This Member Code of Ethics (Code) is applicable to all members of the American College of Occupational and Environmental Medicine (ACOEM). It addresses both general ethical issues and those that are distinctive, e.g., ethical issues that are encountered in the practice of occupational and environmental medicine.
ACOEM recognizes that many health professionals covered by this Code also engage in other areas of practice not described as clinical or public health. These areas include work in the research, teaching, medical/legal, administrative, managerial, regulatory, and insurance realms. ACOEM believes that the fundamental values that underlie its Code apply to health professionals practicing in all of these areas.
Fundamental Beliefs and Values
Compliance with laws, rules, and policies does not ensure that an act is ethical. When making a decision about an act, consider the following axioms.
Beneficence/Nonmaleficence, Autonomy, and Justice
- An act that is legal does not mean it is right or ethical
- An act that is illegal does not mean it is wrong or unethical
- An act that is ethical or right does not mean it is legal
are three fundamental values that are widely recognized in the health care professions and serve here as the basis of the ACOEM Code of Ethics
- BENEFICENCE/NONMALEFICENCE: Beneficence acknowledges that the health professional’s primary role is to do good for the patient. Nonmaleficence acknowledges that the health professional first shall at least try not to make things worse.
- AUTONOMY: Autonomy acknowledges that a patient has the right to decide what is in their best interest.
- JUSTICE: Justice requires ACOEM members to promote a fair distribution of health resources and to work actively to oppose discrimination. This value promotes policies that aspire to reduce inequities and protect or improve the health of all workers and communities.
Balancing Bioethical Values
- In bioethics, none of the fundamental values are viewed as inherently morally pre-eminent. In the practice of clinical medicine, the value of autonomy has been highly weighted. In contrast, the claims of the autonomous individual are weighted less in public health practice.2
- This Code provides ACOEM members a framework of ethical guidance – recognizing that many challenging and difficult decisions will be encountered regarding the conflict between right or wrong behavior and ethical values.
Ethical Principle I: Our Primary Ethical Obligation and Responsibility is to Patient Care and Well-being
- ACOEM members’ ethical obligation is to prioritize the health, welfare, and safety of workers, patients, the public, communities, and society as a whole.
Ethical Principle II: Take Affirmative Measures to Ensure a Safe and Healthy Workplace AND Environment
- ACOEM members strive to protect the health of workers and their environments.
- ACOEM members take affirmative measures for the prevention and amelioration of risks in the workplace and environment that can reasonably be expected to cause harm.
Ethical Principle III: Exhibit Professional Behavior
- ACOEM members conduct professional activities with integrity, honesty, and transparency.
- ACOEM members responsibly address unethical conduct.
Ethical Principle IV: Support Health and Well-being
- ACOEM members strive to maintain personal health in order to care for others.
- ACOEM members recognize and acknowledge impairments, including substance-related and mental disorders, in themselves and others that interfere with the ability to follow this Code.
- ACOEM members intervene in situations of impaired professionals and assist colleagues in distress.
- ACOEM members with impairments that compromise their ability to practice with a reasonable degree of skill and safety refrain from practice until remediation is accomplished.
Ethical Principle V: Oppose Racism and Discrimination
- ACOEM members build relationships of trust and confidence with the people for whom they provide services.
- All people with whom ACOEM members come in contact are treated in an equitable manner, without any form of discrimination.
- ACOEM members strive to identify and overcome bias or stereotypes which may affect medical care and decision making both in individual patients and in the populations served.
- ACOEM and its members avoid racist and discriminatory content in presentations and publications.
Ethical Principle VI: Maintain Professional Competence
- ACOEM members maintain individual competence and expertise based on current scientific evidence and technical knowledge.
- ACOEM members remain knowledgeable and engage in life-long learning regarding work, work-related hazards, and the environments of those whom they serve, applying appropriate methods to eliminate or minimize risks and recognizing when to call upon specialized expert advice.
- ACOEM members express concerns regarding inappropriate medical care and intervene to protect patients.
Ethical Principle VII: Maintain Patient Confidentiality
- ACOEM members keep confidential all individual medical, health promotion, and health screening information, only releasing such information:
- with proper authorization when required by law,
- for overriding public health considerations,
- to other health care professionals according to accepted medical practice,
- to others at the request of the individual, or
- when there is reasonable concern about potential endangerment of third parties.
- ACOEM members are especially protective of highly sensitive information.3
Ethical Principle VIII: Advise and Report
- In the context of patient care activities, ACOEM members disclose all significant observations about an individual’s health and health risk to that individual in a timely manner.
- In the context of patient care activities, ACOEM members provide advice about interventions available to restore, sustain, and improve health or prevent illness.
- ACOEM members, while maintaining privacy and confidentiality, report findings and observations that may be detrimental to the health and well-being of other individuals or populations. Reports must be made to those in a position to respond including:
- scientific community
- employee representatives
- relevant government agencies (including law enforcement)
Ethical Principle IX: Disclose and mitigate Conflicts of Interest
- ACOEM members identify and mitigate conflicts of interest.
- ACOEM members understand that a conflict of interest, while a common condition, is determined by circumstances, that may influence actions or outcomes. A conflict exists when actions are influenced or perceived to be influenced, and a conflict exists whether or not a breach of trust occurs.
- ACOEM members understand that disclosure of conflicts of interest alone are insufficient to mitigate the conflict.4
- Conflicts of interest may be avoided, when ACOEM members disengage or recuse themselves from potentially conflicted interactions. When circumstances do not allow avoidance, then members should mitigate the conflict with full disclosure to, and acceptance from, all affected parties.
Notes and References:
1 The Charter on Medical Professionalism, developed by the Medical Professionalism Project, was published in the Annals of Internal Medicine in 2002 (ABIM Foundation. American Board of Internal Medicine; ACP-ASIM Foundation. American College of Physicians-American Society of Internal Medicine; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002;136(3):243-6.). The full text is available www.annals.org/cgi/content/full/136/3/243. (The charter is the product of several years of work by leaders in the ABIM Foundation, the ACP–ASIM Foundation, and the European Federation of Internal Medicine.)
2 Kass NE. An ethics framework for public health. Am J Public Health. 2001;91(11):1776-82. This article is available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1446875/.
3 Additional guidance is contained in the 2012position statement of the ACOEM Committee on Ethical Practice in Occupational and Environmental Medicine. This statement, Confidentiality of Medical Information in the Workplace, is available at https://acoem.org/acoem/media/News-Library/Confidentiality-of-Medical-Information-in-Workplace.pdf.
4 Examples of circumstances where a conflict of interest might occur and be identified, avoided or mitigated include, but are not limited to:
These are ethical principles and are not to be interpreted as condoning violations of any laws. The Ethics Committee is cognizant that laws and ethics overlap and are not identical. Lawful acts may be inconsistent with ethical principles and ethical acts may be unlawful. For example, providing food, transportation for medical aid, and shelter to an illegal border crosser may be ethical but it is in violation of U.S. Immigration and Naturalization Act (INA §274). Segregation was legal in the U.S. after the 1896 Supreme Court Plessy v. Ferguson decision, yet it was not ethical. Plessy was overturned sixty years later by the 1954 Supreme Court Decision in Brown v. Board of Education.
- Presentations at educational events
- Involvement in creation of guidelines or standards
- Editorial boards or peer review of journals
- Referral to entities where one has a financial interest
- Reporting hazardous events, environmental conditions, processes, etc. that endanger workers’ or public health
Revised November 5, 2022 by the ACOEM Board of Directors