The first time most of us formally swear to uphold a code of ethics is at graduation from Medical School where we take the Hippocratic Oath. While much of the Oath is timeless (first do no harm, an obligation to teach others, and to practice only for the good of our patients) other aspects such as swearing by the gods Apollo, Asclepius, Hygeia and Panacea have not held up as well since the late fifth Century, B.C. More recently, the World Medical Association’s Declaration of Geneva has tried to bring the Code up to date for the third Millennium, A.D.

The ACC Code of Ethics: A Quick Reference Guide The ACC Code of Ethics outlines standards in reference to: Relationship with patients Relationship with other professionals Relationship with the ACC Relationship to the community and to government Continuing Medical Education responsibilities Expert witness testimony Conflicts of interest When charges alleging violations of the ACC Code of Ethics and/or ACC Bylaws are brought by an FACC against another FACC, the following hearing and adjudication rules, and professional conduct procedures are enacted in this order: Initiation of complaint Receipt and acknowledgement of complaint Initial evaluation Notice and hearing Request for hearing Composition of hearing panel Adjudication and hearing process Disciplinary review panel action Appeal to the Executive Committee Disclosure and reporting If you have any questions about the ACC Code of Ethics or how to initiate a complaint, contact Mark Fox in ACC’s Legal Affairs Office at mfox@acc.org or visit ACC.org/RWI.

In a 2003 President’s Page of the Journal of the American College of Cardiology, then-ACC President Carl Pepine, MD, MACC, urged for the creation of an ACC Code of Ethics for cardiologists. Pepine asked: “Without a set of ‘golden rules,’ are we absolutely certain where the College stands, or with whom?” He urged that, “An explicit Code of Ethics – declared, written and voted into policy – would further enable the ACC to clearly demonstrate its intentions and strengths for the benefit of all who might challenge our integrity, our altruism, or our zeal in pursuing our mission.”

More than a decade later, the ACC Code of Ethics, approved in 2006, sets forth the governing principles, values and beliefs shared by Fellows and other physician members of the ACC, as well as the ethical behavior and standards of conduct expected to conform within these principles and beliefs. It was constructed in recognition that as physicians we have obligations to patients, to the profession, to each other, to the community and to the society at large. All of us have sworn to follow the Code at the initiation ceremony and confirmed yearly as part of membership in the ACC.

The Code of Ethics is overseen by the Ethics and Discipline Committee composed of a committee chair and six members selected for their experience and probity, along with their diversity in geography and specialty.

Violations of the Code may lead to a member being “admonished, censored, placed on probation, suspended or expelled for violating the Code of Ethics in proceedings governed by the ACC Professional Conduct Program Hearing and Adjudication Rules” as outlined in the By-Laws of the ACC. Convictions of a felony in a court of law result in immediate expulsion. Only a Fellow of the ACC can bring an action against another Fellow for violating the College’s Code of Ethics.

The Code of Ethics is a living document and revisions have been made by the Board of Trustees to strengthen and clarify its language. In the past, updates have been made in reference to a variety of issues including a physician’s relationship with industry or embargo violations. More recently, the portion of the Code of Ethics referring to expert witness testimony has been modified in response to violations of that portion of the Code that have been brought to the committee.

Violations of the Expert Witness guidelines have been cited in the majority of the cases brought before the Ethics and Discipline Committee. The job of a professional expert witness is very much as a teacher. Expert witnesses are present to explain to a group of non-experts (lawyers, judge and jury) the issues involved in a case without taking an advocacy position. Medicine may be cut and dry but more often there are nuances that can be lost when one becomes an advocate. Our Code of Ethics requires that testimony be “fair, accurate, thorough and objective,” and “an expert witness must identify personal opinions not generally accepted by other cardiologists.” In a couple of recent cases, we have seen how easy it is to cross over the line between teaching and advocacy. This threatens to subvert the legal process and threatens our ethical duty to our profession and our patients.

While the Code of Ethics currently only includes protection for physician members of the College, we are investigating the need for a future update or separate documents to be more inclusive and echo the ACC’s strategic direction as the professional home for the entire cardiovascular care team.

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Article written by By Michael D. Freed, MD, MACC. Freed works in the Department of Cardiology at Boston Children’s Hospital and is chair of the ACC’s Ethics and Discipline Committee.

Keywords: Physicians, Expert Testimony, Codes of Ethics, Language, Hippocratic Oath, Trustees, Schools, Medical, Cardiology Magazine, ACC Publications

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