The AMA Journal of Ethics invites original submissions for peer review consideration on the following themes that will be explored in 2020:

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.

December 2020: Socially Situated Brain Death

In 1980, the Uniform Determination of Death Act (UDDA) defined death as “irreversible cessation of circulatory and respiratory function or irreversible cessation of all functions of the entire brain, including the brainstem in accordance with accepted medical standards.” Interpreting and applying the UDDA definition and the clinical standards for death by neurological criteria are socially situated practices sometimes fraught with uncertainty and ambiguity. The December 2020 issue of the AMA Journal of Ethics investigates some of the ethical, social, and legal complexities of determining and declaring brain death.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow Instructions for Authors and be submitted by 27 November 2019.

January 2021: Legacies of the Holocaust in Health Care

Health professionals played leading roles in the National Socialist (Nazi) movement in Germany in the middle of the 20th Century. Nazi ideology was appealing to many physicians and scientists, who saw the movement as an opportunity to apply genetics, biology, and statistics to national governance and creation of a “master race.” It is commonly thought that Nazi physicians ignored or rejected their professional ethical values when committing heinous crimes. But a tragic fact is that Nazi political stances were explicitly crafted as ethical guidelines for medical practice and research, and were openly developed and taught in medical curricula during the Third Reich.

Health professionals’ involvement in atrocities of the Holocaust has influenced contemporary bioethics in critical ways that warrant reminding and further ethical investigation. Contemporary bioethical inquiry about equitable care, genetics, informed consent, public health, cost-benefit analysis, military and civilian clinical ethics, death and dying, abortion, research ethics, and refugee care has been shaped by Nazi medical crimes. So, one question worth exploring is What do health professions students today need to know about health professionals’ roles in the Holocaust to more fully and deeply internalize values that should guide clinical practice, research, decision-making, and policy-making?

Medicine was a powerful profession in Nazi Germany and it is, perhaps, even more powerful across the world today. Risk of medical abuse remains substantial, so investigating health professionals’ roles in Holocaust history and motivating clarity about how this history can, does, and should inform contemporary bioethics is critical. The January 2021 issue of the AMA Journal of Ethics is devoted to orienting and reorienting contemporary bioethics to legacies of this tragic history.

Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 28 February 2020.