Ethics in Burn Care

Burn injuries present numerous clinical and ethical complexities for caregivers and patients. Discourse on ethical decision making in burn care tends to focus on a few topics, such as end-of-life practices and how to regard consent, refusal, and other expressions of autonomy following Dax Cowart’s case in 1973. The June 2018 issue of the AMA Journal of Ethics will revisit these issues with new perspectives and also explore ethical questions including, but not limited to, expressions of bias in burn care settings, pain management, surgical education practices, the nature and scope of clinicians' roles in burn prevention, whether and when live donor grafts are appropriate, and how to prioritize and weigh values such as survival, function, and cosmesis.

Volume 20, Number 6: 525-605 Full Issue PDF
  • From the Editor
    Jun 2018

    Opening Dialogue on Current Ethical Issues in Burn Care

    Ashwath Gunasekar
    In 1973, Dax Cowart was critically injured in a propane gas explosion. The ensuing care that he received, despite his opposition to it, prompted him to advocate for the view that it was wrong for clinicians to disregard his wish to be allowed to die.
    AMA J Ethics. 2018;20(6):527-530. doi: 10.1001/journalofethics.2018.20.6.fred1-1806.
  • Case and Commentary
    Jun 2018

    When Is It Appropriate to Put a Live Donor at Risk to Help Another Patient?

    Anjay Khandelwal, MD
    Although identical twin-to-twin skin grafting has resulted in excellent survival rates in burn patients, the nature and scope of ethical decision making in monozygotic sibling skin grafting needs further examination.
    AMA J Ethics. 2018;20(6):537-545. doi: 10.1001/journalofethics.2018.20.6.cscm2-1806.
  • Original Research
    Jun 2018

    A Model to Improve Detection of Nonaccidental Pediatric Burns

    Lauren C. Nigro, MD, Michael J. Feldman, MD, Robin L. Foster, MD, and Andrea L. Pozez, MD
    Suspected child abuse cases can be identified and repeat hospitalizations of such cases prevented using multidisciplinary teams to evaluate pediatric burns.
    AMA J Ethics. 2018;20(6):552-559. doi: 10.1001/journalofethics.2018.20.6.org1-1806.
  • Policy Forum
    Jun 2018

    Defining Adequate Quality and Safety Metrics for Burn Care

    Laura S. Johnson, MD and Jeffrey W. Shupp, MD
    Burn care physicians must walk a fine line between providing individualized care and applying population-based quality metrics.
    AMA J Ethics. 2018;20(6):567-574. doi: 10.1001/journalofethics.2018.20.6.pfor1-1806.
  • Medicine and Society
    Jun 2018

    Ethics of Burn Wound Care in a Low-Middle Income Country

    Shelley Wall, MBChB, Nikki Allorto, MBChB, Ross Weale, MBBS, Victor Kong, PhD, and Damian Clarke, PhD
    Caring for severe burn injuries in low- and middle-income countries requires making decisions about resource allocation given particular contextual factors.
    AMA J Ethics. 2018;20(6):575-580. doi: 10.1001/journalofethics.2018.20.6.msoc1-1806.
  • History of Medicine
    Jun 2018

    Getting Past Dax

    Monica L. Gerrek, PhD
    The decision-making capacity and autonomy of burn patients and medical paternalism is examined through the cases of Dax Cowart and Andrea Rubin.
    AMA J Ethics. 2018;20(6):581-588. doi: 10.1001/journalofethics.2018.20.6.mhst1-1806.
  • Personal Narrative
    Jun 2018

    Ask Me about My Pearls: Burn Care, Ethics, and Creative Writing

    Debra Ann Reilly, MD and Steve Langan, MFA
    Physicians’ creative writing is a form of narrative ethics that can mitigate burnout and promote new ways of engaging with burn patients and caregivers.
    AMA J Ethics. 2018;20(6):589-594. doi: 10.1001/journalofethics.2018.20.6.pnar1-1806.
  • Viewpoint
    Jun 2018

    The Four-Quadrant Approach to Ethical Issues in Burn Care

    Chad M. Teven, MD and Lawrence J. Gottlieb, MD
    The four-quadrant approach can illuminate ethical issues in burn care related to decision-making capacity, respect for autonomy, and medical futility.
    AMA J Ethics. 2018;20(6):595-601. doi: 10.1001/journalofethics.2018.20.6.vwpt1-1806.