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


Bleary Image.

Authors:
Manpreet Kaur

AMA J Ethics 2019 Mar 1;21(3):E309-310. Epub 2019 Mar 1.

Pastel and oil paint on wood are used to investigate the importance and challenge of self-preservation during processes of medical training and professionalization. This image considers whether, why, and how self-sacrifice is necessary to become a good physician and investigates this set of themes from ethical and aesthetic perspectives. Read More

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http://dx.doi.org/10.1001/amajethics.2019.309DOI Listing
March 2019
2 Reads

Why We Need a Music Player in Every Patient Room.

AMA J Ethics 2019 Mar 1;21(3):E303-308. Epub 2019 Mar 1.

An anesthesiologist and interventional pain medicine physician who practices in Phoenix, Arizona, and a clinical assistant professor of anesthesiology at Creighton University School of Medicine and the University of Arizona College of Medicine-Phoenix.

Music can influence clinicians' and patients' mental states and emotions via the capacity of rhythm and tone to entrain. Entrainment can facilitate relaxation and distraction from pain and has a role to play in experiences with and in health care. In this article, we discuss the benefits of music from the perspectives of a physician and a veteran. Read More

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http://dx.doi.org/10.1001/amajethics.2019.303DOI Listing
March 2019
2 Reads

Enduring Oaths.

Authors:
Anum Fasih

AMA J Ethics 2019 Mar 1;21(3):E300-302. Epub 2019 Mar 1.

In this image, 3 figures-Hippocrates, a plague doctor, and a modern physician-represent continuity of ethical standards in ancient, medieval, and contemporary medical communities. Read More

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http://dx.doi.org/10.1001/amajethics.2019.300DOI Listing
March 2019
2 Reads

How Communities Attracted Physicians After World War II.

Authors:
Amber Dushman

AMA J Ethics 2019 Mar 1;21(3):E297-299. Epub 2019 Mar 1.

The manager of the American Medical Association's Department of Records Management and Archives in Chicago, Illinois.

Since the end of World War II, the Council on Medical Service of the American Medical Association (AMA) has conducted a Physicians Placement Service to assist physicians seeking a practice location and communities seeking physicians. As part of this service, the AMA offered pamphlets that included articles and exhibits. This article features select images from one of those pamphlets. Read More

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http://dx.doi.org/10.1001/amajethics.2019.297DOI Listing

An Architectural History of US Community Hospitals.

Authors:
Jeanne Kisacky

AMA J Ethics 2019 Mar 1;21(3):E288-296. Epub 2019 Mar 1.

When hospitals became places of treatment and recovery rather than places of sickness and death, hospital-based patient care also changed. This article examines relationships between design-induced practice transformations in US hospitals between the 1850s and 1980s and transformations in hospitals' roles in American communities, with a specific focus on underserved communities. Read More

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http://dx.doi.org/10.1001/amajethics.2019.288DOI Listing

How Should Health Care Organizations and Communities Work Together to Improve Neighborhood Conditions?

AMA J Ethics 2019 Mar 1;21(3):E281-287. Epub 2019 Mar 1.

A professor of pediatrics at the Ohio State University College of Medicine and the director of the Center for Innovation in Pediatric Practice and the vice president of health services research at the Research Institute at Nationwide Children's Hospital.

In the past few decades, scholars have begun to establish ethical principles for public health engagement. A key tension has been how to reconcile public health improvement with local autonomy in decision making so as to express respect for community members' on-the-ground experience. This article describes the experience of one children's hospital in learning to ethically engage a surrounding community in conversations about housing development in partnership with a local faith-based development organization. Read More

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http://dx.doi.org/10.1001/amajethics.2019.281DOI Listing
March 2019
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How Should Nonprofit Hospitals' Community Benefit Be More Responsive to Health Disparities?

AMA J Ethics 2019 Mar 1;21(3):E273-280. Epub 2019 Mar 1.

An assistant professor of health management and policy at the University of Michigan in Ann Arbor.

In 1956, the Internal Revenue Service created the expectation that nonprofit hospitals would offer uncompensated care for those unable to pay; this was the beginning of Community Benefit (CB). CB efforts tend to prioritize inpatient medical care over developing community-based health improvements, and few CB resources are directed toward responding to health disparities. Changes to federal policy should address these concerns by (1) requiring community partners' involvement in CB implementation strategies, (2) requiring that community health needs assessments (CHNAs) be completed every 5 years instead of every 3 years, (3) changing the Internal Revenue Code to recognize organizations' work on social determinants as CB, and (4) requiring CHNAs to describe a community's health disparities and clarify how their implementation strategies address them. Read More

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http://dx.doi.org/10.1001/amajethics.2019.273DOI Listing

Investigating How Geography, Citizenship, and Insurance Influence HPV Vaccination.

Authors:
Sienna Moriarty

AMA J Ethics 2019 Mar 1;21(3):E269-272. Epub 2019 Mar 1.

Research on the human papillomavirus (HPV) suggests a possible relation between HPV type and geography. It also demonstrates that insurance status affects HPV vaccine uptake, which currently provides protection against 9 of the high-risk HPV types known to cause HPV-related cancers. This article reviews this literature with a focus on health justice in HPV vaccination programs. Read More

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http://dx.doi.org/10.1001/amajethics.2019.269DOI Listing

How Can Clinicians Catalyze Investments to Improve Community Health?

AMA J Ethics 2019 Mar 1;21(3):E262-268. Epub 2019 Mar 1.

The assistant director of networks and programs/health at the Center for Community Investment in Washington, DC.

Where people live and work influences how long and how well they live. Clinicians can help keep patients healthy by encouraging health care organizations to support community investments that improve conditions that contribute to health risks, outcomes, and costs. These conditions-the social determinants of health-include housing, transportation, jobs, and educational opportunities. Read More

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http://dx.doi.org/10.1001/amajethics.2019.262DOI Listing
March 2019
5 Reads

AMA Policies and Code of Medical Ethics' Opinions Related to Health Promotion and Community Development.

Authors:
Sienna Moriarty

AMA J Ethics 2019 Mar 1;21(3):E259-261. Epub 2019 Mar 1.

Physicians play important roles in community development. They seek not only to increase patients' overall well-being and the quality of care in clinical settings, but also to engage communities in health promotion and public health efforts. The AMA offers guidance to physicians developing community health initiatives, especially regarding health promotion, community development, and rural health care access. Read More

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http://dx.doi.org/10.1001/amajethics.2019.259DOI Listing
March 2019
2 Reads

Hospitals' Obligations to Address Social Determinants of Health.

AMA J Ethics 2019 Mar 1;21(3):E248-258. Epub 2019 Mar 1.

A legal scholar for the American Medical Association Council on Ethical and Judicial Affairs in Chicago, Illinois.

Federal health care reform has expanded medical insurance to millions of people, altering the role that hospitals play in improving community health. However, current federal and state community benefit policy is an ineffective tool for ensuring that hospitals address the social determinants of health afflicting their communities. Policy shifts and other incentives that promote improved population health outcomes can encourage health care organizations to do the same. Read More

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http://dx.doi.org/10.1001/amajethics.2019.248DOI Listing

How Medical Schools Can Promote Community Collaboration Through Health Systems Science Education.

AMA J Ethics 2019 Mar 1;21(3):E239-247. Epub 2019 Mar 1.

An associate professor of medicine and public health sciences and the associate dean for health systems education at Penn State College of Medicine in Hershey, Pennsylvania, and has been an advocate for health systems science in medical education at his institution and at others across the country.

Traditional focus areas of medical education are insufficient for preparing future clinicians to function well in the rapidly evolving US health care system. In response, many medical schools and residency programs are integrating into their curricula health systems science (HSS), which includes health care policy, public and population health, interprofessional collaboration, value-based care, health system improvement, and systems thinking. To illustrate the value of HSS, the authors draw upon their experiences as a medical student immersed in HSS and as an educator facilitating students' cultivation of HSS skills. Read More

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http://dx.doi.org/10.1001/amajethics.2019.239DOI Listing
March 2019
3 Reads

Medical Students as Certified Interpreters.

Authors:
Gabriela Aitken

AMA J Ethics 2019 Mar 1;21(3):E232-238. Epub 2019 Mar 1.

Spanish speakers make up 13.1% of the US population, and language barriers contribute to health disparities. Medical interpreters are essential for communication between patients with limited English proficiency (LEP) and their clinicians. Read More

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http://dx.doi.org/10.1001/amajethics.2019.232DOI Listing

How Should Health Care Professionals Address Social Determinants of Refugee Health?

Authors:
Julie M Aultman

AMA J Ethics 2019 Mar 1;21(3):E223-231. Epub 2019 Mar 1.

The program director of the Medical Ethics and Humanities Program and a professor of medical ethics and humanities in the Department of Family and Community Medicine at Northeast Ohio Medical University in Rootstown, Ohio.

In the case scenario, RJ is a resettled refugee teenager who presents to his physician with vitamin B deficiency, anemia, and symptoms of mental illness. This commentary considers social determinants of refugee health and the moral importance of freedom to achieve well-being. The capabilities framework is used to analyze this case because it offers an ethical framework for understanding and evaluating social determinants of refugee health that either promote or diminish freedom to achieve well-being. Read More

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http://dx.doi.org/10.1001/amajethics.2019.223DOI Listing

What Should Be the Scope of a Health Network's Obligation to Respond After a Hospital Closure?

AMA J Ethics 2019 Mar 1;21(3):E215-222. Epub 2019 Mar 1.

A research associate with the North Carolina Rural Health Research and Policy Analysis Center at the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill.

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http://dx.doi.org/10.1001/amajethics.2019.215DOI Listing
March 2019
3 Reads

Should Hospital Emergency Departments Be Used as Revenue Streams Despite Needs to Curb Overutilization?

AMA J Ethics 2019 Mar 1;21(3):E207-214. Epub 2019 Mar 1.

An assistant professor of health policy at the Ohio University Heritage College of Osteopathic Medicine in Dublin, Ohio, and a co-director of the Health Policy Fellowship, a program of the American Association of Colleges of Osteopathic Medicine.

This case asks how a hospital should balance patients' health needs with its financial bottom line regarding emergency department utilization. Should hospitals engage in proactive population health initiatives if they result in decreased revenue from their emergency departments? Which values should guide their thinking about this question? Drawing upon emerging legal and moral consensus about hospitals' obligations to their surrounding communities, this commentary argues that treating emergency departments purely as revenue streams violates both legal and moral standards. Read More

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http://dx.doi.org/10.1001/amajethics.2019.207DOI Listing

Evolving Roles of Health Care Organizations in Community Development.

Authors:
Austin J Hilt

AMA J Ethics 2019 Mar 1;21(3):E201-206. Epub 2019 Mar 1.

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http://dx.doi.org/10.1001/amajethics.2019.201DOI Listing

Technological Transformation.

Authors:
Elisabeth Miller

AMA J Ethics 2019 Feb 1;21(2):E196-197. Epub 2019 Feb 1.

Technology has enabled bionics and artificial intelligence, each of which can have important applications in health care. As we continue to substitute body parts with machinery, however, we might wonder, "What makes us human?" This drawing interrogates the relationship between humanity and embodiment, specifically in neck and facial musculature and brain structures. Read More

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http://dx.doi.org/10.1001/amajethics.2019.196DOI Listing
February 2019

What Do Warhol, Pollock, and Murakami Teach Us About AI in Health Care?

AMA J Ethics 2019 Feb 1;21(2):E192-195. Epub 2019 Feb 1.

The assistant director for college and professional learning in the Department of Learning and Public Engagement at the Art Institute of Chicago.

As with medicine, artistic practice has a historical relationship with technologies. As technology advances, artists and medical practitioners will struggle with the complexities of introducing artificial intelligence into pursuits that have long been defined as fundamentally human. How will intelligent mechanization continue to aid efforts in art and medicine, even as it complicates them? Which new dilemmas will arise as essentially human pursuits are ever more deeply aligned with the rise of thinking machines? Read More

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http://dx.doi.org/10.1001/amajethics.2019.192DOI Listing
February 2019

Making Policy on Augmented Intelligence in Health Care.

AMA J Ethics 2019 Feb 1;21(2):E188-191. Epub 2019 Feb 1.

Vice president of the Environmental Intelligence and Strategic Analytics unit at the American Medical Association in Washington, DC.

In June 2018, the American Medical Association adopted new policy to provide a broad framework for the evolution of artificial intelligence (AI) in health care that is designed to help ensure that AI realizes the benefits it promises for patients, physicians, and the health care community. Read More

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http://dx.doi.org/10.1001/amajethics.2019.188DOI Listing
February 2019

What Are Important Ethical Implications of Using Facial Recognition Technology in Health Care?

AMA J Ethics 2019 Feb 1;21(2):E180-187. Epub 2019 Feb 1.

A postdoctoral fellow at the Stanford Center for Biomedical Ethics in Stanford, California.

Applications of facial recognition technology (FRT) in health care settings have been developed to identify and monitor patients as well as to diagnose genetic, medical, and behavioral conditions. The use of FRT in health care suggests the importance of informed consent, data input and analysis quality, effective communication about incidental findings, and potential influence on patient-clinician relationships. Privacy and data protection are thought to present challenges for the use of FRT for health applications. Read More

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http://dx.doi.org/10.1001/amajethics.2019.180DOI Listing
February 2019

Can AI Help Reduce Disparities in General Medical and Mental Health Care?

AMA J Ethics 2019 Feb 1;21(2):E167-179. Epub 2019 Feb 1.

An assistant professor of computer science and medicine at the University of Toronto and a faculty member at the Vector Institute, both in in Ontario, Canada; and previously served as a visiting researcher at Alphabet Inc. within its life sciences research organization, Verily, and as a postdoctoral fellow at the Massachusetts Institute of Technology.

Background: As machine learning becomes increasingly common in health care applications, concerns have been raised about bias in these systems' data, algorithms, and recommendations. Simply put, as health care improves for some, it might not improve for all.

Methods: Two case studies are examined using a machine learning algorithm on unstructured clinical and psychiatric notes to predict intensive care unit (ICU) mortality and 30-day psychiatric readmission with respect to race, gender, and insurance payer type as a proxy for socioeconomic status. Read More

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http://dx.doi.org/10.1001/amajethics.2019.167DOI Listing
February 2019

Are Current Tort Liability Doctrines Adequate for Addressing Injury Caused by AI?

AMA J Ethics 2019 Feb 1;21(2):E160-166. Epub 2019 Feb 1.

A senior research associate for the American Medical Association Council on Ethical and Judicial Affairs in Chicago, Illinois, where he is also the legal editor for the AMA Journal of Ethics.

As capabilities of predictive algorithms improve, machine learning will become an important element of physician practice and patient care. Implementation of artificial intelligence (AI) raises complex legal questions regarding health care professionals' and technology manufacturers' liability, particularly if they cannot explain recommendations generated by AI technology. The limited literature on liability for innovation provides opportunities to consider possible implications of AI for medical malpractice and products liability and new legal solutions for addressing liability issues surrounding "black-box" medicine. Read More

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http://dx.doi.org/10.1001/amajethics.2019.160DOI Listing
February 2019

Emerging Roles of Virtual Patients in the Age of AI.

AMA J Ethics 2019 Feb 1;21(2):E153-159. Epub 2019 Feb 1.

the vice president and founding dean of the School of Health Professions at Eastern Virginia Medical School (EVMS) in Norfolk, Virginia; and a fellow of the Society for Simulation in Healthcare and holds senior faculty appointments in the EVMS School of Health Professions; the Department of Modeling, Simulation and Visualization Engineering at Old Dominion University; Paris Descartes University; and Taipei Medical University.

Today's web-enabled and virtual approach to medical education is different from the 20th century's Flexner-dominated approach. Now, lectures get less emphasis and more emphasis is placed on learning via early clinical exposure, standardized patients, and other simulations. This article reviews literature on virtual patients (VPs) and their underlying virtual reality technology, examines VPs' potential through the example of psychiatric intake teaching, and identifies promises and perils posed by VP use in medical education. Read More

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http://dx.doi.org/10.1001/amajethics.2019.153DOI Listing
February 2019
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Reimagining Medical Education in the Age of AI.

AMA J Ethics 2019 Feb 1;21(2):E146-152. Epub 2019 Feb 1.

The vice president and founding dean of the School of Health Professions at Eastern Virginia Medical School (EVMS) in Norfolk, Virginia; and a fellow of the Society for Simulation in Healthcare and holds senior faculty appointments in the EVMS School of Health Professions; the Department of Modeling, Simulation and Visualization Engineering at Old Dominion University; Paris Descartes University; and Taipei Medical University.

Available medical knowledge exceeds the organizing capacity of the human mind, yet medical education remains based on information acquisition and application. Complicating this information overload crisis among learners is the fact that physicians' skill sets now must include collaborating with and managing artificial intelligence (AI) applications that aggregate big data, generate diagnostic and treatment recommendations, and assign confidence ratings to those recommendations. Thus, an overhaul of medical school curricula is due and should focus on knowledge management (rather than information acquisition), effective use of AI, improved communication, and empathy cultivation. Read More

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http://dx.doi.org/10.1001/amajethics.2019.146DOI Listing
February 2019
1 Read

How Should Clinicians Communicate With Patients About the Roles of Artificially Intelligent Team Members?

AMA J Ethics 2019 Feb 1;21(2):E138-145. Epub 2019 Feb 1.

The director of Graduate Research Ethics Programs and the associate director of the Center for Ethics and Technology at the Georgia Institute of Technology in Atlanta.

This commentary responds to a hypothetical case involving an assistive artificial intelligence (AI) surgical device and focuses on potential harms emerging from interactions between humans and AI systems. Informed consent and responsibility-specifically, how responsibility should be distributed among professionals, technology companies, and other stakeholders-for uses of AI in health care are discussed. Read More

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http://dx.doi.org/10.1001/amajethics.2019.138DOI Listing
February 2019

Should Watson Be Consulted for a Second Opinion?

Authors:
David D Luxton

AMA J Ethics 2019 Feb 1;21(2):E131-137. Epub 2019 Feb 1.

An affiliate associate professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine in Seattle.

This article discusses ethical responsibility and legal liability issues regarding use of IBM Watson for clinical decision making. In a case, a patient presents with symptoms of leukemia. Benefits and limitations of using Watson or other intelligent clinical decision-making tools are considered, along with precautions that should be taken before consulting artificially intelligent systems. Read More

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http://dx.doi.org/10.1001/amajethics.2019.131DOI Listing
February 2019

How Should AI Be Developed, Validated, and Implemented in Patient Care?

AMA J Ethics 2019 Feb 1;21(2):E125-130. Epub 2019 Feb 1.

A professor emerita of philosophy at the University of Connecticut in Storrs, Connecticut.

Should an artificial intelligence (AI) program that appears to have a better success rate than human pathologists be used to replace or augment humans in detecting cancer cells? We argue that some concerns-the "black-box" problem (ie, the unknowability of how output is derived from input) and automation bias (overreliance on clinical decision support systems)-are not significant from a patient's perspective but that expertise in AI is required to properly evaluate test results. Read More

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http://dx.doi.org/10.1001/amajethics.2019.125DOI Listing
February 2019

How Should Health Professionals and Policy Makers Respond to Substandard Care of Detained Immigrants?

Authors:
Rie Ohta Clara Long

AMA J Ethics 2019 Jan 1;21(1):E113-118. Epub 2019 Jan 1.

A US program senior researcher for Human Rights Watch focusing on immigration and border policy.

More people, including children and pregnant women, are being detained for longer periods in a patchwork of over 200 detention centers around the country, most of which are private facilities or county jails. Human Rights Watch has documented systemic medical care failures at these facilities, including incompetent treatment, which is linked to patient deaths. Clinicians working in these facilities face formidable obstacles to providing adequate care, two of which are the Department of Homeland Security's lack of reasonable alternatives to detention and insufficient staffing. Read More

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http://dx.doi.org/10.1001/amajethics.2019.113DOI Listing
January 2019
6 Reads

Sofia's Story: The Sad Reality Behind a Humanitarian Crisis.

Authors:
Rohail Kumar

AMA J Ethics 2019 Jan 1;21(1):E111-112. Epub 2019 Jan 1.

A resident in triple board (pediatrics/adult psychiatry/child and adolescent psychiatry) at Tulane University in New Orleans, Louisiana.

This graphic narrative is a storybook drawn on sketch paper with graphite and charcoal pencils and scanned into Microsoft Word. Sofia represents children of undocumented families currently living in the United States who are being denied fundamental human rights including health care, education, shelter, and food. Read More

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http://dx.doi.org/10.1001/amajethics.2019.111DOI Listing
January 2019

Journeys of Immigrant Families Across the Border.

AMA J Ethics 2019 Jan 1;21(1):E106-110. Epub 2019 Jan 1.

A primary care resident at the University of Pennsylvania Medical Center in Philadelphia and a graduate of the Yale School of Medicine.

In an exhibition called (), members of the undocumented Mexican community in South Philadelphia created stories of their journey to the United States. With help from lead artist Nora Hiriart Litz, their experiences and thoughts on migration, family, love, loss, and hope are conveyed creatively via artwork. Read More

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http://dx.doi.org/10.1001/amajethics.2019.106DOI Listing
January 2019

Is It Ethical to Bend the Rules for Undocumented and Other Immigrant Patients?

Authors:
Nancy Berlinger

AMA J Ethics 2019 Jan 1;21(1):E100-105. Epub 2019 Jan 1.

A research scholar at the Hastings Center in Garrison, New York.

Physicians and other health care professionals who work in hospitals and clinics serving low-income populations will encounter undocumented immigrants as patients, family members, community members, and persons whose health-related rights can be overlooked, imperiled, or difficult to use. The routine uncertainty arising in how to provide good care to patients who are excluded from key public insurance provisions, together with the desire to be a good advocate for this patient population, can give rise to so-called workarounds as problem-solving strategies. This article explores the ethics of workarounds in the care of undocumented patients and considers how advocacy by health care professionals and organizations can assist immigrants in communities they serve. Read More

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http://dx.doi.org/10.1001/amajethics.2019.100DOI Listing
January 2019

Why Physicians Should Advocate for Undocumented Immigrants' Unimpeded Access to Prenatal Care.

Authors:
Rachel Fabi

AMA J Ethics 2019 Jan 1;21(1):E93-99. Epub 2019 Jan 1.

An assistant professor of public health and preventive medicine at SUNY Upstate Medical University in Syracuse, New York.

Nearly 7% of US citizens born each year have at least one undocumented parent, but many pregnant undocumented immigrants are ineligible for public insurance covering prenatal care due to their immigration status. This article reviews national-level and state-level policies affecting access to prenatal care for members of this population. This article also considers ethical challenges posed by some policies that create obstacles to patients' accessing health care that is universally recommended by professional guidelines. Read More

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http://dx.doi.org/10.1001/amajethics.2019.93DOI Listing
January 2019

Strategies for Responding to Undocumented Immigrants With Kidney Disease.

AMA J Ethics 2019 Jan 1;21(1):E86-92. Epub 2019 Jan 1.

An assistant professor of medicine at Emory University School of Medicine in Atlanta, Georgia; and works as a nephrologist and intensivist within the Emory Health Care System.

It is a tough road for undocumented immigrants with kidney disease. There are many barriers that these patients must overcome, which prevents them from receiving proper treatments to prevent or slow the progression of their kidney disease. Those who are dialysis dependent also face an uphill battle, as some states limit access to regular dialysis. Read More

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http://dx.doi.org/10.1001/amajethics.2019.86DOI Listing
January 2019

Good Sanctuary Doctoring for Undocumented Patients.

AMA J Ethics 2019 Jan 1;21(1):E78-85. Epub 2019 Jan 1.

An associate professor of family medicine at Loyola University Chicago Stritch School of Medicine in Maywood, Illinois, where she is also director of the Center for Community and Global Health.

Clinicians whose practice includes a significant immigrant population report a climate of fear adversely affecting their current patients. Increased immigration enforcement targeting undocumented immigrants increases these patients' stress and negatively affects their willingness to seek medical care. To address these concerns, this article draws upon the literature and the authors' experience to develop guidance on sanctuary doctoring. Read More

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http://dx.doi.org/10.1001/amajethics.2019.78DOI Listing
January 2019

AMA Policies and Code of Medical Ethics' Opinions Related to Health Care for Patients Who Are Immigrants, Refugees, or Asylees.

Authors:
Rachel F Harbut

AMA J Ethics 2019 Jan 1;21(1):E73-77. Epub 2019 Jan 1.

Accessing health care resources in the United States often proves to be a difficult task for vulnerable populations. Immigrants, in particular, face barriers and difficulties in obtaining continuous medical care, which negatively impacts both patients and clinicians. The AMA offers guidance on how physicians and health care systems can best support undocumented and lawfully present immigrants alike to promote the best possible care for all who need it. Read More

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http://dx.doi.org/10.1001/amajethics.2019.73DOI Listing
January 2019

April 2018 Flores Settlement Suit Challenges Unlawful Administration of Psychotropic Medication to Immigrant Children.

AMA J Ethics 2019 Jan 1;21(1):E67-72. Epub 2019 Jan 1.

A senior research associate for the American Medical Association Council on Ethical and Judicial Affairs in Chicago, Illinois, where he is also the legal editor for the AMA Journal of Ethics.

A lawsuit filed in April 2018 alleges unlawful administration of psychotropic medications to detained immigrant children in US custody. The suit, under jurisdiction of the Flores Settlement Agreement of 1997, alleges misuse of psychotropic medication to chemically restrain and control immigrant children and prolong their detention. This article describes the legal scope of the suit and considers significant ethically and clinically relevant questions it poses. Read More

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http://dx.doi.org/10.1001/amajethics.2019.67DOI Listing
January 2019

Rights Disappear When US Policy Engages Children as Weapons of Deterrence.

Authors:
Craig B Mousin

AMA J Ethics 2019 Jan 1;21(1):E58-66. Epub 2019 Jan 1.

University Ombudsperson at DePaul University in Chicago, Illinois.

In 1989, the United Nations adopted the Convention on the Rights of the Child (CRC), which the United States provided significant guidance in drafting. The CRC focused on those under 18 years of age, recognizing the rights most other international conventions and declarations accorded to adults. This article explores the ethical and health implications of the United States' failure to ratify the CRC with an emphasis on refugees. Read More

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http://dx.doi.org/10.1001/amajethics.2019.58DOI Listing
January 2019

Resources for Teaching and Learning About Immigrant Health Care in Health Professions Education.

AMA J Ethics 2019 Jan 1;21(1):E50-57. Epub 2019 Jan 1.

A research scholar at the Hastings Center in Garrison, New York.

How to provide good care to uninsured undocumented immigrants who are broadly excluded from federally funded health benefits in the United States can raise ethical challenges for clinicians. The chilling effect of current immigration enforcement policies on health care access affects other immigrant populations and US citizens in mixed-status families. In the current political environment, students in health professions, house staff and other early career professionals, and teachers and mentors in health care settings that serve low-income immigrant populations need a shared understanding of how to provide good care under changing and challenging conditions. Read More

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https://journalofethics.ama-assn.org/article/resources-teach
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http://dx.doi.org/10.1001/amajethics.2019.50DOI Listing
January 2019
5 Reads

Best Practices for Teaching Care Management of Undocumented Patients.

Authors:
Robin E Canada

AMA J Ethics 2019 Jan 1;21(1):E44-49. Epub 2019 Jan 1.

An associate professor at the University of Pennsylvania Perelman School of Medicine in Philadelphia, where she is also the associate program director for the Primary Care Internal Medicine Residency Program; and serves as director of Puentes de Salud, an ambulatory clinic that serves the Latino community in the Philadelphia area, teaches about social determinants of health and health disparities, and is the creator of an Indian Health Service elective for medical students and residents.

Different standards of care for undocumented Latino patients raises ethical questions for teachers and learners. This lack of parity can cause moral distress for both and prompts consideration of whether decisions made on a patient's behalf are ethical. Teaching advocacy and creating projects and partnerships to improve access and quality of care for this vulnerable population can help fight burnout and improve health outcomes. Read More

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http://dx.doi.org/10.1001/amajethics.2019.44DOI Listing
January 2019
1 Read

Are Clinicians Obliged to Disclose Their Immigration Status to Patients?

AMA J Ethics 2019 Jan 1;21(1):E38-43. Epub 2019 Jan 1.

An assistant professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine in Philadelphia.

Undocumented immigrants are part of the health care workforce, whether they are eligible to work in the United States through the Deferred Action for Childhood Arrivals (DACA) program or other visa programs or permits. This case commentary considers whether-and if so, when-a clinician should reveal her immigration status to patients. After reviewing the literature on clinician self-disclosure, this commentary discusses how sharing immigration status could benefit the patient-particularly if the clinician has an immigration status that could interrupt care-but could also draw the focus away from the patient, possibly eroding trust between patient and physician. Read More

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http://dx.doi.org/10.1001/amajethics.2019.38DOI Listing
January 2019

Should Immigration Status Information Be Considered Protected Health Information?

AMA J Ethics 2019 Jan 1;21(1):E32-37. Epub 2019 Jan 1.

A senior research associate for the American Medical Association Council on Ethical and Judicial Affairs in Chicago, Illinois.

In response to a case of an undocumented patient who was reported to immigration authorities, this commentary considers whether a patient's immigration status should be deemed protected health information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. A legal argument, supported by clinical data, is offered that immigration status should be regarded as PHI not subject to valid exception for release without patient authorization. This argument concludes that covered entities (eg, hospitals and health care professionals) are legally precluded under the HIPAA Privacy Rule from disclosing a patient's immigration status. Read More

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http://dx.doi.org/10.1001/amajethics.2019.32DOI Listing
January 2019

How Should Clinicians Respond When Different Standards of Care Are Applied to Undocumented Patients?

AMA J Ethics 2019 Jan 1;21(1):E26-31. Epub 2019 Jan 1.

An associate professor and the associate director of the Program for Biomedical Ethics at Yale School of Medicine in New Haven, Connecticut.

A challenge in caring for patients in resource-poor settings is the ethical discomfort and discouragement clinicians might experience when they're unable to provide optimal care due to lack of resources. This case, in which a resident is faced with rationalizing substandard care for certain classes of patients, probably represents the top of a slippery slope. This article argues that physicians should identify and advocate for optimal care for each patient. Read More

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http://dx.doi.org/10.1001/amajethics.2019.26DOI Listing
January 2019
14 Reads

Is Organ Retransplantation Among Undocumented Immigrants in the United States Just?

AMA J Ethics 2019 Jan 1;21(1):E17-25. Epub 2019 Jan 1.

An associate professor in the Division of Abdominal Transplantation and the Section of Nephrology at Baylor College of Medicine in Houston.

Numerous undocumented children in the United States with end-stage renal disease undergo kidney transplantation funded by charitable donation or state-sponsored Medicaid. However, when these funding sources expire by adulthood, most are unable to pay for follow-up appointments and immunosuppressive medications necessary for maintenance of their organ. The organs fail and patients are then left with the options of retransplantation or a lifetime of dialysis. Read More

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http://dx.doi.org/10.1001/amajethics.2019.17DOI Listing
January 2019

Should Immigration Status Information Be Included in a Patient's Health Record?

AMA J Ethics 2019 Jan 1;21(1):E8-16. Epub 2019 Jan 1.

A neurologist and fellow at the National Clinician Scholars Program at the University of California, Los Angeles (UCLA).

The documentation of immigration status in patient records poses a challenge to clinicians. On one hand, recording this social determinant of health can facilitate continuity of care and improved communication among clinicians. On the other, it might expose patients or their family members to immediate and unforeseen risks, such as being stigmatized and discriminated against by nonimmigrant-friendly clinicians or being exposed to immigration enforcement if staff contact immigration officials in violation of patient confidentiality. Read More

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http://dx.doi.org/10.1001/amajethics.2019.8DOI Listing
January 2019
4 Reads

Trafficked.

Authors:
Stephen P Wood

AMA J Ethics 2018 Dec 1;20(12):E1212-1216. Epub 2018 Dec 1.

An acute care nurse practitioner practicing emergency medicine and a fellow in bioethics at the Center for Bioethics at Harvard Medical School in Boston, Massachusetts. He is also a consultant for the Woburn Police Department, the Southern Middlesex Regional Drug Task Force, and the New England Coalition Against Trafficking; the chair of the Winchester Hospital Substance Use Task Force; and the co-chair of the Southern Middlesex County Mental Health Working Group; and a lecturer at Northeastern University in the Bouvé College of Health Sciences.

This first-person narrative describes some of the barriers to caring well for patients at the intersection of human trafficking and substance use disorder. I canvass some of the ethical considerations regarding these patients' autonomy and call for establishing and using evidence-based practice to manage these complex scenarios. Read More

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http://dx.doi.org/10.1001/amajethics.2018.1212DOI Listing
December 2018

Naming and the Public Health Roles of Physicians.

Authors:
Kelsey Walsh

AMA J Ethics 2018 Dec 1;20(12):E1201-1211. Epub 2018 Dec 1.

The program administrator in the American Medical Association's Department of Records Management and Archives in Chicago, Illinois.

Resources from the American Medical Association (AMA) Archives facilitate historical consideration of how physicians' authority has been exercised in naming diseases, epidemics, and other health-related issues of national importance. Selected images emphasize physicians' roles in motivating public health initiatives through public service posters, advertisements, and minutes of the AMA House of Delegates meetings. Read More

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https://journalofethics.ama-assn.org/article/naming-and-publ
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http://dx.doi.org/10.1001/amajethics.2018.1201DOI Listing
December 2018
9 Reads

Why Naming Disease Differs From Naming Illness.

Authors:
Marvin J H Lee

AMA J Ethics 2018 Dec 1;20(12):E1195-1200. Epub 2018 Dec 1.

A bioethics consultant at the Institute of Clinical Bioethics at Saint Joseph's University in Philadelphia, Pennsylvania.

Addressing the question of how medicine should engage with people who consider their clinical disease condition to be importantly constitutive of their identity, this article focuses on one group-advocates for the fat acceptance (FA) or body positivity movement in American society. Drawing on philosophical analysis, I try to show that FA and physician communities represent different traditions within the larger culture and that whether obesity should be considered a disease is a culture battle. I argue that diseases (medical) and illnesses (cultural) are 2 different designations of clinical symptoms and that both disease and illness designations can change over time or be uncertain. Read More

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http://dx.doi.org/10.1001/amajethics.2018.1195DOI Listing
December 2018

Historical Situatedness of Categories' Meanings in Medicine.

Authors:
Sander L Gilman

AMA J Ethics 2018 Dec 1;20(12):E1188-1194. Epub 2018 Dec 1.

A distinguished professor of the liberal arts and sciences as well as a professor of psychiatry at Emory University in Atlanta, Georgia.

Dichotomies in medicine are real, and the boundaries that define them are constantly shifting. Radical antitheses such as healthy versus ill, reconstructive versus aesthetic, or medical dermatology versus cosmetic dermatology can be more clearly understood by considering the cultural context of medicine. This essay examines the latter two antitheses and asks whether medical dermatology should be a category limited to somatic illness. Read More

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http://dx.doi.org/10.1001/amajethics.2018.1188DOI Listing
December 2018
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Three Things Clinicians Should Know About Disability.

AMA J Ethics 2018 Dec 1;20(12):E1181-1187. Epub 2018 Dec 1.

An assistant professor of philosophy at the University of Massachusetts Lowell in Lowell, Massachusetts, and the 2017-2019 Rice Family Fellow in Bioethics and the Humanities at the Hastings Center in Garrison, New York.

The historical relationship between health care professionals and people with disabilities is fraught, a fact all the more troubling in light of the distinctive roles clinicians play in both establishing and responding to that which is considered normal or abnormal by society at large. Those who wish to improve their clinical practice might struggle, however, to keep up with developments across numerous disability communities as well as the ever-growing body of disability studies scholarship. To assist with this goal, I offer an overview of recent disability theory, outline a set of responsibilities clinicians have to disability communities, and provide recommendations for clinicians who hope to justly treat patients with disabilities and improve their care and health outcomes. Read More

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http://dx.doi.org/10.1001/amajethics.2018.1181DOI Listing
December 2018