The AMA Journal of Ethics invites original submissions for peer review consideration on the following themes that will be explored in 2019:
July 2019: Ethics of Representing Unrepresented Patients
How can we ensure that we are properly advocating and caring for patients without capacity, without anyone to make decisions on their behalf, and about whom we do not know any values or preferences? These unrepresented patients—whether homeless, elderly, or incarcerated—are among the most vulnerable members of society. Challenging decisions regarding end-of-life and long-term care must be made for these patients. The July 2019 issue of the AMA Journal of Ethics addresses some of the complex challenges of who should make decisions for unrepresented patients and according to which criteria these decisions should be made.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 1 November 2018.
August 2019: Access to Prescription Medications
Physicians have traditionally been the gatekeepers for patient access to prescription medications. How a physician assesses their patient’s benefit and risk profile shapes usage, sometimes controversially—as with continuing opioid epidemic, for example. Recently, external factors such as high drug prices and formulary restrictions have created other barriers to prescription drug access. These developments have created some new roles for physicians. That is, physicians now find themselves acting as advocates and coordinators of patients’ access, while high prices induce physicians to ration access to protect system resources. The August 2019 issue of the AMA Journal of Ethics explores some of the ethical tensions physicians and individual patients face in a changing prescription medication landscape.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 30 November 2018.
September 2019: Ethics of Global Health “Immersion” in Health Professions Education
Many health professions schools and training programs offer global health cultural “immersion” opportunities. Many also use domestic clinic settings to situate learning experiences in contexts of urban and rural poverty. These programs tend to be popular among learners eager to hone physical exam and diagnostic skills. When done well, such programs can help build cross-cultural communication skills, foster professional autonomy, offer diverse and cross-disciplinary mentorship opportunities, and allow for service-learning in communities with numerous unmet health needs. However, health professions education organizations have obligations to serve not only the interests of their students and trainees, but also to (1) foster mutually beneficial relationships with domestic and international patients, clinicians, and their communities, (2) honor and not exploit their vulnerabilities, and (3) interrogate the ethical and clinical appropriateness of maintaining long-term programs that actually rely on communities’ and patients’ poverty in order to maintain their experiential learning platforms. The September 2019 issue of the AMA Journal of Ethics investigates these areas of inquiry in light of clinical and ethical values such as continuity of care, standards of care, and educational transparency.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 21 December 2018.
October 2019: Insights on Value and Values from Decision Science for Clinical Ethics
In situations in which uncertainty exists about whether one care option is better than another, patients’ and clinicians’ personal values can color their perceptions of "objective" clinical and economic value. These values tend to be influential in assessing the value of particular procedures, so interventions that help clinicians and patients reveal and assess them is clinically and ethically important. For example, interventions designed to help clinicians draw out and draw upon patients’ assessments of value can help improve health care quality, reduce costs, and facilitate refusal of care that patients perceive as having little value. But, what constitutes good empirical evidence of how patients’ and clinicians’ conceptions of clinical and economic value inform their decision making? How should evidentiary standards of value assessment be used in clinical ethics consultation? This issue of the AMA Journal of Ethics explores these ethical questions about decision science—the development of methods for learning how people make decisions under conditions of uncertainty—and also considers legal, social, cultural dimensions of applying decision science to actual decision making in ethically complex cases in health care settings.
Manuscripts submitted for peer review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 1 February 2019.
November 2019: Ethics of Assessing Quality of Life in Reconstructive Transplantation
Quality of Life (QoL) assessments have roles in a wide range of ethical discussions about end-of-life care, transplantation, health care services' effectiveness and efficacy, and specifying what consitutes "essential health care services." In clinical contexts, how we assign value to QoL can lead to conflicts among patients, surrogate decision makers, and clinicians. In policy contexts, QoL judgments sometimes suggest disagreements about what the facts are and what they mean. In some cases, QoL is the primary reason for undertaking particular clinical interventions. This is true of new types of transplantation, known as reconstructive transplants or vascularized composite allotransplants (VCA), including transplants of the hand, face, penis, larynx, and uterus, which are primarily conducted because of how they can influence a patient's QoL. Yet, ethical inquiry into QoL aspects of VCA is lacking, particularly when engaging topics such as patients' lived outcomes, the impact of social acceptance or stigma on patients' experiences of physical disfigurement or functioning, and the effects of disparate access to personal and financial support on a person's candidacy for VCA. We invite manuscripts examining these and other ideas central to empirical investigations and approaches to health care ethics and policy in the area of VCA.
Manuscripts submitted for peer-review consideration and inclusion in this issue must follow all Instructions for Authors and be submitted by 1 March 2019.