Contemporary American medicine is a fragmented mosaic of interest groups, specialty societies, and state and local medical boards and societies. Each has different goals, mission statements, and sometimes even its own code of ethics. A recent resurgence of popular interest in medical professionalism has spawned numerous professionalism projects, accreditation requirements, and position papers. A host of medical oaths and declarations from Hippocrates to Geneva are recited at medical school graduations around the country. And only about 30 percent of physicians in the United States are members of the American Medical Association (AMA).
In the midst of this individualization, contouring of particular interests, and general reluctance To join organizations, the recent support by 40 state medical societies and 65 specialty societies of a new document that calls physicians to recommit to "medicine's social contract with humanity" comes as something of a surprise. Especially since the document was developed by the AMA.
The Declaration of Professional Responsibility was written by members of the Ethics Standards Group at the AMA in the aftermath of the September 11th terrorist attacks. As concerned citizens everywhere pondered what they could do to help, hundreds of physicians called the AMA to offer their medical assistance, prompting reflection on the social role of the physician in the United States and the world. The result is not a reactionary document, but an articulation of responsibility that recognizes the inter-relatedness of all humans and the integral role of health in global well-being. It is neither a Decalogue for doctors, nor a code of ethics. Rather, it is a list of specific duties that physicians must affirm in fulfilling their commitment to society. This social contract is enforced only by the integrity of those who pledge it. There is no conscripting power at work, only our professional honor.
The Declaration has 2 parts that fit neatly on a single sheet of paper. The first section, the preamble, frames the document in terms of current world conditions and historical physician roles. The second section is the declaration itself, nine short statements to which the "world community of physicians" commits itself. These include respecting the dignity of every individual, accepting personal risk in treating the sick, advocating for social and political change that will ameliorate suffering, contributing to research, and educating the public as well as future physicians. The duties speak to physicians in their roles as clinicians, researchers, educators, and public citizens.
The Declaration was presented to the AMA House of Delegates by the Council on Ethical and Judicial Affairs and was adopted by the House at its interim meeting in December 2001. Since then, it has been formally adopted by a host of state and specialty medical societies which together represent the vast majority of American physicians. The Declaration of Professional Responsibility was included in the 2003-2004 edition of the AMA Code of Medical Ethics.
During the June 2002 Annual Meeting of the AMA, representatives from the societies that have supported the Declaration met to sign an official copy of the document, demonstrating a unanimity that is rare in organized medicine today.
The Declaration is not a panacea for a fragmented profession, and whether it will stand as a medical oath remains to be seen. While many leaders of organized medicine have agreed to its principles, it is unclear how an understanding of the Declaration's duties will reach practicing physicians or play a role in medical education. Nevertheless, the Declaration of Professional Responsibilityis worth serious consideration by anyone interested in the interface between organized medicine and contemporary professionalism.
To view the text of the Declaration of Professional Responsibility or to order your own copy click here.