity as doctors is how uninhibited we remain when deciding to save "an uninsured life", when it can be saved.

Unless of course, in the year 2015, the AMA's Code of Medical Ethics is nothing but a compendium of clichés, instead of being the collection of principles that must guide the medical profession's behavior towards every patient.

Hooman Noorchashm and Amy Reed, husband-and-wife physicians, have campaigned to ban electric morcellators since December 2013, soon after Reed's unsuspected uterine cancer was spread by the device during a routine hysterectomy.