A professional response to demands for accountability: Practical recommendations regarding ethical aspects of patient care

Abstract

Forceful new demands for accountability in medicine are arising from many interested parties. To maintain profes-sional standards, physicians need to establish which de-mands are desirable and which are not. We adopt a model of stratified accountability that includes three major com-ponents: the accountable parties, the subject matter, and the processes for accountability. To begin describing the model, we focus on physicians and health care institutions. We focus on the ethical dimensions of medical practice, both because the difficulty of measuring such behaviors makes this a test case for accountability and because of the importance of ethical standards in maintaining patient trust. We first identify eight widely endorsed content areas for accountability in ethical conduct: medical decisio