Patient-physician covenant.

Medicine is, at its center, a moral enterprise grounded in a covenant of trust. This covenant obliges physicians to be competent and to use their competence in the patient’s best interests. Physicians, therefore, are both intellectually and morally obliged to act as advocates for the sick wherever their welfare is threatened and for their health at all times. Today, this covenant of trust is significantly threatened. From within, there is growing legitimation of the physician’s materialistic self-interest; from without, forprofit forces press the doctor into the role of commercial agent to enhance the profitability ofhealth care organizations. Such distortions of the doctor’s responsibil ity degrade the doctor/patient relationship which is the central element and structure of clinical care. To capitulate to these alterations of the trust relationship is to significantly alter the doctor’s role as healer, carer helper and advocate for the sick, and for the health of all. By its traditions and very nature, medicine is a special kind of human activity— one which cannot be pursued effectively without the virtues of humility, honesty, intellectual integrity, compassion and effacement of excessive self-interest. These traits mark doctors as members of a moral community dedicated to something other than its own self-interest. Our first obligation must be to serve the good of those persons who seek our help and trust us to provide it. Physicians, as physicians, are not and must never be commercial entrepreneurs, gateclosers, or agents of fiscal policy that runs counter to our trust. Any defection from primacy of the patient’s well-being places the patient at risk by treatment which may compromise quality of or access to medical care. We believe the medical profession must reaffirm the primacy of its obligation to the patient through national, state, and local professional societies, our academic, research and hospital organizations, and especially through personal behavior. As advocates for the promotion of health and support of the sick we are called upon to discuss, defend and promulgate medical care by every ethical means available. Only by caring and advocating for the patient can the integrity of our profession be affirmed. Thus we honor our covenant of trust with patients.