South Dakota Administrative Rules › Title 20 - PUBLIC SAFETY › Article 20:52 - PHYSICIAN'S ASSISTANTS › Chapter 20:47:02 - ETHICS › Section 20:52:02:01 - Code of ethics

Current through Register Vol. 51, page 10, July 15, 2024
A licensee under SDCL 36-4A shall comply with the following
				  code of ethics.
Statement of Values of the Physician Assistant
				  Profession
* Physician assistants hold as their primary responsibility
				  the health, safety, welfare, and dignity of all human beings.
* Physician assistants uphold the tenets of patient
				  autonomy, beneficence, nonmaleficence, and justice.
* Physician assistants recognize and promote the value of
				  diversity.
* Physician assistants treat equally all persons who seek
				  their care.
* Physician assistants hold in confidence the information
				  shared in the course of practicing medicine.
* Physician assistants assess their personal capabilities
				  and limitations, striving always to improve their medical practice.
* Physician assistants actively seek to expand their
				  knowledge and skills, keeping abreast of advances in medicine.
* Physician assistants work with other members of the health
				  care team to provide compassionate and effective care of patients.
* Physician assistants use their knowledge and experience to
				  contribute to an improved community.
* Physician assistants respect their professional
				  relationship with physicians.
* Physician assistants share and expand knowledge within the
				  profession.
The PA and Patient
PA Role and Responsibilities
Physician assistant practice flows out of a unique
				  relationship that involves the PA, the physician, and the patient. The
				  individual patient-PA relationship is based on mutual respect and an agreement
				  to work together regarding medical care. In addition, PAs practice medicine
				  with physician supervision; therefore, the care that a PA provides is an
				  extension of the care of the supervising physician. The patient-PA relationship
				  is also a patient-PA-physician relationship.
The principal value of the physician assistant profession is
				  to respect the health, safety, welfare, and dignity of all human beings. This
				  concept is the foundation of the patient-PA relationship.
Physician assistants have an ethical obligation to see that
				  each of their patients receives appropriate care. PAs should be sensitive to
				  the beliefs and expectations of the patient. PAs should recognize that each
				  patient is unique and has an ethical right to self-determination.
Physician assistants are professionally and ethically
				  committed to providing nondiscriminatory care to all patients. While PAs are
				  not expected to ignore their own personal values, scientific or ethical
				  standards, or the law, they should not allow their personal beliefs to restrict
				  patient access to care. A PA has an ethical duty to offer each patient the full
				  range of information on relevant options for their health care. If personal
				  moral, religious, or ethical beliefs prevent a PA from offering the full range
				  of treatments available or care the patient desires, the PA has an ethical duty
				  to refer a patient to another qualified provider. That referral should not
				  restrict a patients access to care. PAs are obligated to care for patients in
				  emergency situations and to responsibly transfer patients if they cannot care
				  for them.
Physician assistants should always act in the best interests
				  of their patients and as advocates when necessary. PAs should actively resist
				  policies that restrict free exchange of medical information. For example, a PA
				  should not withhold information about treatment options simply because the
				  option is not covered by insurance. PAs should inform patients of financial
				  incentives to limit care, use resources in a fair and efficient way, and avoid
				  arrangements or financial incentives that conflict with the patients best
				  interests.
The PA and Diversity
The physician assistant should respect the culture, values,
				  beliefs, and expectations of the patient.
Nondiscrimination
Physician assistants should not discriminate against classes
				  or categories of patients in the delivery of needed health care. Such classes
				  and categories include gender, color, creed, race, religion, age, ethnic or
				  national origin, political beliefs, nature of illness, disability,
				  socioeconomic status, physical stature, body size, gender identity, marital
				  status, or sexual orientation.
Initiation and Discontinuation of Care
In the absence of a preexisting patient PA relationship, the
				  physician assistant is under no ethical obligation to care for a person unless
				  no other provider is available. A PA is morally bound to provide care in
				  emergency situations and to arrange proper follow-up. PAs should keep in mind
				  that contracts with health insurance plans might define a legal obligation to
				  provide care to certain patients.
A physician assistant and supervising physician may
				  discontinue their professional relationship with an established patient as long
				  as proper procedures are followed. The PA and physician should provide the
				  patient with adequate notice, offer to transfer records, and arrange for
				  continuity of care if the patient has an ongoing medical condition.
				  Discontinuation of the professional relationship should be undertaken only
				  after a serious attempt has been made to clarify and understand the
				  expectations and concerns of all involved parties.
If the patient decides to terminate the relationship, they
				  are entitled to access appropriate information contained within their medical
				  record.
Informed Consent
Physician assistants have a duty to protect and foster an
				  individual patients free and informed choices. The doctrine of informed consent
				  means that a PA provides adequate information that is comprehendible to a
				  competent patient or patient surrogate. At a minimum, this should include the
				  nature of the medical condition, the objectives of the proposed treatment,
				  treatment options, possible outcomes, and the risks involved. PAs should be
				  committed to the concept of shared decision making, which involves assisting
				  patients in making decisions that account for medical, situational, and
				  personal factors.
In caring for adolescents, the PA should understand all of
				  the laws and regulations in his or her jurisdiction that are related to the
				  ability of minors to consent to or refuse health care.
Adolescents should be encouraged to involve their families in
				  health care decision making. The PA should also understand consent laws
				  pertaining to emancipated or mature minors. (See the section on
Confidentiality
.)
When the person giving consent is a patients surrogate, a
				  family member, or other legally authorized representative, the PA should take
				  reasonable care to assure that the decisions made are consistent with the
				  patients best interests and personal preferences, if known. If the PA believes
				  the surrogates choices do not reflect the patients wishes or best interests,
				  the PA should work to resolve the conflict. This may require the use of
				  additional resources, such as an ethics committee.
Confidentiality
Physician assistants should maintain confidentiality. By
				  maintaining confidentiality, PAs respect patient privacy and help to prevent
				  discrimination based on medical conditions. If patients are confident that
				  their privacy is protected, they are more likely to seek medical care and more
				  likely to discuss their problems candidly.
In cases of adolescent patients, family support is important
				  but should be balanced with the patients need for confidentiality and the PAs
				  obligation to respect their emerging autonomy.
Adolescents may not be of age to make independent decisions
				  about their health, but providers should respect that they soon will be. To the
				  extent they can, PAs should allow these emerging adults to participate as fully
				  as possible in decisions about their care. It is important that PAs be familiar
				  with and understand the laws and regulations in their jurisdictions that relate
				  to the confidentiality rights of adolescent patients. (See the section on
Informed Consent
.)
Any communication about a patient conducted in a manner that
				  violates confidentiality is unethical. Because written, electronic, and verbal
				  information may be intercepted or overheard, the PA should always be aware of
				  anyone who might be monitoring communication about a patient.
PAs should choose methods of storage and transmission of
				  patient information that minimize the likelihood of data becoming available to
				  unauthorized persons or organizations. Computerized record keeping and
				  electronic data transmission present unique challenges that can make the
				  maintenance of patient confidentiality difficult. PAs should advocate for
				  policies and procedures that secure the confidentiality of patient
				  information.
The Patient and the Medical Record
Physician assistants have an obligation to keep information
				  in the patients medical record confidential. Information should be released
				  only with the written permission of the patient or the patients legally
				  authorized representative. Specific exceptions to this general rule may exist
				  (e.g., workers compensation, communicable disease, HIV, knife/gunshot wounds,
				  abuse, and substance abuse). It is important that a PA be familiar with and
				  understands the laws and regulations in his or her jurisdiction that relate to
				  the release of information. For example, stringent legal restrictions on
				  release of genetic test results and mental health records often exist.
Both ethically and legally, a patient has certain rights to
				  know the information contained in his or her medical record. While the chart is
				  legally the property of the practice or the institution, the information in the
				  chart is the property of the patient. Most states have laws that provide
				  patients access to their medical records. The PA should know the laws and
				  facilitate patient access to the information.
Disclosure
A physician assistant should disclose to his or her
				  supervising physician information about errors made in the course of caring for
				  a patient. The supervising physician and PA should disclose the error to the
				  patient if such information is significant to the patients interests and
				  well-being. Errors do not always constitute improper, negligent, or unethical
				  behavior, but failure to disclose them may.
Care of Family Members and Co-workers
Treating oneself, co-workers, close friends, family members,
				  or students whom the physician assistant supervises or teaches may be unethical
				  or create conflicts of interest. For example, it might be ethically acceptable
				  to treat ones own child for a case of otitis media but it probably is not
				  acceptable to treat ones spouse for depression. PAs should be aware that their
				  judgment might be less than objective in cases involving friends, family
				  members, students, and colleagues and that providing curbside care might sway
				  the individual from establishing an ongoing relationship with a provider. If it
				  becomes necessary to treat a family member or close associate, a formal
				  patient-provider relationship should be established, and the PA should consider
				  transferring the patients care to another provider as soon as it is practical.
				  If a close associate requests care, the PA may wish to assist by helping them
				  find an appropriate provider.
There may be exceptions to this guideline, for example, when
				  a PA runs an employee health center or works in occupational medicine. Even in
				  those situations, the PA should be sure they do not provide informal treatment,
				  but provide appropriate medical care in a formally established patient-provider
				  relationship.
Genetic Testing
Evaluating the risk of disease and performing diagnostic
				  genetic tests raise significant ethical concerns. Physician assistants should
				  be informed about the benefits and risks of genetic tests.
Testing should be undertaken only after proper informed
				  consent is obtained. If PAs order or conduct the tests, they should assure that
				  appropriate pre- and post-test counseling is provided.
PAs should be sure that patients understands the potential
				  consequences of undergoing genetic tests - from impact on patients themselves,
				  possible implications for other family members, and potential use of the
				  information by insurance companies or others who might have access to the
				  information. Because of the potential for discrimination by insurers,
				  employers, or others, Pas should be particularly aware of the need for
				  confidentiality concerning genetic test results.
Reproductive Decision Making
Patients have a right to access the full range of
				  reproductive health care services. Physician assistants have an ethical
				  obligation to provide balanced and unbiased clinical information about
				  reproductive health care.
When the PA's personal values conflict with providing full
				  disclosure or providing certain services, the PA need not become involved in
				  that aspect of the patient's care. By referring the patient to a qualified
				  provider who is willing to discuss and facilitate all treatment options, the PA
				  fulfills their ethical obligation to ensure the patients access to all legal
				  options.
End of Life
Among the ethical principles that are fundamental to
				  providing compassionate care at the end of life, the most essential is
				  recognizing that dying is a personal experience and part of the life
				  cycle.
Physician Assistants should provide patients with the
				  opportunity to plan for end of life care.
Advance directives, living wills, durable power of attorney,
				  and organ donation should be discussed during routine patient visits.
PAs should assure terminally-ill patients that their dignity
				  is a priority and that relief of physical and mental suffering is paramount.
				  PAs should exhibit non-judgmental attitudes and should assure their
				  terminally-ill patients that they will not be abandoned. To the extent
				  possible, patient or surrogate preferences should be honored, using the most
				  appropriate measures consistent with their choices, including alternative and
				  non-traditional treatments. PAs should explain palliative and hospice care and
				  facilitate patient access to those services. End of life care should include
				  assessment and management of psychological, social, and spiritual or religious
				  needs.
While respecting patients wishes for particular treatments
				  when possible, PAs also must weigh their ethical responsibility, in
				  consultation with supervising physicians, to withhold futile treatments and to
				  help patients understand such medical decisions.
PAs should involve the physician in all near-death planning.
				  The PA should only withdraw life support with the supervising physician's
				  agreement and in accordance with the policies of the health care
				  institution.
The PA and Individual Professionalism
Conflict of Interest
Physician assistants should place service to patients before
				  personal material gain and should avoid undue influence on their clinical
				  judgment. Trust can be undermined by even the appearance of improper influence.
				  Examples of excessive or undue influence on clinical judgment can take several
				  forms. These may include financial incentives, pharmaceutical or other industry
				  gifts, and business arrangements involving referrals. PAs should disclose any
				  actual or potential conflict of interest to their patients.
Acceptance of gifts, trips, hospitality, or other items is
				  discouraged. Before accepting a gift or financial arrangement, PAs might
				  consider the guidelines of the Royal College of Physicians, Would I be willing
				  to have this arrangement generally known? or of the American College of
				  Physicians, What would the public or my patients think of this
				  arrangement?
Professional Identity
Physician assistants should not misrepresent directly or
				  indirectly, their skills, training, professional credentials, or identity.
				  Physician assistants should uphold the dignity of the PA profession and accept
				  its ethical values.
Competency
Physician assistants should commit themselves to providing
				  competent medical care and extend to each patient the full measure of their
				  professional ability as dedicated, empathetic health care providers. PAs should
				  also strive to maintain and increase the quality of their health care
				  knowledge, cultural sensitivity, and cultural competence through individual
				  study and continuing education.
Sexual Relationships
It is unethical for physician assistants to become sexually
				  involved with patients. It also may be unethical for PAs to become sexually
				  involved with former patients or key third parties. Key third parties are
				  individuals who have influence over the patient. These might include spouses or
				  partners, parents, guardians, or surrogates.
Such relationships generally are unethical because of the PAs
				  position of authority and the inherent imbalance of knowledge, expertise, and
				  status. Issues such as dependence, trust, transference, and inequalities of
				  power may lead to increased vulnerability on the part of the current or former
				  patients or key third parties.
Gender Discrimination and Sexual
				  Harassment
It is unethical for physician assistants to engage in or
				  condone any form of gender discrimination. Gender discrimination is defined as
				  any behavior, action, or policy that adversely affects an individual or group
				  of individuals due to disparate treatment, disparate impact, or the creation of
				  a hostile or intimidating work or learning environment.
It is unethical for PAs to engage in or condone any form of
				  sexual harassment. Sexual harassment is defined as unwelcome sexual advances,
				  requests for sexual favors, or other verbal or physical conduct of a sexual
				  nature when:
* Such conduct has the purpose or effect of interfering with
				  an individual's work or academic performance or creating an intimidating,
				  hostile or offensive work or academic environment, or
* Accepting or rejecting such conduct affects or may be
				  perceived to affect professional decisions concerning an individual, or
* Submission to such conduct is made either explicitly or
				  implicitly a term or condition of an individual's training or professional
				  position.
The PA and Other Professionals
Team Practice
Physician assistants should be committed to working
				  collegially with other members of the health care team to assure integrated,
				  well-managed, and effective care of patients. PAs should strive to maintain a
				  spirit of cooperation with other health care professionals, their
				  organizations, and the general public.
Illegal and Unethical Conduct
Physician assistants should not participate in or conceal any
				  activity that will bring discredit or dishonor to the PA profession. They
				  should report illegal or unethical conduct by health care professionals to the
				  appropriate authorities.
Impairment
Physician assistants have an ethical responsibility to
				  protect patients and the public by identifying and assisting impaired
				  colleagues. Impaired means being unable to practice medicine with reasonable
				  skill and safety because of physical or mental illness, loss of motor skills,
				  or excessive use or abuse of drugs and alcohol.
PAs should be able to recognize impairment in physician
				  supervisors, PAs, and other health care providers and should seek assistance
				  from appropriate resources to encourage these individuals to obtain
				  treatment.
PA Physician Relationship
Supervision should include ongoing communication between the
				  physician and the physician assistant regarding patient care. The PA should
				  consult the supervising physician whenever it will safeguard or advance the
				  welfare of the patient. This includes seeking assistance in situations of
				  conflict with a patient or another health care professional.
Complementary and Alternative Medicine
When a patient asks about an alternative therapy, the PA has
				  an ethical obligation to gain a basic understanding of the alternative therapy
				  being considered or being used and how the treatment will affect the patient.
				  If the treatment would harm the patient, the PA should work diligently to
				  dissuade the patient from using it, advise other treatment, and perhaps
				  consider transferring the patient to another provider.
The PA and the Health Care System
Workplace Actions
Physician assistants may face difficult personal decisions to
				  withhold medical services when workplace actions (e.g., strikes, sick-outs,
				  slowdowns, etc.) occur. The potential harm to patients should be carefully
				  weighed against the potential improvements to working conditions and,
				  ultimately, patient care that could result. In general, PAs should individually
				  and collectively work to find alternatives to such actions in addressing
				  workplace concerns.
PAs as Educators
All physician assistants have a responsibility to share
				  knowledge and information with patients, other health professionals, students,
				  and the public. The ethical duty to teach includes effective communication with
				  patients so that they will have the information necessary to participate in
				  their health care and wellness.
PAs and Research
The most important ethical principle in research is honesty.
				  This includes assuring subjects informed consent, following treatment
				  protocols, and accurately reporting findings. Fraud and dishonesty in research
				  should be reported so that the appropriate authorities can take action.
Physician assistants involved in research must be aware of
				  potential conflicts of interest. The patient's welfare takes precedence over
				  the desired research outcome. Any conflict of interest should be
				  disclosed.
In scientific writing, PAs should report information honestly
				  and accurately. Sources of funding for the research must be included in the
				  published reports.
Plagiarism is unethical. Incorporating the words of others,
				  both verbatim or by paraphrasing, without appropriate attribution is unethical
				  and may have legal consequences. When submitting a document for publication,
				  any previous publication of any portion of the document must be fully
				  disclosed.
PAs as Expert Witnesses
The physician assistant expert witness should testify to what
				  he or she believes to be the truth. The PAs review of medical facts should be
				  thorough, fair, and impartial.
The PA expert witness should be fairly compensated for time
				  spent preparing, appearing, and testifying. The PA should not accept a
				  contingency fee based on the outcome of a case in which testimony is given or
				  derive personal, financial, or professional favor in addition to
				  compensation.
The PA and Society
Lawfulness
Physician assistants have the dual duty to respect the law
				  and to work for positive change to laws that will enhance the health and
				  well-being of the community.
Executions
Physician assistants, as health care professionals, should
				  not participate in executions because to do so would violate the ethical
				  principle of beneficence.
Access to Care / Resource Allocation
Physician assistants have a responsibility to use health care
				  resources in an appropriate and efficient manner so that all patients have
				  access to needed health care. Resource allocation should be based on societal
				  needs and policies, not the circumstances of an individual patient PA
				  encounter. PAs participating in policy decisions about resource allocation
				  should consider medical need, cost-effectiveness, efficacy, and equitable
				  distribution of benefits and burdens in society.
Community Well Being
Physician assistants should work for the health, well-being,
				  and the best interest of both the patient and the community. Sometimes there is
				  a dynamic moral tension between the well-being of the community in general and
				  the individual patient. Conflict between an individual patients best interest
				  and the common good is not always easily resolved. In general, PAs should be
				  committed to upholding and enhancing community values, be aware of the needs of
				  the community, and use the knowledge and experience acquired as professionals
				  to contribute to an improved community.
Conclusion
The American Academy of Physician Assistants recognizes its
				  responsibility to aid the PA profession as it strives to provide high quality,
				  accessible health care. Physician assistants wrote these guidelines for
				  themselves and other physician assistants. The ultimate goal is to honor
				  patients and earn their trust while providing the best and most appropriate
				  care possible. At the same time, PAs must understand their personal values and
				  beliefs and recognize the ways in which those values and beliefs can impact the
				  care they provide.
General Authority:
SDCL
					 36-4A-42
Law implemented:
SDCL
					 36-4A-37
American Academy of Physician Assistants Guidelines for
					 Ethical Conduct for the Physician Assistant Profession, 2013. Copies may be
					 obtained from https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=815 [File
					 Link Not Available].