AMA Journal of Ethics®

Illuminating the art of medicine

Journal of Ethics Header

AMA Journal of Ethics®

Illuminating the art of medicine

Virtual Mentor. September 1999, Volume 1, Number 1.

Cases in Law and Ethics

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  • If a Colleague is Impaired

    The journal will feature case studies providing legal and/or ethical opinions to assist students in ethical decision-making and acquaint them with case law. This month's issue explores what a medical student should do about a fellow student's drinking.

Both ethics and law address norms that govern physicians’ behavior. Many view the law as a baseline for articulating the limits placed on individuals living within society as well as an enabling device to facilitate social relationships. Encompassing as the law may be in some areas of human conduct, in many others, it is silent. In the absence of legal norms or prohibitions, physicians often find guidance in the standards arrived at through ethical reasoning.

To guide students through the process of ethical reasoning and to acquaint them with case law, a new case study will appear every 2 to 4 weeks. Students will be given legal and/or ethical opinions to assist their decision-making.

September Case Scenario

Tom and Jack have been friends since the start of medical school, and are about to start their third-year rotations. Tom considers himself a social drinker, but he noticed that Jack has been drinking more and more over the last year. Tom was not concerned about this during the 2 years of basic science training, but now that Jack will start seeing patients on a more regular basis, he has become worried. He wants to get some help, but does not want to strain his friendship.

  • What should Tom do?
  • AMA Code of Medical Ethics Opinion E-8.15 on substance abuse, E-9.031 on reporting impaired, incompetent or unethical colleagues, and E-9.04 on discipline and medicine, as well as AMSA principles regarding physician impairment and substance use, all speak to the issues facing Tom. Are these opinions and principles helpful in your decision-making regarding this case? Why or why not?

Further Reading

  • Hughes PH, Brandenburg N, Baldwin DC Jr, et al. Prevalence of substance use among US physicians. JAMA. 1992;267:2333-2339.
  • Tyssen R, Vaglum P, Aasland OG, Gronvold NT, Ekeberg O. Use of alcohol to cope with tension, and its relation to gender, years in medical school and hazardous drinking: a study of 2 nation-wide Norwegian samples of medical students. Addiction. 1998;93:1341-1349. Abstract of article at: MEDLINE. Accessed September 8, 1999.
  • Gray JD, Bhopal RS, White M. Developing a medical school alcohol policy. Med Educ. 1998;32:138-142.
  • Mesquita AM, Laranjeira R, Dunn J. Psychoactive drug use by medical students: a review of the national and international literature. Rev Paul Med. January-February 1997;115:1356-1365.
  • O'Connor PG, Spickard A Jr. Physician impairment by substance abuse. Med Clin North Am. 1997;81:1037-1052.
  • Croen LG, Woesner M, Herman M, Reichgott M. A longitudinal study of substance use and abuse in a single class of medical students. Acad Med. 1997;72:376-381.
  • Murray M, Fleming M. Prevention and treatment of alcohol-related problems: an international and medical education model. Acad Med. 1996;71:1204-1210.
The viewpoints expressed on this site are those of the authors and do not necessarily reflect the views and policies of the AMA.