The AMA Journal of Ethics invites original submissions for peer review consideration on the following themes that will be explored in 2020:
February 2020: Global Burden of Cancer Inequality
In the 21st century, cancer is projected to be the single greatest disease killer in the world and 70% of this disease burden is concentrated in low- and middle-income countries (LMICs). Due to high costs of cancer treatment, governments in these countries will not be able to treat their way out of cancer, so prevention is critical. Thirty to fifty percent of cancers are preventable, but prioritizing prevention can be challenging in LMICs. Cancer prevention often lacks the social visibility and market appeal of treatments. Prevention is also held to a different standard than treatment: treatment’s benefits need only equal costs of care, but prevention is expected to produce a net positive return. The February 2020 issue of the AMA Journal of Ethics explores the ethical complexities of cancer prevention as a global public health imperative. Areas of interest include overcoming language and cultural differences in communicating about cancer; tobacco policy, marketing, and control efforts, including e-cigarette use and youth vulnerability; vaccination and community screening efforts, with special consideration of trade-offs between cost-effectiveness and screening sensitivity; expanding cancer epidemiology and cancer registries and their roles in prevention; and ensuring prioritization of local needs in international cancer prevention partnerships.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 31 May 2019.
March 2020: Wielding Organizational Influence in Health Care
Not long ago, most physicians were solo practitioners, but today, large and complex organizations dominate the health care sector. Organizational cultures shape policies, policies shape practices, and practices express the reasons clinicians have for acting in relationships with patients. Distributing authority and responsibility in health care environments is not only a function of a clinician’s professional background and training, but also how organizations situate encounters and relationships among clinicians, patients, and other stakeholders. The March 2020 issue of the AMA Journal of Ethics considers intersections of clinical ethics and organizational policy framing in health care settings.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 28 June 2019.
April 2020: Anesthesiologist-Surgeon Relationships
Ideally, surgeons and anesthesiologists work together to motivate best possible outcomes for surgical patients. However, physicians separated by a surgical drape can sometimes have different perspectives about what it means to take good care of patients when things go wrong perioperatively. Anesthesiologists’ and surgeons’ capacity for collaboration and collegiality are critical to keeping patients safe. Decision making about airway plan implementation, whether and when DNR suspension is appropriate, and coordinating communication about procedures’ risks and benefits or about a patient’s unexpected death prompt interesting, important, and neglected ethical questions about how we think about scope of these different physicians’ expertise and authority. Explorations of these and other topics will be considered in the April 2020 issue of the AMA Journal of Ethics.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 1 August 2019.
May 2020: Sharing Health Decisions
Ideally, shared decision making happens within patient-clinician relationships and gives shape to critical health decision point collaboration. Shared decision making is not solely definitive of a patient-clinician relationship, but it is typically conceived as broader than an informed consent process, as a model of deciding that informs a treatment plan trajectory over the long- or short-term of a patient’s illness, injury, and recovery experiences. Patients do not always comprehend their diagnoses or treatments, physicians can define successful outcomes differently than patients, and sometimes neither has enough information to confidently set priorities, choose among several high stakes options, and avoid regret. The May 2020 issue of the AMA Journal of Ethics considers what exactly should be shared—authority, risk, knowledge, for example—in shared decision making and investigates what else clinicians, patients, or their proxies need when making health care decisions.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 30 August 2019.
June 2020: Portraiture in Health Care
Art and medicine courses have grown in popularity. Though many of these courses emphasize honing students’ observational skills, using art in health care ethics education can be much richer, illuminating critical nuances about vulnerability and need. That is, ethics is not just about responding to moral questions and about trying to resolve dilemmas, it’s about the human project of discerning value. This issue considers how portraiture introduces innovative strategies for perceiving ethical and aesthetic value and motivates deeper and fuller understanding of patients’, clinicians’, and others’ health care experiences. Portrait artist Mark Gilbert has worked with patients and clinicians in clinic- and studio-based settings since the early 1990s. Gilbert curates this June 2020 issue of the AMA Journal of Ethics to motivate consideration of interesting, important, and neglected intersections of aesthetics and ethics in health care. Portraiture invites a viewer to discern a subject’s vulnerabilities through texture, color, and figure, for example. Portraiture invites introspection, not only from viewers, but from artists and those sitting for a portrait and also suggests clinical, ethical, and artistic relevance of common experiences of diagnosis, treatment, and recovery. As in patient-clinician and student-teacher relationships, ethical values such as mutuality and reciprocity are critical in subject-artist relationships, and foundational to healing.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 1 October 2019.
July 2020: Humor in Health Care
One definition of humor is the art of creating “funny,” and this is why inquiry into what is funny is a part of value theory called aesthetics. Like ethics, aesthetics helps us interrogate what we value and when, why, and what we see as worth a risk to get a benefit. To some, not much is funny about illness and injury. To others, there seems to be a lot to joke about. According to philosophers of humor, relief theory considers how our experiences of funny can help release nervous tension; superiority theory considers how our experiences of funny express our feelings of being better than others; and incongruity theory considers how our experiences of funny reveal our struggles with trying to assimilate something unexpected. Relief theory has received the most attention in the bioethics literature on humor in health care: numerous articles use this approach to try to explain why it is ethically permissible for clinicians to enjoy “gallows humor” or joke behind their patients’ or colleagues’ backs. But superiority and incongruity theories of humor also explain some interesting, important, complex, and neglected phenomena in health care settings and in interactions among clinicians, colleagues, patients, and patients’ loved ones. For the July 2020 theme issue, we invite manuscripts on humor and other witty considerations in health care.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 1 November 2019.
August 2020: Opioids and Public Health
Manufacturers of prescription opioids offered assurance in the mid-late 1990s that these drugs wouldn’t make patients with pain into patients with substance use disorders. Some physicians believed them and prescribed these drugs without appropriate regard for their addictiveness, contributing to prescription and street opioid misuse that have reached alarming proportions. Time will tell whether the pain-relieving benefits of opioids outweigh their harm in the long run, but right now, the US is in the midst of a public health emergency. The August 2020 issue of the AMA Journal of Ethics considers ethical questions that contextualize the opioid epidemic from social, cultural, and policy-based perspectives and illuminate potential solutions.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 27 November 2019.
September 2020: Behavioral Architecture In Health Care
Behavioral architecture applications, such as default settings and how options are framed, can motivate health service delivery efficiency, encourage use of interventions thought to be beneficial, curb use of interventions or behaviors thought to be risky, promote specific health outcomes, or contain costs. These behavioral applications are numerous, often opaque to those being targeted, and when adopted by health care organizations, their influence on clinicians’ decisions and patients’ behaviors is not ethically neutral. The September 2020 issue of the AMA Journal of Ethics invites investigation of ethical questions about the sources and consequences of these behavioral applications in health care.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 20 December 2019.
October 2020: Caring for Native American Patients
Disparities in health status and in access to services are pervasive and largely unrecognized or poorly addressed in American Indian and Alaska Native (AI/AN) communities. Articulating the nature and scope of health care professionals’ duties, understanding the origins of historically-entrenched and present-day practices and policies governing Indian Health Service units, and innovating health professions education partnerships with AI/AN communities can motivate health justice. The October 2020 issue of the AMA Journal of Ethics considers ethical complexities of providing equitable care to Native American patients living on rural sovereign reservations and everywhere else in America.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 31 January 2020.
November 2020: Risk Management Ethics
Patient-centered approaches to care guides health care professionals to includes patients’ cultural traditions, personal preferences, and values as integral components of care planning and management. But, expressing respect for patients’ choices can test typical risk management tendencies to prioritize patient safety. When risk managers find themselves at odds with a patient’s right to self-determination or right to refuse treatment, they might engage a colleague in ethics to consider particulars that could justify deviating from standard of care or justify not implementing a routine legal risk mitigation strategy. Collaborations among ethicists, risk managers, and clinicians can be particularly helpful in situations in which patients do not feel safe or feel dissatisfied with clinicians or services. Disciplines of ethics and risk management also prepare their practitioners to field and consider a broad range of possible responses to situations in which patients don’t progress clinically or situations in which care tasks are not executed—by clinicians or by organizations—safely, efficiently, or equitably. The November 2020 issue of the AMA Journal of Ethics investigates these and other intersections of ethics and risk management.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 28 February 2020.