What is the purpose of ethics guidelines?

Medical professionals are obligated to adhere to ethical standards, and violations of these norms can result in severe consequences. However, recent events reveal a troubling trend where some public figures have misrepresented critical public health issues and have strayed from established ethical principles. A case in point is the overdose crisis and the measures implemented to address it, which seem to overlook the human suffering involved when examined closely.

This article series will explore the nuances of ethics, the historical necessity for these standards, instances of federal overreach, and recent actions by key players shaping contemporary medical and public health practices.

Many healthcare workers—bureaucrats, physicians, and nurses—have contributed to preventable deaths and unnecessary suffering in the United States and beyond. It prompts us to ask:

1. Why has it taken so long to establish codified ethical practices, given the historical abuses recognized by the government?
2. Why does it appear that the enforcement of these ethical standards is in a precarious decline?

Before addressing these questions, it is essential to define what we mean by ethics.

The AMA Code of Medical Ethics

The American Medical Association (AMA) Code of Medical Ethics is a comprehensive guide that provides direction on ethical issues that may arise in healthcare and medical research.

The AMA describes these guidelines as essential for defining ethical behavior among physicians. Yet, what exactly constitutes ethics, and what are the specific roles of these guidelines?

Ethics, by definition, refers to the moral principles that govern a person's conduct. To better understand the appropriateness of the AMA Code as a robust ethical framework, I consulted Dr. Chad Kollas, who indicated that while some states adopt the AMA Code as the standard of care, others treat it as guidelines, albeit strong ones. Although physicians are required to follow ethical standards, adherence to the AMA’s guidelines is not always mandatory. Nevertheless, we will use the AMA Code as a foundational reference due to its widespread recognition.

Medical Ethics: An Overview

According to the AMA:

'The AMA Code provides ethical guidance for all physicians, regardless of specialty. The AMA acknowledges that other physician organizations may have their own codes of conduct, and physicians may sometimes need to balance these guidelines.'

'Conduct that contradicts these expectations is deemed unethical and unprofessional.'

'The relationship between law and ethics is intricate. While ethical values often align with legal principles, ethical obligations typically surpass legal duties. Actions that are legally permissible may still be ethically unacceptable. Conversely, a physician acquitted of alleged illegal behavior is not automatically exonerated from ethical scrutiny.'

'In circumstances where laws conflict with ethical values, physicians should advocate for legal reform. In extreme cases of unjust laws, ethical responsibilities should take precedence over legal obligations.'

The AMA, among others, maintains a strong stance on professionalism, with violations of ethical duties carrying serious repercussions. We will later delve into unjust laws and the responsibility of physicians to challenge them, illustrating the significance of ethical practices within the medical field and their broader societal implications.

Historic Human Rights & Ethics Violations by the US Government

Many foundational ethical principles in medicine have emerged from notorious studies, such as those prompting the Research Act of 1974 and the Belmont Report. However, current trends threaten to undermine these values, indicating a potential for future harm.

Recently, there have been alarming changes to ethics regulations that were originally established to prevent human rights violations. These modifications have weakened oversight of federal health agencies and their collaborators, eroding the culture of ethics within the United States.

While public health officials often are not physicians, some have significantly contributed to unnecessary suffering and death in the U.S. This has largely been due to unchecked curiosity and insufficient oversight. The Department of Health & Human Services (HHS) and its agencies have repeatedly engaged in harmful practices due to a lack of supervision, risking a recurrence of past mistakes.

The Common Rule governs ethical practices for human research trials. However, significant changes made by HHS in 2018 have introduced exemptions that undermine key aspects, such as obtaining informed consent. This rule was originally established following the public outcry over the Tuskegee Experiment, a study that lasted from 1932 to 1972, focusing on untreated syphilis.

Dr. Taliaferro Clark, involved in the Tuskegee study, exhibited a troubling disregard for the subjects' wellbeing, indicating a disconcerting mindset prevalent among researchers at the time.

The Public Health Service conducted this unethical study on a vulnerable population, continuing for decades until exposed by the media and public pressure for human rights protections. Alarmingly, no individuals were held accountable for the atrocious practices or the suffering they inflicted.

Unfortunately, the PHS also participated in unethical experiments in Guatemala, which involved intentionally infecting healthy individuals with diseases. This was led by Dr. John Charles Cutler, who had a history of unethical practices, including the Tuskegee study.

Oversight is Again Lacking

HHS is responsible for updates to the Common Rule, yet it simultaneously governs itself, allowing for significant regulatory changes without external oversight. This lack of accountability extends to the drastic modifications made to the Common Rule, reflecting a worrying trend in the aftermath of the Tuskegee scandal.

The changing political landscape, regulatory environment, and cultural zeitgeist contribute to this decline in ethical enforcement, with far-reaching implications for healthcare, academia, and industries collaborating with federal agencies.

In Part II of this series, we will delve deeper into the urgent need for medical ethics and the adverse effects of their decline, examining how federal overreach fosters an environment ripe for ethical violations and human rights abuses.

Historical and Recent Overreach

The pervasive use of coercive tactics by the DEA, particularly in the context of the “war on drugs,” has a long history, but we will focus on developments over the past two decades. An example of questionable actions includes a 2002 press release from the DEA, which was later retracted, indicating an intention to foster a less punitive approach for physicians prescribing pain medications.

The DEA's withdrawal from this commitment led to stricter regulations that have contributed to the current punitive climate regarding analgesic prescriptions, creating challenges for physicians to provide adequate patient care while navigating the agency's coercive practices.

The DEA has historically overstepped its mandate, often acting as if it regulates medical practice, despite legal prohibitions against such interference. This has resulted in a punitive environment hindering physicians from acting in their patients' best interests.

Patterns of Overreach

Recent developments indicate that the DEA continues to assert its influence over medical practice, further limiting the availability of opioid medications. Reports show that the agency plans to drastically reduce the inventories of controlled substances available to manufacturers, exacerbating shortages experienced by hospitals in treating patients.

Despite evidence showing that illegal substances, rather than prescribed medications, are primarily responsible for the overdose crisis, the DEA persists in its misguided approach, contributing to an environment where ethical violations and human rights abuses are likely to occur.

The ongoing overreach by the DEA not only compromises patient health but also raises serious concerns about accountability and oversight, echoing historical abuses in healthcare.

Conclusion

The current overdose crisis, punitive measures surrounding pain management, and the troubling trends in ethical oversight could lead to dire consequences for public health in the United States and beyond.

The loosening of regulations by HHS regarding informed consent, alongside the DEA’s aggressive tactics, creates an environment that facilitates ethical violations and human rights abuses. The juxtaposition of the AMA Code of Medical Ethics, the historical context of ethical failures, and the ongoing federal overreach makes a compelling case for the urgent need to address the decline in ethical practices in medicine.

Part II will further explore these issues and the implications for healthcare and human rights.