2020 Nov 20. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan–.
Medical ethics is a required element of American physicians' formal training. Familiarity with ethical principles on a basic level is necessary to pass initial medical licensing examinations. However, many physicians are unable to elucidate specific ethics principles, explain how or why medical ethics principles have come to be, or integrate and prioritize medical ethics principles systematically.
Many different medical ethics guidelines are available, such as from the American Medical Association (AMA), American Osteopathic Association (AOA), and the American College of Physicians (ACP). The AMA code is of historical interest since it originates from the world's first medical ethics code (written in 1847) intended to serve as an authority at a national level. It was revised in 2016 with some minor alterations in 2019.
Although the AMA advertised its 2016 code as "designed to meet the ethical challenges of medical practice" and as "the medical profession’s authoritative voice," the first page of the code stated that the code was "not intended to establish standards of clinical practice." That language has been removed leaving language that serves as a more authoritative standard with a system of hierarchy in the appropriateness of actions involving degrees of obligation, such as must, should, and may, with flexibility provided depending on circumstances.
Nevertheless, not all physicians are held by other policy-making bodies to uphold the AMA code. Given a lack of definitive ethical standards and premises, let alone a hierarchy or algorithm for prioritizing or enforcing them, physicians often still face great challenges in achieving satisfactory solutions to ethical challenges for themselves, their patients, and other parties involved.