ACEP’s policy statement on emergency physician rights and responsibilities also supports autonomy in clinical decision making that is not restricted by cost-saving guidelines and rights to reasonable compensation, due process, and freedom from unreasonably restrictive agreements limiting the ability to practice medicine after separation. Also listed in this policy statement are the responsibilities of the emergency physician, including to practice ethical, current, and evidence-based medicine and to obtain basic knowledge of the business of emergency medicine, among others.

The Code of Ethics and related policy statements also discuss the potential for conflicts of interest among emergency physicians. At an individual level, ACEP recognizes that emergency physicians should be able to interact with industry representatives, particularly to obtain important product information. Emergency physicians need to consider the purpose and consequences of accepting gifts offered by industry. ACEP believes that treatment choices should be solely based on risks and benefits to the patient. Professional services such as research or providing CME can be compensated by industry but only at fair market value.

On an organizational level, ACEP policy states that those ACEP members in a position of College responsibility and with a fiduciary duty to the College must act in good faith on behalf of the College. Conflicts arise when these individuals have personal, financial, business, or professional interests that could interfere with their ACEP duties. For potential conflicts of interest that do not relate significantly to College duties, disclosure may be sufficient. If potential conflicts do relate to College activities, disclosure and recusal may be required. In the case of a serious irreconcilable conflict, resignation from the position within the College or from the conflicting entity may be indicated.

Clearly, potential ethical violations can arise if commercial influence unduly affects either the employment conditions of emergency physicians or how they provide clinical care. What is unclear is how an ethical violation in this realm might be judged. One can imagine a scenario where one ACEP member alleges a violation by another related to an employment or other commercial relationship. The question of whether the necessary combination of ethical and business expertise exists, without personal conflicts of interest in the College to evaluate such a complaint, is one that will require careful consideration moving forward.

Conclusion

The ACEP Code of Ethics and related policy statements provide a framework by which emergency physicians articulate and uphold their ethical obligations in their professional lives. While, to date, the ethics complaints brought by members have focused on expert witness testimony, the Code of Ethics extends well beyond that issue. This broader context should lead to consideration by ACEP members as to how they meet their obligations, whether other potential ethical violations are taking place, and, if so, how these issues can best be addressed and resolved.