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Ethics Manual

Patients Near the End of Life

Advance Care Planning

Problems of Life–Sustaining Treatments

Medicine, law and social values are not static. Re–examining the ethical tenets of medical practice and their application in new circumstances is a necessary exercise. The fourth edition of the American College of Physicians Ethics Manual, covers emerging issues in medical ethics and revisits old ones.

Ethics Manual

It reflects on many of the ethical tensions faced by internists and their patients and attempts to shed light on how existing principles extend to emerging concerns. In addition, by reiterating ethical principles that have provided guidance in resolving past ethical problems, it may help physicians to avert future problems. The Manual is not a substitute for the experience and integrity of individual physicians, but it may serve as a reminder of the shared obligations and duties of the medical profession.

Ann Intern Med. 1998, 128:576–594.

The secret of patient care: Francis Weld Peabody
Some aspects of medicine are fundamental and timeless. Medical practice, however does not stand still. Clinicians must be prepared to deal with changes and yet reaffirm what is fundamental.The fourth edition of the American College of Physicians Ethics Manual examines emerging issues in medical ethics and revisits older issues that are still very pertinent. Changes in the Manual since its last revision in 1992 include new sections on genetic testing, the changing practice environment and managed care, organ donation and disability certification. A method for ethics decision–making has also been added. Such issues as patient responsibility and discrimination are discussed more extensively and the section on decisions near the end of life (which includes physician–assisted suicide) has been revised substantially. The literature of biomedical ethics expands at a rate that does not allow a bibliography to remain current, therefore, an exhaustive list of references or suggested readings is not included in this edition of the Manual.

The Manual is intended to facilitate the process of making ethical decisions in clinical practice and medical research and to describe and explain underlying principles of decision making. Because ethics must be understood within a historical and cultural context, the second edition of the Manual includes a brief overview of the cultural, philosophical and religious underpinnings of modern medical ethics. In this edition, we refer the reader to that overview and to other sources that more fully explore the rich heritage of medical ethics.

Patients’ Rights
Physician and Patient
Genetic Testing
Alternative Treatments
Disability Certification

Care of the Physician’s Family, Friends and Employees
Determination of Death
Organ Donation
Irreversible Loss of Consciousness
Intravenous Fluids and Artificial Feedings

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