Editorials

An ethical code for everybody in health care

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7123.1633 (Published 20 December 1997) Cite this as: BMJ 1997;315:1633

A code that covered all rather than single groups might be useful

  1. Donald Berwick, Presidenta,
  2. Howard Hiatt, Professor of medicinea,
  3. Penny Janeway, Executive directorc,
  4. Richard Smith, Editor, BMJc
  1. Institute for Healthcare Improvement, Boston, MA 02215, USA
  2. Harvard Medical School, Brigham and Women's Hospital, Boston, MA 02115, USA
  3. Initiatives for Children, American Academy of Arts and Sciences, Cambridge, MA 02138, USA

Perhaps there was a time when professional ethics alone gave health care a sufficient moral compass. If so, that time has passed. The fate of patients and the public's health depends now on interactions so complex that no single profession can credibly declare that its own code of ethics is enough. We think that we need an ethical code to cover everybody involved in health care, and we have embarked on the search for such a code.

Consider the following cases.

A doctor working in an NHS trust thinks it wrong that his patients will be denied a new treatment for cancer—despite the hospital formulary committee deciding that it should not be prescribed. Should he contact the local media? Should the trust punish him if he does?

A staff surgeon employed full time by a not for profit health maintenance organisation develops an approach to postoperative pain control for a surgical procedure that shortens average length of stay by 1.5 days. Is she ethically obliged to share information of her discovery with the world?

A British general practice that plans to become a fundholding practice deliberately keeps its prescribing costs high for a year so that it will receive a bigger budget in its first year as a fundholder (the budget is based on the previous year's activity). Is this defrauding other practices and health organisations or doing the best by the patients in the practice?

A health maintenance organisation considers investing in improvements in its system for caring for AIDS patients. The vice president for marketing warns that such improvements may lead to selective enrolment of unprofitable HIV positive members. Is the organisation ethically bound to improve its HIV care, even if that …

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