The physician charter on medical professionalism: a Jewish ethical perspective

Organised medicine both in Europe and the United States has called for a renewed sense of professionalism among physicians and for an emphasis on this set of attributes in undergraduate and postgraduate medical education. Both the American Board of Internal Medicine ¹ and the Association of American Medical Colleges ² have in the last decade launched major initiatives promoting professionalism, and the Accreditation Council on Graduate Medical Education in the Unites States lists professional development as one of the major goals of residency education. ³ These efforts have culminated in the European Federation of Internal Medicine, the American College of Physicians/American Society of Internal Medicine, and the American Board of Internal Medicine working together to develop a Charter on Medical Professionalism , ⁴ which seeks to define better these attributes and mandate physician responsibilities. To date the charter has been accepted and endorsed by over ninety professional societies worldwide. ⁵ The charter is based on the overriding principles of primacy of patient welfare, patient autonomy, and social justice. ⁴ From these principles a specific set of professional obligations are derived. As Harold Sox has pointed out in an introduction to the charter, the principle of the primacy of patient welfare dates from ancient times and is intuitive to most physicians. ⁴ In contrast, the principle of patient autonomy is a product of the past century and is the basis for much of modern Western medical ethics. The almost universally accepted Helsinki code on human experimentation relies heavily on this principle. The obligation to pursue social justice is in a sense the most revolutionary of the principles and for many physicians will represent an expansion of their responsibilities toward their patients and society as medical organisations have in the past often acted more in their self interest than for societal benefit. The impetus for these efforts in the words of the charter's authors is the fact that "the medical profession is confronted by an explosion of technology, changing market forces, problems in healthcare delivery, bioterrorism and globalization. As a result, physicians find it increasingly difficult to meet their responsibilities to patients and society". ⁴

The professional responsibilities outlined in the charter are: a commitment to professional competence; honesty with patients; patient confidentiality; maintaining appropriate relations with...