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Journal of Clinical Oncology, Vol 24, No 36 (December 20), 2006: pp. 5780-5782 © 2006 American Society of Clinical Oncology. DOI: 10.1200/JCO.2006.08.5068
ASCO Core Values
From the Winship Cancer Institute of Emory University, Atlanta, GA; Dana-Farber Cancer Institute; Beth Israel Deaconess Medical Center, Boston, MA; the National Institutes of Health Department of Clinical Bioethics, Bethesda, MD; David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA; and Princess Margaret Hospital and University of Toronto, Toronto, Canada Address reprint requests to Rebecca D. Pentz, PhD, Winship Cancer Institute, Emory University, 1365 C Clifton Rd NE, Rm C 3008, Atlanta, GA 30322; e-mail: rebecca.pentz{at}emoryhealthcare.org
American Society of Clinical Oncology (ASCO) membership is strong, diverse, respected, and growing.1 With approximately 450 new members each quarter, ASCO has grown to more than 23,500 members, one quarter of whom are international members from over 100 countries. The membership, Board of Directors, and 22 committees are supported by close to 200 full-time staff and a foundation. In conjunction with ASCO's 40th anniversary and in acknowledgment of ASCO's tremendous growth, the 2003 Board of Directors re-examined ASCO's 1999 Strategic Plan, consisting of a mission statement, organizational goals and objectives, and core values. In this context, the Board asked the Ethics Committee for advice on refining ASCO's Core Values. The Ethics Committee decided, with Board approval, to reaffirm the Core Values from 1999, but to rephrase them in order to articulate them more clearly to our members, associates, and patients. In this article, the Ethics Committee reports this Board-approved restatement of the Core Values. Practitioners of medicine and medical research face particular challenges today. Medicine must retain its essential character of caring for the sick and relieving human suffering, while acting as a responsible steward of society's limited resources. Medical research must retain its integrity by focusing on the discovery of truth and the improvement of outcomes, whether funded by for-profit or not-for-profit sponsors. As medical practitioners and researchers discover more powerful tools, both must ask, "Even though we can, should we?" Core values—fundamental, enduring, deeply held beliefs—anchor our decisions in a changing world.2 Core values are not new to medicine. Although the contemporary literature on core values, often directed primarily at corporations,3 is informative, medicine's core values are "ancient virtues distilled over time."4 The fifth century BC Hippocratic corpus began this distillation. While discussing a series of clinical cases, Hippocrates coined the famous ethical dictum, "As to diseases, make a habit of two things—to help and not to harm," demonstrating the integration of the practice of medicine and ethics.5 The early Hippocratic descriptions of physician decorum are not merely prescriptions of proper etiquette,6 but rather always include acting virtuously; a decorous physician embodies integrity. These same themes, care for the patient and integrity in all actions, are echoed throughout medicine, from Galen (the second century Roman physician), to Cyprian (the third century bishop of Carthage), to Avicenna (the tenth century Islamic physician), to Maimonides (the twelfth century Jewish physician), to Percival and Gregory (the late eighteenth century British physicians). Nor is this a Western phenomenon. Both Buddhism and Confucianism extol the virtue of compassion for those who suffer. "These similarities across very different cultures and eras make one wonder whether there may not be some inherent and universal moral atmosphere that surrounds the work of caring for the sick and pervades that work, regardless of culturally diverse moral systems."7 ASCO stands in this ancient medical tradition with our restatement of Core Values. ASCO has also joined with our contemporary peers in an endorsement of an articulation of the principles and commitments associated with medical professionalism.8
Beginning with the 1999 statement of Core Values, a subcommittee of the Ethics Committee (see Acknowledgment) attempted to crystallize the essence of those statements. Their work was then further refined by the entire Ethics Committee. Three characteristics and three questions guided these discussions. First, core values are those values that constitute the moral foundation of an organization; they flow directly from its mission and goals. We therefore interviewed longtime ASCO members to gain a historical perspective on ASCO's ethical ideals. Second, while descriptive, these values are also aspirational, inspiring the organization to embody the ideals it cherishes. Third, core values are authentic; they ring true to members. For each Core Value we asked, "Is this merely an attractive thought, or is it true of and fundamental to ASCO?" Finally, we asked three questions based on those posed by Collins and Porras in their well-known analysis of visionary companies, Built to Last9:
We believe the five ASCO Core Values, commitment, integrity, competance, innovation, and inclusivity) meet these standards (Table 1). We offer them to our fellow members, colleagues, and friends as the standards to which ASCO aspires. Though designed for the organization, we hope they will also prove meaningful in our members' individual professional activities.
In keeping with our education mission, the Ethics Committee drafted examples of representative actions to clarify and exemplify each Value. The representative actions are intended as educational tools, describing how the Core Values can be lived out by the organization (Table 2). They also provide context for how these Values can be put into operation in everyday practice in today's health care climate.
The leadership of ASCO understands that these values and practices set the bar high. We will work to implement them in policies, education events, publishing, and day-to-day activities. We encourage our members to exercise them in the course of their professional activities. Most important, these Core Values describe the moral underpinnings of our organization and the standard by which we wish to be judged. We ask our members, patients, and colleagues to hold ASCO accountable as we endeavor to keep these Core Values central to our work.
The subcommittee was composed of Ezekiel Emanuel, MD, PhD (National Institutes of Health Department of Clinical Bioethics, Bethesda, MD); Charles M. Haskell, MD (David Geffen School of Medicine at UCLA, Los Angeles, CA); Steven Joffe, MD, MPH (Dana-Farber Cancer Institute, Boston, MA), Rebecca D. Pentz, PhD (Winship Cancer Institute of Emory University, Atlanta, GA); and Lowell Schnipper (Beth Israel Deaconess Medical Center, Boston, MA).
Reviewed and approved by the American Society of Clinical Oncology Board of Directors, Atlanta, GA, June 1-2, 2006. Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.
1. Bunn PA: Implementing ASCO's strategic plan 2003: Diverse membership needs, prevention, and patient partnerships. J Clin Oncol 21:231s-236s, 2003 (suppl) 2. Souba W: Academic medicine and the search for meaning and purpose. Acad Med 77:139-144, 2002[Medline] 3. Joyner BE, Payne D: Evolution and implementation: A study of values, business ethics and corporate social responsibility. J Bus Ethics 41:297-312, 2002[CrossRef] 4. Smith R: Medicine's core values. BMJ 309:1247-1248, 1994 (quotation: Sir Maurice Shock) 5. Epidemics I: xi, On conctions, in Jones WHS (trans): Hippocrates: Ancient Medicine. Cambridge, MA, Harvard University Press, 1962 6. Leake CD: Percival's Medical Ethics. New York, NY, Williams and Wilkins, 1927 7. Jonsen AR: A short history of medical ethics. New York, NY, Oxford University Press, 2000, pp 41 8. ABIM Foundation, American Board of Internal Medicine, ACP-ASIM Foundation, American College of Physicians-American Society of Internal Medicine, European Federation of Internal Medicine: Medical professionalism in the new millennium: A physician charter. Ann Intern Med 136:243-246, 2002 9. Collins JC, Porras JI: Built to Last. New York, NY, HarperCollins, 1994, pp 224 Submitted July 28, 2006; accepted September 12, 2006. This article has been cited by other articles:
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Copyright © 2006 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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INTRODUCTION
PROCESS GUIDING THE RESTATEMENT...
