The AMA Journal of Ethics invites original submissions for peer review consideration on the following themes that will be explored in 2021 and 2022:
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.
November 2021: Health Care and Homelessness
Homelessness dramatically undermines personal and community health status. Children, elders, and anyone chronically unsheltered confronts the cumulative, combined health detriments of exposure and poor nutrition. With limited access to health care services and poor continuity of care when they can access care, people experiencing homelessness endure some of the poorest health outcomes tolerated in the US health care system.
Clinicians and health professions students caring for unsheltered patients can experience distress and feel overwhelmed by these patients’ extreme vulnerability, material deprivation, and lack of social support. These patients’ critical needs—basic human needs for shelter, warmth, food, and hygiene—aren’t typically met during clinical encounters by even the most skilled, compassionate clinicians. Perhaps this is unsurprising, as clinical encounters are simply not designed to offer reliable, durable access to things like shelter, warmth, food, and hygiene. Yet, when these needs go unmet, particularly chronically, it is widely known that health status diminishes in a variety of ways. The influence of depriving any person sufficient means to meet these needs is thoroughgoing, persistent throughout one’s life course (from prenatal to end-of-life), and empirically and ethically undeniable. So, how should clinicians, health professions, and all of us respond? How should we equip US clinicians and health systems to respond to unmet health needs of well over 500 000 fellow residents per year who experience homelessness?
We invite manuscripts for the November 2021 issue of the AMA Journal of Ethics that consider these questions and other strategies for thinking powerfully and responding effectively to homelessness as an ongoing public health crisis.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 23 December 2020.
December 2021: Health Justice and Diversity in Medical School Admissions
During a 1966 Chicago assembly of the Medical Committee for Human Rights, Reverend Dr. Martin Luther King Jr. has been credited with stating, “We are concerned about the constant use of federal funds to support this most notorious expression of segregation. Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.” Truth of this declaration echoes across decades to the present time. As Dr. King noted, health inequity has persisted, in our organizational policies and practices, along axes (race, ethnicity, and gender, for example) of socially and economically entrenched patterns of oppression. So, health inequity is not merely a product of the turn of fate’s wheel, not unfortunate, but unjust, and therefore, remediable over time.
Diversifying the work forces of health care is necessary, but not sufficient, for achieving health equity. One good start, however, has been to define what constitutes underrepresentation in, arguably, the most prestigious of the health professions: medicine. The Association of American Medical Colleges defines underrepresented in medicine in terms of “racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.” Diversity motivates key clinical and professional educational goals, and this can be a source of common ground when conflict emerges about which kinds of diversity matter most and how applicants’ self-identifications as members of minoritized groups should be regarded when awarding scholarships and offering admission. Since different strategies vary in how effectively they motivate equity or retention among members of different groups in medicine, how influential these factors should be in admissions diversification strategies is hotly contested and worthy of investigation through an ethics lens.
The December 2021 issue of the AMA Journal of Ethics will investigate these strategies and questions. We invite manuscripts considering diversity as a priority in medical school admissions; the nature and scope of legal, ethical, cultural, and social stakes of these decisions at procedural and policy levels; and what should constitute just admissions criteria for achieving diverse class composition.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 29 January 2021.
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.
February 2022: Tactical Health and Law Enforcement
Tactical health involves providing field-based clinical support to law enforcement operations in frontline crisis interventions and prehospital emergency care. Health professional skill can inform individual officers’ occupational health maintenance and help agents of the state navigate primary and secondary trauma and post-trauma experiences in field-based and clinic-based settings. Tactical medicine and social work expertise can also inform department- and agency- level policies, decisions, and responses to community health and safety threats. Ethical questions considered in this issue focus on the nature and scope of health professionals’ collaborations with law enforcement personnel during and following critical event preparation and responses.
This issue of the AMA Journal of Ethics seeks wide-ranging perspectives on what the nature and scope of clinical expertise should be in emergency response systems engineering, whether and when in-field tactical clinicians should carry weapons, degrees of field environment austerity in which tactical clinicians should be prepared to provide support to law enforcement or care to ill or injured persons, how dual loyalty conflicts should be managed by tactical clinicians in detention or interrogation environments, how clinical expertise should inform real-time law enforcement de-escalation strategies, whether and when tactical clinical demands in the field should be prioritized according to needs of an individual ill or injured person or according to public health and community needs, and whether and to what extent tactical health goals should prioritize local, regional, national, or international interests.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 30 March 2021.