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AMA Journal of Ethics

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https://www.readbyqxmd.com/read/28905736/hydrochlorothiazide
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/28905728/what-are-physicians-responsibilities-to-patients-whose-health-conditions-can-influence-their-legal-proceedings
#9
David Beckmann
Correctional populations are disproportionately affected by conditions that affect cognition, such as psychiatric illness and head trauma. Honoring bioethical principles in the care of such patients can be particularly difficult in the correctional setting. However, the approach should not change markedly because a patient is incarcerated. That is, the same standards of respecting patient autonomy and confidentiality should be maintained, and the fact that correctional populations are already marginalized makes it all the more important for clinicians to honor these principles...
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905727/-teach-to-goal-to-better-assess-informed-consent-comprehension-among-incarcerated-clinical-research-participants
#10
Cyrus Ahalt, Rebecca Sudore, Marielle Bolano, Lia Metzger, Anna M Darby, Brie Williams
Correctional health research requires important safeguards to ensure that research participation is ethically conducted. In addition to having disproportionately low educational attainment and low literacy, incarcerated people suffer from health-related conditions that can affect cognition (e.g., traumatic brain injury, substance use disorders, mental illness). Yet modified informed consent processes that assess participants' comprehension of the risks and benefits of participation are not required by relevant federal guidelines...
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905726/compassionate-release-policy-reform-physicians-as-advocates-for-human-dignity
#11
Andreas Mitchell, Brie Williams
A rapidly aging correctional population has led to an increasing number of patients with serious progressive and terminal illnesses in correctional settings. "Compassionate release" describes a range of policies offering early release or parole to incarcerated patients with serious or debilitating illnesses. However, in many states that have compassionate release policies, few patients are actually granted release. We describe how the continued incarceration of patients with serious or debilitating illness can constitute a violation of human dignity if appropriate palliative care is unavailable...
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28905725/ethics-students-go-to-the-jail
#12
Oliver Schirokauer, Thomas A Tallman, Leah Jeunnette, Despina Mavrakis, Monica L Gerrek
This article describes an educational initiative in which clinical ethics students, who were either in a bioethics master's degree program or in the fourth year of medical school, spent two days observing health care in an urban jail. Students submitted reflections about their experience, in which they drew attention to concerns about privacy, physical restriction, due care, drug addiction, mistrust, and the conflicting expectations that arise when incarcerated people become patients. The rotation was of great value to the students both because it exposed them to many of the ethical issues that arise in a correctional setting and because it deepened their understanding of various ethical concerns that are pervasive in health care...
September 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28846523/performing-pain-and-inflammation-rendering-the-invisible-visible
#13
Arseli Dokumaci
These drawings represent everyday experiences of an artist who has been living with rheumatoid arthritis since her teenage years. Over the course of 20 years, the disease has damaged a series of joints in her body. Pain and inflammation accompany the most mundane of her movements and gestures. Fatigue and side effects of medications are routine parts of life. None of her impairments are publicly recognized and duly accommodated, as she is not (yet) visibly disabled. Asking for a seat on the bus, for instance, turns into a thorough social negotiation, as does having to constantly remind people that she actually is disabled...
August 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28846522/are-physicians-blameworthy-for-iatrogenic-harm-resulting-from-unnecessary-genital-surgeries
#14
Samuel Reis-Dennis, Elizabeth Reis
We argue that physicians should, in certain cases, be held accountable by patients and their families for harm caused by "successful" genital surgeries performed for social and aesthetic reasons. We explore the question of physicians' blameworthiness for three types of genital surgeries common in the United States. First, we consider surgeries performed on newborns and toddlers with atypical sex development, or intersex. Second, we discuss routine neonatal male circumcision. Finally, we consider cosmetic vaginal surgery...
August 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28846521/nontherapeutic-circumcision-of-minors-as-an-ethically-problematic-form-of-iatrogenic-injury
#15
J Steven Svoboda
Nontherapeutic circumcision (NTC) of male infants and boys is a common but misunderstood form of iatrogenic injury that causes harm by removing functional tissue that has known erogenous, protective, and immunological properties, regardless of whether the surgery generates complications. I argue that the loss of the foreskin itself should be counted, clinically and morally, as a harm in evaluating NTC; that a comparison of benefits and risks is not ethically sufficient in an analysis of a nontherapeutic procedure performed on patients unable to provide informed consent; and that circumcision violates clinicians' imperatives to respect patients' autonomy, to do good, to do no harm, and to be just...
August 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28846520/should-euthanasia-be-considered-iatrogenic
#16
Silvana Barone, Yoram Unguru
As more countries adopt laws and regulations concerning euthanasia, pediatric euthanasia has become an important topic of discussion. Conceptions of what constitutes harm to patients are fluid and highly dependent on a myriad of factors including, but not limited to, health care ethics, family values, and cultural context. Euthanasia could be viewed as iatrogenic insofar as it results in an outcome (death) that some might consider inherently negative. However, this perspective fails to acknowledge that death, the outcome of euthanasia, is not an inadvertent or preventable complication but rather the goal of the medical intervention...
August 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28846519/what-do-clinicians-caring-for-children-need-to-know-about-pediatric-medical-traumatic-stress-and-the-ethics-of-trauma-informed-approaches
#17
Nancy Kassam-Adams, Lucas Butler
Medical experiences can be frightening and traumatic for children. Ill and injured children can experience pediatric medical traumatic stress-psychological and physiological distress responses related to their medical event and subsequent medical treatment experiences-which can lead to symptoms of posttraumatic stress disorder (PTSD) and suboptimal health outcomes. Trauma-informed care provides a framework for acknowledging, addressing, and mitigating the risks of psychological trauma associated with medical treatment experiences and is congruent with the ethical principles of respect for autonomy, beneficence, nonmaleficence, and justice...
August 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28846518/etiology-and-manifestations-of-iatrogenesis-in-pediatrics
#18
Stowe Locke Teti, Kathleen Ennis-Durstine, Tomas Jose Silber
There is general agreement in the literature of what ought to occur following iatrogenic harm. Senior members of the team should disclose what occurred and how the problem will be remedied. Those involved should express heartfelt regrets and apologize sincerely. But in the pediatric setting, parents, as surrogates, can sometimes place clinicians on the horns of a dilemma: respect parental autonomy, which may involve continuing nonadvised therapy, or uphold the patient's best interests, which may indicate another course of care...
August 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28846517/clowning-as-a-complementary-approach-for-reducing-iatrogenic-effects-in-pediatrics
#19
Alberto Dionigi
Hospitalized children who undergo painful procedures are more susceptible than others to experiencing iatrogenic effects, such as anxiety, pain, and severe stress. Clowns in clinical setting have been found to be effective in reducing children's experiences of these effects during hospitalization and before procedures. This article provides an overview of clowning in health care settings; reviews major studies conducted on clowning for hospitalized children, discussing evidence that clown interventions decrease pain and distress in pediatric patients; and concludes with a discussion of health care clowning as a profession...
August 1, 2017: AMA Journal of Ethics
https://www.readbyqxmd.com/read/28846516/how-should-physicians-help-gender-transitioning-adolescents-consider-potential-iatrogenic-harms-of-hormone-therapy
#20
Thomas D Steensma, S Annelijn Wensing-Kruger, Daniel T Klink
Counseling and treatment of transgender youth can be challenging for mental health practitioners, as increased availability of gender-affirming treatments in recent years raises ethical and clinical questions. Is a gender identity diagnosis helpful? What is the right time to treat, and should the adolescent's age matter in decision making? In this article, we discuss these questions in light of a case in which an adolescent wishes to pursue hormone therapy. Our analysis focuses on the importance of balanced decision making when counseling and treating adolescents with nonconforming gender identities...
August 1, 2017: AMA Journal of Ethics
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