Ethical decision-making is a foundational element of the medical profession. Ethics education should be included in all medical school curriculums, and physicians should have opportunities to discuss ethical issues as part of their daily clinical practice. Physicians also have a responsibility to speak out on public policy issues that directly impact patient care and the medical profession.

A physician’s advocacy efforts should always be guided by a commitment to the ethical principles of the profession. This is particularly important when addressing public policy issues related to health care delivery, such as funding and resource allocation, access to services for underserved patients, genetic testing, abortion, assisted suicide, and end-of-life decision making.

In these and other areas, physicians Medical Ethics Advocate must strive to balance the competing demands of their responsibilities to patients, society, and themselves. This may require physicians to take a public stand on issues that make them or their colleagues uncomfortable. When this is necessary, it is important that physicians be able to articulate the reasons for their positions, so that legislators and others understand their reasoning and do not misconstrue their motives.

Whether by legislation, regulatory action or judicial decision, governments are increasingly involved in medical ethics and clinical practice. This convergence of forces, including scientific advances, social movements such as consumer and civil rights, and the effects of law and economics, demands that physicians speak out to defend their ethical principles.

For example, when states adopt laws limiting the ability of physicians to practice comprehensive, evidence-based medicine, physicians must stand up and advocate for their patients’ autonomy. Such actions may make legislators and the media uncomfortable, but it is vital for physicians to have their voices heard at critical junctures.

Another example of a political issue that requires a physician’s voice is the debate over the legal status of patients who participate in office-based research. In this context, the ACP has developed a new brochure that explains the basic principles of responsible conduct of office-based research, and provides tips on how doctors and their staffs can best support patients who volunteer for research. The brochure is available free to ACP members for distribution in their offices.

The field of patient advocacy is complex and diverse. As such, it is not surprising that advocates may be influenced by a variety of codes and standards of practice, as well as by their own moral judgment. In addition to the AMA Code of Ethics, which is a foundational set of ethical guidelines for all advocates, the Collaborative Ethics for Patient and Health Care Advocates (2022) is a helpful tool for guiding practitioners. The new code builds on the original set of ethical standards from 2019 and introduces a number of new ethical considerations, including technology safeguards and more clarification around diversity and equity.