789 results match your criteria AMA journal of ethics[Journal]


Response to "Ethics and Linguistics of 'omestic Global Health' Experience".

Authors:
Sural Shah

AMA J Ethics 2020 May 1;22(5):E462-464. Epub 2020 May 1.

Assistant clinical professor at the University of California, Los Angeles David Geffen School of Medicine and chief of the Primary Care Division at Olive View-UCLA Medical Center.

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http://dx.doi.org/10.1001/amajethics.2020.462DOI Listing

Response to "How Should Academic Medical Centers Administer Students' 'Domestic Global Health' Experiences?" Ethics and Linguistics of "Domestic Global Health" Experience.

AMA J Ethics 2020 May 1;22(5):E458-461. Epub 2020 May 1.

A family medicine resident at Erie/Northwestern McGaw beginning in July 2020.

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http://dx.doi.org/10.1001/amajethics.2020.458DOI Listing

How Should Decision-Sharing Roles Be Considered in Adolescent Gender Surgeries?

AMA J Ethics 2020 May 1;22(5):E452-457. Epub 2020 May 1.

Social worker and researcher at the Center for Gender Surgery at Boston Children's Hospital in Massachusetts.

The nascent field of gender-affirming surgery (GAS) for binary and nonbinary transgender adolescents is growing rapidly, and the optimal use of shared decision making (SDM)-including who should be involved, to what extent, and for which parts of the decision-is still evolving. Participants include the adolescent (whose goals might center on aesthetics and functionality), the surgeon (who might focus more on minimizing complications), the referring clinician (whose participation is mandated by present standards of care), and the caregiver (whose participation is required for patients below the age of consent). This article argues that effective, ethical SDM in adolescent GAS care requires a different conceptualization of roles than might be expected in other situations and should be a longitudinal experience rather than a singular event. Read More

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http://dx.doi.org/10.1001/amajethics.2020.452DOI Listing

Overcoming Obstacles to Shared Mental Health Decision Making.

AMA J Ethics 2020 May 1;22(5):E446-451. Epub 2020 May 1.

Assistant professor of medical humanities and bioethics at the University of Arkansas for Medical Sciences in Little Rock.

Shared decision making (SDM) is difficult to implement in mental health practice, but it remains an ethical ideal for motivating therapeutic capacity in patient-clinician relationships; this discrepancy warrants attention from clinical and ethical perspectives. This article explores what some clinicians see as obstacles to even attempting SDM with patients with psychiatric disabilities. In particular, this article identifies 4 such obstacles: a patient's lack of decision-making capacity, a patient's poor insight, a health care professional's therapeutic pessimism or personal dislike, and a patient's or health care professional's conflicting recovery orientations or goals of care. Read More

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http://dx.doi.org/10.1001/amajethics.2020.446DOI Listing

Salvation in a Time of Plague.

Authors:
Ginia Sweeney

AMA J Ethics 2020 05 1;22(5):E441-445. Epub 2020 May 1.

Assistant director of interpretation in the Department of Learning and Public Engagement at the Art Institute of Chicago in Illinois.

Health workers offer their skills and care to COVID-19 pandemic patients, just as St Roch offered healing to those stricken by bubonic plague during the Renaissance. This article interprets 3 works of art in light of Roch's story of illness and recovery and applies key insights of ethical, artistic, and clinical relevance to the COVID-19 pandemic. Read More

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http://dx.doi.org/10.1001/amajethics.2020.441DOI Listing

Hold Me.

Authors:
Shengxun Lin

AMA J Ethics 2020 May 1;22(5):E439-440. Epub 2020 May 1.

Senior product design student.

In 2010, artist Shengxun Lin created , a cast resin replica of her own hand as a comfort object and stress reliever. This work continues that practical design theme with a focus on how use and comfort augment aesthetics. Read More

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http://dx.doi.org/10.1001/amajethics.2020.439DOI Listing

Modernizing Sir Luke Fildes' The Doctor.

AMA J Ethics 2020 May 1;22(5):E437-438. Epub 2020 May 1.

First-year resident in the AnMed Health Family Medicine Residency Program in Anderson, South Carolina.

Sir Luke Fildes' , exhibited in 1891, is a classic work, celebrated for presenting a physician's posture, presence, and concentration before a patient. This reimagination of Fildes' work responds to modern demands on the patient-clinician relationship while suggesting the persistence of this relationship's sanctity. Read More

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http://dx.doi.org/10.1001/amajethics.2020.437DOI Listing

What Cy Twombly's Art Can Teach Us About Patients' Stories.

AMA J Ethics 2020 May 1;22(5):E430-436. Epub 2020 May 1.

Deputy director for exhibitions, education, and programs at the Rhode Island School of Design Museum in Providence, Rhode Island.

Some patients' stories can be hard to tell and hard to listen to, especially in pressured, time-pinched clinical environments. This difficulty, however, doesn't absolve clinicians from a duty to try to understand patients' stories, interpret their meanings, and respond with care. Such efforts require clinical creativity, full engagement, and the recognition that emotions and personal feelings leak into the space between storyteller and story listener. Read More

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http://dx.doi.org/10.1001/amajethics.2020.430DOI Listing

What Does the Evolution From Informed Consent to Shared Decision Making Teach Us About Authority in Health Care?

AMA J Ethics 2020 May 1;22(5):E423-429. Epub 2020 May 1.

Associate professor of medical education (health humanities) at the University of Virginia School of Medicine in Charlottesville.

This article examines the legal doctrine and ethical norm of informed consent and its deficiencies, particularly its concentration on physician disclosure of information rather than on patient understanding, which led to the development of shared decision making as a way to enhance informed consent. As a vague and imprecise rubric, shared decision making encompasses several different approaches. Narrower approaches presuppose an individualistic account of autonomy, while broader approaches view autonomy as relational and hold that clinician-patient relationships grounded in good communication can assist decision making and foster autonomous choices. Read More

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http://dx.doi.org/10.1001/amajethics.2020.423DOI Listing

What's the Role of Time in Shared Decision Making?

AMA J Ethics 2020 May 1;22(5):E416-422. Epub 2020 May 1.

Assistant professor of medicine in the Bioethics Research Center at Washington University School of Medicine in St Louis, Missouri.

Shared decision making (SDM) is a desirable process and outcome of patient-clinician relationships. Ideally, patients and clinicians have sufficient time to engage in SDM. In reality, time is often insufficient. Read More

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http://dx.doi.org/10.1001/amajethics.2020.416DOI Listing

Epistemic Authority and Trust in Shared Decision Making About Organ Transplantation.

AMA J Ethics 2020 May 1;22(5):E408-415. Epub 2020 May 1.

Richard Parrillo Family Professor of Healthcare Ethics in the Department of Medicine, associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago in Illinois.

acknowledges respect for a patient's knowledge claims, an important manifestation of patient autonomy that facilitates shared decision making in medicine. Given the scarcity of deceased donor organs, transplantation programs state that patient promises of compliance cannot be taken at face value and exclude candidates deemed untrustworthy. This article argues that transplant programs frequently lack the data to make this utilitarian calculation accurately, with the result that, in practice, the psychosocial evaluation of potential transplant candidates is discriminatory and unfair. Read More

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http://dx.doi.org/10.1001/amajethics.2020.408DOI Listing

Should Decision Making Be Shared in High-Risk Pediatric Heart Donation?

AMA J Ethics 2020 May 1;22(5):E401-407. Epub 2020 May 1.

Medical director of pediatric heart failure, mechanical circulatory support, and heart transplantation services at the UCSF Benioff Children's Hospital San Francisco in California.

This article considers complexities of shared decision making in pediatric heart transplantation and suggests that decisions about pediatric heart transplantation should be shared between a clinical team and parents. This article also considers goals of shared decision making involving Public Health Service increased-risk donors and recommends policy changes to strengthen decision sharing. Read More

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http://dx.doi.org/10.1001/amajethics.2020.401DOI Listing

How Will Artificial Intelligence Affect Patient-Clinician Relationships?

AMA J Ethics 2020 May 1;22(5):E395-400. Epub 2020 May 1.

Third-year clinical fellow in pediatric hematology and oncology at Washington University School of Medicine in St Louis, Missouri.

Artificial intelligence (AI) could improve the efficiency and accuracy of health care delivery, but how will AI influence the patient-clinician relationship? While many suggest that AI might improve the patient-clinician relationship, various underlying assumptions will need to be addressed to bring these potential benefits to fruition. Will off-loading tedious work result in less time spent on administrative burden during patient visits? If so, will clinicians use this extra time to engage relationally with their patients? Moreover, given the desire and opportunity, will clinicians have the ability to engage in effective relationship building with their patients? In order for the best-case scenario to become a reality, clinicians and technology developers must recognize and address these assumptions during the development of AI and its implementation in health care. Read More

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http://dx.doi.org/10.1001/amajethics.2020.395DOI Listing

How Should Shared Decision Making Be Taught?

AMA J Ethics 2020 May 1;22(5):E388-394. Epub 2020 May 1.

Linda Kohler Anderson Professor of Surgery; vice chair for ethics, professional development, and wellness in the Department of Surgery; and the chief of endocrine surgery at the University of Chicago in Illinois.

As the field of medicine shifts from a paternalistic to a more patient-centered orientation, the dynamics of shared decision making become increasingly complicated. International globalization and national socioeconomic differences have added unintended difficulties to culturally sensitive communication between physician and patient, which can contribute to the growing erosion of clinician empathy. This article offers a strategy for teaching students how to enter into conversations about shared decision making by bolstering their empathy as a result of exposing them to the many variables outside of their patients' control. Read More

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http://dx.doi.org/10.1001/amajethics.2020.388DOI Listing

How Should the Recovery Process Be Shared Between Patients and Clinicians?

AMA J Ethics 2020 May 1;22(5):E380-387. Epub 2020 May 1.

Orthopedic hand surgeon at Washington University School of Medicine in St Louis, Missouri.

Illness and injury often entail lasting health and social consequences beyond the acute event. During the immediate and long-term recovery period, consequences of illness or injury can often be mitigated and addressed. As patients and their clinicians discuss care decisions, whether for initial or ongoing management of illness or injury, they must consider patients' personal goals of recovery alongside possible clinical outcomes to choose the best path forward. Read More

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http://dx.doi.org/10.1001/amajethics.2020.380DOI Listing

How Should Adolescent Health Decision-Making Authority Be Shared?

AMA J Ethics 2020 May 1;22(5):E372-379. Epub 2020 May 1.

Associate professor in the Department of Pediatrics' Division of Hematology-Oncology at the University of Washington School of Medicine in Seattle.

Shared decision making (SDM) is used in adult and pediatric practice for both its ethical and its practical benefits. However, its use is complicated with adolescents whose emerging and relational autonomy is distinct from that of adults, who make decisions independently, and children, whose parents make decisions for them. This hypothetical case scenario and commentary provide clinicians with a practical and stepwise approach to SDM with adolescents as well as guidance when SDM breaks down. Read More

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http://dx.doi.org/10.1001/amajethics.2020.372DOI Listing

Can Consent to Participate in Clinical Research Involve Shared Decision Making?

AMA J Ethics 2020 May 1;22(5):E365-371. Epub 2020 May 1.

Professor at the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire.

Shared decision making honors patient autonomy and improves patient comprehension and therefore should be a part of every clinical decision a patient makes. Use of shared decision making in research informed consent conversations is more complicated due to diverse and potentially divergent investigator and patient interests, along with the presence of clinical equipoise. This article clarifies these different interests and discusses ways in which shared decision making can be applied in research. Read More

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http://dx.doi.org/10.1001/amajethics.2020.365DOI Listing

Sliding-Scale Shared Decision Making for Patients With Reduced Capacity.

AMA J Ethics 2020 May 1;22(5):E358-364. Epub 2020 May 1.

Professor at the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire.

Shared decision making honors patient autonomy, particularly for preference-sensitive care decisions. Shared decision making can be challenging, however, when patients have impaired decision-making capacity. Here, after presenting an illustrative case example, this paper proposes a capacity-adjusted "sliding scale" approach to shared decision making. Read More

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http://dx.doi.org/10.1001/amajethics.2020.358DOI Listing

When a Patient Regrets Having Undergone a Carefully and Jointly Considered Treatment Plan, How Should Her Physician Respond?

AMA J Ethics 2020 May 1;22(5):E352-357. Epub 2020 May 1.

Chair of the Department of Surgery at The Ohio State University College of Medicine in Columbus.

Shared decision making is best utilized when a decision is preference sensitive. However, a consequence of choosing between one of several reasonable options is decisional regret: wishing a different decision had been made. In this vignette, a patient chooses mastectomy to avoid radiotherapy. Read More

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http://dx.doi.org/10.1001/amajethics.2020.352DOI Listing

Cohesion in Distancing.

Authors:
Michael Shen

AMA J Ethics 2020 04 1;22(4):E344-345. Epub 2020 Apr 1.

Artist and internal medicine resident at NYC Health + Hospitals/Bellevue in New York City.

In isolation, we are physically apart; in solidarity, we are together. The COVID-19 pandemic emphasizes our social responsibility to maintain physical distance from one another. In doing so, we solidify our collective strength. Read More

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http://dx.doi.org/10.1001/amajethics.2020.344DOI Listing

Who's in the Hospital Lobby?

Authors:
Katelyn Norman

AMA J Ethics 2020 Apr 1;22(4):E342-343. Epub 2020 Apr 1.

Third-year resident, Yale-Waterbury Internal Medicine Residency Program in Waterbury, Connecticut.

Lobbies and waiting rooms of hospitals and clinics tend to be places where physicians spend little time. These spaces, intended for occupancy by patients and their loved ones, can accommodate a physician who is alone, in reflection, after hours. Read More

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http://dx.doi.org/10.1001/amajethics.2020.342DOI Listing

Surgical Transfiguration.

Authors:
Kristina Alton

AMA J Ethics 2020 Apr 1;22(4):E340-341. Epub 2020 Apr 1.

Third-year medical student, University of North Carolina at Chapel Hill.

This drawing considers the nature and scope of clinicians' responsibilities to speak and act in ways that express great regard for the breadth and depth of their capacity to influence patients' pre- and postsurgical self-understandings. Read More

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http://dx.doi.org/10.1001/amajethics.2020.340DOI Listing

From Ship Captains to Crew Members in a History of Relationships Between Anesthesiologists and Surgeons.

AMA J Ethics 2020 Apr 1;22(4):E333-339. Epub 2020 Apr 1.

Associate professor and the division chief of cardiothoracic anesthesiology in the Department of Anesthesiology at the University of North Carolina School of Medicine in Chapel Hill.

With increasing specialization, more collaborative relationships have developed between anesthesiologists and surgeons. Specialization has influenced not only relationships but also communication between anesthesiologists and surgeons. This article considers the nature and scope of these transitions in recent histories of both professions. Read More

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http://dx.doi.org/10.1001/amajethics.2020.333DOI Listing

Strategies for Collaborative Consideration of Patients' Resuscitation Preferences.

AMA J Ethics 2020 Apr 1;22(4):E325-332. Epub 2020 Apr 1.

Board-certified general surgeon and hospice and palliative medicine specialist.

Procedural treatment teams encounter patients with preoperative do-not-resuscitate (DNR) orders who are seeking procedural interventions to improve their quality of life. is the professional discussion standard that seeks to engage patients or their surrogate decision makers in revisiting patient preferences for rescinding or maintaining a DNR order perioperatively. This article canvasses features of a required reconsideration discussion and guidelines for adhering to this standard. Read More

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http://dx.doi.org/10.1001/amajethics.2020.325DOI Listing

Should Surgeons or Anesthesiologists Manage Perioperative Pain Protocols?

AMA J Ethics 2020 Apr 1;22(4):E319-324. Epub 2020 Apr 1.

Associate professor of anesthesiology with subspecialty certification in pain management at the University of North Carolina School of Medicine in Chapel Hill.

Enhanced recovery after surgery (ERAS) protocols vary by surgery type. This article examines benefits of ERAS pathways, compares ERAS pathways to traditional protocols from clinical and ethical standpoints, and discusses formal recommendations of the American College of Surgeons, the American Society of Anesthesiologists, and other groups. Read More

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http://dx.doi.org/10.1001/amajethics.2020.319DOI Listing

Should Anesthesiologists and Surgeons Take Breaks During Cases?

AMA J Ethics 2020 Apr 1;22(4):E312-318. Epub 2020 Apr 1.

Trauma surgeon at the University of North Carolina at Chapel Hill.

Anesthesiologists regularly take breaks during operations, whereas surgeons do so more rarely. This article considers the origins of this difference in practice in relation to different characteristics of the work of these 2 specialties as well as differences in professional identity, both of which can contribute to varying break practices and perceptions of the value of breaks. The authors draw upon current literature about the influence of breaks on attention, focus, and stamina and then reflect on the influence of breaks on the relationships between anesthesiologists and surgeons. Read More

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http://dx.doi.org/10.1001/amajethics.2020.312DOI Listing

Escape the Drape Divide by Making Off-Service Rotations a Part of Surgery and Anesthesia Residencies.

AMA J Ethics 2020 Apr 1;22(4):E305-311. Epub 2020 Apr 1.

Professor of surgery in the Division of Cardiothoracic Surgery and program director of the Integrated Thoracic Surgery Residency Program at the University of North Carolina School of Medicine in Chapel Hill.

Unfortunately, the drape dividing the anesthesiologist from the surgeon is far too often a symbol of a greater divide in both communication and culture between the 2 specialties. When anesthesiologists and surgeons spend time rotating on each other's services, they develop a mutual respect for each other's clinical acumen and foster open communication channels for times of both routine clinical care and crisis. There is no better time than in residency, and no better way than cross-training, for anesthesia and surgical residents to hone these skills. Read More

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http://dx.doi.org/10.1001/amajethics.2020.305DOI Listing

What Constitutes Effective Team Communication After an Error?

AMA J Ethics 2020 Apr 1;22(4):E298-304. Epub 2020 Apr 1.

Associate chief medical officer for quality and safety for UNC Medical Center, the interim director for quality for the UNC faculty practice, and the vice chair of the Division of Patient Safety and Quality Improvement within the Department of Anesthesiology at the University of North Carolina at Chapel Hill.

Many procedures performed today involve a team of specialists with their own training histories and backgrounds. Some errors are inevitable in the course of clinical careers. Because errors tend to lead to complications, they often also lead to assignations of blame. Read More

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http://dx.doi.org/10.1001/amajethics.2020.298DOI Listing

How Should a Surgeon and Anesthesiologist Cooperate During Intraoperative Cardiac Arrest?

AMA J Ethics 2020 Apr 1;22(4):E291-297. Epub 2020 Apr 1.

Associate surgeon in the Division of Trauma, Burn, and Surgical Critical Care at Brigham and Women's Hospital and an assistant professor of surgery at Harvard Medical School in Boston.

Surgeons and anesthesiologists each have a unique sense of duty and responsibility to patients throughout all phases of perioperative care. Intraoperative cardiac arrest during elective, noncardiac surgery is rare, with an incidence between 0.8 to 4. Read More

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http://dx.doi.org/10.1001/amajethics.2020.291DOI Listing

What Should an Anesthesiologist and Surgeon Do When They Disagree About Terms of Perioperative DNR Suspension?

AMA J Ethics 2020 Apr 1;22(4):E283-290. Epub 2020 Apr 1.

Associate professor of orthopedic surgery and the chief of the Foot and Ankle Division at Johns Hopkins University in Baltimore, Maryland.

This case examines perioperative suspension of a do-not-resuscitate (DNR) order during surgery. The commentary considers the appropriateness of DNR orders; types of DNR order suspension in the context of alternative anesthesia techniques; and what is required from a surgeon, anesthesiologist, and patient or surrogate to reach a decision expressing the patient's best interest. It concludes by offering communication recommendations based on joint discussion and decision sharing. Read More

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http://dx.doi.org/10.1001/amajethics.2020.283DOI Listing

Who Should Manage a Patient's Airway?

AMA J Ethics 2020 Apr 1;22(4):E276-282. Epub 2020 Apr 1.

Laryngologist at the University of Virginia in Charlottesville.

Ear, nose, and throat procedures in intraoperative environments often involve surgeons' and anesthesiologists' use of shared and sometimes competing approaches to managing a patient's airway. Both clinicians have expertise in laryngoscopy and unique skill sets needed for advanced airway management. This article explores how joint decision making is best achieved despite disagreements and how collegial, collaborative relationships can be preserved to prioritize patients' safety during risk assessment and goal setting. Read More

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http://dx.doi.org/10.1001/amajethics.2020.276DOI Listing

How Should Trainees' Influences on Postoperative Outcomes Be Disclosed?

AMA J Ethics 2020 Apr 1;22(4):E267-275. Epub 2020 Apr 1.

Institutional ethics committee at Memorial Hermann Hospital in Houston, Texas.

Conflict arises when surgeons and anesthesiologists disagree about goals of care in perioperative settings. Collaboration is essential for safe, efficient, and effective care. Drawing on 2 pediatric cases that highlight risks of anesthetic exposure, this article examines the influence of surgical training on outcomes, barriers to collaboration, and anesthesiologists' ethical obligations to educate surgeons and parents about anesthesia-induced neurotoxicity risks. Read More

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http://dx.doi.org/10.1001/amajethics.2020.267DOI Listing

Pronouns and Advocacy in Medicine.

Authors:
Nat Mulkey

AMA J Ethics 2020 Mar 1;22(3):E255-259. Epub 2020 Mar 1.

MD candidate at Boston University School of Medicine in Massachusetts.

In September 2019, a prominent dictionary recognized as a proper pronoun for nonbinary individuals. This change can be seen as a source of newfound legitimacy for students and trainees self-advocating for nonbinary pronoun recognition in health care practice and training. This article considers one student's experience after coming out as nonbinary and voicing that their pronouns are they/them. Read More

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http://dx.doi.org/10.1001/amajethics.2020.255DOI Listing

Justice is the Best Medicine. And, Yes, You Can Call Us by Our Pronouns.

Authors:
Ryan Brewster

AMA J Ethics 2020 Mar 1;22(3):E253-254. Epub 2020 Mar 1.

Fourth-year medical student at Stanford University School of Medicine, in Stanford, California.

One recent essay suggests that emphasis on social justice in medical education is done at the expense of clinicians' technical competency. This response to that stance is a digitally illustrated series that contextualizes patient health as both physiological and determined by social, economic, and cultural conditions. Read More

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http://dx.doi.org/10.1001/amajethics.2020.253DOI Listing

Community Health in Rural America During the Mid-20th Century.

Authors:
Amber Dushman

AMA J Ethics 2020 Mar 1;22(3):E248-252. Epub 2020 Mar 1.

The Council on Rural Health (1945-1975) of the American Medical Association (AMA) collaborated with domestic health care organizations in the mid-20th century to improve access to health care in rural areas. This council promoted health and farm safety education, public health measures, insurance plans, and construction of health facilities. It also lobbied state and county medical societies to form rural health committees. Read More

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http://dx.doi.org/10.1001/amajethics.2020.248DOI Listing

How Should We Judge Whether and When Mission Statements Are Ethically Deployed?

AMA J Ethics 2020 Mar 1;22(3):E239-247. Epub 2020 Mar 1.

Associate professor and interim chair in the Department of Family Medicine at the University of Chicago in Chicago, Illinois.

Mission statements communicate health care organizations' fundamental purposes and can help potential patients choose where to seek care and employees where to seek employment. They offer limited benefit, however, when patients do not have meaningful choices about where to seek care, and they can be misused. Ethical implementation of mission statements requires health care organizations to be truthful and transparent about how their mission influences patient care, to create environments that help clinicians execute their professional obligations to patients, and to amplify their obligations to communities. Read More

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http://dx.doi.org/10.1001/amajethics.2020.239DOI Listing

Do Conflict of Interest Disclosures Facilitate Public Trust?

AMA J Ethics 2020 Mar 1;22(3):E232-238. Epub 2020 Mar 1.

PhD student in marketing at the Yale School of Management in New Haven, Connecticut.

Lab experiments disagree on the efficacy of disclosure as a remedy to conflicts of interest (COIs). Some experiments suggest that disclosure has perverse effects, although others suggest these are mitigated by real-world factors (eg, feedback, sanctions, norms). This article argues that experiments reporting positive effects of disclosure often lack external validity: disclosure works best in lab experiments that make it unrealistically clear that the one disclosing is intentionally lying. Read More

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http://dx.doi.org/10.1001/amajethics.2020.232DOI Listing

What Should Health Care Organizations Do to Reduce Billing Fraud and Abuse?

AMA J Ethics 2020 Mar 1;22(3):E221-231. Epub 2020 Mar 1.

Distinguished Service Professor of Public Health, Medicine and Pharmacy and associate vice president for health law, policy, and safety at the University of South Florida Morsani College of Medicine in Tampa.

Whether physicians are being trained or encouraged to commit fraud within corporatized organizational cultures through contractual incentives (or mandates) to optimize billing and process more patients is unknown. What is known is that upcoding and misrepresentation of clinical information (fraud) costs more than $100 billion annually and can result in unnecessary procedures and prescriptions. This article proposes fraud mitigation strategies that combine organizational cultural enhancements and deployment of transparent compliance and risk management systems that rely on front-end data analytics. Read More

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http://dx.doi.org/10.1001/amajethics.2020.221DOI Listing

AMA Code of Medical Ethics' Opinions Related to Organizational Influence in Health Care.

Authors:
Abigail Scheper

AMA J Ethics 2020 Mar 1;22(3):E217-220. Epub 2020 Mar 1.

Fourth-year undergraduate student at North Carolina State University in Raleigh.

In recent decades, organized health care has displaced some traditional solo-practitioner physician roles. As larger organizations become more influential in the health care sector, American Medical Association (AMA) positions on professionalism and organizational development, as outlined in the , can help physicians navigate organizations' influence on practice. Read More

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http://dx.doi.org/10.1001/amajethics.2020.217DOI Listing

Which Legal Approaches Help Limit Harms to Patients From Clinicians' Conscience-Based Refusals?

AMA J Ethics 2020 Mar 1;22(3):E209-216. Epub 2020 Mar 1.

Associate professor of law and political science at Northeastern University in Boston, Massachusetts.

This article canvasses laws protecting clinicians' conscience and focuses on dilemmas that occur when a clinician refuses to perform a procedure consistent with the standard of care. In particular, the article focuses on patients' experience with a conscientiously objecting clinician at a secular institution, where patients are least likely to expect conscience-based care restrictions. After reviewing existing laws that protect clinicians' conscience, the article discusses limited legal remedies available to patients. Read More

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http://dx.doi.org/10.1001/amajethics.2020.209DOI Listing

How Should Organizations Respond to Repeated Noncompliance by Prominent Researchers?

AMA J Ethics 2020 Mar 1;22(3):E201-208. Epub 2020 Mar 1.

Staff optometrist at the VA Portland Health Care System in Portland, Oregon.

This article considers a case in which a prominent researcher repeatedly made protocol deviations year after year while the institutional review board and university leadership failed to adequately address his continuing noncompliance. This article argues that, in addition to reporting this researcher's pattern of noncompliance to the Office for Human Research Protections, as required by federal regulations, the university should implement a remedial action plan. Read More

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http://dx.doi.org/10.1001/amajethics.2020.201DOI Listing

What Should Physicians Consider Prior to Unionizing?

Authors:
Danielle Howard

AMA J Ethics 2020 Mar 1;22(3):E193-200. Epub 2020 Mar 1.

Third-year neurology resident at Duke University Hospital in Durham, North Carolina.

Physicians considering unionization face many practical, emotional, and moral obstacles. Even some who feel that a collective bargaining unit is necessary remain concerned that patient care could suffer if physicians unionize. This article discusses unionized physicians' moral obligations to patient populations and health care systems' share in this responsibility. Read More

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http://dx.doi.org/10.1001/amajethics.2020.193DOI Listing

How Should Commerce and Calling Be Balanced?

AMA J Ethics 2020 Mar 1;22(3):E187-192. Epub 2020 Mar 1.

Chancellor's Professor of radiology, pediatrics, medical education, philosophy, liberal arts, philanthropy, and medical humanities and health studies at Indiana University in Indianapolis.

Physicians and all health professionals need to find an appropriate balance between the interests of individual patients and their organization's bottom line. Corporatization in health care has complicated such efforts. More and more health professionals function as employees of health care organizations, some of which value leaders' and shareholders' interests over those of patients. Read More

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http://dx.doi.org/10.1001/amajethics.2020.187DOI Listing

Six Tips for Giving Good Health Care to Anyone With a Cervix.

Authors:
Ryan K Sallans

AMA J Ethics 2020 02 1;22(2):E168-175. Epub 2020 Feb 1.

Cervical cancer is most frequently diagnosed in patients ages 35 to 44, but risk persists as individuals age. Among patients who are regularly screened via the Pap test, cancer is rare and death rates have dropped dramatically in the United States. Nevertheless, access to regular screening can be difficult for transgender men (individuals assigned female at birth but with a male gender identity) due to misinformation, discomfort scheduling appointments, fear of being mistreated or of refused services, lack of insurance, and clinicians' lack of knowledge. Read More

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http://dx.doi.org/10.1001/amajethics.2020.168DOI Listing
February 2020

Girl and Rooster.

AMA J Ethics 2020 02 1;22(2):E166-167. Epub 2020 Feb 1.

A third-year psychiatry resident at the Virginia Tech Carilion School of Medicine in Roanoke, Virginia.

This colorful oil painting suggests how a fearless child can inspire compassion, particularly regarding our clinical, political, and ethical orientations to ongoing practices of separating children from parents at the US southern border. Read More

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http://dx.doi.org/10.1001/amajethics.2020.166DOI Listing
February 2020

Risks, Benefits, and Conundrums of Cancer Screening.

Authors:
Nick Love

AMA J Ethics 2020 02 1;22(2):E164-165. Epub 2020 Feb 1.

A pathology fellow and fourth-year medical student at Stanford University School of Medicine in Stanford, California.

This graphic narrative is a fictional case report illustrated using paint pens and histological micrographs collaged with Adobe Illustrator. The story of Mr P and his physician recapitulates an ethical dilemma presented by cancer screening: screening can save lives, but it also generates diagnostic morbidity and incurs costs. Read More

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http://dx.doi.org/10.1001/amajethics.2020.164DOI Listing
February 2020

How Should Biobanking Be Governed in Low-Resource Settings?

AMA J Ethics 2020 02 1;22(2):E156-163. Epub 2020 Feb 1.

An associate professor of bioethics in the Department of Medicine at the University of Cape Town in South Africa.

Development of biobanks in Africa raises ethical questions related to particular features of African cancer research contexts, such as underresourced health care and research infrastructures and low-average research literacy. This article describes ethical challenges of informed consent, benefit sharing, and stigmatization and proposes navigating these challenges by developing a comprehensive governance framework to ensure African leadership in biobanking research programs in Africa. Read More

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http://dx.doi.org/10.1001/amajethics.2020.156DOI Listing
February 2020

How Should Low- and Middle-Income Countries Motivate Equity in Cancer Prevention and Control?

AMA J Ethics 2020 02 1;22(2):E147-155. Epub 2020 Feb 1.

A primary care physician and the director of innovation in clinic efficiency and cancer control at NYC Health + Hospitals in New York City.

Cancer continues to be a prominent cause of morbidity and mortality in low- and middle-income countries (LMICs). Many LMICs, however, lack adequate data to better understand and respond to trends in cancer incidence. This article highlights crucial roles that government and public-private coalitions can play in cancer surveillance in LMICs. Read More

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http://dx.doi.org/10.1001/amajethics.2020.147DOI Listing
February 2020

How Should Global Tobacco Control Efforts Be Prioritized to Protect Children in Resource-Poor Regions?

AMA J Ethics 2020 02 1;22(2):E135-146. Epub 2020 Feb 1.

A senior research fellow at the National University of Singapore Saw Swee Hock School of Public Health and has a research background in global tobacco control and public health ethics.

The tobacco industry's aggressive marketing of tobacco products and electronic (e-)cigarettes is well documented. Yet existing restrictions on tobacco and e-cigarette marketing are poorly implemented in most low- and middle-income countries. Ongoing challenges include weak implementation and enforcement of some aspects of the WHO Framework Convention on Tobacco Control and a lack of consensus among health professionals on how to address the tobacco industry's health claims related to e-cigarettes and other novel tobacco products. Read More

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http://dx.doi.org/10.1001/amajethics.2020.135DOI Listing
February 2020

How Should Cervical Cancer Prevention Be Improved in LMICs?

AMA J Ethics 2020 02 1;22(2):E126-134. Epub 2020 Feb 1.

A professor in the Department of Family Medicine at the University of Michigan Medical School in Ann Arbor, where he serves as director of the Japanese Family Health Program.

Cervical cancer has become rare in high-income countries but is a leading cause of mortality among women in low- and middle-income countries (LMICs). This inequity is due to economic, social, and cultural factors and should be seen as an epidemiological tragedy. This article examines ethical considerations that should compel policymakers and international donors to prioritize cervical cancer prevention in LMICs. Read More

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http://dx.doi.org/10.1001/amajethics.2020.126DOI Listing
February 2020