The AMA Journal of Ethics invites original submissions for peer review consideration on the following themes that will be explored in 2021 and 2022:

February and March 2021: Racial and Ethnic Health Equity in the US

Health equity is defined by the World Health Organization as the “absence of unfair and avoidable or remediable differences in health among social groups.” Historically, health inequities have persisted along axes (race, ethnicity, and gender, for example) of socially and economically entrenched patterns of oppression. This theme issue focuses specifically on racial and ethnic health inequity as a phenomenon that is not a historical accident, but a product of political and economic structures that advantage some and disadvantage others. While the goal of optimal health for all is elegant in simplicity, it is fully achievable only if we confront the ethical complexities of how racial and ethnic health inequities are situated in legacies of colonialism and white supremacy. This theme issue interrogates the nature and scope of individual and collective responsibility for racial and ethnic health equity.

The February 2021 issue of the AMA Journal of Ethics welcomes explorations about roles and responsibilities of health care professionals and institutions in combatting individual biases and structural racism that underpin racial and ethnic health inequity. Content on how research, teaching resource development, organizational obligations, policy innovation, technological innovation, and clinical ethics, should motivate equity in health outcomes, health status, and access to health care services, for example, are welcome.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 1 April 2020.

April 2021: Compassionate Uses of Force

Much has been written on whether and when uses of force are justifiable when caring for patients. It is recognized that uses of force can be justifiable based on risk-benefit analyses or a need to promote a patient’s best interests. However, even in situations in which it might be generally agreed upon that using force is probably better than not doing so, care teams must navigate ethical complexities and moral remainders, such as risk of patient harm, or significant disagreement among clinicians about what constitutes the most compassionate way to execute force. Given that physical, pharmaceutical, or other means of force—even when justifiable, all things considered—can undermine therapeutic capacity in patient-clinician relationships, erode trust, or exacerbate moral distress, the clinical and ethical stakes are high. Yet, they are rarely discussed. How should force be executed and by whom? How should force be executed to be as compassionate (not just minimally harmful) as possible? These questions suggest the importance of clinical and ethical interrogation of the goals, motivations, and protocols according to which force is implemented when patients’ wellbeing is in clinicians’ hands.

This issue of the AMA Journal of Ethics seeks wide-ranging perspectives on the nature of force in medicine, the scope of its utility in practice, exemplary or scalable models for reducing or eliminating uses of force in health care, and lessons from clinical work about what might constitute compassionate applications and processes of implementing force protocols.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 26 June 2020.

May 2021: Equity and Erasure in Ending the HIV Epidemic

A human immunodeficiency virus (HIV) epidemic in the United States began in the 1970s. Since then, best practices in HIV have evolved. “Ending the Epidemic: A Plan for America” was launched in October 2019 by the US Department of Health and Human Services, with a goal of stopping the spread of HIV by 2030 through the four pillars of diagnosis, treatment, prevention, and investigation. Accomplishing this goal demands not only the expansion of existing programs, but recognition and response to clinically, ethically, socially, and culturally relevant features of contemporary patients’ experiences of stigma, oppression, and living with HIV. This issue of the AMA Journal of Ethics seeks cross-disciplinary perspectives on the ethics, health policy, education, historical, and other important dimensions of HIV diagnosis, treatment, prevention, and investigation specific to the contemporary context and the “Ending the Epidemic” initiative.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 26 June 2020.

June 2021: Transgenerational Trauma

Emotional and physical repercussions of global and domestic insults and atrocities such as slavery, internment, and poverty ramify intergenerationally in communities, families, and individuals’ bodies. Consequences of transgenerational trauma for mental and general health are documented in the public health literature as manifestations of health ecology variables, including racial and ethnic health inequity. Disparities in health status tend to garner attention from a population health standpoint, but equally clinically, ethically, and socially relevant is how marginalization influences health and health outcomes in terms of persons’ lived experiences of historically entrenched patterns of oppression and marginalization across space and over time.

Clinical, epidemiological, and biostatistical research has, for many years now, illuminated racial, ethnic, and other kinds of inequity in health status and in access to health care services. Clinical, ethical, social, cultural, and historical relationships and lived experiences among people with connections to historical insults and atrocities over time, however, receive less attention. Defined as combined affective, social, and clinical consequences of historical and present insults to minoritized racial and ethnic identities, transgenerational trauma also involves social and cultural losses and associated grief. We invite manuscripts for this issue of the AMA Journal of Ethics that consider disease and illness burdens wrought by historical insults and legacies of oppression on living individuals and in contemporary communities.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 30 July 2020.

July 2021: Illness Invisibility and Immeasurability

Some illnesses and diseases are not apparent to onlookers. Post-concussive syndrome, endometriosis, multiple sclerosis, chronic fatigue syndrome, fibromyalgia, and many psychiatric illnesses, for example, tend to present in ways that are not easily observable or measurable. Clinicians and health care systems deeply value empirical verifiability, however, so this issue investigates some of the clinically, ethically, and socially important consequences for patients who have “invisible” conditions or “immeasurable” symptoms.

Hard-to-measure or immeasurable symptoms can result in some patients receiving insufficient support and empathy, despite that their illnesses are physically and mentally burdensome, isolating, and sometimes ill-understood. When a condition’s measurability corresponds neatly and tidily to how easily it can be diagnosed and treated, this is helpful for everyone. But, when clinicians’ frustrations navigating illnesses of invisible etiology or symptom presentation express as blaming patients, accusing them of dishonesty or being “difficult,” or pathologizing them as malingering or their symptoms as psychosomatic, for example, patients’ status in patient-clinician relationships is undermined and the knowledge they have about their experiences are undervalued.

These dynamics illuminate interesting, important, and complex questions about a tendency in health care practice to privilege diagnostic measurability over patients’ narratives and claims. We invite manuscripts for the July 2021 issue of the AMA Journal of Ethics that consider these and other intersections of visibility and measurability of illness.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 31 August 2020.

August 2021: Economic Decision Modeling in Health Care

Rising health care costs in the US have created need for effective and economical prevention and treatment strategies. Decision modeling studies aim to help policy makers and organizational leaders anticipate influences of interventions by standardizing how prospective costs and benefits are quantified, despite that actual health care systems’ operations and patients’ and clinicians’ behaviors are complex and not reliably predictable. This issue explores roles key assumptions play in even the best designed value analyses and economic models that inform decisions shaping clinicians’ practices and patients’ experiences.

We invite manuscripts for the August 2021 issue of the AMA Journal of Ethics that consider ethically and economically complex features of decision modeling and value analysis in health care.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 30 September 2020.

September 2021: Implantable Material and Device Regulation

About 10% of Americans will have a device implanted into their bodies by a clinician during their lifetimes. Fewer than 0.5% of these devices, however, are likely to have been tested in rigorous clinical trials generally regarded as standard by US regulators. Despite looser regulation of materials and devices than for pharmaceuticals, clinician-investigators and the Food and Drug Administration are obligated to balance patient-subjects’ safety with demand for patients’ timely access to technologies and interventions that might improve or extend their lives.

In health care and clinical research environments, ethical questions about conflicts of interest, resource allocation, and advertising new interventions can be as critical and time-sensitive as decisions about whether and when to report protocol deviations or adverse events. Many clinicians and members of the public are unfamiliar with processes by which devices come to market, with frameworks that govern device manufacturers’ and implanters’ interactions with each other and patient-subjects, and with how US approaches to regulating materials and devices differ from those of international peers. The September 2021 issue of the AMA Journal of Medical Ethics invites diverse perspectives about clinicians’, researchers’, manufacturers’, and agencies’ material and device innovation pursuits.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 30 October 2020.

October 2021: Palliative Surgery

Palliative care is defined by intention. It aims not to cure disease, nor to prolong life, but to improve a patient’s quality of life via symptom management-directed interventions, counseling, and goal-elucidating conversation. Palliative care is not just for dying patients. In fact, dying patients are living patients, and all patients deserve palliation. Contrary to popular belief, palliative treatments can be invasive, including not only medical, but surgical intervention.

This issue considers the clinical and ethical high stakes for palliative surgical patients at or near the end of life. Surgical and iatrogenic complications can be particularly devastating in patients with limited life expectancy, including possibly shortening a patient’s remaining lifetime or severely diminishing their quality of life. We invite manuscripts for the October 2021 issue of the AMA Journal of Ethics that consider how palliative surgery should be defined, how informed consent should change when goals of a major intervention are palliative instead of curative, and how palliative surgical costs should be considered.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 30 November 2020.

January 2022: Disparities Along the Medical/Dental Divide

Dental and medical professionals tend to experience structural barriers to responding fully to patients’ needs because of differences in training, insurance coverage, and access to services. This issue of the AMA Journal of Ethics seeks wide-ranging perspectives on the nature, scope, and influence of the medical/dental divide, exemplary or scalable models of improved care coordination, and lessons from dental and medical care service delivery that can benefit all clinicians and motivate better outcomes for patients and communities.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 26 February 2021.