Institutional Code of Ethics Today, the healthcare industry is faced with rising costs, increasing regulation and growing numbers of patients with age-related conditions as the Baby Boomer segment of the U.S. population enters their retirement age. Combined with innovations in medical technologies, these trends have created the need for codes of ethics that can provide clinicians and employees with the general guidelines they need to resolve the wide range of day-to-day ethical dilemmas that are endemic to the healthcare profession. For this purpose, the American Medical Association (AMA) publishes a code of medical ethics and many public and private sector hospitals likewise maintain codes of ethics for their clinicians and employees. To gain some fresh insights into these issues, this paper reviews the literature to provide an analysis of the specific requirements of a code of ethics, three critical elements of the AMA's code that are deemed the most important and an assessment of the differences and similarities between the AMA's Code of Medical Ethics requirements and the code requirements of three hospitals. Finally, an explanation concerning why certain individuals and/or groups should follow a hospital's code of ethics is followed by a summary of the research and important findings concerning codes of ethics in the conclusion.

Analyze the specific requirements of a code of ethics

Any code of ethics should contain the general guidelines that clinicians need to resolve ethical dilemmas in their practice. For instance, Doran and Fleming (2015) note that, "Clinicians have traditionally dealt with ethical issues by keeping their own counsel, turning to trusted colleagues or professional codes of ethics or seeking guidance from religious authorities" (p. 45). Likewise, a requirement for codes of ethics is to standardize what is regarded as ethical practice at the local, regional and national levels (Zahedi & Sanjari, 2013). Further, another requirement of codes of ethics is to ensure that clinicians take appropriate actions to ensure that patient safety is not jeopardized by the "incompetent, unethical or illegal acts of others - including the system" (Johnstone, 2004).

Other requirements for a code of ethics include the following:

Written standards concerning honest and ethical conduct, including the ethical handling of actual or apparent conflicts of interest between personal and professional relationships;

Description of the centrality of compliance with applicable governmental laws, rules, and regulations;

Provisions for the prompt internal reporting to an appropriate person or persons identified in the code of violations of the code; and,

Accountability for adherence to the code (Legal requirements for ethics codes, 2016).

It is also important to note that codes of medical ethics should describe the healthcare facility's mission and provide relevant interpretations of ethical principles. In this regard, Verschoor (2009) points out, "A code emphasizing proper values deals with setting examples [and] interpreting ethical principles" (p. 22). One code that serves as a standard by which others are measured in the healthcare profession is the AMA's code of medical ethics which is discussed further below.

Three critical elements of the AMA's code that are most important

One of the first acts taken by the AMA was to adopt a code of ethics and the original has been revised numerous times over the years (Baker & Emanuel, 2000). The current AMA code of ethics is published online as well as in e-book form (available for purchase for members at $45 a copy) and is comprised of ten sections as follows:

1.00 -- Introduction;

2.00 - Opinions on Social Policy Issues;

3.00 - Opinions on Interprofessional Relations;

4.00 - Opinions on Hospital Relations;

5.00 - Opinions on Confidentiality, Advertising, and Communications Media Relations;

6.00 - Opinions on Fees and Charges;

7.00 - Opinions on Physician Records;

8.00 - Opinions on Practice Matters;

9.00 - Opinions on Professional Rights and Responsibilities; and,

10.00 - Opinions on the Patient-Physician Relationship (AMA code of medical ethics, 2016, para. 1).

As can be seen from the list above, the AMA code of medical ethics is comprehensive and includes guidelines on the major issues that confront healthcare providers today. Three critical elements of the AMA's code that can be regarded as most important are as follows. In section 1.02, "The Relation of Law and Ethics," the AMA code emphasizes the need for clinicians to advocate for changes in any law that mandates unethical conduct, but when controlling legislation and ethical conduct conflict, the patient's best interests should prevail and supersede unjust laws. Likewise, section 5.05, "Confidentiality," stresses the need for clinicians and employees to safeguard all personal patient data maintained by a healthcare provider. Finally, section 10.01, "Fundamental Elements of the Patient-Physician Relationship," outlines the rights of all patients and the responsibilities that clinicians have to protect these fundamental rights.

Differences and similarities between the AMA's Code of Medical Ethics requirements and the code requirements of three hospitals

Greenville Memorial Hospital, Greenville, South Carolina. The Greenville Memorial Hospital (GMH)...

The (GMH) provides their employee code of ethics in a 21-page booklet that is also available online in PDF format. The GMH's code of ethics for employees contains the following sections:
GHS Vision, Mission and Values;

Policies;

Compliance Is Mandatory;

To Report Compliance Concerns;

Non-retaliation ["whistleblowing"];

Service Quality/Patient Care;

Laws, Rules and Regulations;

Contact With Government and Outside Investigators;

Stark Law;

Anti-kickback Statute;

False Claims Act;

Fraud, Waste and Abuse;

Confidentiality and HIPAA;

Electronic Communications;

Property;

Hiring or Retention of Excluded Individuals or Entities;

Harassment and Disruptive Behavior;

Equal Opportunity;

Drug-free Workplace;

Environmental Health and Safety;

Conflicts of Interest;

Research With Human Participants;

Finance and Billing;

Proper Accounting;

Cost Reports;

Retention and Disposal of Records, and,

Marketing (Greenville Memorial Hospital code of ethics, n.d.).

Like the other codes of ethics discussed below and the AMA code, the purpose of the GMH code of ethics is to provide employees with general guidelines concerning the actions they should taken when confronted with ethical dilemmas. This code of ethics emphasizes that it is not possible to address every possible ethical dilemma that may be encountered in the workplace, although it is clear that this hospital made an effort to cover as many conceivable situations as possible. The GMH code of ethics applies to all employees, and reading and compliance with the code is mandatory. In addition, the GMH code of ethics makes reference to other system-wide applicable policies such as the GHS Infection Control Manual and the GHS Safety Manual (GHM code of ethics, n.d.).

The Mayo Clinic, Rochester, Minnesota. The Mayo Clinic's code of ethics is subsumed as part of its integrity and compliance program. This hospital's code of ethics states in part that, "Mayo's policy is to prevent unethical or unlawful behavior, to halt such behavior as soon as possible after its discovery, and to discipline employees who violate the standards in the Code" (2015, p. 5). The Mayo Clinic's code of ethics is also obligatory reading and compliance is likewise mandatory. This code of ethics also stresses that it is not possible to foresee all of the potential ethical dilemmas that might be encountered on the job, and that the guidelines contained in the code are meant to be general in nature but their "overall philosophy and concepts" should be applied to every situation (Mayo Clinic code of ethics, 2015, para. 5).

The Mayo Clinic's code of ethics is divided into the following sections:

Mayo Clinic Code of Conduct;

Ethics;

Conflict of Interest and Outside Activities;

Use of Mayo Funds and Assets;

Confidential Information and Trade Secrets;

Dealing with Suppliers and Referring Providers;

Books and Records;

Political Activity and Contributions;

Safety, Health and Environment;

Employee Relations;

Compliance Resources;

Mayo Compliance Office;

Frequently Asked Questions; and For More Information or to Report a Suspected Violation (Mayo Clinic code of ethics, 2015).

The Mayo Clinic code of ethics is published in booklet form and is also available online in PDF format. This code of ethics is required to be followed by all Mayo Clinic employees, but reading the code is not specifically required. The Mayo Clinic code of ethics is prefaced by an overview that emphasizes that not all ethical dilemmas can be anticipated, and employees should seek additional guidance from the hospital's compliance officer when in doubt concerning how best to proceed.

TriHealth (a merger of Bethesda and Good Samaritan Hospitals), Bethesda, Maryland. This hospital's code of ethics is contained it is code of ethical business and professional behavior. The purpose of this code of ethics is to provide all hospital employees with general guidelines concerning what types of ethical conduct are expected and required (TriHealth code of ethics, 2012). Like the Mayo Clinic and GMH, the TriHealth code of ethics also stresses that it is not possible to foresee every type of ethical dilemma that may arise and that all employees are expected to follow the guidance contained in the code. In this regard, TriHealth's code of ethics states: "Although the Code addresses Standards of Conduct in certain key areas, it does not cover every decision-making situation or replace our own good judgment. The Code is designed to provide guidance and does not replace the policies and procedures of the organization" (TriHealth code of ethics, 2012, p. 4).

The code of ethics maintained by TriHealth is comprised of the following major divisions:

Introduction to the code;

Our ethical duty;

Our duty as employees, supervisors and managers;

Our responsibilities to our patients, excellence of care and service;

Our responsibility to TriHealth; and,

Our responsibility to…