Help Me, Please
Michael Applebaum, MD, JD, FCLM
I am trying to understand something here.
But I can’t, so help me, please.
Here is the issue.
The American Medical Association claims to be the
organization for “Physicians dedicated to the health of America.”
It has a Code of Medical Ethics. “For more than 155 years, the AMA Code of Medical Ethics
has been considered the most comprehensive ethics guide for physicians on a wide
range of patient-physician issues.” Okay.
The AMA has nine Principles of Medical Ethics which were
Adopted by the AMA's House of Delegates June 17, 2001.
“The nine principles are standards of conduct which define the
essentials of honorable behavior for the physician and are the basis for the
opinions that make up the Code.” Okay.
The Preamble to the Principles reads:
The medical profession has long
subscribed to a body of ethical statements developed primarily for the benefit
of the patient. As a member of this profession, a physician must recognize
responsibility to patients first and foremost, as well as to society, to other
health professionals, and to self. The following Principles adopted by the
American Medical Association are not laws, but standards of conduct which define
the essentials of honorable behavior for the physician.
Among the Principles are:
III. A physician shall respect
the law and also recognize a responsibility to seek changes in those
requirements which are contrary to the best interests of the patient.
VII. A physician shall recognize
a responsibility to participate in activities contributing to the improvement of
the community and the betterment of public health.
VIII. A physician shall, while
caring for a patient, regard responsibility to the patient as paramount.
“Medical Ethics” web page, the AMA has a link to the “Public Health”
page. Presumably they are related.
“Public Health” web page the AMA has a link to the “Obesity” page.
Presumably they are related. Okay.
“Obesity” web page, the following is posted:
U.S. Surgeon General Richard
Carmona, MD called it the greatest threat to public health today. It kills more
Americans every year than AIDS, all cancers and all accidents combined. And it's
causing problems in children that were unthinkable 20 years ago. That is why the
American Medical Association (AMA) is working to halt the spread of obesity.
Leaders in the field of
preventive health, pediatrics, family practice, nutrition and more, convened at
AMA headquarters in Chicago for the first meeting of the AMA Working Group on
Managing Childhood Obesity. Their goal: to develop a set of strategies to help
physicians more effectively work with families, youth-serving organizations,
school health professionals, public health organizations and community groups to
reduce overweight and obesity and to eliminate racial and ethnic disparities in
The AMA has also been
collaborating with the U.S. Department of Health and Human Services to produce a
series of publications entitled, Roadmaps for Clinical Practice – Case Studies
in Disease Prevention and Health Promotion. Roadmaps help physicians and other
health professionals identify and reduce health disparities by integrating
focused interventions into routine medical care. The latest edition, Assessment
and Management of Adult Obesity is now available online.
to qualify for funding under the Child Abuse Prevention and Treatment Act (CAPTA)
1996 version), 42 U.S.C. 5101, et seq., all 50 states have passed some form of a
mandatory child abuse and neglect reporting law.
The Act was originally passed in 1974.
It has been amended several times and was amended and reauthorized on
October 3, 1996, by the Child Abuse Prevention and Treatment and Adoption Act
Amendments of 1996 (P.L. 104-235).
“the term ‘child abuse and neglect’ means, at a minimum, any recent act or
failure to act on the part of a parent or caretaker, which results in death,
serious physical or emotional harm, sexual abuse or exploitation, or an act or
failure to act which presents an imminent risk of serious harm.”
require certain professionals and institutions to report suspected child abuse,
including health care providers and facilities.
to report suspected child abuse can result in civil liability or criminal
liability (although the liability is typically a misdemeanor punishable by a
requires states to enact legislation that provides for immunity from prosecution
arising out of the reporting abuse or neglect. In most states, a person who
reports in "good faith," i.e., not maliciously, is immune from
criminal and civil liability.
But here is where I get stuck.
Isn’t the AMA saying that overweight or obesity
“results in…serious physical…harm” to children?
Now if the AMA really believed that obesity is
“the greatest threat to public
“kills more Americans every year than AIDS, all cancers and all accidents combined” and is
“causing problems in children that were unthinkable 20 years ago”
“respect the law,”
“recognize a responsibility to participate in activities contributing to the improvement of the community and the betterment of public health” and
“regard responsibility to the patient as paramount”
by “working to halt the spread of obesity” and call for
physicians, i.e., health care providers, to report obese children (at the very
least) to the authorities under CAPTA?
If physicians “must recognize responsibility to patients
first and foremost, as well as to society,” following the law would seem like
a good beginning.
This certainly seems like one way “to help physicians more effectively work …to reduce overweight and obesity…”
What am I missing here?
Somebody help me, please.