Model Resolutions

AMERICAN MEDICAL ASSOCIATION HOUSE OF DELEGATES

Resolution: 718 (I-04)

Introduced by: Louisiana Delegation

Submitted by: AAPS Member Frederick J. White, III, M.D.

Subject: Criminalization of Physician Departure from Governmental Guidelines and Standards

Referred to: Reference Committee J (Brooks F. Bock, MD, Chair)

Whereas, In response to this year’s influenza vaccine shortage some state jurisdictions have used their emergency powers to mandate compliance with the Centers for Disease Control and Prevention (CDC) recommendations for the use of available supplies of vaccine, and in so doing criminalized (with attendant fines, imprisonment and/or sanctions by medical licensing boards) medical decisions of health care providers who do not comply with the CDC guidelines; and

Whereas, Current CDC recommendations for administration of the influenza vaccine were not promulgated in accordance with American Medical Association Policy H-410.980[7], which states that clinical practice guidelines implemented at the local/state/regional level shall acknowledge the ability of physicians to depart from the recommendations in clinical practice guidelines when appropriate, in the care of individual patients; and

Whereas, Policy H-410.961 recommends that clinical practice guidelines contain a disclaimer reaffirming that such guidelines are not a substitute for the experience and judgment of a physician, and Policy H-410.970 states that physicians must retain autonomy to vary from practice parameters without retribution in order to provide the quality of care that meets the individual needs of their patients; and

Whereas, AMA Council on Scientific Affairs Report 1-I-94 recognizes the subtle but important difference between a guideline and a standard, and the experience resulting from the current vaccine shortage now brings into conflict the application of voluntary guidelines versus mandated standards for medical care; and

Whereas, The International Code of Medical Ethics of the World Medical Association states that a physician owes his patients complete loyalty and all the resources of his science; and

Whereas, No AMA policy clearly opposes administrative promulgation of governmental standards mandating or prohibiting certain acceptable medical decisions (versus the greater legal latitude allowable for guidelines for medical practice), and no AMA policy clearly opposes criminal prosecution of physicians whose non-compliance with such guidelines or standards is based on a good faith medical decision made in loyalty to and in the best interests of a patient; therefore be it

RESOLVED, That our American Medical Association study and report back at the 2005 Annual Meeting as to: (1) the need for a national clarification of the terms guidelines (parameters, algorithms, etc.) vs. standards (mandating compliance) for medical care and resource allocation; (2) the legal, moral, and ethical impact of appropriate departure from guidelines or standards, the clarification of what constitutes appropriate departure, and the rights of physicians and other health care providers accused of non-compliance with a guideline or standard; and (3) the legal, moral and ethical impact of the criminalization of medical decisions and actions of physicians and other health care providers who appropriately depart from such guidelines and standards (Directive to Take Action); and be it further