The AMA Journal of Ethics invites original submissions for peer review consideration on the following themes that will be explored in 2019:
May 2019: Advanced Cardiopulmonary Care Ethics
Advances in cardiopulmonary care—technologies such as ventricular assist devices, artificial hearts, and extracorporeal membrane oxygenation—prompts reexamination of appropriate uses of life-sustaining technologies. Long term life-sustaining care technologies can change how we think ethically and clinically about our goals and intentions around key concepts, such as urgency or chronicity of need for treatment and severity of disease. These technologies might dramatically change our conceptions of what physicians owe patients when talking about how patients will die. Is it appropriate that these technologies are now see by some as chronic care interventions rather than as urgent life sustaining interventions? The May 2019 issue of the AMA Journal of Ethics will consider these concepts and explore how the goods of technological advancement should be weighed against risks of harm in the care of patients with life-threatening conditions.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 31 August 2018.
June 2019: Limits to Patient Preferences
Patients are typically the most vulnerable individual in health care encounters, and this is a core reason to respect patients’ preferences. There are limits, however, to what clinicians should be expected to tolerate when patients’ preferences express unjust racial, ethnic, gender, religious, or other kinds of bias. How should clinicians respond to patients whose views or behaviors are offensive? How should colleagues and organizations respond? What are best strategies for balancing regard for patients’ preferences with clinicians’ desert of respect? Where those limits should be placed, why, and who is obliged to enforce them in health care settings are ethical questions we investigate in the June 2019 issue of the AMA Journal of Ethics.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 1 October 2018.
July 2019: Ethics of Representing Unrepresented Patients
How can we ensure that we are properly advocating and caring for patients without capacity, without anyone to make decisions on their behalf, and about whom we do not know any values or preferences? These unrepresented patients—whether homeless, elderly, or incarcerated—are among the most vulnerable members of society. Challenging decisions regarding end-of-life and long-term care must be made for these patients. The July 2019 issue of the AMA Journal of Ethics addresses some of the complex challenges of who should make decisions for unrepresented patients and according to which criteria these decisions should be made.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 1 November 2018.
August 2019: Access to Prescription Medications
Physicians have traditionally been the gatekeepers for patient access to prescription medications. How a physician assesses their patient’s benefit and risk profile shapes usage, sometimes controversially—as with continuing opioid epidemic, for example. Recently, external factors such as high drug prices and formulary restrictions have created other barriers to prescription drug access. These developments have created some new roles for physicians. That is, physicians now find themselves acting as advocates and coordinators of patients’ access, while high prices induce physicians to ration access to protect system resources. The August 2019 issue of the AMA Journal of Ethics explores some of the ethical tensions physicians and individual patients face in a changing prescription medication landscape.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 30 November 2018.
September 2019: Ethics of Global Health “Immersion” in Health Professions Education
Many health professions schools and training programs offer global health cultural “immersion” opportunities. Many also use domestic clinic settings to situate learning experiences in contexts of urban and rural poverty. These programs tend to be popular among learners eager to hone physical exam and diagnostic skills. When done well, such programs can help build cross-cultural communication skills, foster professional autonomy, offer diverse and cross-disciplinary mentorship opportunities, and allow for service-learning in communities with numerous unmet health needs. However, health professions education organizations have obligations to serve not only the interests of their students and trainees, but also to (1) foster mutually beneficial relationships with domestic and international patients, clinicians, and their communities, (2) honor and not exploit their vulnerabilities, and (3) interrogate the ethical and clinical appropriateness of maintaining long-term programs that actually rely on communities’ and patients’ poverty in order to maintain their experiential learning platforms. The September 2019 issue of the AMA Journal of Ethics investigates these areas of inquiry in light of clinical and ethical values such as continuity of care, standards of care, and educational transparency.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 21 December 2018.
November 2019: Ethics of Assessing Quality of Life in Reconstructive Transplantation
Quality of life (QoL) assessments have roles in a wide range of ethical discussions about end-of-life care, transplantation, health care services’ effectiveness and efficacy, and specifying what constitutes “essential healthcare services.” In clinical contexts, how we assign value to QoL can lead to conflicts among patients, surrogate decision makers, and clinicians. In policy contexts, QoL judgments sometimes suggest disagreements about what the facts are and what they mean. In some cases, QoL is the primary reason for undertaking particular clinical interventions. This is true of new types of transplantation, known as “reconstructive transplants” (RT) or “vascularized composite allotransplants” (VCA), including transplants of the hand, face, penis, larynx, and uterus, which are primarily conducted because of how they can influence a patient’s QoL. Yet, ethical inquiry into QoL aspects of RT/VCA is lacking, particularly when engaging topics such as patients’ lived outcomes, the impact of social acceptance or stigma on patients’ experiences of physical disfigurement or functioning, and the effects of disparate access to personal and financial support on a person’s candidacy for RT/VCA. We invite manuscripts examining these and other ideas central to empirical investigations and approaches to health care ethics and policy in the area of RT/VCA.
Manuscripts submitted for peer-review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 1 March 2019.