Development of Ethical Codes

The earliest professional codes of ethics can be traced to the time of the Greek physician Hippocrates, whose influence is still reflected in modern healthcare ethics. Traditional medical codes of ethics emphasize the physician’s (1) duties in the individual patient-physician relationship, including the obligation of confidentiality; (2) authority and duty of beneficence (i.e., acting for the patient’s good); and (3) obligations to professional colleagues.³ In return for the privileges and trust granted to a profession, a code of ethics serves as a promise to society to uphold certain values and standards of conduct. Although codes generally are not legal mandates, they establish standards of professional conduct, they take on greater significance within professions that maintain systems of self-regulation. State boards and professional organizations may use ethical standards when evaluating professional conduct and determining appropriate disciplinary actions. Codes may also be recognized in legal proceedings through a provision called judicial notice, which allows courts to acknowledge commonly accepted professional standards even when those standards are not laws themselves.

Ideally, professional codes foster a shared sense of responsibility among members of a profession. Professionals are expected to uphold common standards, support one another in ethical practice, and contribute to the profession’s commitment to self-regulation.

The elements of modern codes reflect values that have been emphasized for centuries, including honesty, competence, confidentiality, and concern for patient welfare. Early codes focused heavily on personal character and professional conduct, reflecting the social values of their time. Historical writings also emphasized obligations to benefit patients, avoid harm, and maintain the trust placed in healthcare professionals. Some historical writings identified behaviors that violated professional expectations, including abandoning patients, breaching confidentiality, pursuing personal gain at the expense of patients, and treating patients while impaired.⁵ Many contemporary professional standards address concerns that have existed for centuries.

Even centuries ago, people recognized that specialized knowledge carries both a responsibility and the potential for misuse when professionals are entrusted with the well-being of others. Today’s clinicians must understand the responsibilities that accompany the trust placed in them by patients and society. Health care professionals have a special responsibility to the patients they treat because of their knowledge and the resulting dependence that patients place on their expertise and judgment.

A code of ethics serves two important functions:

• First, it provides an enforceable standard of minimally acceptable conduct for those who fall below that standard.

• Second, it identifies in general terms, ethical considerations that professionals should consider when making decisions about their conduct.

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A code of ethics serves as an important tool of self-regulation, a fundamental component of professionalism.

The use of professional codes in health care, does however, have some limitations. Not every situation can be addressed in a code or fully explained in an accompanying interpretation. Some philosophers have noted that most codes focus on the obligations of health care professionals more than the rights of those receiving care.⁶ The use of patient bills of rights in health care settings helps address this concern by highlighting the rights and interests of patients