The AMA Journal of Ethics invites original submissions for peer review consideration on the following themes that will be explored in 2021 and 2022:
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. Conditions like chronic fatigue syndrome, fibromyalgia, multiple sclerosis, post-concussive syndrome, endometriosis, and many psychiatric illnesses, for example, have symptoms that are not easily or at all measurable. Both clinicians and health care systems, however, tend to value measurability, and this can result in important consequences for patients who have these conditions. Hard-to-measure or immeasurable symptoms often result in these patients receiving insufficient support and empathy, despite that their illnesses are physically and mentally burdensome, isolating, and sometimes ill-understood by some clinicians. For clinicians, a condition’s measurability tends to dictate how easily it can be diagnosed and treated. Some clinicians’ frustration with navigating illnesses with invisible etiologies or symptom presentations is expressed through blaming patients, accusing them of being dishonest or “difficult,” or pathologizing them as malingering, psychosomatic, or other labels that effectively undermine patient’s status and patients’ knowledge claims about their experiences. These kinds of experiences among patients, their caregivers, and their clinicians illuminate interesting, important, and complex questions about the tendency in health care practice to privilege diagnostic measurability over patients’ narrative descriptions of their experiences. We invite manuscripts for the July 2021 issue of the AMA Journal of Ethics that consider these and other features of “invisible” illness experiences.
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 Unites States have created need to identify prevention and treatment strategies that are both effective and economical. Decision modelling studies aim to help policy makers and organizational leaders quantify prospective costs of different interventions in objective, standardized ways. But health care system operations, patients’ and clinicians’ behaviors, and differentials between actual and anticipated risks and benefits are complex and not easily predicted. So, reliable value analysis and economic decision modeling require identification of assumptions expected to play key roles in how findings yielded from those analyses and models are incorporated into health systems performance, clinical practice, and patients’ health care experiences. We invite manuscripts for the August 2021 issue of the AMA Journal of Ethics that consider ethically and economically relevant features of cost and value decisions in health care organizations and practices.
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 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.
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.