ACP American College of Physicians - Internal Medicine - Doctors for Adults

Effective Clinical Practice


On the next four pages of ecp, you will find "A Shared Statement of Ethical Principles for Those Who Shape and Give Health Care: A Working Draft." The statement is an effort by a multidisciplinary group to find a common ground among separate, discipline-based codes of ethics. Truth be told, I’m not a big fan of "ethical principles" (and have even been known to wince upon hearing the term "ethicist"). On the other hand, we all know that our health care system is increasingly dominated by money (a reality that applies to providers and payers alike) and is increasingly distracted from caring. So if the statement by the Tavistock Group can help us rebalance, I’m all for it. (Hence my decision to publish the document).

I particularly like the fact that the statement on ethical principles is a working draft. The document has already been published in several medical journals, and the goal of this widespread publication is to elicit feedback to improve the document. Your mission, should you choose to accept it, is to look it over and voice your honest opinion of its contents.

To get you in the spirit, I’ll share the two areas I take issue with. The first is really a quibble. Although the prevention of illness takes center stage in Principle 3, none of the five principles say anything about caring for the sick. The second is more fundamental: the characterization of health care as a human "right." Is it any more of a "right" than food, clothing, shelter, or education? Does the word help foster a recognition of competing social needs or is it more of "trump card" to be played by those of us with obvious self-interest? Sure, health care warrants special status, but wouldn’t "public good" or "social obligation" do the trick? Can’t we find a phrase that moves health care beyond the commercial realm, but not beyond reproach? What do you think? If you have comments, send them to: Ms. Penny Janeway, Initiatives for Children, American Academy of Arts and Sciences, Norton Woods, 136 Irving Street, Cambridge, MA 02138-1996; e-mail:

H. Gilbert Welch, MD, MPH