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AMA Journal of Ethics

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https://www.readbyqxmd.com/read/29028475/response-to-what-should-physicians-do-when-they-disagree-clinically-and-ethically-with-a-surrogate-s-wishes
#1
Petros Ioannou
No abstract text is available yet for this article.
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028474/capacity-determinations-and-elder-self-neglect
#2
Joshua M Baruth, Maria I Lapid
No abstract text is available yet for this article.
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028473/elder-self-neglect-another-ethical-dilemma-for-physicians
#3
Nancy Lutwak
No abstract text is available yet for this article.
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028472/waterborne
#4
Kwesi Reynolds
These photos capture the Flint water crisis from the perspective of a photographer and cinematographer who is a resident of Flint. They represent citizens' struggles, town hall meetings, and some of the city's repair efforts. They also illuminate environmental injustice as a violation of human rights.
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028471/water-safety-and-lead-regulation-physicians-community-health-responsibilities
#5
Bruce Jennings, Leslie Lyons Duncan
This article reviews the regulation of lead in drinking water, highlighting its epidemiological, engineering, and ethical aspects with a focus on the Flint water crisis. We first discuss water quality policy and its implementation with a focus on lead contamination of water, primarily from pipe systems between a water treatment facility and a tap. We then discuss physicians' roles and ethical responsibilities regarding safe drinking water using a human rights framework. We argue that physicians can play an important role in safeguarding drinking water in their communities by being vigilant, honoring the community's trust in them, and warning, educating, and empowering patients and broader communities so as to protect tap water safety and public health...
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028470/the-safe-drinking-water-act-of-1974-and-its-role-in-providing-access-to-safe-drinking-water-in-the-united-states
#6
Richard Weinmeyer, Annalise Norling, Margaret Kawarski, Estelle Higgins
In 1974, President Gerald Ford signed into law the Safe Drinking Water Act, the first piece of legislation of its kind to provide a comprehensive regulatory framework for overseeing the nation's drinking water supply. The law has proven instrumental in setting standards for ensuring that the US population can access drinking water that is safe. However, the law delegates much of its monitoring requirements to states, creating, at times, a confusing and complicated system of standards that must be adhered to and enforced...
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028469/the-importance-of-clinicians-and-community-members-receiving-timely-and-accurate-information-about-waterborne-hazards
#7
Steven S Coughlin, Osman Yousufzai
It is important for clinicians and community members to receive up-to-date information about the microbiological and elemental composition of local water supplies. Clinicians play an important role in helping their patients to interpret water quality data and understand the potential impact of water quality on their health. Expanding the medical school curriculum to include environmental health, public health, and health disparities-including disparities related to environmental quality and waterborne hazards-is key to clinicians' fulfilling this role...
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028468/lessons-for-physicians-from-flint-s-water-crisis
#8
Laura A Carravallah, Lawrence A Reynolds, Susan J Woolford
Physicians form a vital front in recognizing unusual clinical presentations that could herald a health threat. In the Flint water crisis, physicians can be credited with playing critical roles in both uncovering the crisis and providing leadership when government failed to respond effectively. Yet most physicians in Flint were not formally trained in advocacy or leadership and might have recognized the health implications of the crisis more quickly had they received formal environmental health training. Furthermore, connections to other professional disciplines-and to the community-are vital for effective responses to environmental health threats...
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028467/expanding-ethics-review-processes-to-include-community-level-protections-a-case-study-from-flint-michigan
#9
Kent D Key
As the Flint community endeavors to recover and move forward in the aftermath of the Flint water crisis, distrust of scientific and governmental authorities must be overcome. Future community engagement in research will require community-level protections ensuring that no further harm is done to the community. A community ethics review explores risks and benefits and complements institutional review board (IRB) review. Using the case of Flint, I describe how community-level ethical protections can reestablish a community's trust...
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028466/is-acute-care-oriented-research-ethical-in-resource-limited-settings
#10
Anwar D Jackson, Harold W Neighbors
In this case scenario, a medical student, Jenny, is conducting congenital heart disease research in a resource-limited setting faced with water insecurity. She has concerns about how ethical it is for her to conduct advanced clinical research in a region with more basic health needs. The first commentary argues that advanced clinical research in resource-limited settings follows the ethical principle of beneficence and interactional justice but violates the principle of distributive justice. The second commentary questions whether beneficence is enough, since the Belmont Report states that beneficence is the obligation to simultaneously reduce harm and increase benefit...
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028465/cultivating-humility-and-diagnostic-openness-in-clinical-judgment
#11
John R Stone
In this case, a physician rejects a patient's concerns that tainted water is harming the patient and her community. Stereotypes and biases regarding socioeconomic class and race/ethnicity, constraining diagnostic frameworks, and fixed first impressions could skew the physician's judgment. This paper narratively illustrates how cultivating humility could help the physician truly hear the patient's suggestions. The discussion builds on the multifaceted concept of cultural humility as a lifelong journey that addresses not only stereotypes and biases but also power inequalities and community inequities...
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/29028464/should-physicians-consider-the-environmental-effects-of-prescribing-antibiotics
#12
Jeremy Balch, Julia H Schoen, Payal K Patel
Pharmaceuticals are beginning to receive attention as a source of pollution in aquatic environments. Yet the impact of physician prescription patterns on water resources is not often discussed in clinical decision making. Here, we comment on a case in which empiric antibiotic treatment might benefit a patient while simultaneously being detrimental to the aquatic environment. We first highlight the potential harm caused by this prescription from its production to its disposal. We then suggest that Van Rensselaer Potter's original conceptualization of bioethics can be used to balance clinicians' obligations to protect individual, public, and environmental health...
October 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905736/hydrochlorothiazide
#13
Satyajeet Roy
No abstract text is available yet for this article.
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905735/surgery-in-shackles-what-are-surgeons-obligations-to-incarcerated-patients-in-the-operating-room
#14
Sara Scarlet, Elizabeth Dreesen
Incarcerated patients frequently require surgery outside of the correctional setting, where they can be shackled to the operating table in the presence of armed corrections officers who observe them throughout the procedure. In this circumstance, privacy protection-central to the patient-physician relationship-and the need to control the incarcerated patient for the safety of health care workers, corrections officers, and society must be balanced. Surgeons recognize the heightened need for gaining a patient's trust within the context of an operation...
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905734/swift-and-certain-proportionate-and-consistent-key-values-of-urine-drug-test-consequences-for-probationers
#15
Amy B Cadwallader
Traditionally, urine drug testing (UDT) in the correctional population (both prison and community corrections) has been infrequent, is scheduled, and has a high possibility of delayed results. Of practical relevance is that scheduled testing is ineffective for identifying drug misuse. Of ethical relevance is that consequences of positive scheduled tests can be unpredictable-in the form of overly severe punishment or a lack of treatment options-and that the scheduled testing paradigm is a poor way to change behaviors...
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905733/why-it-s-inappropriate-not-to-treat-incarcerated-patients-with-opioid-agonist-therapy
#16
Sarah E Wakeman
Due to the criminalization of drug use and addiction, opioid use disorder is overrepresented in incarcerated populations. Decades of evidence supports opioid agonist therapy as a highly effective treatment that improves clinical outcomes and reduces illicit opioid use, overdose death, and cost. Opioid agonist therapy has been both studied within correctional facilities and initiated prerelease. It has been found to be beneficial, yet few incarcerated persons receive this evidence-based treatment. In addition to not offering treatment initiation for those who need it, most correctional facilities forcibly withdraw stable patients from opioid agonist therapy upon their entry into the criminal justice system...
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905732/medicine-and-mass-incarceration-education-and-advocacy-in-the-new-york-city-jail-system
#17
Jonathan Giftos, Andreas Mitchell, Ross MacDonald
The United States incarcerates more people than any other country in the world. The scale of mass incarceration ensures that almost all practicing physicians will treat formerly incarcerated patients. Yet the majority of physicians receive little training on this topic. In this paper, we will outline the need for expanded education on the interface between incarceration and health, describe initiatives taking place within the New York City jail system and nationally, and describe future directions for curriculum development...
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905731/what-does-health-justice-look-like-for-people-returning-from-incarceration
#18
Lisa Puglisi, Joseph P Calderon, Emily A Wang
Access to health care is a constitutional right in the United States correctional system, and many incarcerated adults are newly diagnosed with chronic diseases in prison. Despite this right, the quality of correctional health care is variable, largely unmeasured and unregulated, and characterized by patients' widespread distrust of a health system that is intimately tied to a punitive criminal justice system. Upon release, discontinuity of care is the norm, and when continuity is established, it is often hindered by distrust, discrimination, poor communication, and racism in the health system...
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905730/how-should-a-health-care-professional-respond-to-an-incarcerated-patient-s-request-for-a-particular-treatment
#19
Tom Peteet, Matt Tobey
Incarceration complicates the ethical provision of clinical care through reduction in access to treatment modalities and institutional cultures that value order over autonomy. Correctional care clinicians should expand their guiding principles to consider autonomy and health justice for their patients, which in turn should prompt development of processes and care plans that are patient-centered and account for the inherent restrictions of the setting.
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905729/how-to-talk-with-patients-about-incarceration-and-health
#20
Kimberly Sue
The United States has the highest incarceration rate of any nation in the world-more than 700 people per 100,000. For this reason alone, clinicians practicing in the US should be aware of the numerous ways in which incarceration adversely affects the health of individuals, their families, and communities. While we clinicians are taught how to discuss ways that culture, religion, or sexuality can affect health outcomes, we are not instructed on how to talk about incarceration history with patients when it might be affecting their health, as highlighted in the case scenario...
September 1, 2017: AMA Journal of Ethics
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