The Patient-Physician Covenant

This is excerpted from Crawshaw R, Rogers DE, Pellegrino ED, et. al. Patient-physician covenant. JAMA 1995; 273: 1553.

Medicine is, at its centre, a moral enterprise grounded in a covenant of trust. The 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 whereever their welfare is threatened and for their health at all times [...]

By its traditions and very nature, medicine is a special kind of human activity - one that cannot be pursued effectively without the virtues of humility, honesty, intellectual integrity, compassion, and effacement of excessive self-interest. These traits mark physicians 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 that may compromise quality of or access to medical care [...]

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 the covenant of trust with patients.