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Proposals to modify the principles underlying APA's ethics requirements provoked considerable and often heated debate at the March meeting of the Board of Trustees in Washington, D.C.
Ethics Committee Chair Peter Gruen-berg, M.D., introduced a proposed change to the APA Constitution and Bylaws deleting the requirement that APA members are bound by the American Medical Associ-ation's Principles of Medical Ethics. The Ethics Committee recommended replacing it with a statement mandating that APA members must adhere instead to APA's ethics code.
A related proposal would also change the ethics-related section of the APA Operations Manual to indicate that APA's ethics code consists of the AMA's Principles of Medical Ethics and annotations especially applicable to psychiatry, "except where APA has an official, explicitly different, position."
Trustee and former APA president Jerry Wiener, M.D., acknowledged that the proposals had "a seductive appeal" because of the independence they appeared to confer on APA in the ethics arena, but warned that it "set a bad precedent" for APA to have an ethics code that in important areas might differ from that adhered to by the rest of medicine. He also voiced a suspicion that underlying the proposal was an attempt to free psychiatrists from having to abide by the AMA's ethical prohibition against participating in physician-assisted suicide. APA has yet to formulate a position on the controversial issue.
Lawrence Hartmann, M.D., also a former APA president, took a sharply opposing view, insisting that the proposal is a constructive step in APA's "taking responsibility for writing its own ethics code." He challenged Wiener's contention that he and other supporters of the proposals were basing their advocacy largely on the possibility that APA would adopt a stance on physician-
assisted suicide more liberal than the AMA's. Hartmann emphasized that with only about 35 percent of APA members belonging to the AMA, it was "unfair to 65 percent of members to impose" the AMA's ethics code on them.
Hartmann cited obligations regarding the treatment of AIDS patients as one crucial area in which the two organizations disagree and where APA's position should take precedence.
The Ethics Committee's recommendations were also supported by Area 2 Trustee Herbert Peyser, M.D., who pointed out that the AMA's code is far more lax about physicians' political activities in professional settings, allowing them, for example, to leave politically oriented pamphlets in their waiting room. APA takes the position against the practice, Peyser said, and is another reason to formalize the ascendance of APA's positions.
Former APA president Joseph T. English, M.D., who is chair of the AMA's Section Council on Psychiatry, urged the Trustees to reject the proposal. He was dismayed that APA might take a step "that will be perceived by the public as setting [psychiatrists] apart from the rest of medicine" at a time when APA is engaged in a concerted effort to educate the public about psychiatrists' medical qualifications and training. He contended that any ethical disagreements should be resolved "through discourse with the AMA."
After considerable debate, the Board voted to refer the recommendations back to the Ethics Committee with the instruction that it refine the proposals.
The Trustees also agreed to discuss before their March 1999 meeting the issue of whether APA should take a position on physician-assisted suicide. APA President Herbert Sacks, M.D., wanted such a discussion to follow an Association-wide dialogue on this controversial topic. To facilitate such a dialogue, he established the Work Group to Educate Members on Physician-Assisted Suicide and urged the Ethics Committee to discuss this issue as well.