AMA Journal of Ethics

Childbirth in hospitals settings is considered by some to be medicalized and not natural. When medicalization is associated with loss of autonomy and control, clinicians should be aware of how they express respect for women during in-hospital births.

Responding to “Added Points of Concern about Caring for Dying Patients,” authors argue that physicians’ refusal to prescribe lethal drugs in accordance with states’ death with dignity laws could damage patient-physician relationships and harm patients.

A lack of consensus guidelines or a belief that current evidence does not support such guidelines might be justified if a clinician expresses a commitment to patient-centered care and shared decision making.

Authors respond to “How Should Physicians Care for Dying Patients with Amyotrophic Lateral Sclerosis?” by arguing that patients’ motives for accessing death with dignity laws should be thoroughly explored and that temporarily limiting patient autonomy can promote well-being at the end of life.

Health care organizations have obligations to support all patients mothering newborns in making informed choices about formula and breast feeding.

Perhaps machine learning systems trained on patients’ electronic health records and social media footprints could be used as decision aids when patients lack capacity or face overwhelming decisions.

Eliciting the patient’s motives and goals and helping the patient and her loved ones explore alternatives are essential to maintaining trusting relationships and open communication.

A patient’s refusal of tracheostomy during an anticipated difficult intubation prompts critical questions about how to best express respect for a pediatric patient’s autonomy and whether and when deviation from standard of care is clinically and ethically appropriate.

Physicians should accommodate patients’ religious or spiritual understanding of suffering, even when they disagree, as long as they uphold their commitment to health. Both physicians and chaplains, who promote patients’ spiritual well-being, should respectfully challenge patients when necessary.