A Code of Professional Ethical Conduct for AMIA

AMIA Board of Directors approved White Paper

John F. Hurdle, MD, PhD, Samantha Adams, PhD, Jane Brokel, PhD, RN, Betty Chang, DNSc, RN, FAAC, Peter Embi, MD, MS, Carolyn Petersen, Enrique Terrazas, MD, Peter Winkelstein, MD

Publication Source

J Am Med Inform Assoc. 2007 Sep-Oct;14(5):686

Abstract

The AMIA Board of Directors has decided to periodically publish AMIA's Code of Professional Ethical Conduct for its members in the Journal of the American Medical Informatics Association. If you have questions or to provide comments or feedback, contact Karen Greenwood. The AMIA Board acknowledges the continuing work and dedication of the AMIA Ethics Committee. AMIA is the copyright holder of this work.

MeSH terms: Ethics, Ethics Committees, Code of Ethics, Bioethics.

Introduction

The American Medical Informatics Association, in common with other large professional societies, has had a long-standing interest in promoting a strong ethical framework for its membership.* This white paper presents the new AMIA Code of Professional Ethical Conduct, which was approved in February of this year by the AMIA Board of Directors. In an effort to keep pace with the intrinsic dynamism of the field itself, the code presented below is a dynamic document. It will evolve as the field itself evolves. The AMIA Web site will continue to publish the most up-to-date version of the code, a process that hinges on continued input from the AMIA membership.

The code is meant to be practical and easily understood, so it is presented in a compact form using very general language. Unlike the ethics codes of some professional societies, the AMIA code is not intended to be prescriptive; it relies on the commonsense of the membership. It provides the broad strokes of a set of important ethical principles especially pertinent to the field of biomedical informatics. The code is organized around the common roles of AMIA members and the constituents they serve and with whom they interact. The AMIA Board and the AMIA Ethics Committee encourage AMIA members to flesh out gaps in coverage and scope. We are especially interested in real-world examples of ethical situations members have encountered. In this way the code will continue to evolve to best serve the informatics community.

* For example, see Robert Greenes' and the AMIA Board of Director's strategic plan description in JAMIA, 1994 May-Jun;1(3):263-71.

Principles of Professional Ethical Conduct for AMIA Members

As a member of the American Medical Informatics Association, I acknowledge my professional duty to uphold the following principles and guidelines of ethical conduct:

1. Key ethical guidelines regarding patients, their families, their significant others, and their representatives (called here collectively 'patients'):
   
   1. Patients have the right to know about the existence of electronic records containing personal biomedical data;
      1. Do not mislead patients about the how these data are used, about the origin of these data, nor about how and with whom these data are communicated;
      2. Answer truthfully patients' questions concerning their rights to review and annotate their own biomedical data, and seek to facilitate a subject's legitimate right to exercise of those rights.
   2. Advocate and work to ensure that biomedical data are maintained in a safe, reliable, secure, and confidential environment that is consistent with applicable law, local policies, and accepted informatics processing standards;
   3. Never knowingly disclose biomedical data in a fashion that violates legal requirements or accepted local confidentiality practices;
      1. Likewise, even if it does not involve disclosure, never use patients' data outside the stated purposes, goals, or intents of the organization responsible for these data.
   4. Treat the data of all patients with equal care, respect, and fairness.

    

2. Key ethical guidelines regarding colleagues:
   
   1. Facilitate colleagues' work in a timely, respectful, and conscientious way to support their role in the healthcare or research enterprise;
   2. Advise colleagues in a timely fashion about real, or potential, adverse outcomes or adverse situations you discover that could hinder their ability to discharge their responsibilities to patients, other colleagues, involved institutions, or other stakeholders;
   3. To the extent you can, foster a professional environment that is conducive to the highest ethical and technical standards;
   4. Disclose to colleagues any personal biases, prejudices, technical shortcomings, or other constraints that may hinder your ability to discharge your professional responsibilities;
   5. If you work as a leader:
      1. Communicate and promote these ethical guidelines to those you lead;
      2. Manage personnel and other resources effectively and fairly;
      3. Communicate and promote policies that protect the dignity of patients and colleagues.
   6. Be forthright in correcting malfeasance or unprofessional conduct on the part of colleagues.

    

3. Key ethical guidelines regarding institutions, employers, and clients (called here collectively 'employers'):
   
   1. In a professional working relationship, employers have the right to expect from you diligence, honesty, and loyalty to common purpose. In return, exercise your right to work in a fair, safe, honest, and productive environment;
   2. Work to apply the guidelines for patients (described above in I) to your relationship with an employer (e.g., do not mislead; be truthful; maintain a safe, reliable, secure, and confidential data environment; do not disclose confidential or sensitive information; treat the employer fairly);
   3. Likewise, work to apply the guidelines for colleagues (described in above in II) to your relationship with an employer (e.g., facilitate the working enterprise in a timely, respectful, and conscientious way; immediately advise an employer of adverse or disadvantageous circumstances; work to foster an ethical and technically proficient professional environment; and disclose biases, prejudices, technical shortcomings, or other constraints on your ability to conduct your assignments);
   4. Learn and respect your intellectual property rights and interests as well as those of your employer, colleagues, and patients;
   5. Learn and respect the legal obligations of your employer and comply with local policies and procedures to the extent that they do not violate ethical norms.

    

4. Key ethical guidelines regarding society and regarding research:
   
   1. Be mindful and respectful of the societal or public-health implications of your work, ensuring that the greatest good for society is realized by your work under the constraints of your ethical obligations to your patients, colleagues, and employers;
      1. The constraints of your ethical obligations to your patients, colleagues, and employers are not absolute, carefully weigh those obligations against the potentially greater interests of society and the public's welfare.
   2. Basic human rights, especially as articulated and regulated in conducting research, must remain the highest ethical standard;
   3. Know the applicable governmental regulations and local policies that define ethical research in your professional environment. Strive to meet the spirit as well the letter of those regulations and policies.

    

5. General ethical guidelines
   
   1. Always disclose to any relevant party all real or potential conflicts of interest that may constrain your professional work;
   2. Maintain your competence as an informatics professional;
      1. Recognize your technical and ethical limitations and seek consultation when needed;
      2. Work diligently to meet the continuing education expectations in your field, and if you undertake service obligations (e.g., voluntary participation on technical committees or membership on regulatory boards) discharge these duties with the same care and conscientiousness as you would your regular duties.
   3. Take responsibility for your actions and your work, while taking and sharing credit where credit is due;
   4. Avoid exploiting professional relationships, especially positions in AMIA, for personal gain beyond those reasonably expected for good service;
   5. Respect professional confidences to the extent that it does not hinder other ethical obligations;
   6. Strive to encourage the adoption of informatics approaches proven to improve health and healthcare;
      1. Strive to make research, development, and evaluation of health information technology a priority;
      2. Strive to involve others who have an appropriate expertise in biomedical and health informatics initiatives in your own work.
   7. Be mindful that your work and actions reflect both on the profession and on the AMIA organization as a whole.
6. Enforcement, compliance, and violations
   The adoption of a code of ethical conduct naturally raises the questions of compliance. What are the consequences of violating the code? How is the code enforced? The authors have suggested to the AMIA Board of Directors that these are issues best decided by the AMIA membership itself. In future forums, AMIA will initiate a dialog with the membership to seek consensus on this important topic.

Acknowledgements

The authors and the AMIA Ethics Committee would like to thank the AMIA Board of Directors for their continuing interest in refining and publicizing these guidelines. Additional comments on the code were provided by Dan Stein and Kristina Thomas. Other members of the AMIA Ethics Committee who contributed to drafts of the code include: Mureen Allen, MSBS, MS, MA, Joseph Catapano, MD, Oscar Gyde, MD, Carol Hope, PharmD, and Helga Rippen, MD, PhD, MPH.

References

Additional reading and related professional codes that influenced the Ethics Committee's most recent deliberations on this iteration of the Code maybe found in:

[1] American Association of Critical-Care Nurses. Nursing Code of Ethics Resources. 2006 [cited 2006 11/01/06]. Available from: http://www.aacn.org/AACN/practice.nsf/....

[2] American Health Information Management Association. American Health Information Management Association Code of Ethics. 2004 [cited 2006 10/24/2006]; On-line version of the AHIMA Code of Ethics. Available from: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_024277.hcsp?dDocName=bok1_024277.

[3] Association of Computing Machinery. ACM Code of Ethics and Professional Conduct. 1992 [cited 2006 11/04/06]. Available from: http://www.acm.org/constitution/code.html.

[4] Healthcare Information and Management Systems Society. Code of Ethics. 2002 [cited 2006 November]. Available from: http://ethics.iit.edu/codes/coe/healthcare.info.mgt.systems.soc.coe.html.

[5] Illinois Institute of Technology. All online Codes of Ethics. 2006 [cited 11/05/2006]. Available from: http://ethics.iit.edu/codes/codes_index.html.

[6] International Medical Informatics Association. IMIA Code of Ethics for Health Information Professionals. 2002 [cited 2006 3/16/2006]; On-line version of the IMIA Code of Ethics. Available from: http://www.imia.org/English_code_of_ethics.html.