1. Background and Expectations
This document provides specific tenets for the behavior of all members for the American Academy of Clinical Toxicology (AACT). It is not intended to include all aspects of activities of the member, and those not included should not be assumed to be acceptable. This document applies to AACT members who are clinical toxicologists as defined as scientists and health care providers.
This document is intended to provide underlying ethical expectations upon which AACT members shall base their responsibilities and relationships to their patients, colleagues, society, health care professionals and science.
This document is intended to be interpreted and applied in conjunction with other AACT documents that may also be relevant to a particular circumstance, such as the AACT Bylaws or a conflict of interest or conduct policy.
Membership in AACT is contingent upon compliance with this Code of Ethics. The AACT Board of Trustees, through the President, may take disciplinary measures, including but not limited to censure or revocation of membership, against members who violate this Code, in accordance with established policies and procedures. The AACT Board of Directors may authorize an investigation by AACT of an alleged violation of this Code or may defer acting pending any investigation and decision by an appropriate institution or authority (e.g., a university, a court, or another professional society)
The AACT is committed to equal opportunity for all persons without regard to gender, age, race, color, religion, creed, national origin, marital status, disability, or sexual orientation. It is the policy of the AACT to comply with all federal, state and local laws and regulations regarding equal opportunity. In keeping with that policy, the AACT is committed to maintaining a professional environment that is free of discrimination and harassment. Accordingly, the AACT will not tolerate discrimination against or harassment of any of our members, by any of our members, or by others present at AACT functions, including vendors, clients of the AACT, or others.
Discrimination includes treating someone differently in opportunities for work (e.g., promotions, shifts, overtime, etc.) as well as professional opportunities within an organization such as AACT (e.g., elected AACT positions, publication of manuscripts, speaking opportunities) because of protected status (race, national origin, gender, age, religion, sexual orientation, disability or other protected attribute). Harassment consists of unwelcome or unwanted conduct, whether verbal, physical or visual, that is based upon a person’s protected status. Examples of harassment include words, gestures, stories, jokes or nicknames that are derogatory, demeaning or insulting to a person based upon race, national origin, gender, disability, age, religion or another protected attribute.
3. Maintenance of Professional Competency in Clinical Toxicology
Members will ensure the care provided to patients is safe, effective, and consistent with the most current and accepted practices in the field of toxicology. Members will practice within their areas of competence and expertise, consistent with their educational background, training and skill level. The practicing member-clinician must maintain competency and skills. This includes maintaining current health care professional licensure and meeting the requirements necessary to maintain their board certification in clinical toxicology. Members will discontinue practice in clinical toxicology if they become unable to maintain competency.
4. Patient Relationship(s)
As with other healthcare professionals, the members shall always have the principle of beneficence foremost in their minds, striving to provide recommendations, advice, and therapeutic plans that are in the best interest of their patients. Along with this determination to work toward their patients’ benefit, the clinical toxicologist must also endeavor to observe the code of non-maleficence, taking care that their recommendations or actions do not carry with them undue risk and questionable benefit.
These primary tenets of ethical patient care must be accompanied by conscientiously providing informed consent to patients regarding recommended medical therapies where available. Educating patients (or their surrogates) in regards to the rationale for recommendations, to the inherent risks and benefits, and to possible alternative treatments are key to the clinical toxicologist’s responsibility to allow their patients to make informed choices. Ultimately, a patient with the clear capacity to make decisions has the right to then do so in an autonomous fashion with their choices being respected. Given the key role of informed consent, members must be skilled at recognizing those patients that are lacking this decision-making capacity. When informed consent is not possible, careful and measured clinical judgment is required with emergent or lifesaving care being provided in a timely manner. Furthermore, a member has a responsibility to inform and educate patients with regard to any proposed testing or therapy that would not be in their best interest or potentially harmful. Patients who are considered “children” under the law can provide assent, but consent is obtained by the legal guardian.
While providing care for their patients, it is imperative for members to respect the sensitive nature of this relationship with their patient. Maintaining patient confidentiality and respecting their privacy are crucial to preserving open communication and trust. Patient information should only be released at a patient’s request (or that of their surrogate), to other healthcare professionals involved in the patient’s care, or as otherwise permitted by law.
In most circumstances, members should have the option to provide their services to patients of their choosing, however, there are ethical limits to this freedom. Within reason, acute care should be provided to all patients with an emergent or life-threatening clinical condition. Furthermore, a member shall not refuse to provide emergency care based on their protected status as defined in Section 2 as well as legal status or their ability to pay.
5. Relations with Colleagues and Other Professionals
Members are expected to uphold professional standards of conduct not only in their relationships with patients, but also in their relationships with other health care professionals. Acknowledging and utilizing the expertise of other health professions in patient care ensures optimum treatment. The relationship includes, but is not limited to, fairness, honesty, respect and integrity.
Members are encouraged to participate in peer-review activities to promote the best care for their patients. Members shall not unjustifiably criticize a colleague’s judgment, training, knowledge, or skills; however, members shall not knowingly ignore a colleague’s incompetence or professional misconduct.
Sexual harassment is unacceptable. Unwelcome sexual advances, requests for sexual favors and other verbal or physical conduct of a sexual nature may create an intimidating, hostile and/or abusive environment that is antithetical to the vision and mission of AACT. This includes behavior that may occur in the context of an official AACT function or at other times.
6. Relations with Business and Administration
Members shall cooperate with persons whose expertise is in the management and administration of health care systems to provide efficient care. Incentives from businesses shall not influence patient-centered clinical judgment. Members may not accept gifts in violation of the United States Government ethical rules.
Members have a responsibility to disclose any financial conflicts of interest to the AACT President or Executive Director prior to agreeing to participate in any invited AACT activity, including but not limited to presentations, continuing education activities, and written guideline or position papers. Consideration should also be given to whether action in addition to disclosure would be appropriate, such as recusal from relevant discussions or decision making.
The AACT logo is the property of the organization. Written permission from the Academy Director is required in advance for any use.
7. The Clinical Toxicologist’s Relations with Trainees
AACT members have an important duty as an educator. While working with trainees, the members shall serve as an ambassador for the field. In this capacity they should both help meet the specific educational needs of their learners and provide a better understanding of the role of clinical toxicologists. Any instruction in the field of toxicology should be done in the context of current research and the best available evidence-based practice, and must be free of bias. In this position of authority, members should always be aware of their status as role models for their learners and consistently demonstrate ethical standards. These relationships must be treated with respect and solemnity. Explicit agreements between mentors and mentees are encouraged. A member shall never exploit the work or talent of a trainee nor represent a trainee’s work as their own.
8. Relations with the Research Community
Members are scientists and researchers and are frequently required to interact with elements of the pharmaceutical and other industrial, government or academic research community. The search for facts and truth should engender an atmosphere of mutual collaboration and cooperation; the honest and open exchange of information with concern for and assurance of the safety and well-being of research subjects are the paramount objectives for all research endeavors.
In their interactions with the scientific research community and in their own research activities members must abide by the established moral and legal principles contained in federal, institutional, and professional guidelines that govern human and animal research, such as the Declaration of Helsinki and the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. These guidelines include requirements for appropriate and identified study goals, guarantee of informed consent, confidentiality of records, and minimization of risks to subjects. Approval from appropriate institutional review boards does not make immune the clinical toxicologist from the responsibility to protect the rights and well-being of research subjects, which remains the responsibility of the individual researcher.
Members must diligently avoid potential sources of influence or bias when conducting research. In no circumstances shall a member seek to avoid or bypass restrictive research subject safeguards. Data should be collected carefully, interpreted correctly, and reported accurately. Members should claim authorship as defined by standard published and accepted guidelines, such as the International Committee of Medical Journal Editors (ICJME).
Members shall publish research results truthfully and completely. Members must not falsify, plagiarize, or fabricate data, verbally or in publications. In reporting research results to the news media, members shall make statements that are clear, understandable, and supportable by the facts. Members should disclose if results of research are being released before appropriate peer review. In addition, the AACT encourages their members to participate in the creation and development of creative and useful works in connection with their service to the AACT.
If a member has any potential or real financial benefit associated with their research this must be disclosed to the research institution and to any potential publishers of the research. If research is being done on a commercial product, or one that is likely to become commercial, it is unethical to invest or to buy or sell equity in the company that may financially benefit or suffer from the results of the research until the study is completed and the results are made public unless doing so occurs in the routine course of the toxicologists employment. Reasonable requests for access to raw data should be obliged, provided doing so does not create an onerous task for the investigator and that there are no contractual obligations to the contrary.
Before embarking on research, members should pre-register with www.clinicaltrials.gov or another applicable registry.
9. Contractual Relationships
It is anticipated that members may enter contractual relationships related to their professional services. These may involve, but are not limited to, employment, consulting and reimbursements. When such relationships involve clinical care the well-being of patients should take precedence over other interests.
Some contractual relationships might involve a possible conflict of interest with other activities. When such possible conflicts exist, they should be managed as covered in the section on Conflicts of Interest in this Code.
10. Conflicts of Interest
Conflicts of interest may arise from activities of members involving, but not limited to, business, contractual, or consulting activities. When such activities have the potential to create possible or perceived conflicts of interest related to patient care, teaching, publishing, peer-review or other activities those possible conflicts should be divulged, to the extent possible, to involved parties. Consideration should also be given to whether action in addition to disclosure would be appropriate, such as recusal from relevant discussions or decision making.
Investments in excess of $1,000 that may create possible or perceived conflicts should likewise be divulged to involved parties.
11. Expert Witness Guidelines
Members who serve as expert witness must abide by the following guidelines:
- Expert witness should possess current experience and ongoing knowledge in the area in which is asked to testify.
- Expert witness should provide expert testimony that is truthful and based on evidence and acceptable standards within the field and not provide expert testimony that is false, misleading, or without foundation.
- Expert’s opinion should reflect the knowledge at the time of the event giving rise to the case.
- Expert witness should review the medical facts in a thorough, fair, and objective manner and should not exclude any relevant information to create a view favoring either the plaintiff or the defendant.
- Expert witness should not engage in advertising or solicit employment as an expert witness where such advertising or solicitation contains false or deceptive representations about the physician’s qualifications, experience, titles or background.
- Expert witness should be willing to submit the transcripts of depositions and testimony to peer review.