The AMA Journal of Ethics invites original submissions for peer review consideration on the following themes that will be explored in 2022 and 2023:
May 2022: Unregulated Supplements
Dietary supplements, such as oral vitamins, minerals, and herbals cannot be marketed with claims to prevent or treat disease. Yet, they are typically recommended, used, and expected to improve a person’s health. Unlike prescription and over-the-counter medications, dietary supplements are not approved by the Food and Drug Administration (FDA) for safety and efficacy. They are categorized by the FDA among many food products for which labeling about content and claims about purpose, safety, or efficacy are best regarded as marketing. This issue investigates why buyers and clinicians should not only beware of dietary supplements’ risks, but carefully consider their beliefs about roles these unregulated products play in forming expectations, planning care, and sustaining a 35-billion-dollar US market.
The FDA’s categorization of dietary supplements as outside the scope of its regulatory authority is neither clinically nor ethically neutral. Some uses of some of these products generate interactions with medications, which can exacerbate a person’s current health problems or cause new ones. Clinicians are often unaware dietary supplements’ actual ingredients or quality and are often unaware of which ones their patients take, which can complicate treatment planning and outcomes assessment. Roles of American household expenditures on products believed to help a person lose weight, build muscle, or improve sex, in particular, should be considered in light of overall health care spending, public health, and equity.
The May 2022 issue of the AMA Journal of Ethics considers these and other ethical, clinical, and legal implications of not federally regulating dietary supplements. We welcome manuscripts about challenges posed by the current FDA regulatory framework for dietary supplements, what clinicians should know about these products’ quality and safety, social and cultural factors that inform decisions to recommend or use dietary supplements, and roles of laboratory testing and physician-pharmacist collaborations in determining dietary supplements’ composition.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 29 June 2021.
June 2022: Health Care in Conflict Zones
Protracted conflict requires health care systems, organizations, and professionals to try to manage clinical, ethical, and legal complexities of service delivery under austere conditions. Triage demands prioritizing most severely ill or wounded civilians and combatants prompt and creating policies and practices that seek to do good, or at least enough good, with few resources. Protecting clinicians and their capacities to respond to crises requires extraordinary moral imagination and adaptability.
The June 2022 issue of the AMA Journal of Ethics welcomes wide-ranging explorations about resources allocation during armed conflict responding to conflict-affected civilians and combatants without being perceived as taking sides navigating clinician-patient relationships when fighting is nearing health care sites navigating patient access to care when transportation routes have been ambushed or responding to expressions of disrespect for the bodies of dead, dying, or surviving patients. Perspectives on human subject research whether and when to collaborate with governments, rebels, paramilitary groups, or nongovernmental organizations and lessons from the field are welcome, too.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 29 July 2021.
July 2022: Arts-Based Research in Health Care
Visual, musical, and poetic forms of creative expression have embodied healing in many cultures for millennia. Research methods based in these artistic forms have grown in prominence as the enterprise of health care has been led by kindred disciplines of bioethics and humanities to interrogate overmedicalization, to resist hyper focus on measurability when the cost is neglect of narratives and experiences, and to recognize tendencies that too often privilege outcomes over processes. What we’ve learned is that medicine has much to learn from and contribute to the arts, and that the arts have much to learn from and contribute to medicine.
Both artistic and clinical practices require professionals who value relationships and can skillfully draw from those relationships to collaboratively generate beauty or healing, perhaps humanity's greatest pursuits. Our best artists and clinicians express virtues of integrity, compassion, curiosity, and empathy and appreciate the possibility that some of the most poignant expressions of respect for others grow from sharing one’s own vulnerabilities and from sharing power. Reflexivity is required for both subject-artist, patient-clinician, and subject-investigator relationships to inform, evoke, enthuse, inspire, and maximize what can be learned from well-designed research protocols and partnerships. The July 2022 issue of the AMA Journal of Ethics welcomes wide ranging explorations of how arts-based approaches to investigation promote scientific rigor, generate evidence, communicate outcomes, and illuminate key ethical and aesthetic insights about what it means to care well and be cared for well.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 29 August 2021.
August 2022: Inequity and Iatrogenic Harm
Three kinds of health inequity are these: inequity in access to health care; inequity in the quality of health care services, experiences, and interactions; and inequity in health status. Iatrogenic harm constitutes damage—not limited to errors—induced by health care. These kinds of inequity can exacerbate iatrogenic harm to people whose embodiment experiences and identities are minoritized along axes of gender, race, ethnicity, and comorbidities. Iatrogenic harms also exacerbate health inequity. This theme issue investigates ethical, clinical, legal, and social dimensions of relationships between iatrogenic harm and health inequity and illuminates possible responses.
The August 2022 issue of the AMA Journal of Ethics welcomes wide ranging explorations of iatrogenesis as informed by diversity and plurality in human embodiment forms; inequity in how US health care is poised to respond less robustly to mental illness or cognitive disability than to general medical comorbidities; inequity along axes of class, race, ethnicity, English language proficiency, health literacy, or ability; and related topics.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 30 September 2021.
September 2022: What We Owe Health Care Workers Earning Low Wages
If you’re a health care professional in the US with colleagues who are paid a minimum wage, their labor is valued so little in the health care marketplace that it would be a crime to pay them less. The US Federal Labor Standards Act of 1938 requires employers under its jurisdiction to pay workers at least a federal minimum wage. Yet in most places in the US, a living wage is at least twice that amount. Privation, risk of injury and illness, uninsurance, and underinsurance undermine economic, gender, and racial and ethnic social and health equity for US health aides, environmental services workers, nursing and medical assistants, paramedics, and their children. This theme issue investigates what we—as citizens, clinicians of status, and organizations—owe these vulnerable workers whose hour-to-hour care for some of our most vulnerable patients is heavily relied upon and woefully undervalued.
Persistent tolerance for underpaying and undervaluing many health care workers and their labor says much about our characters, our conceptions of reciprocity, and our regard for women and immigrants. This September 2022 issue of the AMA Journal of Ethics welcomes wide-ranging ethical, clinical, legal, economic, social, and cultural perspectives on key questions about occupational safety, just compensation, unionization trends, the nature and scope of the solidarity obligations of clinicians and organizations of status to promote the interests of colleagues with low incomes, and the fact that vast racial and ethnic diversity does not extend to positions of status in health care educational opportunity and workplaces.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 30 October 2021.
October 2022: Health Care Waste
Most health care generated waste is not hazardous, but it is voluminous. Health care organizations have obligations to manage waste in ways that minimize environmental impact and express their status as good citizens of their global, domestic, and regional communities. Resource-rich countries generate on average more than double the amount of hazardous waste per bed per day than resource-poor countries, and waste processing is concentrated in minoritized communities nearly everywhere. Segregating waste and reducing overall volume are key to curb primary and secondary emissions that contaminate air and water, and moving the health care sector to net zero and decarbonization means motivating health equity.
This issue of the AMA Journal of Ethics® investigates these and other key issues related to health care waste; climate change; civic and urban planning for waste management; how much and which kinds of waste should be more or less tolerated for health care purposes; whether and when patients, clinicians, or others should be regarded as end-users and whether and to what extent end-usership confers just disposal responsibility; criteria for what constitutes just waste management and disposal; how geopolitical waste processing and disposal trends influence health care practices; net zero waste and decarbonization leadership; and the legal landscape of future health care waste production and management.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 30 November 2021.
November 2022: How Much Will It Cost?
An honest answer to the question How much will it cost? is what most people mean by price transparency in health care. Yet, what your health care costs you or your family, or even being given an opportunity to assess whether you can afford it, is not how price transparency in health care is defined by even the most dedicated advocates. A 2014 report from a landmark task force, for example, states that what all Americans deserve from health care price transparency is “accurate price estimates from a reliable source.” If this is the best definition of price transparency a well-intentioned, well-informed task force suggests the American public can expect, one might reasonably suspect that, without dramatic reforms to financial structures of US health care, an honest answer to How much will it cost? might not even be possible. This theme issue investigates why this problem matters clinically and ethically to every stakeholder, rich or poor, in the US health care system.
One reason knowledge of how health services’ prices are determined is important to patients and purchasers is that it informs what demand-side stakeholders (ie, patients, payers, and purchasers) think services should cost in the marketplace and at a point of emergent or elective care. Health services’ price information also shape stakeholders’ ideas about how valuable those services are. Such construals of value are economic and ethical in nature, as they inform stakeholders’ comparisons among how services motivate (on the demand side) our own, loved ones, or communities’ health goals or payers’ willingness to finance them and (on the supply side) our clinicians’ and organizations’ goals or payers’ authority to limit them.
Overall, calls for price transparency have been both demand- and supply-driven in health care. We welcome a wide range of manuscripts, as these calls tend to express goals generally shared by patients and clinicians who recognize that pricing opacity abets ongoing unstainable rises in US health care costs, which harm all of us and gravely harm the most vulnerable among us. The November 2022 issue of the AMA Journal of Ethics considers topics listed here and what pricing transparency should mean, according to whom, and why.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 23 December 2021.
December 2022: With Stillness and Solidarity
This issue considers the necessity of stillness and solidarity, as orientations to health care practice and professionalism, that enable transformation of students and clinicians from bystanders to upstanders. Stillness is conceived herein as a kind of virtue of intentional discipline applied to creating deliberate, restorative spatial and temporal interruption from day-to-day demands in order to nourish the moral motivational generosity needed for clinicians to care well for patients and to be good colleagues. Solidarity is conceived herein as an ethical value that must be deliberately nourished in health care education and work environments to maintain conditions such that slowing down, a necessary precedent to becoming still, can be transformed from being the political act of a single individual into a collective organizational and professional commitment to responding with care to our common and unique vulnerabilities.
This December 2022 issue of the AMA Journal of Ethics® considers these dimensions of health care ethics, moral psychology, and policy making and invites wide-ranging manuscripts on strategies for productive workflow interruption that promote stillness and solidarity; alliance-building; equity advocacy; and inclusive co-creation of sustainable models of health care organizational citizenship and community membership. Considerations about payers’ policies about reimbursement and about whether and clinicians’ work environments (ie, academic health centers, private practices) matter are also welcome.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 29 January 2022.
February 2023: Child Abuse and Neglect
Children are 40 times more likely to be confirmed victims of abuse or neglect than to be diagnosed with cancer. Clinicians have “upstream” obligations to help prevent abuse and neglect of children and “downstream” obligations as mandatory reporters, first responders, secondary illness and injury documentarians, gatherers of forensic evidence, and communicators with children, perpetrators, parents, and colleagues during or following clinical encounters. Less frequently considered, however, is how clinicians should try to promote short- and long-term healing among persons who are or were victims of childhood abuse or neglect trauma and how clinicians can best promote healing among persons—including themselves— struggling to manage their own psychological and emotional responses and secondary trauma of taking care of child victims of abuse or neglect.
This issue of the AMA Journal of Medical Ethics® considers these and related topics. Manuscripts exploring how extended home stays during the COVID-19 pandemic exacerbated hardship for children living in abusive or neglectful environments; communication strategies for navigating prenatal or postnatal neonatal abstinence syndrome; clinicians’ roles in child welfare agencies’ child removal decision making processes or agencies’ maintenance of decision files; nature and scope of pediatric patients’ rights to consent to or refuse pelvic examinations indicated for rape or sexual abuse; conflict of duties to mandatorily report with duties to keep patients’ health information confidential; whether, when, and how to try to recruit others as allies when the nature and scope of their roles as perpetrators of or accessories to a crime against a child is unknown or unknowable; model curricula; and other topics are welcome.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 29 March 2022.