AAHCP Medical Ethics

With Annotations Especially Applicable to Home Care Physicians Prepared by the American Academy of Home Care Physicians

The following are each of the AMA Principles of Medical Ethics* printed separately along with annotations especially applicable to Home Care Physicians.

PREAMBLE

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility not only to patients, but also to society, to other health professionals, and to self. The following principles, adopted by the American Medical Association, are not laws, but standards of conduct, which define the essentials of honorable behavior for the physician.

SECTION 1
A physician shall be dedicated to providing competent medical service with compassion and respect for human dignity.

1. The home care physician will respect the dignity and privacy of the patient and the patient's home.

2. The home care physician will be vigilant regarding the physical and emotional boundaries of the doctor/patient relationship.

3. The home care physician will not be a party to any type of policy that excludes, segregates, or demeans the dignity of any patient because of ethnic origin, race, creed, age, socioeconomic status, or sexual orientation.

SECTION 2
A physician shall deal honestly with patients and colleagues, and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.

1. The home care physician will practice and provide services within his/her usual area of competence, exclusive of emergent needs.

2. The home care physician will explicitly establish the terms of the financial arrangements with the patient.

3. Payment to physicians by home health agencies must be compensation for appropriate activities and must not be provided as an inducement for referrals.
   Source: Code of Medical Ethics, American Medical Association, copyright 1996

4. Physician referrals for home health agency services, home diagnostics, home medical equipment and other non-physician home care services will be determined by legitimate clinical needs and will not be motivated by personal gain or self interest.

5. Physicians practicing in the home care setting will be honest and forthright with patients, informing them of any factors that may effect their care, including, but not limited to expectations and/or changes regarding visit frequency, identity of who will be rendering the care and the relationship of that individual to a medical group or organization, if not in solo practice.

SECTION 3
A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.

1. The home care physician will request payment only for those services rendered.

2. The home care physician will render only those services indicated by the circumstances of the clinical setting.

3. Specifically, those physicians ordering patient services or supplies from a home health agency will be responsible for timely approval of the Care Plan and subsequent orders, including service lines involved (occupational therapy, physical therapy, etc.), frequency of home visits and medications.

4. A physician who requests payment for Care Plan Oversight is expected to have provided the services detailed within the guidelines and regulations provided by the payor source.

SECTION 4
A physician shall respect the rights of the patient, of colleagues, and of other healing professionals, and shall safeguard patient confidences within the constraints of the law.

1. The home care physician will protect the patient's confidentiality as expected in a patient/physician relationship with special attention to protecting records or other pertinent information from public exposure, for example within view in the physician's automobile.

2. The home care physician may release confidential information only with the authorization of the patient or under proper legal compulsion.

3. The home care physician will respect the advance directives already established or seek clarity from the patient or appropriate family member when no clear directive has been prepared.

SECTION 5
A physician shall continue to study, apply, and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation, and use the talents of other health professionals when indicated.

1. In view of rapid development of technological advances effecting medical care provided in the home, the home care physician will be responsible for their own continuing education and be mindful that theirs must be a lifetime of learning.

2. The home care physician will often be involved with providers of services from a variety of fields. The home care physician needs to recognize both his/her role in the leadership and direction of the patient's care and his/her role in facilitating the activities of the other providers.

3. When possible, the home care physician will provide education and/or consultative services to home health personnel, so as to encourage continual learning and improvement in clinical skills.

SECTION 6
A physician shall, in the provision of appropriate patient care, except in emergencies, be free to choose whom to service, with whom to associate, and the environment in which to provide medical services.

1. The home care physician will determine whether or not the home is the appropriate environment to diagnose and treat the patient.

2. The home care physician may refuse to provide treatment to a person, who, in the physician's opinion can not be adequately evaluated in the home setting.

3. The home care physician has a right to determine if entering a neighborhood or specific domicile is safe. If determined or suspected to be unsafe, the physician has the right to decline the home visit. A physician who declines to make a visit under these circumstances has an obligation to communicate with the patient/caregiver and arrange for an alternative approach to care for the patient.

SECTION 7
A physician shall recognize a responsibility to participate in activities contributing to an improved community.

1. Home care physicians are encouraged to communicate and cooperate with health care and government organizations in order to promote an improved environment for the practice of medicine in the home.

2. Physicians with home care experience are encouraged to teach their colleagues about treating patients in the home care setting, conveying their experience and establish techniques that provide for a safe and secure environment for the practice of medicine.

3. Physicians will respect the professional integrity and needs of non-physicians on the home care team and will interact with these others in an appropriate manner commensurate with that professional respect.